by Jane Grant
‘Shut up,’ I said, as we both looked with distaste at the congealed remains of our lunch.
‘Well, we got to the coffee stage, and I just picked up my fork naturally and was about to stir my coffee with it – when something sort of said to me No, and I just stopped myself in time. Then I said brightly, “Oh what nice cutlery they have here” which sounded as I said it a completely daft remark. I didn’t half get the fish eye from the waiter!’
‘Mary – you’re a disgrace.’
‘I know. I have an awful fear that I’ll do the same sort of thing when I go to see Mike’s parents again. They’re terribly correct; finger bowls and napkins, and one just gets dragged up here as far as table manners go. I do wish,’ she added, looking round the room and wrinkling her nose at the smell of old dinners – ‘I wish there was a bit more elegance in our lives.’
‘I wish there was a bit more filets mignon,’ I said bitterly.
The week in the Anaesthetic Room passed slowly. I seemed to have returned to the frightened scampering junior I had been four years ago; any aptitude for the job which I had had seemed to have disappeared, and I felt myself to be no better than a stuttering idiot when I was given an order.
The following Monday it seemed incredible that I should be showing a new person what to do in the Anaesthetic Room; impossible that I myself should know what to do. However, I had to get on with it. I was just showing the new girl where to write the names of the patients when the theatre technician came in.
Like ambulance drivers, theatre technicians are in general a pleasant breed; cheerful and helpful. They are in the happy position of not having to jump too much when the whip cracks, and any criticism from authority doesn’t send them into a frenzy of despair and depression, as it is apt to do with nurses. This particular technician was a big breezy man, who rejoiced in the unfortunate name of Walter Rowbotham. He was known generally as Walter, however.
As he slid through the doors and began ostensibly to check the gas cylinders, he uttered one pungent phrase from the corner of his mouth.
‘Watch it!’ he said.
We bent over our books with redoubled enthusiasm, and the swing doors burst open to admit a wrathful Sister Blythe. Something had obviously put her in a bad mood, and she was well on the war-path.
She looked round searchingly to find something to find fault with, but nothing outstanding presented itself, so she looked me and my companion up and down searchingly.
‘Grant!’ she snapped. ‘You have some hair showing. Go and cover it, please.’
I scuttled off, pleased to have got away with so little trouble, but when I was in the Nurses’ Room a feeling of rage came over me, and I suddenly felt very tired of the whole rat race. That constant bowing and scraping, lest in some infinitesimal way you should offend the powers; that fear of being made to appear the fool you felt you were; and the continual running out of the way of the great dictators in case they decided to start on you! I wished heartily I were out of it all.
It was in this state of mind that I found myself in the sluice the following day, dismissed there with a curt nod from Sister, as she allocated the day’s tasks. But it was the last time I was able to reflect on my status for one long weary week, because when I was on duty I didn’t have time, and when I was off duty I was too tired. There seemed to be an eternal stream of dirty trolleys being shoved into the little dark corner of theatres that no one entered unless they were forced to from absolute necessity. Mostly the nurses just stood at the door and yelled.
‘Have you cleaned those clamps from the last case? Well, would you mind bucking up because I want them for the next case, and the patient’s on the table!’ This last phrase would be uttered in a high-pitched voice, as the other nurses from the Sterilising Room would rush out and give hand signals to indicate the extreme urgency.
The clamps were inevitably at the bottom of the bowl of dirty instruments. I began to know the nurses by the way they left their trolleys, and I vowed if ever I reached the exalted heights of Scrubbing-up in these theatres, I would never leave the blades on the knife; the scissors pointing upwards for unsuspecting fingers; the needles threaded and the dirty instruments mixed up with the clean.
Daily I got drenched, because I never remembered until too late the temperamental tap at the sink, which would pour forth a gush of cold water at the slightest pressure of the hand. My feet were in a permanent morass of wet linen and mackintoshes, also water, because the drain was temperamental too. My hands became chapped with the constant immersion in water, my arms were chafed with the raw disinfectant I used on the linen. Daily my temper grew shorter and shorter.
My weekend off flew by; I seemed scarcely to have seen Donald before I was saying goodbye to him – and there I was getting soaked with the blasted tap again.
Then, miraculously, someone about a year later opened the gateway and invited me into the big world again. Instead of cold water, I was now up to my neck in steam; steam that came out of the sterilisers like a giant’s breath, and engulfed your hands and face; boiling water that spat at you when you put instruments into it; and people that bellowed at you to hurry up with those trolleys for goodness’ sake! And there you were, by all that was extraordinary, telling the nurse in the sluice to gee up with the clamps they wanted for the next case! Bowls, towels, kidney dishes, instruments, blades, scissors, knives, swabs; on to the glistening white top they went hugger mugger, while the Staff Nurse in charge told you to lay it from the back so you don’t have to lean over the trolley – to put the bowls this side – she didn’t care what they did on other theatres – Main Theatres this was, and the bowls went on the left-hand side. Why – because Sister Blythe liked it that way, that was why. No – hold your Cheatle forceps this way, they weren’t flags to wave; hold them neatly in front of you so the disinfectant didn’t run down your arms. And all the time hurry, hurry, hurry!
When I staggered off duty at the end of the day, Mary was waiting with the tea to make up my fluid losses as she put it. Lying on the bed table was the post, and topmost a letter from Phyllis.
‘Dear Jane,’ it began – which was in itself unusual. ‘I have the most wonderful news!’
‘Oho,’ I said to Mary without reading further, ‘you’ve no need to worry about Phyllis any more. It looks as though she’s nobbled David.’
‘Oh good,’ said Mary, frowning with concentration at the meagre milk supply which she was trying to divide into four, so it would serve two cups of tea for each of us. ‘What does she say?’
I started to read again. ‘Mrs Bell’s baby is not a Mongol,’ I read out stupidly.
‘What?’ asked Mary incredulously.
‘Oh, it’s a patient of hers,’ I told her, ‘who Phyllis thought had a Mongol baby. But apparently,’ I read on, ‘apparently we’ve no need to worry.’
‘Oh good,’ said Mary politely, helping me to some tea.
The rest of Phyllis’s letter consisted of the wonders of midwifery, and how she was planning to go on District later on with a girl from the Home, when she had taken Part Two. Of David there was no mention. I turned the letter over thoughtfully.
‘She doesn’t say anything about David,’ I said casually.
Mary took the letter and read it. ‘Gosh! She sounds as though she had really signed the pledge.’
‘Perhaps,’ I said, considering the matter, ‘perhaps she’s just biding her time.’
Mary looked at me quizzically. ‘Could be.’
I yawned. ‘Well, I’m going to bye-bye.’
‘Don’t you ever do anything but eat and sleep?’ Mary grumbled.
‘Yes,’ I said firmly. ‘Work. W-O-R-K.’
After a week of the Sterilising Room, I was ticked off in the work book again, and put down to Run in Theatre – Run being the operative word.
‘Fix the Diathermy. Get me some more swabs. Watch the patient’s arm.’ Run round till your feet drop off, then run round some more. In the evenings I staggered off too tired to think, a
nd before my head had touched the pillow it seemed I was back on duty. Putting patients on the table, putting specimens into pots, putting catgut on to trolleys ...
This went on for a fortnight, and then on the Monday as we queued up patiently to have our work allocated – there was Sister Blythe telling me to scrub up for a hernia and two appendices! She must have made a mistake – but no, she went on quite casually to the next nurse. And was it my imagination, or had there been a glint of humour in her eyes when she said it?
The next week I was shouting at the runner, and the week after and the week after that. Cholecystectomies; gasuectomies; hemicolectomies, became a part of my daily routine. Gradually the things that had seemed so distant to me – could it have been only a month ago? – were now a part and parcel of my day’s work; never a thing to be alarmed or worried about, just one of the occurrences of a nurse’s life.
One morning, after a particularly trying abdominoperineal resection, I was summoned by Sister Robeson to the High Priestess’s office.
I had now worked on the theatre for two months, and during that time I had not once thought about my prospects there. Now I realised with a cold pang that I had only another month to work of my contract, and I must start thinking of my future without delay.
I wondered as I hurried through the swing doors to the significant brown door, if my work had been unsatisfactory. I thought bitterly about my first week in the theatre. I had no means of knowing how I had done since, for I did not seem to have seen anything of anybody since then. I had just become another cog in the mechanism of the theatre.
I knocked timidly at the door, and the well-known and awe-inspiring voice of Sister Blythe called: ‘Come in.’
Realising with surprise that the voice did not sound cross, I entered and closed the door quietly behind me.
‘Good morning, Sister.’ Glancing at the clock, I immediately realised I should have said ‘Good afternoon.’
She nodded silently, and pointed at the chair opposite her desk. I sat down, and waited anxiously for her to speak.
‘I have been watching your progress closely, Nurse,’ she said at last in a soft voice. ‘I find you have only a month left of your contract. Have you thought what you will do when you leave?’
‘No, Sister.’
‘I see. Well, I had a talk to Sister Robeson, and she is quite prepared to let you assist her with her case tomorrow.’
I smiled blankly, not really knowing what this was leading up to.
‘As you know,’ went on Sister Blythe, ‘Sister Robeson is in charge of the chest surgery, and if you scrub up with her for one or two cases, you will get the feel of it and be able to take the Registrar for some of the more minor cases later on.’
‘Thank you. Sister,’ I said slowly, taking some time to assimilate the great news.
‘Now I want you to spend the rest of the day helping Sister to prepare for the aortic graft tomorrow.’
At last I began to take in the astounding implications of her words. She now looked pointedly at the papers on her desk, and in a daze I got up to go. The chair made an appalling noise as I scraped it back, and my footsteps to the door sounded like King Kong’s; the door squeaked loudly as I opened it, and my own voice saying ‘Thank you, Sister,’ sounded like a gong. Wrapped in a dream, I walked away like an automaton.
So my last weeks had not ended in disgrace! Where I could have taken a step down, I had gone up on to chest surgery; one of the most exciting fields in surgery, where entirely new techniques were being worked out. I could hardly believe my luck.
Chapter Twenty-nine
The operation was a coarctation of the aorta; a big chest operation performed when the aorta, the huge artery from the heart, has a bottleneck in it which has to be cleared. Either a graft is put in to widen this narrow passage, or the narrow part is cut out and the two ends brought together.
Sister Robeson and I started to prepare theatre early next day. The human graft Sister had sent for the day before sat in its case on one of the trolleys; the scales to weigh the swabs to ascertain the amount of blood lost were put by the side of it; the defibrillating apparatus to apply electric shock directly to the heart should it stop, was sterilised and placed ready. Sister Robeson supervised and assisted the laying of the trolleys and the preparation of the theatre, pointing out to me as she did so the uses of all the various apparatus.
At last everything seemed to be ready. No stone was left unturned to deal with any emergency that might arise. The patient’s bed was brought up and placed in the corridor, so that the two moves from the table to the trolley, from the trolley to the bed, could be made in one, and thus disturb the sick patient less.
While we were occupied in the theatre, the team of anaesthetists in the Anaesthetic Room were cooling the patient; already anaesthetised, he was placed in a bath of cold water and gradually packed round with ice. The temperature of the patient being reduced also lowered the metabolic rate, and in doing so minimised post-operative shock.
We began to scrub up silently, and as usual on the brink of a big case, the bustle and rush of theatre seemed to be moderated, and everything moved in slow motion, thus affecting the entire atmosphere with unseen tension, and filling us all with a great desire to give only of the best.
I noticed in a detached way how dry my hands were becoming with the constant use of soap and water and scrubbing brush, then the immersion in spirit, then the glove powder, that stuck in the nails and made the area between the fingers brittle and sore. Scrubbed up, I put on my gown, then the gloves, avoiding touching the outside of them with my fingers, sliding them on in the approved style, then easing the rubber wrinkles over my fingers with the other gloved hand, until both my hands looked as if they had been poured into the casing.
The theatre was cold and I shivered, though this was half from nervousness. I started under Sister Robeson’s directions to prepare the various delicate silk sutures.
At last the patient was wheeled in. He was a young man, still in his teens; his shrouded form looked long and thin; a boy of nineteen cut off from all normal activities by a congenital deformity of the aorta. Sister explained to me that he would, if the operation was not performed, in all probability die of a cerebral haemorrhage. He had very high blood pressure in his head, as the blood which was trying to get through the aorta was forced upwards to the upper part of his body.
The patient was placed in position on his right side. His hands were now carefully arranged with his right hand stretched in front of him, and his left arm circled round his head. This position was maintained by sandbags and padded cushions. Then the assistant surgeons who had come in painted and towelled the patient.
The chest surgeon now put in an appearance. Mr Knightley was a charming man in early middle-age; unlike most of his kind, he was unawed by his responsibilities, and completely relaxed in his manner with everyone in the theatre.
‘Good morning,’ he said politely to everyone in general. He advanced to the table, looked down at the patient and gently shook his head.
‘I think this poor boy has got it quite badly. We’ve got a graft, have we, Sister?’
‘Yes, sir. It is ready.’
‘Oh, good.’ He sighed. ‘Knife,’ he said softly – and the operation began.
A large incision was made from the middle to the side of the patient’s body, and his ribs were bared. The skin from the ribs was then cleared by the heat of diathermy, and one of the ribs was snapped off. With one rib out of the way, the surgeon had got a clear field, and a large retractor was screwed into position to hold the ribs open.
Pushing the lung up out of the way, Mr Knightley then dissected down to the aorta. Eventually the narrow portion of the channel was exposed, this was only about half an inch in length.
‘Oh, good,’ he said. ‘I don’t think we need a graft here, do we?’
He asked for the large clamps. Horrified, I asked Sister in a whisper if the surgeon was going to clamp off the aorta.
&
nbsp; Mr Knightley overheard my question. ‘That’s all right, Nurse,’ he said. ‘You see, he has a good collateral circulation, all the blood vessels in the area are enlarged to take the supply to the lower limbs. So we feel it’s quite safe to clamp off the aorta till we’ve done the anastomosis.’
I watched fascinated while delicate fingers freed the affected part and clamped each side of it.
‘Scissors, please,’ he said. As he spoke they were already in his hand.
‘I’m going to cut now. All right?’ he asked the anaesthetist, who nodded in reply.
He cut out the small piece of tube. Then he took the cut ends and with tiny but firm stitches he sewed them together. When he had completed the anastomosis, the join was barely visible.
‘Now,’ he said, ‘we’ll let off the clamps and see if there is any leakage.’
He did this. The aorta now, instead of being funnel-shaped, was straight and of normal size. He waited for a few minutes, watching to see if the blood seeped through, but all that came through were a few pinprick drops at the join. The expert eye of Mr Knightley soon dismissed this as trauma caused by the needle.
He began to sew up. Reaching rib level, he removed the retractors, and with a double thickness of the thickest catgut, he stitched through the intercostal space, and drew the ribs back into position, fastening them tightly. He then, with a finer needle and catgut, sewed the ribs together and afterwards cut and removed the thick stitches. The rest of the incision was then closed and stitched up, a drain being left in position, to remove any blood that might drip through.
A dressing was applied, and the patient was very gently straightened and removed to his own bed, which had been brought into the theatre.
This perfect example of a fine surgeon’s work had taken just under four hours.
Mr Knightley courteously thanked the anaesthetist and his assistant, and his two assistant surgeons. Then he turned to us.
