Silent Song

by Lucilla Andrews

  ‘Simply,’ said Sister Cardiac, ‘the man’s a genius. Personally, one can only admire, gasp, and thank God one’s not married to him. Though his wife’s nearly as alarming.’

  ‘She is? I haven’t met her.’

  ‘An Oxbridge Double First. Makes one feel so inadequate. But they do have two very sweet little geniuses. Or do I mean genii? They intend sending them to a comprehensive. A good comprehensive.’

  Sister was talking to a relative in her day office when I reached the Cardiac Unit. Her office overlooked the main Unit corridor and the first of the two large general wards.

  ‘I’ll join you in Coronary Care for the report, shortly, Nurse Dorland. Just see how Dr Jones is getting on with Mrs Higgs’s pacer. I’ve sent our new Course nurse in to help, but as she’s only just come to us from Heart-Lung, she may be a little lost. And I’d better warn you in case the door’s screened, that isn’t Richard in C.5. We had to have his cubicle, so he’s now in William and Mary.’

  But for the relative I would have groaned. Richard had been the joy of Coronary Care for weeks. ‘Thank you, Sister.’

  Richard Blake was six, and born with a hole in his heart. He shouldn’t have come to us at all as our Children’s Block had its own Cardiac Unit, but the day before he was due in, the Block was closed for a minor scarlet-fever epidemic. Rather than postpone the anxiety for his parents and alter the arrangements for which Richard had been carefully mentally prepared, Dr Lincoln Browne had sent him first to us, and after his post-operative period in Heart-Lung, with Mr Roseburn’s consent, back to us as he knew our faces and from the start had settled happily into Cubicle 5.

  Coronary Care lay off that corridor behind soundproofed, self-sealing, opaque glass doors. The doors were always kept shut and carried a large notice: No unauthorized visitors. If you wish to inquire after a patient receiving intensive care in this Unit please see Sister or Staff Nurse in charge in day office.

  The Coronary Care cubicles were actually six single-bedded small wards arranged in a curved row off one side of a narrowish corridor. The special plate-glass cubicle doors were roughly double the normal size, and only screened from the inside, when staff were attending to the patients. Over every door on the corridor side was a cardiac monitor connected to the individual electrocardiograph machine and bedside monitor in every cubicle. The bedside monitors were the size of largish transistor radios, those in the corridor were much larger and when blank looked not unlike blank television screens.

  The desk in Coronary Care looked nothing like a desk. It was a long, high, broad metal-and-fibre-glass counter built into the floor to face every cubicle door and corridor monitor. The right half of the flat top was fitted with panels of small bulbs and switches. The left half was the writing area, and as it was a Unit rule that writing could only be done facing the cubicles, all the high stools lived permanently behind the desk and between it and the rows of filing cabinets and X-ray screens against the wall. The planners had labelled this part ‘the nursing area’. Staff and patients called it ‘Sister’s desk’.

  There were only two other doors in the department. The solid door of the relatives’ rest-room, near the entrance and on the same side as the desk, and a swing glass door at the other end. The planners labelled the cul-de-sac beyond ‘the hygiene annex’. To staff and patients it was ‘the privy passage’.

  It was a hospital as well as Unit rule that the desk must never be left unattended by a trained nurse. Only trained nurses worked in Coronary Care. The Course nurses, generally newly trained Martha’s girls, though sometimes we had male and female S.R.N.s from other hospitals, were taking the special course in intensive care nursing required by most hospitals, including Martha’s, before an appointment in any intensive care unit. Since all Martha’s staff nurses wore the same grey-blue dresses, to help staff and patients differentiate, the Course nurses wore plain white American-style caps instead of frilled muslin with a huge butterfly bow at the back. From time to time some planner suggested our caps were very old-fashioned, difficult to make and launder, and surely the time had come to modernize. Miss Evans and her predecessors had informed the respective planners the suggestion alone would make nursing history by evoking the first wholesale mutiny amongst the nursing staff of a British teaching hospital.

  Four monitors were live that afternoon and the one over C.3 was disturbing. I stopped on one foot but couldn’t see round the screen. ‘Miss Sims hasn’t had another?’

  The girl on the desk shook her head. ‘We moved her to the Private Wing yesterday. That’s our Brigadier. Came in yesterday and stopped twice last night. He’s better than he was. We’ve had a right general post since you left. Old Mother Higgs’ll be the only one you know. And our own dear Dr Jones.’

  ‘So who expects life to be perfect?’

  She grinned and jerked a thumb downwards.

  Mrs Higgs’s heart had her in and out of Martha’s since before I was born. Dr Lincoln Browne said she should have died years ago and under oath he couldn’t have explained why she hadn’t, though it wouldn’t surprise him if she saw him out. ‘These frail little elderly ladies who look as if one breath’ll blow them out are the real physical and mental toughs of the human race. Our Mrs Higgs is a lady of admirable courage and spirit and having bullied two generations of her family, the arrival of great-grandchildren has given her a new lease and further confounded the experts ‒ myself included!’

  Mrs Higgs had the face of a shrewd, aged, hawk and wore her white hair in rows of tidy curls. Being Monday, she had on the pink shell-patterned bedjacket knitted by her second daughter, Dora. On Sunday she wore Hilda, the eldest’s, blue blackberry-pattern. She had three daughters, three sons and all married. None of her daughters-in-law liked knitting and their bought jackets she wore Thursday to Saturday. ‘I mean,’ she said, ‘goes to show, doesn’t it?’

  She was in C.1 and watching her bedside monitor with experienced eyes when I went round the screen. Dr Jones had his back to the door and was checking on the pacing machine against a wall the position of the catheter in the right ventricle of her heart. The new nurse standing by Mrs Higgs I recognized instantly as one Shirley Carter though we had never worked together, as she was outstandingly tall, very slim, and had by common consent currently the best colouring in Martha’s. Her long straight hair fixed in a huge, stylish, beautifully groomed bun was dark red, her eyes were lapis lazuli and her skin pale. We exchanged smiles. Mrs Higgs beamed. Dr Jones ignored my ‘Afternoon, Doctor,’ and arrival. He was like that.

  ‘How’d you get on in all that snow, duck? Thought we’d have to fetch the St Bernard out to you! My Hilda was in yesterday ‒’ Mrs Higgs never allowed breathlessness to slow her speech ‒ ‘all very well for you to fuss, my girl, I said, seeing you’ve Harry and the boys waiting below. Won’t hurt them to dig up a little snow, I said. You want to think of poor Staff Dorland, I said, up there with the Scotch ‒ shame about Staff Anstey’s mum ‒ but like I said to Sister a daughter as won’t put her mum first ‒ well, I said, not much of a daughter, is she?’ She noticed the scowls Dr Jones was sending Nurse Carter and myself. ‘Not talking too much for you, am I, Doctor? No, don’t tell me ‒ I know what my Dr Lincoln says ‒ Mrs Higgs, he says, only time I’ve known you stop talking is when you’re asleep or unconscious. Wouldn’t do for me to be unconscious now would it, duck? Got it in tickety-boo have you?’

  Dr Jones, a tallish, sturdy man with light brown hair, was the most junior cardiac registrar. He had only very recently come to us from Thoracics and become a Member of the Royal College of Physicians. He had a Grecian profile of which he was equally over-aware. ‘The machine says so, Mrs Higgs. How does it feel?’

  ‘Comfortable. Itches, mind.’ She patted the strapping on her chest. ‘Well, I said to my Dr Lincoln, you may have me on the three channels, I said, but you still can’t stop the tickles, can you? Always call him my Dr Lincoln,’ she told Nurse Carter, ‘seeing as I knew him when he was in his short white coat and just plain M
r Browne then. You’ll want to get yourself a fancy middle name one of these days, Doctor.’

  Dr Jones tried not to look too pained as she was a patient. ‘I shall think on your excellent advice, Mrs Higgs. If you’re comfortable, I’ll be back anon. Many thanks for your co-operation.’ He sauntered off as if Nurse Carter and I were invisible. We looked at each other.

  Mrs Higgs being a very old hospital hand missed nothing. ‘He’s young. Always the young ones as get toffy-nosed. He’ll learn ‒ and I’ll say this for him ‒ gives a lovely injection. Missing little Richard, I shouldn’t wonder.’ She laid a paper-thin hand on my arm. ‘You’ll be missing him, duck, and him you. Thought the world of his Nursie Dorland his mum told my Hilda in the rest-room. Still, he’ll have his teddy. Name of Frank, duck,’ she added helpfully to Nurse Carter.

  Dr Jones was writing notes when Sister swept in to report, sent the desk nurse to late lunch, Nurse Carter to C.3. ‘We’ll watch the desk whilst I report.’

  Dr Jones looked up, reluctantly. Since we had no office it was an unwritten rule that the residents should offer to remove themselves from the desk itself during handing over reports. ‘Must one move, Sister?’

  Had he been any one of our other residents she’d have told him to rest his feet and turn a deaf ear. ‘The registrars’ office next door is available to you, Doctor.’

  He sighed, very slowly collected up his notes, pen and stethoscope, then ambled away exuding annoyance with the back of his neck.

  Sister climbed on a high stool. ‘I’m much afraid I may shortly have to tell that young man an M.R.C.P. doesn’t automatically convey droits de seigneur in the Cardiac Unit. Unless Joe does the job first, which I’m happy to say is very probable.’ Joe Mathers was our senior cardiac registrar. She scanned the live monitors. ‘You see why I wanted you back. I’m glad cutting short didn’t spoil too much. You did say you drove down when you rang this morning?’

  ‘Yes. Someone gave me a lift.’

  ‘That was lucky.’ She opened the report book, sorted some memos. ‘Pity we’ve lost our Richard, but we were too pressed to hang on to him. We thought William and Mary as he should be on his own a little longer and less temptation up there than in the Kids’ Block. They’ve always got snuffles and sore throats going round the playrooms, and being an only child he’s good at amusing himself as you all know in here. You’ll be happy to hear Frank says the new small ward is jolly smart.’

  I smiled at the monitors. ‘That’s good.’

  ‘Before I forget, Frank says can you go up to say good night to Richard tonight. I said I was sure you would if you could and had a word with Sister William and Mary. I’m afraid she was rather taken aback to receive an official request from a teddy-bear, but after I explained Frank is Richard’s voice, chum and security symbol, she was very understanding and said my staff could go up anytime as L.B. had already given his blessing on that. She’s your set, I’ve just discovered.’

  I nodded. ‘We’re the last two left here. Jilly Smythe. She’s got the flat immediately below mine.’

  ‘Has she now? I didn’t know.’ Briefly she looked away from the monitors and sadly at me. ‘My dear, is your soul ever your own?’

  ‘Quite often since they gave her Willie-May in March.’

  ‘What a mercy! All that alarming efficiency! Isn’t promotion useful. Perhaps we could persuade someone to promote Dr Jones elsewhere?’

  ‘Not easily. Joe told me Jones is aiming for his job.’

  ‘And has the brains to get it! Dear me.’ She brightened. ‘That’ll be your problem, not mine! Miss Evans asked me yesterday if you had come nearer to a decision. I said you liked to make up your mind slowly, but I thought you would eventually accept. Right?’

  ‘Yes. I expect so.’

  ‘Splendid! Let’s get down to it as I’ve lots to tell you. C.1, Mrs Higgs. Seen by Dr Lincoln Browne this morning …’ Five minutes later I forgot I had been away or had ever had any life outside of Coronary Care.

  I was on until nine and as that would be too late went up to see Richard at seven before going to supper. William and Mary was on the ninth floor, the transition ward for our Wing, occasionally used as an overspill by the rest of the hospital, and on Monday had open visiting until 8 p.m. As all the patients were either semi-convalescents, or admissions with minor ailments only in for a few days, it was a very sociable ward and the landing was thick with visitors coming and going, when I left the lift. William (male) and Mary (female) were general wards and in addition there were four single-bedded small wards in a row off the main ward corridor. The staff nurse in charge said Richard was in small ward 1. ‘Sister said you’d be up, Mrs Dorland and I’m afraid you’ve missed his parents by about ten minutes. He was dropping off when I last looked in, but do have a look ‒ oh, so sorry ‒’ a relative wanted to talk to her ‒ ‘will you excuse me if I leave you?’

  It was my first visit to the ward since Jilly Smythe took over. The staff nurse was two years my junior, we had never worked together but knew each other well by sight. Never before had she treated me with such respect. I could feel the invisible notice on my cap. ‘Sister’s set. Watch it.’ Martha’s sets were rather like families. Individual members could tear each other apart, but at any attack from an outsider, the set ganged up to fight back. And as with families, outsiders meeting one member judged the whole on that one. Jilly had anachronistic views on etiquette, but too strong a character for her staff to question them to her face, or in confidence to Miss Evans. This last wasn’t cowardice, but common sense. Miss Evans would listen and then almost certainly arrange a transfer. None of Jilly’s nurses wanted a transfer as she was one of our rare sisters who drew up the nurses’ off-duty rota not merely weekly, but monthly, and only allowed a major disaster to alter the rota once made. I had never met the nurse unwilling to put up with a bit of unnecessary starch if it also meant she could be sure of her time off and of getting off on time. Jilly raised the roof if anyone was two minutes late on or off-duty. ‘Either’, she said, ‘is unprofessional, slipshod. I won’t have it!’ The joy of knowing Tuesday fortnight one’s free at three is something no nine-to-fiver on a five-day week, but every student and trained nurse, appreciates to the full. It is a joy that is still a rare experience for nurses.

  The patients in small wards 3 and 4 had visitors, their doors shut and full lights on behind the fanlights. Richard and his neighbour in 2 had on their red night lights and there were mufflers on their door handles to prevent them banging or closing. Richard was asleep on his back, with one arm round Frank, the other outstretched on his pillow.

  I went in quietly and sat on his locker for a few moments before tying round Frank’s neck in a bow the bit of gauze bandage I had brought up. This was an old joke between Richard and myself dating from his illest period in Coronary Care. Frank wearing a gauze bow tie meant I had found Richard asleep and for some reason struck him as better than any turn on telly. Later he would fall about laughing and tell me what Frank said. Frank was a great talker.

  Once my eyes grew accustomed to the light, mentally I compared the sleeping child with the one we had admitted.

  A small, under-sized little boy, his pale face pinched and strained, with great shadows under too-adult eyes, blue lips pathetically gasping for every breath, and the tragically unnatural patience of a child who had never been able to play, shout, or run. ‘I’m sending you a good little boy,’ said Dr Lincoln Browne. ‘Poor little chap. Much too good.’

  He was still small for his age, but his fair hair now had a sheen, his face the beginnings of a childish roundness, the shadows and the pallor had gone. His skin was tinged with the normal pink of his lips and his breathing, to anyone who had seen him before his op, was miraculously normal.

  I had been in our rest-room the evening his father, with anxiety, asked, ‘Mr Roseburn, if your operation on my son is successful, does that mean he’ll be able to live the normal life of a normal kid? No messing about, please! Yes, or no?’

 
; ‘Yes,’ said Mr Roseburn. Then we had all waited in silence as father turned his back. He was twenty-nine and adored Richard. He hadn’t wanted us to see he was crying.

  I had been on-duty the day of Richard’s op. Sister as official observer for the Cardiac Unit, a Martha’s custom, had watched from the Heart-Lung theatre gallery, with Dr Lincoln Browne and Joe Mathers for some of the time. Joe had come into Coronary Care when it was over, leant against the desk, and I had lacked the nerve to ask the result.

  Then Joe said, ‘Back in the Recovery Ward and Roseburn’s singing “Onward, Christian Soldiers” under the showers.’

  We had smiled at each other foolishly, joyfully. Richard had been on the operating table about six hours. The physical and mental strain of such a long and highly complex op exhausted the operating team and above all the leader as his was the over-all responsibility. After such an op, Mr Roseburn looked an old man. He was thirty-seven. If something had gone wrong, or despite all the scientific evidence he sensed the eventual outcome of apparently successful surgery would go wrong ‒ and it was one of his talents to recognize his instincts about his patients ‒ he hardly opened his mouth for the rest of the day. When his intelligence, experience and instincts told him all was, and would be, well, he sang rousing hymns under the surgeons’ room showers. He was the second son of a country vicar and knew all the words.