The Quiet Wards

by Lucilla Andrews

  It was the Assistant Matron. ‘Nurse Snow, have you had scarlet fever?’

  Now ‒ what? I said, ‘Yes, Sister.’

  ‘Splendid,’ she said warmly, ‘how convenient.’ She asked if I had a cold or sore throat.

  Curiouser and curiouser. ‘No, Sister.’

  ‘Then will you put away what you are doing and go straight to the general surgical theatre? Sister Theatre is short of a trained nurse this morning, and you were last there in the summer, so you should be able to be of some use to her.’

  I said, ‘Yes, Sister, thank you very much, Sister,’ delighted at the prospect of being in action again, and she rang off.

  Sister Theatre was a tall, plump woman with short heavy fair curls and deep-set blue eyes. She was around the same age as Sister O.P.s and had also trained at Martha’s, but there the resemblance ended. Sister Theatre was never irritable and unfailingly considerate; she was also apparently tireless. She came out of her duty-room as I arrived in the theatre corridor. She was carrying a white enamel tray.

  ‘There you are, Nurse Snow! Good morning!’ She said she was delighted to hear I had had scarlet fever.

  ‘Who’s got it, Sister?’

  ‘Nurse Brent (the staff nurse). She was on this weekend, and went down with it last night. Fortunately, although I was off, I hadn’t gone away, and equally fortunately you are spare this morning. Matron is afraid we may be in for an epidemic ‒ these things never come singly ‒ and she said she could not send me anyone who had not had it in case they might be cooking it.’ She said would I go and change, and she would tell me what she wanted done. ‘We have a fairly long list this morning.’

  ‘On Sunday, Sister?’

  ‘On Sunday, Nurse,’ she echoed dryly. ‘So off with that cap and on with a turban. This is going to be a Monday Sunday.’

  The general surgical theatre was the largest in the hospital. It consisted of the theatre itself, with its large glass-walled gallery for the students; a sterilising room in which stood an autoclave; anaesthetic room; glove-room; duty-room; and surgeons’ changing-room. The whole place was cut off from the hospital by large double doors and inside those doors, whatever the date on the calendar, it was always midsummer. There were no windows, and the air-conditioner and purifier in the roof hummed like an overworked bee. While I was doing my theatre training I had always felt as if I was at sea. There was the same sensation as you get when you go below decks on a liner; and you smell the tar in the air that rushes down the corridors between the cabins, and the throb of the ship’s engines makes your ears ring. There was no tar in the theatre, but the ether and chloroform hung in the air constantly, and the air plant overhead made the same noise as a ship’s screw.

  I went into the duty-room and removed my cap and apron. I tied on the long gown, a sexless garment worn by the surgeons, dressers, and nurses alike. The one I had chosen would have fitted John. It reached my ankles and I had to wind the gown tapes twice round my waist. Sister came in when I was struggling with the T-shaped turban.

  ‘Like this, Nurse. Forgotten already?’

  ‘I’ve lost the knack.’ I stood still while she wound it round my head, then pushed the whole thing slightly backward so that it stood away from my ears. She removed her own cap and told me about the day’s cases.

  ‘Mr Dexter wants to catch up on some of the cold (less acute) cases, so he’s doing a string of them this morning. Three appendices, two repairs. And this afternoon we have a nephrectomy (the removal of a kidney).’

  ‘Is Mr Dexter doing that, Sister? Why not Mr Smith (the urological surgeon)?’

  Sister’s eyes smiled over her mask. ‘I don’t think this is a very nice nephrectomy, Nurse. So Mr Smith thought Mr Dexter might like it.’

  I said, ‘I see.’ I gathered by that that this patient’s prognosis was considered poor, and consequently Mr Smith did not want to spoil his statistics. Resident surgical officers do not have statistics, they just have a job to do and they do it to the best of their ability. As they are always highly qualified and experienced young men, their best is very good. John was a Master of Surgery. Like most nurses in Joe’s if I had to lose an appendix, a thyroid, a lung, or anything else, I would as soon have it removed by him as by any of the more exalted consultants. Sooner, in fact. The S.S.O. was the surgical dogsbody, but the variety of his surgery only made him, in our opinion, the better surgeon.

  The three theatre pros had finished cleaning and they came to report for their morning’s work. They were also wrapped up like white paper parcels. I did not recognise their eyes. The tallest parcel said. ‘Good morning, Nurse Snow,’ and I recognised her voice as belonging to a girl with whom I had worked in Christian. She was in her third year and was the Senior Pro.

  Sister assigned us to our various jobs. She told me to stay in the anaesthetic room. ‘And come in for the last case and watch. You may have to take a case this evening.’

  The morning passed quickly. The anaesthetist and his attendant students grumbled quietly about working on Sunday morning, but the anaesthetist was efficient and neat, and there was little for me to do but stand by the patient’s trolley and smile encouragingly. ‘Just turn your arm over, my dear, and the Doctor will give you an injection. Now, start counting up to fifteen.’ Only one man reached eight. The others dropped into the first stages of unconsciousness between five and six.

  I went in with the last patient as Sister had said, and stood by her instrument trolley watching her. John was operating and Tom assisting. Two dressers stood by the table, but the gallery was empty because it was Sunday.

  When the list was over the men disappeared to the surgeons’ room to change, write notes, and drink tea. Sister went to lunch, leaving the Senior Pro and myself to clear up. ‘The other probationers can carry on when they get back from lunch.’

  Anstey, the head theatre porter, took off his cap and wiped his forehead. ‘Cor stone the crows, Nurse Snow’ ‒ he came over to the sink where I was scrubbing kidney dishes ‒ ‘what a carry on an’ all.’

  ‘Sunday isn’t what Sunday used to be when I was last here,’ I agreed.

  ‘Ah,’ he said darkly, ‘be worse afore we’re better. You mark my words, Nurse.’

  ‘Do you think that nephrectomy is going to be heavy going?’

  ‘Not ’im. Not with Mr Dexter. Now if it was Mr Smith it’d be different. ’E’d ’ave a real show ‒ but you know what that Mr Dexter is’ ‒ he gesticulated as if John removed kidneys in his sleep ‒ ‘all in the day’s work it is to ’im, as you might say. Nah.’ He shook his head gloomily and said there was a young chap as was in Henry and he’d be down, mark his words, afore the day was out.

  ‘What’s wrong with him, Anstey?’ I did not doubt him for an instant. Theatre porters are excellent diagnosticians; they also possess second sight about forthcoming operations.

  ‘Cooking a perforation. G.U. On the bad side. They want to keep ’im quiet ‒ on a diet and a drip, like. But it won’t work.’

  ‘It won’t?’

  ‘Nah,’ he said again. ‘He’ll burst. You see, Nurse.’

  When Sister returned I told her what Anstey had said, and she said Sister Henry had been discussing the man at lunch. ‘Anstey’s seldom wrong. Is Mr Dexter still here?’

  ‘I’m afraid I don’t know. I’ve not been out of the theatre since you left.’ The Senior Pro looked up from the mackintoshes she was scrubbing. ‘Mr Dexter left with Mr Thanet a few minutes ago, Sister. He said he was going to lunch.’

  Sister hesitated. ‘We don’t want to tread on anyone’s toes, and physicians can be touchy. I think I’ll ring Sister Henry on the quiet. I’d like to have that man’s blood group just in case we need it.’ She smiled at us. ‘Then we can say “dear, dear, how convenient ‒ we have some of that blood waiting in our ’fridge.” ’

  Matron rang the theatre before I left for lunch and said I was to stay there for the remainder of the day.

  ‘That’s a mercy,’ said Sister frankly, when I repe
ated this, ‘because although I don’t mind working straight through the weekend, I would like to be off for a couple of hours. My mother has come up to see me, and it’s hard on her having to spend the time sitting in a hotel room.’ She said she would not go out of the hospital. ‘I’ll be in my room in uniform if you need me.’

  She sent me off duty, telling me to return at five. ‘The nephrectomy should be over by then, and as we’ve nothing else scheduled ‒ if Anstey is wrong ‒ you should have a quiet evening.’

  Anstey was not wrong. The man from Henry was operated on as an emergency during the afternoon, and when I got back to the theatre the sinks were piled high with mackintoshes waiting to be scrubbed, and Sister was sitting on a high stool drying rows of instruments.

  ‘We’ve had them both,’ she announced; ‘wasn’t that nice of us, Nurse? It’s all over, the hospital is quiet, Mr Dexter has gone out to a very late tea, and Mr Henderson is on call.’

  We changed places; she collected the two pros who had been working with her and sent them off duty, leaving the Senior Pro and myself to finish the clearing and then clean and reset the theatre for the night.

  The theatre was always left ready for work, and if any emergency occurred during the night Night Sister had only to tell the porter to turn on the steam, wake the specific pair of nurses who were on call, and the theatre could deal with any case in approximately fifteen minutes ‒ the time it took to get the necessary temperature in the heating pipes and the sterilisers.

  It took us over an hour to deal with the results of the afternoon’s work; then we systematically cleaned everything in the place, whether it looked dirty or not. That is one of the laws of a theatre: you leave nothing to chance. You polish shining surfaces, scrub spotless bowls and dishes, and wash the glass shelves, legs, and feet of trolleys, whether they have been used or not. We finished by six-thirty and sat down to test the gloves. Every glove was tested after use; those intact were dried and repacked for sterilising, the punctured ones repaired and left in the special basket where they were taken for use in the plaster theatre. We never used any repaired gloves for general surgical operations.

  The Senior Pro was called Davis. She was a pretty girl, and she told me she loved the theatre and dreaded the thought of returning to the wards.

  ‘You do or you don’t,’ I said, swinging a glove and testing it against my cheek. ‘I’m not all that keen. I like people.’

  She inflated her own glove. ‘Messy,’ she said simply, and I laughed.

  ‘How about those mackintoshes? Weren’t they messy?’

  She said it was clean mess. ‘And it’s so much more peaceful in here ‒ nobody stops you in the middle of your work to ask you to get out their biscuits or boil them an egg.’

  The telephone rang, and I went to answer it. It was Sister Theatre ringing to know if we were quiet.

  ‘Just mending gloves, Sister, that’s all.’

  ‘Good.’ She said she wanted to take her mother to Euston. ‘Poor darling, I’ve hardly seen her. I’ve rung the office to ask Matron if it was all right, and she said it was, but I thought I would ring you to make sure. I don’t like leaving you alone like this.’

  I rapped the desk top. ‘We’ve got nothing on here, Sister. We haven’t set eyes on a surgeon, even Anstey has gone off, and Brown (his opposite number) is helping at the switchboard.’ I said I was sorry she had seen so little of her mother.

  ‘That’s not your fault, Snow. I couldn’t possibly leave the theatre today. Well, if you’re sure you’re all right?’

  ‘Truly, Sister.’ She rang off.

  A quarter of an hour later the telephone rang again. ‘Acute abdo?’ said Nurse Davis hopefully, and I went to answer it.

  It was the Assistant Matron. ‘Nurse Snow, will you set the theatre for a Caesarian section? Sister Mary will come over from Mary (the Maternity Wing) to take the case, and one of her staff midwives will be with her to look after the baby. I think you had better “dirty,” and Nurse Davis can see to the anaesthetist. You had a Caesarian,’ she reminded me, ‘in June. Do you remember the setting?’

  I said, ‘I think so, Sister.’

  ‘Sister Mary will be with you directly. She will tell you all you need to know.’ She rang off.

  Davis was beside me. ‘What’s cooking, Nurse?’

  I told her, and she whistled. ‘Wow! I’ve never seen that. What fun!’

  I looked at her curiously. She was genuinely enjoying the prospect. ‘I’m glad you think so. I don’t care for Caesars.’

  She said, why not? Surely they were just madly exciting?

  ‘Madly,’ I said drily, ‘and madly dangerous, too, so I’ve heard tell.’

  She asked who was doing it.

  ‘Oh Lord, I forgot to ask.’ I reached for the phone. ‘I’d better ring Mary. I don’t know what size hands the obstetricians have.’

  I did not have to ring Mary because at that moment one of the two obstetrical house-physicians walked into the theatre, and he gave me all the details.

  Sister Mary, a short, red-faced, well-corseted lady, arrived almost immediately.

  ‘Well, Nurse ‒ you Nurse Snow?’ I said I was. ‘Bustle to. Where is the instrument cupboard?’

  I showed her the way, although she apparently knew it better than I did. She explained that the case was being done here as it was Sunday evening, and they had chosen this particular Sunday to repair some fault in the Mary Theatre heating system.

  ‘This girl isn’t one of our own bookings, she’s an emergency. She hasn’t been in long, although she’s been in labour too long,’ she added grimly.

  I asked about a cot. ‘Shall we borrow one from Christian, Sister?’

  She said her staff midwife was bringing one from Mary.

  ‘Look sharp, Nurse. I want to get this girl down as soon as possible. She’s had a bad time. Time it was over. Are you going to “dirty” for me?’

  ‘Yes, Sister.’

  The ‘dirty’ nurse is the one unsterile person in the theatre; she wears a clean but not sterilised gown, mask, and cap, works as a liaison between the sterile gowned and gloved theatre staff and the outside world of bowl, forceps, nail-brushes, telephones, sterilisers, and anything else that they may require but may not touch themselves.

  Sister suddenly bellowed, ‘You know Mr Dexter is taking this, Nurse?’

  I said the obstetrical house-physician had told me. ‘I didn’t know he did obstetrics here, Sister. I thought he was a general surgeon.’

  Sister was busy with her trolley, and I was laying out sterile gowns and gloves on one of the tables draped with sterile towels. Nurse Davis was lifting the steaming nail-brushes from the steriliser and placing them in their bowls by the sinks.

  Sister Mary said, ‘Don’t be ridiculous, Nurse. Of course the S.S.O. does obstetrics. And did you not know that Mr Dexter was an obstetrical registrar here before he became S.S.O.?’

  I went out to the anaesthetic room to see if the patient had arrived. It was empty. Nurse Davis came out of the surgeon’s room.

  ‘The O.H.P. has got small feet. I’ve left him a large pair of our boots. I hope they’ll fit.’

  ‘What does he take?’

  ‘Sevens.’

  I smiled into my mask. ‘He’s going to enjoy wearing sixes.’

  She said she wondered how the S.S.O. liked missing his tea-party.

  I looked at the corridor clock. Ten to seven. ‘Surely it was over long ago?’

  ‘He was still here at five, Nurse ‒’ she could not go on because the surgeons then arrived in a body. They said, ‘Good evening,’ and vanished into their room.

  Davis said, ‘This is going to be a party. Two O.H.P.s and two H.S.s. What’s all the flap about?’

  ‘It’s useful to know how to do a Caesar. Nobody wants to do ’em ‒ everyone has to once in a while. Those two’ ‒ Tom and Peter had come in with John and the obstetrical men ‒ ‘are on this weekend, so they’ve come to see how it goes.’

  None of th
e men had recognised me, which was not surprising since all that was visible of me were my eyes and my ankles. I had somehow found another outsize gown. The rule was that you took the first in a gown pile and did not bother about size. That camouflage was one of the things I liked about the theatre; I liked watching people work and talk, and not being visible myself. John and Tom had seen me all morning without knowing that I was there. It was a restful sensation.

  I went back to Sister Mary and told her the men had arrived. Then, as we had nothing to do until the patient came from Mary, I asked why the operation was necessary.

  She said, ‘It would not have been necessary, probably, if this silly girl had had the sense to see us ‒ or some doctor ‒ in time. She’s one of these intellectual young women who mistake common sense for an old wives’ tale. Apparently neither she nor her husband hold with ante-natal care ‒ which may be all right if you haven’t her medical history.’ She explained what this was. Then she sighed. ‘A Caesarian section is now our only hope if we want a live mother and a live child. And whether we get that remains to be seen.’

  We heard the soft rumble of the rubber-wheeled stretcher-trolley outside. The surgeons came in in their shirt sleeves, and in the gallery four students, probably midwifery clerks from Mary, settled down in the front row, and leant forward. The staff midwife came with her cot, and went over to one of the sinks to wash. The anaesthetist, the porter Brown, and Nurse Davis wheeled in the stretcher. John said, ‘Right,’ and turned to the instrument trolley.

  Chapter Nine

  MY MIND DECIDES FOR ITSELF

  It was very hot in the theatre that evening; far more hot than was usual because the heat had been raised intentionally to counteract the shock of birth for the child who had yet to be born. Sister Mary’s forehead was purple, as if her mask was too tight; and the men, standing directly under the great light that illuminated the table, breathed as if they had been running hard.

  It was very quiet; so quiet that the faint sizzling that came from the anaesthetic machine seemed deafening, the muffled clink of instruments being replaced on Sister’s covered trolley was a clatter, and the throbbing of the air-plant in the roof sounded ominous. Then even those sounds seemed to stop and the three young men round the table drew back slightly and stiffened like a well-trained chorus. The fourth, Tom, was holding the silver retractors in position. John lifted the baby and held him high over the table. The baby’s skin looked very white against the brown of his gloves. The baby had black hair.