Flashlights not Lamps

When I began training as a nurse, doctors and nurses rarely starred in romantic comedies. The hospital, like an alien subterranean city, swallowed up its medical and nursing trainees and some of them didn’t leave until they were ready to become bald or gray-haired patients. Doctors did their thing and nurses did theirs and most of the time they both realized they were on the same side. And then as now, nurses spent a lot of time on the wards without seeing or hearing from a doctor.

Now nurses learn theory about what they are going to do before they do it. Psychology looms large. The body is important or why do we spend so much time and money on it? However, the new nurse must never forget that each patient (officially called a client now because that is a less demeaning word than patient) has a mind and a soul. So, before nurses were told about minds and souls, did they wade in blindly treating only a person’s physical being? Not if they met patients like the ones I met. Every one of them had a mind and shared it with me. About the soul, well, that’s another story.

When I was a student nurse in the UK, intensive care units had not been invented so the very sick and patients facing medical crises lay in beds next to those of patients who expected to walk out of the hospital within a week. People whose hearts had been damaged in childhood by rheumatic fever or a strep throat might be hospitalized in their forties. Their hearts would continue to weaken until they died or spent their last few months confined to a wheelchair. Since their hearts couldn’t pump fluid around their bodies, it started to accumulate in their feet first creeping upwards until they couldn’t breathe. At the bedside, doctors would insert tubes through a patient’s abdominal wall to drain off fluid into a small tub.

People died of something called malignant hypertension. They were admitted with high blood pressure and none of the medications known at the time could bring their blood pressure down so it kept rising. Most of the patients I met with this kind of hypertension were middle-aged men. When their blood pressure remained high, they developed terrible headaches and their anxiety increased to almost panic levels.

Morphine was our big pain-killer. Intravenous medications hadn’t been thought of so nurses gave morphine via injection with glass syringes and big steel needles. A lot of people used to receive shots of morphine every three and then every two hours, especially at night.

So how were nursing students prepared for this frontline confrontation? We spent three months in a beautiful old house with carefully tended grounds. Twenty of us, eighteen women and two men, spent our weekdays in class and our weekends with families and boy or girlfriends. We each had out own room where we could study. We had classes in anatomy and physiology, in pathology, in medicine and surgery, and in nursing.

I remember well all my instructors but I remember best the nursing instructor, over six feet tall and weighing about three hundred pounds when one hundred and twenty pounds was considered normal for a woman. She would brush chalk dust from the shelf of her ample bosom and remind us that she had six and one-half degrees. I always wanted to ask her what the half was for. Born in Ireland, she had come to England to be trained as a nurse, had met and married a tiny university professor, and stayed on to give us all the benefit of her degrees. She had pronounced views on everything. We never had to wonder about the right and wrong thing to do. She knew the right thing to do in every circumstance. You can guess we all made fun of her and bided our time until we could rebel. But I need to state up front that none of us could say she didn’t care. She wanted all her students to be the best nurses the world had ever seen. It wasn’t her fault that we had feet of clay.

About make-up, she said, “Nurses shouldn’t let their noses shine except on very hot days when they don’t have time to stop and powder them. But never, never should a nurse wear red lipstick. A hospital ward is not a dance hall.” Nothing was too small or too large for her mind to grind up and spit out.

When a patient died, we were to perform our last service for that person. The instructor brought in the death trolley (something like a two-tiered cart with wheels) so we would know what to bring to the patient’s bedside. She suggested we place flowers in the patient’s hands and, if it was part of our belief, say a prayer. So vivid was her portrayal of care after death that once, when I entered the room of a patient who had died less than an hour ago, and I heard the flutter of wings, I assumed the patient’s soul had taken wing. It was a pigeon on the window sill.

That instructor had a mission, a calling, and I’m not sure why she was so unhappy. I don’t think it was her disappointment in us because we left after three months. Maybe she cared about too many things. She was so large and strong-minded that no one seemed to care about her. Was that what she needed?

She wore the dark navy blue dress with a white collar of teachers and administrators. The dress reached just below the knee and buttoned up the front. The matron and head nurses wore bright blue dresses with wide navy belts adorned with fancy buckles. Floor nurses wore dresses with tiny blue and white checks, white aprons, and small white caps. The cap was the bane of my life. After I washed my hair, a thousand bobby pins wouldn’t hold it in place. I consistently underestimated my height by two inches. After six months, a student nurse displayed half a stripe, after one year, a whole stripe, and so on until the nurse graduated and wore a plain white cap and wide belt with a fancy buckle. Slender waists showed off the belt to best advantage.

Although England has been a predominantly Protestant country since the sixteenth century, hospitals there still cling to the traditions of caring for the sick. Monks first followed by nuns ministered to the sick and dying in monasteries. Head nurses are still called sisters. Our caps were an adaptation of the wimple, although I believe the lucky nurses of today don’t wear anything on their heads.

So, after our intense three month training was complete and we passed all exams, we joined the tradition and donned our uniforms and caps ready to begin our sixty-hour weeks as the work horses of the hospital. We learned the old-fashioned way, by experience. We spent three and one-half years rotating through all the wards containing thirty patients with only bed curtains for privacy in a large urban hospital. One day a week we attended classes and took physical and written exams regularly. Specialist doctors taught us disease symptoms in their areas of expertise and the cures available at the time. Specialist surgeons described their surgeries. I don’t know whether the doctors were energized by the nubile student nurses in their audience but we did seem to inspire them into adding humor to their repertoire of diseases and knife-cuttings. Fearing we’d remember the jokes and not the diseases, our instructors tried to curb the physicians’ sense of fun. Senior nurses on the wards helped us with complicated procedures. Nurses put in gastric tubes and catheters, and had many dressings and tubes to worry about on surgical floors. Nurses took care of the large metal containers on each ward where instruments were sterilized. Instruments were boiled for five minutes to destroy all known bacteria except “in the presence of tetanus” when twenty minutes of boiling was required. These were pre-AIDS days.

Nothing stood between the nurse on the ward and the patient except her own defenses. In my first year I took care of an eighty-eight year old woman called Britannia. She seemed so frail. Once, when I bent forward to help lift her up the bed, she snatched my scissors out of my top pocket and threatened to stab me if I didn’t leave her alone. Another time she used the grab bar made of metal and wood, attached to a hook over her bed, to whack me on the side of the head so I learned for the first time what seeing stars meant. She was an ex-prostitute. As a teenager, I appreciated the irony of her name. I doubt whether any of my instructors would have seen the humor.

Although our small group of twenty student nurses worked on different floors, we remained friends and shared our experiences. We knew patients who had stayed at the hospital for years because they had nowhere to go and no relatives. No one knew the social history of a sixty year old woman who had been on R3, a medical floor, for as long as anyone could remember. Despite her need for total care and her extreme dementia, we figured she must have come from a good family because, even when she was mad with us for waking her up, all she could call us was, “you rat people.” We had many patients who called us a lot worse.

We saw tragedies on a weekly and sometimes daily basis, and most of us weren’t yet twenty. One Christmas Eve night, I, with the help of one graduated nurse, admitted two very sick patients and took care of three patients who died. And how did we deal with all that? Well, we were young and of an age to search for a mate so we attended a lot of parties and regularly paid the entrance fee for the nearby dance hall.

Dance halls in those days served no alcoholic beverages and their patrons were the young people who spent hours learning the latest dances so they could appear to their best advantage at weekends. Girls dressed up in full-skirted dresses with bouffant petticoats, and young men wore suits and white shirts. We danced until midnight hoping to meet a young man with a car who could take us back to the hospital where we lived and who would later park outside the nurses’ home and impress our friends with his looks and make of car.

Since I was caught up in the pain and pleasures of dating, perhaps that is why I remember so vividly a recently married couple. They were in their mid-thirties. I, and other nurses on the floor, thought marriage in the thirties strange because then people usually married in their early twenties and their family was often complete before they were thirty. But, after a year on the front lines, I’d become tolerant of differences.

After listening to a report lasting no longer than ten minutes, I learned that the thirty-five year old man had recently driven six-hundred miles during the first week of his honeymoon. When he’d developed shortness of breath, his new wife had insisted he come to the hospital before they continued their trip. No one knew what had caused his breathing difficulties. He’d always been healthy and he didn’t have asthma. His wife was constantly at his bedside. Young student nurses appreciated the romance of this even though she was an older woman of thirty-two who, so far, had no children.

That afternoon, we had thirty patients who needed attention, and the other nurse with me, a fully graduated nurse, started preparing medications. As I walked from bed to bed, I talked with and looked at patients to see who needed care first. When I reached the bed of the man on his honeymoon, his eyes suddenly showed fear; he let out a cry and dropped forward. I put my arms around him to catch him before he fell out of bed. As I glanced at his face, although I’d worked on the floors no more than a year, I knew he was dead. Codes hadn’t been invented. Gently, I placed his head back on his pillows and drew the curtains around his bed before I returned to the small nurses’ office to let my co-worker know what had happened.

On my way past the beds of patients watching me, I thought of the man’s new bride who spent so many hours at his bedside but hadn’t been there when he took his last breath. Now, I know, even though the man was relatively young, since he’d driven a long distance, he would have been checked in the emergency room for blood clots in his legs and lungs. He would have been given a special lung scan to rule out a blood clot that had traveled from his legs to a major artery in his lungs. Intravenous medication and treatment protocols might have saved his life before he was admitted to a floor. What a difference that would have made to a newly married couple.

I can talk endlessly about the number of lives ending abruptly because medicine hadn’t advanced far enough to save them. That had to make a big difference to the way we used to practice nursing.