Shroud for a Nightingale (3 page)

She bestowed on students and teacher her brief smile of reassurance and encouragement and perched herself on one of the four chairs placed ready at the side of the room. Matron Taylor and Miss Rolfe seated themselves on either side of her as quietly and unobtrusively as possible in the face of Mr. Courtney-Briggs’s determination to be fussily gallant over pulling out the ladies’ chairs. The arrival of the little party, however tactfully arranged, seemed temporarily to have disconcerted the nurse tutor. An inspection was hardly a natural teaching situation, but it was always interesting to
see how long it took a tutor to re-establish
rapport
with her class. A first-class teacher, as Miss Beale knew from personal experience, could hold a class’s interest even through a heavy bombing raid let alone the visit of a General Nursing Council Inspector; but she did not feel that Mavis Gearing was likely to prove one of that rare and dedicated band. The girl—or woman rather—lacked authority. She had a propitiatory air; she looked as though she might easily simper. And she was a great deal too heavily made up for a woman who should have her mind on less ephemeral arts. But she was, after all, merely the clinical instructor, not a qualified nurse tutor. She was taking the session at short notice and under difficulties. Miss Beale made a mental resolution not to judge her too harshly.

The class, she saw, were to practise feeding a patient by intra-gastric tube. The student who was to act as patient was already in one of the demonstration beds, her check dress protected by a mackintosh bib, her head supported by the back rest and a bank of pillows. She was a plain girl with a strong, obstinate and oddly mature face, her dull hair drawn back unbecomingly from a high nobbly forehead. She lay there immobile under the harsh strip lighting, looking a little ridiculous but strangely dignified as if concentrating on some private world and dissociating herself from the whole procedure by an effort of will. Suddenly it occurred to Miss Beale that the girl might be frightened. The thought was ridiculous but it persisted. She found herself suddenly unwilling to watch that resolute face. Irritated by her own unreasonable sensitivity, she turned her attention to the nurse tutor.

Sister Gearing cast an apprehensive and interrogative glance at the Matron, received a confirmatory nod and resumed her lesson.

“Nurse Pearce is acting the part of our patient this morning. We have just been going through her history. She is Mrs. Stokes, the fifty-year-old mother of four children, wife of a council refuse collector. She has had a larynectomy for the treatment of cancer.” She turned to a student sitting on her right. “Nurse Dakers, will you please describe Mrs. Stokes’s treatment so far.”

Nurse Dakers dutifully began. She was a pale, thin girl who blushed unbecomingly as she spoke. It was difficult to hear her but she knew her facts and presented them well. A conscientious little thing, thought Miss Beale, not outstandingly intelligent, perhaps, but hard-working and reliable. It was a pity that no one had done anything about her acne. She retained her air of bright professional interest whilst Nurse Dakers propounded the fictional medical history of Mrs. Stokes and took the opportunity of a close look at the remaining students in the class, making her customary private assessment of their characters and ability.

The influenza epidemic had certainly taken its toll. There was a total of seven girls only in the demonstration room. The two who were standing one on each side of the demonstration bed made an immediate impression. They were obviously identical twins, strong, ruddy-faced girls, with copper-coloured hair clumped in a thick fringe above remarkable blue eyes. Their caps, the pleated crowns as saucers, were perched well forward, the two immense wings of white linen jutting behind. Miss Beale, who knew from her own student days what could be done with a couple of white-tipped hat pins, was nevertheless intrigued by the art which could so firmly attach such a bizarre and unsubstantial edifice on such a springing bush of hair. The John Carpendar uniform struck her as interestingly out of date. Nearly every hospital she visited had replaced
these old-fashioned winged caps with the smaller American type which was easier to wear, quicker to make up, and cheaper to buy and launder. Some hospitals, to Miss Beale’s regret, were even issuing disposable paper caps. But a hospital’s nurse uniform was always jealously defended and changed with reluctance and the John Carpendar was obviously wedded to tradition. Even the uniform dresses were slightly old-fashioned. The twins’ plump and speckled arms bulged from sleeves of check pink gingham which reminded Miss Beale of her own student days. Their skirt lengths paid no concession to modern fashion and their sturdy feet were planted in low-heeled black lace-up shoes.

She glanced quickly at the remaining students. There was a calm, bespectacled girl with a plain, intelligent face. Miss Beale’s immediate reaction was that she would be glad to have her on any ward. Next to her sat a dark, sulky-looking girl, rather over made-up and assuming an air of careful disinterest in the demonstration. Rather common, thought Miss Beale. Miss Beale, to her superiors’ occasional embarrassment, was fond of such unfashionable adjectives, used them unashamedly and knew precisely what she meant by them. Her dictum “Matron recruits a very nice type of girl” meant that they came of respectable middle-class families, had received the benefit of grammar school education, wore their skirts knee length or longer, and were properly aware of the privilege and responsibilities of being a student nurse. The last student in the class was a very pretty girl, her blonde hair worn in a fringe as low as her eyebrows above a pert, contemporary face. She was attractive enough for a recruiting poster, thought Miss Beale, but somehow it was the last face one would choose. While she was wondering why, Nurse Dakers came to the end of her recital.

“Right, Nurse,” said Sister Gearing. “So we are faced with the problem of a post-operative patient, already seriously under-nourished and now unable to take food by mouth. That means what? Yes, Nurse?”

“Intra-gastric or rectal feeding, Sister.”

It was the dark sulky-looking girl who answered, her voice carefully repressing any note of enthusiasm or even interest. Certainly not an agreeable girl, thought Miss Beale.

There was a murmur from the class. Sister Gearing raised an interrogative eyebrow. The spectacled student said: “Not rectal feeding, Sister. The rectum can’t absorb sufficient nourishment. Intra-gastric feeding by the mouth or nose.”

“Right, Nurse Goodale, and that’s what the surgeon has ordered for Mrs. Stokes. Will you carry on please, Nurse. Explain what you are doing at each step.”

One of the twins drew the trolley forward and demonstrated her tray of requirements: the gallipot containing sodium bicarbonate mixture for cleaning mouth or nostrils; the polythene funnel and eight inches of tubing to fit it; the connector; the lubricant; the kidney bowl with the tongue spatula, tongue forceps and gag. She held up the Jacques oesophageal tube. It dangled from her freckled hand obscenely like a yellow snake.

“Right, Nurse,” encouraged Sister Gearing. “Now the feed. What are you giving her?”

“Actually, it’s just warm milk, Sister.”

“But if we were dealing with a real patient?”

The twin hesitated. The spectacled student said with calm authority: “We could add soluble protein, eggs, vitamin preparations and sugar.”

“Right. If tube feeding is to continue for more than forty-eight hours we must ensure that the diet is adequate in
calories, protein and vitamins. At what temperature are you giving the feed, Nurse?”

“Body temperature, Sister, 38°C.”

“Correct. And as your patient is conscious and able to swallow we are giving her this feed by mouth. Don’t forget to reassure your patient, Nurse. Explain simply to her what you are going to do and why. Remember this, girls, never begin any nursing procedure without telling your patient what is to happen.”

They were third-year students, thought Miss Beale. They should know this by now. But the twin, who no doubt would have coped easily enough with a real patient, found it embarrassingly difficult to explain her procedure to a fellow student. Suppressing a giggle she muttered a few words at the rigid figure in the bed and almost thrust the oesophageal tube at her. Nurse Pearce, still gazing fixedly ahead, felt for the tube with her left hand and guided it into her mouth. Then shutting her eyes she swallowed. There was a convulsive spasm of the throat muscles. She paused to take breath, and then swallowed again. The tube shortened. It was very silent in the demonstration room. Miss Beale was aware that she felt unhappy but was unsure why. It was a little unusual perhaps for gastric feeding to be practised on a student in this way but it was not unknown. In a hospital it might be more usual for a doctor to pass the tube but a nurse might well have to take the responsibility; it was better to learn on each other than on a seriously ill patient and the demonstration doll wasn’t really a satisfactory substitute for a living subject. She had once acted as the patient in her own training school and had found swallowing the tube unexpectedly easy. Watching the convulsive movements of Nurse Pearce’s throat and swallowing in an unconscious sympathy she could almost recall, after thirty years, the sudden chill as the tube slid over the soft palate and the faint shock of
surprise at the ease of it all. But there was something pathetic and disturbing about that rigid white-faced figure on the bed, eyes tightly closed, bibbed like a baby, the thin tube dragging and wriggling like a worm from the corner of her mouth. Miss Beale felt that she was watching gratuitous suffering, that the whole demonstration was an outrage. For a second she had to fight an urge to protest.

One of the twins was now attaching a 20-ml syringe to the end of the tube, ready to aspirate some of the gastric juices to test that the end of the tube had reached the stomach. The girl’s hands were quite steady. Perhaps it was just Miss Beale’s imagination that the room was preternaturally silent. She glanced across at Miss Taylor. The Matron had her eyes fixed on Nurse Pearce. She was frowning slightly. Her lips moved and she shifted in her seat. Miss Beale wondered if she were about to expostulate. But the Matron made no sound. Mr. Courtney-Briggs was leaning forward in his chair, his hands clasping his knees. He was gazing intently, not at Nurse Pearce, but at the drip as if mesmerized by the gentle swing of the tubing. Miss Beale could hear the heavy rasp of his breathing. Miss Rolfe sat bolt upright, her hands folded loosely in her lap, her black eyes expressionless. But Miss Beale saw that they were fixed, not on the girl in the bed, but on the fair pretty student. And for a fleeting second the girl looked back at her, equally expressionless.

The twin who was administering the feed, obviously satisfied that the end of the oesophageal tube was safely in the stomach, lifted the funnel high over Nurse Pearce’s head and began slowly to pour the milky mixture down the tube. The class seemed to be holding its breath. And then it happened. There was a squeal, high-pitched, horribly inhuman, and Nurse Pearce precipitated herself from the bed as if propelled
by an irresistible force. One second she was lying, immobile, propped against her mound of pillows, the next she was out of bed, teetering forward on arched feet in a parody of a ballet dancer, and clutching ineffectually at the air as if in frantic search of the tubing. And all the time she screamed, perpetually screamed, like a stuck whistle. Miss Beale, aghast, had hardly time to register the contorted face, the foaming lips, before the girl thudded to the floor and writhed there, doubled like a hoop, her forehead touching the ground, her whole body twitching in agony.

One of the students screamed. For a second no one moved. Then there was a rush forward. Sister Gearing tugged at the tube and tore it from the girl’s mouth. Mr. Courtney-Briggs moved resolutely into the mêlée, his arms wide. The Matron and Sister Rolfe bent over the twitching figure hiding her from view. Then Miss Taylor rose and looked round at Miss Beale.

“The students … could you look after them please? There’s an empty room next door. Keep them together.”

She was trying to keep calm but urgency made her voice sharp. “Quickly please.”

Miss Beale nodded. The Matron bent again over the convulsed figure. The screaming had stopped now. It was succeeded by a piteous moaning and a dreadful staccato drumming of heels on the wooden floor. Mr. Courtney-Briggs took off his coat, threw it to one side, and began to roll up his sleeves.

Muttering gentle encouragement, Miss Beale shepherded the little group of students across the hall. One of them, she was not sure which, said in a high-pitched voice: “What happened to her? What happened? What went wrong?” But no one replied. They moved in a shocked daze into the room next door. It was at the back of the house, a small, odd-shaped room which had obviously been partitioned from the original high-ceilinged drawing-room and which now served as the Principal Tutor’s office. Miss Beale’s first glance took in a business-like desk, a bank of green steel filing cabinets, a crowded notice-board, a small pegboard fitted with hooks from which hung a variety of keys, and a chart along the whole of one wall showing the teaching programme and the progress of each individual student. The partition wall cut the mullioned window in half so that the office, unpleasing in its proportions, was also inconveniently dark. One of the students clicked down the switch and the central bar of fluorescence began to flicker into light. Really, thought Miss Beale, her mind clutching desperately at the comfort of its normal preoccupations, it was a most
unsuitable room for a Principal Tutor, or for any other tutor, come to that.

This brief remembrance of the purpose of her visit brought a second’s comfort. But almost immediately the awful reality of the moment reasserted itself. The students—a pathetic and disorganized little bunch—had crowded together in the middle of the room as if incapable of action. Glancing quickly around, Miss Beale saw that there were only three chairs. For a moment she felt as embarrassed and nonplussed as a hostess who is not sure how she is going to seat all her guests. The concern wasn’t altogether irrelevant. She would have to get the girls comfortable and relaxed if there were to be any chance of keeping their minds off what was happening next door; and they might be incarcerated for a long time.