#Sister of Night ...# (Gore/Lee)
“Good evening Student Nurse MacFarlane. Welcome to Pye-Smith Ward. Night Sister Low has only just rung to say our regular Staff Nurse is off sick this evening. This is most unsatisfactory. What are they thinking of, putting a Second Year in charge ...”
Pye-Smith Ward’s biro-thin matriarch Sister Grey tutted. She was clearly pained at having to commune with a dim junior nurse like me at Sheffield’s prestigious Royal Hospital.
“And to add to our woes Student Nurse, we’re running very late because a critically-ill gentleman has just been brought up from Casualty,” Sister Grey continued in her Northern bark. “I will go through my report with you as soon as it’s finished. Now, run along and hang your cape in the cloakroom.”
“Thank you, Sister,” I replied shaking, now I was actually on the ward.
Who wouldn’t be in status panicus from being re-routed at the last minute to take charge of the hospital’s senior ward? It is March 1964, two weeks after my eighteenth birthday and at the beginning of my second year of training as a nurse. I had been snatched from a much cosier night-duty assignment on Women’s Geriatric where we could get away with some larking about with our favourite barmy auxiliary, a real pantomime dame with red pom-pom slippers, plenty of slap and pencilled-in eyebrows that could have scared the Grim Reaper.
Sister Grey’s immaculate Pye-Smith Ward by contrast was the hospital’s thirty-bedded critical care ward for male patients. Many would be on death’s door. This is also the age before the cardiac resuscitation facilities of the NHS’s smaller Intensive Care Units (ICUs). We had learnt during our training that if a patient’s heart arrested it was likely to be kaput for the unfortunate soul.
“Ee, Rose! I’ve just ‘eard they’ve sent you up to death-watch alley to take bloody charge!” yelled Manic Myrtle minutes earlier as we’d hurtled past each other in opposite directions along the old hospital’s gloomy corridors. “Rather thee than me with old Granite Chops Grey!”
Manic Myrtle was a Barnsley Whippet and my ultra-skinny room mate at Tapton Court Nurses’ Home on nearby Fulwood Road. She could have been an understudy for Audrey Hepburn except she was a firecracker. Though juniors, both of us were already night-duty ward-floaters, filling in for our student pals on their nights off. We could also be dispatched at a moment’s notice as an extra pair of trembling hands in various witching-hour emergencies. As rooky no-nothings we had only been entrusted thus far to take brief charge of low-key wards when the Staff Nurse was on one of her two meal breaks. I say her, as there weren’t any male nurses at The Royal, at any NHS hospital as far as I know, in those days.
The prospect of being in charge of thirty or so patients through the night even for a few minutes with no Staff Nurse present terrified us, as it would a new air stewardess asked to take over the controls of an airliner. Any dozy moth could tell our gormless forms tiptoeing around the beds of the very poorly patients expected to pop off, willing them to hang on until the Staff Nurse returned.
To non-medical people, determining if someone is dead may seem a no-brainer. This is how it seems in death scenes on television and film. Cardiac arrest is an easy one to determine as the unfortunate pegs out very quickly. For patients in slow decline it can be as though they are having the last laugh by stopping breathing for an age, then shuddering back to life like a wheezy old steam engine. This could go on for hours and is very upsetting for the relatives.
Now I was walking-the-walk. I was flying solo. Sister Low, our senior night-time commandant may as well have delegated Mad Mave Bolsover who tramped endlessly around Sheffield’s city centre, to run Pye-Smith Ward. Haunting memories of my older brothers’ merciless mocking as Nurse Twitty-Toes whenever I wore my childhood nurse’s uniform floated into my hippocampus.
As I turned towards the cloakroom I felt Sister Grey’s ferret-brown eyes bore into me through her pince-nez spectacles.
“You have worked on my ward before, on days, as I recall, Student Nurse MacFarlane?”
“Yes, Sister,” I nodded grimacing, hoping she wouldn’t link me with the recent Prize Ward-howler.
“Hmm ... I trust and pray you’ll have an uneventful night tonight Student Nurse. Now let me finish the report. And do tidy your hair off your collar, you look a fright.”
Such sniping at trainee nurses was now almost music to our well-tuned ears. It was rash to think of ourselves as anything above cockroach droppings. The hospital’s punitive training regime was ring-fenced to keep us obedient and ever desperate to please. Whatever we endured, be it low pay, no social life, constant exhaustion, scowling sisters and a complete lack of self-esteem, we were still privileged and proud to be Sheffield Royal Hospital nursing students. Add this to being brought up in the God-fearing, self-denigrating ‘Fifties and of course, we were putty in their immaculate hands.
The howler had happened a couple of weeks earlier on the ward when I had been feeding a cachexic ‘Jack Tar’ suffering from insane paralysis, the last stages of syphilis. Our miniscule but muscular Deputy Matron, Sister Foggart on her daily stomp asked my syphilitic patient a tad too unconvincingly how he was feeling. He waited until she had walked on a little way before spitting out his milk, raising his ‘skull’ from the pillow, curling his little finger and yelling in a clear Cockney voice,
“An I bet ‘er ‘ole’s only that big!”
A silence descended on the ward, as after a huge natural catastrophe. Staff and patients were aghast. Ex-Sergeant-major Foggart froze, her koala-brown eyes spinning like Catherine Wheels. Thankfully, she marched off the ward without uttering a word leaving the staff barely able to contain themselves with mirth. Those were the patient’s final words. He died that night, his skeletal body curled like a Pompeii victim.
Hanging up my comfort blanket in Pye-Smith’s tiny cloakroom, my full-length cape with blood-red woollen lining, I tidied my frizzy mop in front of a sliver of mirror. Were the broken mirror and my fear-induced migraine a twin omen goading me into calling it quits? Could I dare jack it all in and flee to London to join my Catholic school pals living the high-life in Hippy Land, so they had me believe?
As I fantasised about jumping ship before I’d even sailed, a willing moron serving in an overheated edifice, images of my stern mother came to mind instructing me to do the right thing for Queen and Country. In true passive style, Nurse People-pleaser MacFarlane trooped back to the ward and the discomfort of a lengthy report to get to grips with.
Sitting in a Ward Sister’s hallowed office for the first time is as disquieting as being called in to the Headmistress’s study. Observing Sister Grey with her permed, fading ginger hair and repaired hair-lip gave me a glimpse of her as a vulnerable old stick more to be empathised with than feared. For five seconds, anyway. The longer she spun out the day’s report on her thirty patients, the more jittery I became, a mouse being toyed with.
She went through the report in painstaking detail allowing me time to underline in my notebook specific care requirements and to note especially the patients who might not last the night. The thought there might not be any patients left in the morning crossed my mind. Seeing the harassed woman’s tired face matching her name I hadn’t the nerve to whimper like a witless nitwit.
Sister Grey, unwittingly perhaps, left the coup de grâce to the end.
“And we are a little behind tonight Student Nurse because the critical admission you have just underlined is His Worship the Lord Mayor. He had an acute asthma attack and requested a bed on main ward rather than a side room, Labour through and through, you know!” she whispered respectfully. “He is in the last bed by the side wards. He was very tired on admittance and best you leave him to sleep. He is critical but stable but he could go into a bronchial spasm which would be, as you are well aware, life-threatening.”
Did she say the Lord Mayor of Sheffield was on my ward, on my first night in charge ... that he could spasm and die? Headlines flashed before my eyes,
LORD MAYOR PERISHES, IDIOT NURSE BLAMED
“The duty doctor is Doctor Smythe,” Sister Gray concluded, “your auxiliaries tonight are both sterling ladies. Senior Night Sister Low will have the drug cupboard keys and will be in at ten. Let us hope you have a quiet night ... Nurse!”
I thanked Sister, almost curtseying, preening for a moment on her addressing me as “Nurse.” We couldn’t call ourselves Nurse until qualified. Until then we were addressed as “Student Nurse” or more likely “brainless idiot ... stupid moron ... excuse for a simpleton ...” There would be no pantomime dame activity that night. Maybe just witches stirring a cauldron on the staircase cackling “bubble, bubble, toil and trouble for you, this full moon, nitwit nursie ... hah, hah, hah!”
After Sister Grey’s departure at about eight-thirty that chilly March night, Naked Nurse gathered up the report book in which the nurse-in-charge on all wards entered a synopsis of each patient’s progress through the shift. Sister Grey’s first entry was typical:
Day Report: 03/03/1964
Patient: Mr. Reg Sweeney, aged 76
Consultant: Dr. Carruthers
Slept poorly, a little agitated. Temperature: F102.00, 2 am. Dr. Wilson called. Penicillin injections commenced as per chart. Fluids encouraged, pressure-areas good. Please encourage fluids, turn 4 hrly. when in bed and ambulate if possible. Record 4 hrly. TPR. He’s worried about his wife and feeding his racing pigeon Harry ...
As Nurse-in-charge I would have to put my skates on and rush around the ward meeting and greeting, hoping to absorb all the patients’ names, ages, diagnoses, medication and concerns. It was said Night Sister Low always knew every one of the Royal Hospital patient’s details, even on a first night back on duty. She, the Ancient One, as she seemed to us at eighteen, expected all her junior and senior nurses to know their stuff by the middle round at two am. If you failed in this task you were marked as a klutz. Demotion was subtle, taking the form of subsequent night duties as outcasts on wards like Ear, Nose and Throat (ENT) where nothing ever happened except for the midnight stroll of the ‘White Lady.’
Tonight has to be a good night, Naked Nurse prayed, as Sister Grey’s black court shoes clacked off into the distance. She now had to run for the Sisters’ bus back to their designated Virgin’s Retreat, also in leafy Fulwood. I wouldn’t have left me in charge of this precious ward with its impeccable reputation, I thought, still shaking a little.
Adjusting her starched white cap, smoothing her pristine apron and patting her frilly white cuffs for luck, Naked Nurse took a deep breath and entered Pye-Smith Ward as self-conscious as John Wayne when he was made to walk across camera. The compos mentis patients turned to stare.
“Smile for the nice gentlemen,” I urged myself. “Go cure or kill, Honey!”
Introducing myself to my ward auxiliaries was my first priority as they would be my backbone for the night. One was serving the old faithfuls Horlicks and Ovaltine. The other was on the urine bottle round chatting away to the male patients about ‘owt and nowt.’ Their seasoned eyes clocked my brand new second-year belt as they greeted me with a polite welcome.
“I’m Missers Mac,” announced the chubbier one with a kindly face that resembled a pickled walnut.
“And I’m Martha. Welcome Luv, looks like we’re in for a reet ‘ard neet. But we’ll ‘elp yer. Won’t we Missers Mac?” chirped her sidekick.
“’Course we will! But you’ll need a special dispensation to get through t’neet, Luv. Wot with our VIP admission, ‘n’ all!”
“Thanks ladies. It’ll be a breeze I’m sure,” I lied.
Before introducing myself to our Lord Mayor dozing at the far end of the ward, I had to attend to two moribund gentlemen feverish with end-stage cancer, lying as still as stricken angels on a mini death row close to the ward entrance and morgue. As they lived, so they were dying, circumspect and uncomplaining in their neat-as-ninepence beds. None of Dylan Thomas’s “rage, rage against the dying of the light” here.
I had a vision of my own brother Damien laid out, enshrouded, labelled and carted off on a metal trolley to the same soulless hospital morgue a year earlier. He was now at my shoulder reminding me to treat all dying patients as I would a loved relative. My two terminal patients in Pye-Smith that night would need their Brompton Cocktails four-hourly on the dot. No social drink, this. It was a gin-based concoction of morphine and cocaine that would need Night Sister’s authoritative touch.
Student nurses were not allowed medicine cupboard keys or to do ward round medicines on their own. All opiates and sleep or relaxation medications were double-locked away. Items could only be checked out by a nurse with at least one other nurse or auxiliary present. Usage of all medicines was recorded on a patient’s prescription sheet, entered in a ledger regarded as a legal document and signed for.
I moved on to introduce myself to the two other critically-ill but by contrast, hyperactive gentlemen Billy and Fred. These desperadoes were sitting bolt upright next to each other in oxygen tents, distressed from laboured breathing and cruel deprivation of the Capstan and Senior Service cigarettes that had caused their demise. Breathless Billy managed a smile and drew my attention to a note he had scrawled,
‘Elp, fech Copper, I am Billy, bin eld prisner. Gi US A FAG’
With nicotine junkies a sharp eye is needed for any sympathetic mobile patient or visitor who might slip cigarettes and matches into an oxygen tent. Fag hags can be as wily as alcoholics. One match strike, however and we could all be victims of the habit. Oxygen tent patients can become confused and hostile due to their confinement and a build-up of carbon dioxide in the brain.
Many patients like these desperadoes came from the poor areas of Sheffield and their pathetic plight was upsetting. Former grafters in the city’s steel works or “down‘t’ pit” from thirteen or younger, their work was all they knew. Typically, they had pinched faces, tinged blue extremities and spoon-shaped finger nails. Their anguish couldn’t be alleviated with sedatives or opiates as this risked depressing their breathing even more. It was a harsh way to go and we couldn’t comfort them with any physical contact inside their zipped-up tent. Anyway, a reassuring handhold up here in the North of England would probably have been spurned with a “gerroff, ye daft booger!”
The Angel of Death could collect any of our five very sick patients that night and my concern was how I could also keep an eye on the remaining flock of poorly men. I felt particularly for three emaciated lads of my age with serious bowel problems. Ulcerative colitis tends to occur in younger people and I was to administer slow-release steroid enemas to them at bedtime in the hope it would help keep them off their commodes by forestalling frequent and embarrassing bouts of bloody diarrhoea.
My other patients were a fascinating mix of complex diagnoses. They included two dangerously unstable diabetics, four chronically ill kidney and liver patients, three recovering double pneumonias, one rheumatic fever and one polio case, as well as our VIP asthma patient.
There was much to do before lights out at ten o’clock. Mrs. Mac and Martha, ward fixtures of many years were a dream team settling the patients and I really appreciated their support. Their presence enabled me to visit each patient to say hello at least and check their notes, even if some were giving my youthful countenance and beginners’ uniform the Third Degree. I only recognised this wary eye years later when I found myself looking over doctors or police officers who looked as though they would have preferred being out on Pogo Sticks.
My VIP in the last bed in the ward was sitting propped up with an oxygen cylinder by him and a mask over his nose and mouth. His chest rose and fell with the effort of a very poorly asthma patient. As I removed his mask to check his tongue was not drying up I noted he was gorgeous and not the elderly whiskered worthy I had envisioned. His Worshipful, Mr. J. S. W. “call me Jack, please, Nurse,” was a forty-something Alan Bates with a grin as wide as the River Don.
While I was checking his blood pressure, temperature and pulse we had a brief chat. He promised he would be on his best behaviour! The elderly gent next to him was busy emptying his heavy glass urinal onto the floor, set on throwing it at our VIP. With a pared-down night staff it can be a conjuring act getting everything done before lights out and my first night on this ward was already building up to being a true test. Once lights are out, ward activities can take on a surreal atmosphere. Heaven help me if it turned into a ‘full moon night’ when the moon can actually trigger bizarre nocturnal activity, particularly among seriously ill patients.
Tonight, four patients including my two in oxygen tents, were already chattering gibberish. This was not a good sign. Billy the breathless tent-scribe had managed a second note,
Elp - the Boogers ave captured me - fech Bobbies
Sister Low arrived at ten o’clock on the dot for her first round and to oversee the giving out of medicines. If all the senior staff were getting on in years, Sister Low was truly vintage. She was an awesome thickset matriarch who tramped miles of hospital corridors with an aura of Cruella de Ville. If Jane Eyre had a grandmother it could have been her. We viewed her as a cool operator who never lost her temper and who always spoke quietly, unlike most of the daytime Sisters who were arguably certifiable in their behaviour. Sister Low was unnervingly calm and feared and respected by nurses and doctors alike.
As we began the Papal tour, Naked Nurse’s memory bank of the hastily learnt patients’ details blanked as her hypersensitive ears detected the terrifying sound of desperate wheezing and laboured breathing at the end of the ward. His Worship the Lord Mayor was turning a delicate shade of grey-blue as a major asthma attack caused his breathing to spasm and constrict. We were there in a flash.
“We’ll manage alright won’t we, Nurse?” he gasped, winking at me, trying to reduce my poorly undisguised anxiety.
Sister Low drew his curtains calmly and told me to call the houseman and tell him it was an emergency call. Minutes later, after an intravenous injection of Theophylline to calm the patient’s breathing his condition stabilised. A side-effect of this drug, however, can be over-stimulation of the heart and cardiac arrest. This was a worry in the days before the routine use of ECG monitors to check a patient’s heart beat. Sister Low instructed me to stay with the Lord Mayor. She would finish the ward round on her own.
Saved by the Mayor that night from memory blanking, some blagging and the Evil Eye, Night Sister had also reassured him I was one of the most competent young nurses she had and he was in safe hands. I didn’t learn this until later and would really have appreciated hearing it at the time.
Of five terminal patients that night, four lived for another day, another shift. It was for me as a Second Year the best and worst of nights. The Lord Mayor was wonderful and he became adept at ducking stuff thrown at him by his confused neighbour. Aggravating patients are moved but when emergency admissions occupy all spare beds this becomes impossible.
Thankfully, I also managed my first ward death competently having been alerted to it by my new friend, Jack. It was Billy in the adjacent bed who had expired. Saddened as I was at not being able to spend more time at his bedside, it wouldn’t have made much difference. A last fag wouldn’t have done him any harm either, though his time left would have been even shorter out of the tent. I supervised Martha with the itemising of the contents of his locker, laying him out and labelling him ready for the porters to take him down to the mortuary.
On my first night in charge it was not only my late brother Damien who came to mind. Maverick older brother Billy had contracted Rheumatic Fever in the late 1940s and was in Pye-Smith Ward for weeks. As he got better, he said, the fitter among them organised a syndicate betting on who would be the next to croak.
My two auxiliaries shone the long night. Martha’s only little quirk was her refusal to enter the sluice between midnight and one o’clock in the morning when yet another ‘White Lady,’ according to her, sometimes appeared. Bizarrely, at midnight exactly when the good ladies had gone to supper, I had to fetch a bedpan from the haunted sluice. Timidly switching the light on, I grabbed a stainless steel pan only to drop it on the concrete floor as the light went out of its own accord. Martha was wide-eyed with joy at the vindication of her foible.
As ever on night duty, a night of pandemonium evaporates at daylight, just as Day Staff come breezing in. It may have been my own tiredness but even the most recalcitrant and aggressive patients were sitting up fresh as daisies, smiling and sane.
My VIP boosted my self-esteem more than I could have imagined when taking over Pye-Smith Ward, despite the fact he must have felt pretty awful on admission. He could easily have spent the night being cosseted on the detested private wing instead of spending a sleepless night on an open ward. I went to say goodbye to him and he promised an invitation to the mayoral parlour for tea. I must bring a friend, he insisted. The mayoral Rolls-Royce would pick us up!
A few days later my mate Ditzy Delia and I were chauffeured through the streets in our well-pressed, bottle green outdoor uniforms. The citizens of our good town gawped as we waved imperiously, giggling. Tea was a grand affair and I thanked the Lord Mayor for helping me through what might have been a night to forget rather than a night to remember.
He was my first ‘person of power’ patient and his tangibly giving temperament was calming. Such people never abuse their status. Instead, they go out of their way to make you feel good. The best of men, women and children I met during my career were modest, encouraging, kind and fun to be with whatever their circumstances. I have witnessed people from babies to centenarians bear intolerable suffering with astounding dignity.
The fact that I’m writing these words shows this night on the ward was a seminal moment in my early nursing and one that would make my forty-plus years as a nurse worth every moment. Before I go any further, I realise I should actually start at the beginning with my childhood in Sheffield and tell you firstly, about some of the incidents from the year dot to my teenage years that compelled me to become a nurse.