The Hive

by Claire Rayner

  The other refusal had come from the children’s ward sister. ‘I’d really rather not, if you don’t mind, Matron. I haven’t the time, to tell you the truth. I hadn’t meant to talk about it just yet, but—well, I’m leaving in about three months. I’m engaged to be married——’ She had almost bubbled with pride as she said it. ‘And I just haven’t the time.’

  Elizabeth had accepted her refusal with equanimity. Really, things were working out very well. One sister definitely leaving soon, another one possibly going—within a year, it might be possible to have a strong section of the senior staff who were her own people, because she had appointed them. She knew quite well that it would take some time to make the present sisters regard her as someone to whom they belonged. People she herself appointed would feel like that—she would see to it that they did. So she was happy to accept the children’s ward sister’s explanation, and made no attempt to persuade her to give up any of her free time to the group discussions.

  She set out on her hospital round in an excellent humour. Now the sisters had stated their agreement, they could hardly change their minds. She had a freer hand now; if she wanted to comment adversely on anything she saw, she could, with no danger of arousing a resentment that might show in refusal to co-operate with her plan. For the first week, she had walked on eggshells. Now she could tread more firmly.

  There was one ward in which she very definitely intended to tread more firmly, and that was female medical. She had seen enough during her previous week’s rounds to show her how the sisters ran their wards, and had made her judgements on them (the same judgements she had offered James French), on the basis of her observations.

  Only two wards seemed to her to be really badly run; Ruth Arthur’s and Josephine Cramm’s. She felt that the faults in Ruth’s ward would be simple to put right. Ruth was indolent, basically untidy, even dirty in her ways, and this was reflected in the slipshod appearance of the female surgical and gynae ward. She would bide her time, and deal with Ruth Arthur when it seemed right to do so. But the faults in Josephine Cramm’s ward were more important, in Elizabeth’s eyes. She could not, in all conscience, allow matters to continue as they were there without making some mention of it.

  Had Elizabeth brought her gift for analytical thought to bear on her own attitudes to these two wards, she would have realised how much those attitudes reflected her past five years’ experience. She was far more concerned about the psychological wellbeing of the patients under her charge than their physical care. There could be real dangers to life in Ruth Arthur’s ward. A surgical ward that was run with scant care for principles of cleanliness and asepsis could suffer severe infection problems. This could not happen in Josephine’s ward as it was run at present. But because Elizabeth’s main interest for five years had been psychology, she gave less thought to the problem of the female surgical ward than perhaps she should have done. This morning, it was Josephine she was concerned about.

  Sister Cramm’s ward was quiet, almost oppressively so. She was hovering by the doctor’s washbasin, near the doors, when Elizabeth arrived, making it obvious she had been waiting for her, had prepared carefully for the routine Matron’s round. Elizabeth was faintly irritated. She did not want the forms of respect such preparation indicated. She had been much happier to see the other wards clearly operating as usual, to see sisters with their sleeves up, to see work in progress. It wasn’t like that here. On Female Medical all was in order, all was finished.

  There were only two nurses to be seen, one industriously entering figures in a pile of charts, and the other working in an already impeccable linen cupboard, refolding towels into a painfully neat pile. Sister Cramm, the apron over her wide hips sparkling white and uncrumpled, her cuffs over her long sleeves unmarked with any sign of use, looked like a child’s picture book impression of a hospital sister.

  Josephine escorted her round the ward, telling her each patient’s condition before mentioning the woman’s name, and Elizabeth looked at the blank faces on each pillow, and smiled and said ‘Good morning’ to each one.

  She asked some of them—those who seemed sufficiently alert to be questioned, for many of these patients were very old, many of them senile—how they were, but they gave nothing back to her. No complaints, no cheerful chatter of the sort she would have liked. Just a colourless ‘Very comfortable, thank you, Matron’ was all she got.

  When they reached the end of the round and were standing again by the double doors, Elizabeth said carefully, ‘Your ward is very—peaceful, Sister.’

  Josephine looked back down the double row of beds, at the tidy curtains against the walls, the chairs set in exact symmetry between each bed, and smiled in intense satisfaction, regarding Elizabeth’s comment as praise.

  ‘I like to keep it nice, Matron,’ she said. ‘There’s no need for noise and mess if you plan your day properly——’

  ‘Do none of these patients get up?’

  ‘Get up? Oh, yes, Matron. The physiotherapist comes each afternoon and we sit them out of bed for a while. I have a list of the ones who are supposed to——’

  ‘But can none of them just be up and about during the day, when the physiotherapist isn’t here?’

  ‘Oh, no, Matron. I don’t allow that. I won’t have them wandering about. No, you needn’t worry about that. I always know just where each patient is all the time. Much better, really——’

  ‘I’m not sure that it is——’

  Josephine looked at her, her face creasing into its familiar anxious lines. ‘I beg your pardon, Matron?’

  ‘Wouldn’t some of these patients be better off walking about freely, Sister? It is hardly—natural to be always in bed, if you are fit enough to walk about or sit in a chair. And it might be nicer for them, don’t you think, those who could be up? They could sit together, and talk. Less lonely for them.’

  ‘But they’re patients.’ Josephine sounded puzzled. ‘If they were fit enough to be up and about, they wouldn’t be in hospital, would they?’

  Elizabeth abandoned this line of questioning.

  ‘I see you have bedsides on every bed, Sister. Do they all need them?’

  Josephine became defensive. ‘Well, many of them do, Matron——’

  ‘But all of them? Are they all in danger of falling out of bed?’

  ‘Every patient is in danger of that,’ Josephine said with an oddly triumphant air. ‘A man did on male surgical only last week—it could have been nasty——’

  ‘Oh, I appreciate that. But bedsides all the time? Don’t you think it might be—depressing for them?’

  ‘I think they’re safer with the sides up.’

  ‘Oh, I’m sure you think they are. But do they feel it? And do they like it? And do they all—all thirty of them—do they all need them?’

  ‘I’d rather not take chances, Matron. These old people—if one of them fell out of bed, she could break a leg—that can be very bad in old age——’

  Elizabeth pushed down her mounting irritation.

  ‘I quite appreciate that, Sister. I’m just surprised you feel that all thirty beds need sides permanently in position.’

  ‘It—it saves time. If someone shows signs of restlessness, well, she could fall out by the time the nurses had the sides on. And there’s the storage, too. I mean, thirty sets in the linen cupboards—we wouldn’t be able to get in there—it’s more methodical——’

  Elizabeth sighed. ‘I see, Sister.’

  Josephine became more anxious. ‘I hope you agree it’s a good plan, Matron. I’m very—well, I worry a lot about my responsibility to these patients. I can’t always be here, and at night, there aren’t so many nurses about. Night Sister has often said how glad she is I’m so careful. It makes it much easier for her. And it looks so much nicer, doesn’t it? I mean, if just some beds had them, it would look so untidy. I’m sure the patients like the place to look nice. I’m sure it would worry me, if I was ill, to see a mess all round me all the time. When things are nice a
nd tidy and quiet, everyone’s much happier——’

  The irritation that had filled Elizabeth changed, became an odd sort of pity.

  ‘Yes, I see, Sister,’ and now she sounded gentler. ‘It would worry you to have an—untidy ward——’

  ‘It should worry any nurse who cares about her work,’ Josephine said, a little sharply. ‘I mean there’s so much to do, isn’t there? If you haven’t got a method, things get left out, forgotten. There isn’t a patient in this ward with a hint of a bedsore, and some of them are very heavy—and incontinent. They have their backs done every four hours, every one of them, without fail. With the shortage of nurses the way it is, I don’t see how we’d get the back rounds done, without a method to the day—and there’s the other work, too——’

  There was a short silence, then Elizabeth said quietly, and gently, ‘Sister Cramm—tell me. What do you feel is the most important part of nursing?’

  Josephine stared at her.

  ‘The most important part? Well, that’s difficult. I mean, there are so many things——’

  ‘Try to tell me them. In order of importance. Can you?’

  ‘Well, I—I suppose to help patients get well——’ Josephine frowned sharply. ‘Really Matron, I feel like a student at an examination——’

  ‘Oh, please, Sister. You mustn’t think I’m catechising you in any spirit of—anger or reprimand. I genuinely want to know. You see, you and I—well, I suspect we have a different approach to this, and I can’t adjust my own ideas until I understand yours.’

  Josephine’s brief flash of anger died, to be replaced by her more customary anxiety.

  ‘Well, to help them get well, first of all. That’s what hospitals are for, and I suppose that’s what nurses are for. Everything else is part of that, isn’t it?’

  ‘I couldn’t agree more,’ Elizabeth said with great charm. ‘That is, of course, the essence of nursing. The question is, how do we set about doing it?’

  ‘Well, it’s up to the doctors really. I mean, they decide the treatment, and we provide it——’

  ‘But don’t you think nurses can provide treatment without being given direct medical instructions? That would be to underestimate our value, wouldn’t it? If it were just a matter of following orders, the minimum of training would be needed. Don’t you feel we can, by our approach to our patients as people, give them help to get well that the doctors can’t?’ She warmed to her theme. ‘This question of the bedsides, now. You use them because you have a well developed sense of responsibility. You want to protect your patients from injury, which would be the opposite of helping them to get well——’

  ‘Well, yes, of course, that’s really why——’ Josephine reddened with pleasure, almost feeling that this was indeed why she liked to keep each of her beds looking like cots. Miss Manton, she felt with sudden gratitude, had put her own thoughts into words.

  ‘But, Sister, isn’t it possible that there is more to your liking for bedsides than that?’ Elizabeth said very softly. ‘Do you think it’s possible that you are satisfying your own need for tidiness and order by using them? Isn’t it possible that you’ve gone too far with what was at first an idea designed to benefit patients—gone so far that you actually, well not harm them, but distress them, even delay their recovery?’

  Josephine went scarlet, her gratitude and pleasure vanishing in a wave of sheer amazement.

  ‘Delay their recovery? Delay—I don’t know what you’re talking about! Of course I like the ward to be tidy—I told you, I wouldn’t be happy myself in a mess, in a noise, and I try to treat them as I’d like to be treated myself—delay their recovery! Well, really, Matron, I——’

  ‘Sister, please, don’t misunderstand me! I’m just trying to show you that it’s possible for the best of motives to be overlaid by deeper needs of our own. This ward——’ She turned and looked at it, and then looked at Josephine again. ‘It’s too—too orderly, too quiet. Almost inhuman in its perfection——’

  ‘Inhuman——!’

  ‘I know that isn’t a pleasant word, but just think about it. There are thirty living people in this ward—and it’s more like a—well, it doesn’t feel to me as though there are live people in here. Does it to you?’

  ‘Of course it does!’ Josephine said, almost piteously, lost in her distress, completely unable to understand what Elizabeth was saying. ‘Of course it does. They’re just—peaceful, the way it ought to be in hospital. That’s all. And they’re old—most of them—I get a lot of very old people here. The more—the younger medical patients, the more interesting ones, I suppose you’d call them, they go to the Central. They’ve a bigger unit there——’

  ‘I know that, Sister. It can’t be easy for you, with so many chronics, I know that. I’m just trying to suggest that there might be a better way of caring for them. A less—methodical way—a more relaxed one.’

  ‘I—— Honestly, Matron, I just don’t see what you’re getting at. The doctors—they like this ward. They’re always saying how nice it is, it never smells the way it might, with so many incontinents——’

  ‘My dear Sister, I told you—I appreciate all that—very well indeed. Look, perhaps I can explain if——’ She stopped. Then with a rather uncharacteristic diffidence she went on.

  ‘I didn’t want to talk of things that happened before I came here—I hardly have any right to do so. But something did happen on this ward that very clearly illustrates the point I want to make. About six months ago, a patient climbed over her bedsides, and fell, and she fractured her femur.’

  ‘It happened at night! There weren’t enough nurses on duty! And anyway——’ Josephine’s voice rose in shrill triumph. ‘Doesn’t that show that bedsides are needed?’

  Elizabeth shook her head. ‘I’m afraid it shows the opposite. I went for the woman’s notes, and as far as I could see, she was in no way disoriented when she was admitted. There was nothing in the report book to show she ever became so. She was in for investigation of hypertension——’

  ‘I remember. She shouldn’t have been in for more than a few days——’

  ‘But she was in for months, over on the surgical ward. It seems to me that that accident happened because of the bedsides. She may have felt shut in—imprisoned. Maybe that was why she tried to get out of bed and only succeeded in falling over the top of the bedsides. Or she may have wanted to go to the lavatory and not been able to attract the nurse’s attention. So she tried to get out for that reason—and whatever the reason, in having to climb over the bedsides she didn’t need, because she was in no way displaying the sort of disturbed behaviour that makes the sides necessary, in trying to get over them, I say, she fractured her femur. They made her illness worse, rather than better. I didn’t want to use this example, but I had to, to show you what I meant——’

  ‘You mean to say you think that accident was my fault?’

  ‘Not directly, and certainly not from negligence. But perhaps partly because of your misdirected zeal.’

  ‘No one—not the doctors, or Mr. Heston, no one, said it was my fault when it happened. Even the relatives, they all saw we’d done our best. If the sides hadn’t been on and it had happened it would have been different. I’d have thought it was my fault then, and I’d have said so——’

  Elizabeth tried not to look impatient. ‘I’m sure no one blamed you. I’m not trying to blame you now. It’s all past history anyway. I’m simply trying to suggest to you that you might be—too rigid. That you worry too much about details——’

  ‘Well, I can’t deny I get into a state sometimes, but it’s only that I want to do things properly——’ Josephine stopped, and then said almost slyly, ‘Is this to do with the group discussion idea?’

  Elizabeth looked startled.

  ‘I wasn’t thinking about that when I decided to talk to you about this. Why do you think I might have been?’

  ‘It was something someone said. About the discussions. It could—help people to get bet
ter methods—or more co-operation from the nurses with the ones you’ve got. I just thought—well, if you don’t like my way of doing things—I don’t know——’ Her voice trailed off.

  Elizabeth smiled. ‘Well, whoever said that was quite right. The discussions could help people to understand their methods in rather more depth. Look, Sister, let me say this. I’m not happy altogether with this ward. It’s run very well in many ways—a showpiece——’

  ‘I try to keep it nice——’

  ‘And you succeed. Very much so. And when I assured you all I had no wish to interfere drastically with individual wards, I meant it. But I feel very strongly that these patients of yours have some needs that aren’t being met as fully as they might be. I’m not criticising your efforts, or doubting your—sense of responsibility. I’m simply suggesting that you need to give some thought to what I’ve said.’