大象传媒

This was typed for and in the presence of Cissie Ridings by Age Concern East Cheshire.

Typhoid Fever

During the final year of my training as a nurse, there was an outbreak of Typhoid Fever in Farnworth, amongst those affected was the parish priest. A ward was opened specially to admit these cases. This was real nursing care. The patients were very ill, with high temperatures, diarrhoea consisting of green pea soup like stools. The rash was nothing like I had seen before, a pale rose coloured spot. Doctor drew a ring round the spots on one of the patients to illustrate to me how in a couple of days they had moved out of the ring a little.

I was the only non Roman Catholic nurse on the ward, and had never spoken to a priest before. At first I was in awe of him, however he was very easy to like. It always seemed to be my task to bed bath him and take his temperature, take specimens of both faeces and urine. He was nursed in the side ward and I remember on one occasion he asked me to describe the view out of his window, he was unable to see the outside from his bed. The view was quite pleasant but not much to see. I told him about the walnut tree, not far away. I described the old house and the lake. The second time he asked me to tell him what was happening outside, there was very little activity, so I invented some things, and I wonder if he knew?

The importance of hand washing after dealing with bedpans and soiled linen was stressed. It was emphasized, never ever throw soiled linen in the linen carrier, always place gently as germs are spread this way. We were constantly tepid sponging to reduce their high temperatures. They were so weak and weary. Faeces were not disposed of in the usual way. There were two metal drums, half full of disinfectant (Izal). When one drum was full it was sealed and a notice attached of time sealed and date. The porter would then take this away. All soiled linen was first autoclaved. (A type of sterilisation). Not one of these patients died. During my training at Astley, no nurse there contracted an infectious disease.

Christmas

I cannot remember the wards being decorated for Christmas. There was a visit from Father Christmas and each child received a present. The nursing staff had a special Christmas dinner and each nurse received a gift from Doctor, a tin of talcum powder. I remember we had to find our place at the dinner table by a specially worded card, done by Doctor. It was a little poem with characteristics of each of us that we should recognise. We did go carol singing at Christmas, first to Matron's flat, then Doctor's house and the Lodge, where we were given a glass of sherry.

Not Much Humour

There was not much humour about, hard to laugh when we were at war, and the dreaded sound of the sirens warning us of enemy planes in the vicinity. Nursing didn't make us invincible. The nurses' home at Salford Royal Hospital had received a direct hit and five nurses were killed. That night the sky was red and smoky as if the whole of Manchester was one great fire.

There was no television, money was scarce, my wages were 拢2.10 shillings per month, and most of this I gave to my mother.

When off duty we gathered in the nurses' sitting room to listen intently to the news. On reflection I don't think we thought of losing the war, only when we would win. This period didn't make me feel more religious, only helpless in moments when the German bombers were overhead, or when a child was dying.

There were three German probationary nurses at Astley sanatorium at this time. I never understood how they came to be there, on reflection, perhaps because we thought if Matron deemed it alright, then it must be alright. Their names were, Iltza Moritz, she had been a nanny to two doctors' children, living in Tyldesley. Ursula Hodes, she did tell me her father was a leading barrister in Leipzig, and Herta Andres, all I know about her was she probably came from Hamburg. They were very friendly and we worked well together in fighting our own enemy, disease.

I have a particular memory of each of them, Iltza Moritz used to knit vests for the doctors' children in two ply wool. They were so fine and I admired her patience. Herta Andres, I came off duty one night and went into the nurses' sitting room, Herta was listening to the news on the radio. We had bombed Hamburg, heavily, she was crying and saying, poor Hamburg, dear Hamburg. Shame but I couldn't help shedding tears also. Ursula Hodes asked me to go into Manchester with her, on our half day off. After looking around the shops, we had tea, I agreed thinking she meant tea in a caf茅, I panicked when she took me into the Midland Hotel. I had never been in a hotel before, never mind the Midland. She was so confident, we were shown a table for two, the waiters were dressed very smart. She ordered afternoon tea, even in wartime we were given dainty sandwiches, scones with jam and cream, and cake. During tea the waiter came to Ursula and presented her with a note on a little silver tray. She read it, and said, "The reply is no thank you". Mystified, I said, who was the note from. She said the two gentlemen over there. They wanted to join us, to me that only happened in love stories or the movies.

My Final Year

It was my final year, and I thought I knew all the rules by now. One morning matron sent for me. Although one never associated anything good with a summons to Matron's office, I couldn't think of anything I had done wrong, so I was not too perturbed. It appears it was related to the evening before. I had been out with Edith, one of the maids. Someone had told Matron. In her formidable manner, she asked me if this was correct. I said it was, Matron then informed me that nursing staff did not mix socially with the maids.

There was another incident relating to a maid. We learned that one of the maids had been caught stealing and had been instantly dismissed. The room opposite me was empty, but just before I entered my room, after having a bath, I thought I heard a sound from there. I knocked, no answer, so I opened the door the room was empty, but I still felt, someone was there. I opened the wardrobe door, there she was, we just looked at each other, I never said a word and neither did she. I closed the wardrobe door and left. Since then I have wondered why I didn't speak. The only conclusion, I believe is, that if we didn't speak, I could pretend she wasn't there, after all where would she go, she must have been terrified.

On reflection the onus for learning was put upon us. The skills were taught with pride. Discipline at first was hard to take. Theory was quite small in relation to practice, knowledge was not freely passed on, it was almost a secret. There were many discrepancies, caps and omissions. Care of the patient in so far as it was understood, was good, but many needs were not recognised. I never heard the word stress used either in relation to patient or nurses. So this was never consciously alleviated. We were never given permission to voice our inadequacies, so could not hope to overcome them. The foundation of discipline and obedience was good though I believe as Florence Nightingale did, that to obey intelligently is the real meaning of all disciplines. Management and attention to detail was well and truly laid. We all believed we did a good job, but then in ignorance we all do.

Nursing Tuberculosis at Ladywell Hospital

By this time the war was in its last year, I am now a registered fever nurse, and have applied for a post as staff nurse at Ladywell Hospital, Eccles, near Salford. My interview was successful, but to my dismay the post was staff nurse on a male Tuberculosis ward. My previous experience had not included this disease, patients suffering from Tuberculosis were not admitted to Astley sanatorium, but to a hospital especially for this disease. The hospital was Peel Hall about a mile away from Astley. Ladywell differed from Astley, the wards were two storeys high. There was also a new building, this was the cubicle block. Each cubicle similar to those at Astley. Though the grounds were very different from Astley. No lovely old house, no lake or lovely rolling green lawns and no Rooks. I later learned that Ladywell had been the workhouse, this image remained with the local people, they felt degraded to be admitted there.

My first surprise was the uniform. A mauve striped fitted dress, with starched collar and cuffs, and the usual starched bibbed apron and cap. The ward I was assigned to was F1 for males, females were upstairs, F2. Again a grim looking old brick building, situated very near to the Manchester ship canal. We could actually see the canal from the ward. The interior was similar to the wards at Astley, though not as bright. There were thirty beds in all, fifteen each side. The first two on either side were separated from the rest by a large wood partition. On each locker was a stainless steel sputum mug. These patients were voluntary in-patients. The length of stay varied, could be anything from months to years. The ages varied from teens to sixty years of age. At this time there were no drugs to combat the disease and again no protection for us. Streptomycin had not been released for use at this time. These patients would be in various stages of up and about, or dying. It would be learning a new routine once more, and adapting my basic training to this disease. Having had no experience in nursing patients with Tuberculosis, I had little idea of what to expect.

My first impression of the staff was that they were less starchy, more friendly and relaxed. My first impression of the ward and patients, was quite different from my other experiences. But not doom and gloom, as I had anticipated. Again huge windows almost floor to ceiling but this time wide open, great in the summer but not so pleasant in the winter. Abundant fresh air was an essential part of their treatment. Also good food but as we were still at war this was not plentiful. We were still rationed, however these patients did have the best that was available. The dominant sound was of coughing and spitting, followed by the clink of the sputum mug lids as they fell back in place. It was not a pleasant sound, but one I would grow accustomed to over this period. Haemoptysis was not uncommon, from blood stained sputum to a huge haemorrhage.

It's my first night and staff nurse was in charge. As I accompanied her to be introduced to the patients, it was obvious this staff nurse was well liked. At the same time I was aware of being assessed. Were they also aware of how nervous and insecure I felt? One could almost smell fear. I was to quickly learn a pattern. Temperature rise in the evening, sputum and observation of this was important. Night sweats, weight loss or gain.

For the first time I worked with a nurse who never overcame the fear of contracting Tuberculosis. Was it really because fear was her constant companion that she became a victim of the thing, she feared, and died. This brought to the fore the fact that we are not invincible. Does fear weaken one's resistance? I wondered, this was the second time I had given serious thought to the effect the mind could have on the body.

The routine was quickly established. The most difficult observation was the need to inspect the sputum, especially as I was aware of the anxiety displayed by the patient in this procedure. More so if the sputum was blood stained. These patients would be well aware of the significance of this, and I found difficulty in meeting the fear present in their eyes, with an appropriate response. Weight loss or gain was of great significance to these patients, if loss the patient would become introverted and depressed. If gain his manner would be almost euphoric. Soluble aspirin gargles would be prescribed for Tuberculosis of the throat, Morphine would also sometimes be prescribed. At that time it was in tiny tablet form, a quarter of a grain. The procedure was to light the spirit burning lamp, put the tablet on a teaspoon, and drop 8 minims of water on to the tablet, and stir to dissolve with the end of a syringe minus its needle. Then draw up into the syringe.

Albert

The relationship between nurse and patient on this ward was more relaxed, this was because of the length of incarceration and the nature of the illness. I had heard stories of patients falling in love with their nurses, but had never until now thought it would happen to me.

The young man's name was Albert, he was twenty three years of age and he was dying, although it was almost a year after I met him that he died. Under normal circumstances one would have dealt with the situation differently. Albert was bedfast, he couldn't even sit up for very long. There were many little innocent ways of making him feel loved, and allowing him to show his love for me. One thing was certain, he would never attempt to kiss me on the mouth. This was taboo in someone with Tuberculosis, it was dangerous, one sure way of spreading the disease. Albert told me he had never kissed a girl on the mouth, how sad.

The week before I was due to go on holiday Albert had deteriorated. On my last night on duty I believe both of us silently wondered if it would be the last time we saw each other. The only indications of his thoughts were in his last words to me, he said, "You know that my favourite piece of music is the Intermezzo from Cavalier Rusticano." I nodded, he then said whenever you hear it I will be there. Leaning forward I gently kissed him on the mouth. On my return from holiday Albert had died. It was strange to see someone else in Albert's bed, this patient was totally different, Scottish, with a lovely accent, and a great sense of humour.

With heart aching I had to get into the routine of things again and try to be bright and cheerful. It was the night nurse's duty to butter the sliced bread for breakfast. All windows were open, not just in the wards, it was chilly. Often you would have the creepy feeling someone was watching you. Sure enough there would be a cat at the open window, just waiting for you to disappear. These cats were wild and I believed lived in the cellars under the kitchen. Sometimes as you were walking from the grounds to the dining room they would dart across your path, giving you a real fright.

On Saturdays those patients who wished and were able could go out in the evening for a drink at the local public house, in Eccles. This was possible because although the disease was notifiable, it was not compulsory that they entered hospital. One elderly gentleman used to stay out later than he should. The rule was back at the hospital by ten o'clock, whenever he arrived back he was always very merry. I used to hope he came back before night sister commenced her ward rounds. I had to help him undress and put him to bed. It was so difficult to keep him quiet. Sometimes when night sister was on her rounds he would sing a few bars. I told night sister he was dreaming. She just smiled. Did she believe me? I think not.

The men used to pull my leg and try to embarrass me. Needless to say death would affect the whole ward, these patients had been together for longer than patients suffering from other diseases. They had shared so much in common with each other. Their relationship was more camaraderie, as experienced by soldiers. At this time the war was coming to an end.

The war ends

The linen cupboard was a walk in cupboard, the linen arranged in neat piles, on slatted wood shelves. On the floor underneath the bottom shelf was a radio. We would tune into the news quietly when all patients were settled for the night. This particular night I tuned in as usual. I couldn't believe it, the war in Europe was over, it was such exciting news, but who to tell. I crept around the ward to see who was awake. There was one gentleman who was desperately ill and awake. Unthinkingly, I said to him in a quiet excited voice, "The war in Europe is over." He replied, "Sadly, mine's not. "

In human relationships I had much to learn. I believe that I cared. As with many other aspects of nursing, care was not something we consciously thought about. If I had been asked what I meant by care at this time, it would have been, on balance, leaning to the emotional side.

Now, after years of experience and learning from my mistakes, I have a different concept of care. I believe that care is not how we feel, though feeling is an indication that we have the ability to care. Feelings or emotions can be evoked by words, ideas, or events. They can be intense at the time, and after seeing or hearing something that moved us deeply emotionally, the feeling may stay with us and we are unable to forget it. We may relate it the next day and say how deeply we felt, even at the time how we cried. That is not caring, it is an account of feeling which is good and necessary, but care begins after that by stating what you have done, or intend to do. Care is an informed experienced commitment. In nursing no matter what changes occur in training or in the advancement of technology, the element of care does not change. First the foundation for trust must be present. That is to work safely and competently. Then the essence of care will be demonstrated within that structure.

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