The Liverpool Nightingales, page 13
‘Don’t talk like that,’ said Maud firmly. ‘Yes, it’s a risk that every woman takes, even those who’ve birthed before, but you have to try to manage the fear, Alice, and try to think that it won’t happen to you or your baby.’
‘It’s not easy,’ said Alice.
‘I’d like to say I know,’ said Maud, ‘but I’ve never been in your situation and a spinster like me probably never will be, so I really have no idea how you must feel. But like I said, I will help you in any way that I can. Just come to me any time. Always talk to me, Alice. I can’t stand it if you stop talking to me.’
‘Thanks, Maud,’ said Alice, reaching out a hand to her. ‘You really are a good friend, the best.’
Maud just gave her a smile and then said, ‘Right, come on then, we can’t stand in the coal yard for the rest of the day. We’d best get off to the ward or we’ll be even later than Eddy.’
‘Does Eddy know?’ said Alice, her eyes wide.
‘No,’ said Maud. ‘All she knows is that you were crying on and off last night and you weren’t speaking to me. She knows nothing else, as far as I’m aware, but if Nancy’s guessed then it’s possible Eddy will have done, too. Anyway, it’s up to you if and when we tell her.’
‘All right, thanks,’ said Alice. ‘I think I will tell her but I don’t want to just yet.’
‘That’s fine,’ said Maud. ‘And for now at least she’s working on another ward so she won’t see you making a bowl out of your hands and puking into it.’
‘That’s true,’ said Alice, starting to giggle again. ‘The things you have to do, honestly.’
They arrived on the ward with seconds to spare. Maud could see the group of probationers around Sister Law at the top of the ward as they gathered, as always, before they commenced the morning’s work. They were in luck it seemed: Sister was speaking directly to another probationer and hadn’t yet done the head count to make sure that they were all there. Maud saw Nancy glance round just as she and Alice slipped in at the back of the group. She couldn’t tell what Nancy was thinking but that one glance had made her feel very protective of Alice and she felt her body tighten and her right hand ball into a fist. She smiled to herself: she felt like she could be turning into one of those bare-knuckle fighters just like Harry Donahue, whom she’d glimpsed sitting up in his bed as she’d flown in through the ward door.
As the group dispersed, Sister Law gestured to Maud to come forward. ‘Nurse Linklater,’ she said, and Maud thought, uh-oh, she has seen me after all. But then Sister Law said, ‘Mr Jones told me how well you did in theatre yesterday and he has requested that you are allowed to observe again, as often as we can spare you.’
‘Thank you, I would like that very much,’ said Maud, delighted but instantly checking to make sure that Nancy wasn’t in earshot. ‘And the man with the appendix, how is he doing?’
‘Ah, sadly,’ said Sister, ‘he died during the night. It’s often the way with those cases. If they come in too late there is very little chance that they will survive.’
‘But he seemed all right after the surgery,’ said Maud, struggling to believe that there could have been such a change.
‘Yes,’ said Sister, ‘but if the poison has already entered the bloodstream then it affects the whole system and within hours the patient is overwhelmed and there is nothing more that can be done. We lose many, many patients with the same thing year after year.’
‘I see,’ said Maud, bleakly, wishing there was more she could have done for the poor man. Aware, too, of how much she had to learn about everything.
‘Now, Nurse Linklater, there is no more that could have been done for the man. Going to theatre was the only option and very few survive an appendectomy … You go with Nurse Sellers to the bottom of the ward. Nurse Sampson can work up at this end. The man you attended yesterday has already been discharged but Harry Donahue is still waiting to see the doctor. His left hand is very swollen. Once he is checked he will be going on his way also. Nurse Sellers is best placed to assess him; she seems to have taken a special interest in that particular patient. I need you to go directly to Mr Clifford in the opposite bed. He hasn’t been able to pass urine all night and he needs urgent assessment. Report back to me.’
Maud walked quickly down the ward. She could see straight away that Mr Clifford was thrashing around and looking very uncomfortable.
She grasped his hand and started to speak gently to him. ‘Tell me—’
But the words were hardly out of her mouth before he was crying out for a urinal. The poor man looked desperate so she rushed to get him one as quickly as she could. By the time she got back his face was bright red and he was breaking out into a sweat.
‘Thanks, Nurse,’ he said, grabbing the urinal. ‘I’ve been trying to pee all night but nothing will come.’
She left him with the urinal but could soon see by the effort on his face that there was nothing doing and he seemed to have a real problem. Glancing up the ward, Maud could see that Sister was busy but she thought it likely that she would need to report back to her very soon.
Turning back to the man she said gently, ‘Is there anything I can do to help?’
‘Leave me be, Nurse,’ he almost shouted. ‘There is nothing that will help me. I’m in agony here.’ And then he started crying, tears of pain and frustration running down his face. She asked if she could see what he had managed in the urinal and he thrust it at her from under the bedclothes. There was just one small drop of very dark urine in the bottom, a tiny amount. No wonder the man was in agony.
Right, thought Maud, this is no good. I need to report back to Sister immediately.
‘What is it, Nurse Linklater?’ said Sister, back to her usual snappiness and seeming to have forgotten her previous instruction to Maud amidst the busy morning ward. ‘Out with it,’ she ordered when Maud seemed stuck for words.
‘It’s just that Mr Clifford is still unable to pass urine. He seems to be in a great deal of pain and he’s getting distressed.’
‘Why didn’t you say so?’ said Sister. ‘Right, yes, I’ll be down there directly, Nurse Linklater, directly. You go back to him.’
And she was true to her word, arriving at the man’s bed soon after Maud with Mr Jones in tow.
‘Lie on your back, flat on your back,’ said Mr Jones calmly to the patient. Then he turned briefly to Sister Law. ‘So, he was admitted yesterday and he had leeches applied to the perineum overnight, is that correct?’
‘Yes,’ said Sister. ‘He has been in a great deal of pain and we have given him numerous doses of laudanum but to no avail.’
Mr Jones nodded and then he leant over the bed and pressed on the man’s belly. Mr Clifford screamed out in pain but Mr Jones did not desist. ‘Lie still,’ he said and then he pressed again. The man screamed again.
‘The bladder is very distended. It feels as though it might be about to rupture,’ said Mr Jones. Maud saw the look of horror on the patient’s face and reached down to hold his hand.
‘There must be some obstruction to the bladder neck. It could be a large bladder stone or a soft growth of some kind. We need to remove the obstruction as soon as we can.’
Maud squeezed the man’s hand tighter as she saw his face crease with fear and pain.
‘Take him straight to theatre,’ said Mr Jones. ‘I will see what I can do.’
‘You will be all right, we’re going to look after you,’ soothed Maud. The poor man clung on to her hand like his life depended on it and all she could do was keep by him and pray that everything would be all right.
‘You stay with the patient,’ said Sister Law, ‘and go into theatre with him.’
‘Yes, Sister,’ said Maud, feeling that even if she hadn’t been given official permission she would have found some way to keep by his side.
The orderlies were called, the man was moved on to the stretcher and then up the ward and in through the door of the theatre. Maud caught her breath as she saw the high wooden table in the centre of the room. She stood back a little as the orderlies placed the man on the table and then she moved in by the side of him, grabbing his hand as the waves of pain kept hitting him, a spiral of pain that seemed to have no end. He was squeezing her hand so tight that she was almost crying out herself sometimes, but she stood firm beside him. She found herself looking around, impatient to see Dr McKendrick. When would he come and perform his magic with the drops? He needed to come soon.
Mr Jones was over at the sink, scrubbing his hands, Sister was laying out instruments and Maud heard the clank of the bucket and the enamel bowl on the floor, but there was no chloroform yet. Maud just wanted the man to be knocked out, to not be in pain any more. She felt she couldn’t wait.
And then she heard the door open and with a wave of relief she saw Dr McKendrick coming through with a determined look on his face as he immediately started asking questions about the patient.
‘What do we have here, Jones?’
The surgeon filled him in on the man’s history. Maud was too impatient to listen; she just wanted the conversation to be over and then McKendrick could put her patient to sleep and out of his pain.
Then she smelt the drops of chloroform as they came out of the bottle and she felt her whole body relax a little, knowing that the man would soon be out of his agony. Or maybe it was the whiff of the chloroform itself that relaxed her. She did like the smell of it.
Within moments Dr McKendrick had spoken to the patient and then put the lint over his nose and mouth, and in seconds there was quiet in the theatre. The man wasn’t completely asleep, he was still groaning a little, but at least he was no longer screaming out in pain. And then with one or two more drops of chloroform, Maud could see that the patient was sound asleep and just for a few seconds there was a ringing silence in the theatre.
Maud went straight over to the sink to wash her hands as Mr Jones stood drying his own and silently nodding approval of his new recruit.
‘Right then,’ said the surgeon, waiting for Maud to finish at the sink, ‘let’s have a look at this fine fellow.’
Maud almost held her breath as the surgeon moved towards the theatre table, stopping on his way, as before, to open up the window and let some air in. Then as he stood over the patient Maud braced herself for the sight of an abdominal incision, like last time. But this time the surgeon did not take up the knife. Instead, he lifted the man’s shirt. ‘Let’s have a feel at his belly now that he is relaxed,’ he said, placing his hand on the man’s abdomen. Maud noted to herself how long his fingers were and she saw how carefully he pressed around all areas, sometimes with quite firm pressure.
At last Mr Jones said, ‘Right, yes, his bladder is distended above the umbilicus … that’s the belly button,’ he said, looking across at Maud. ‘It is difficult to tell but there is definitely an obstruction to the urethra … that’s the tube that connects the bladder to the end of the penis,’ he said, looking at Maud again. She felt a red flush start on her neck at the mention of a man’s anatomy, but she was so interested in what might happen and how they might be able to help the man that she didn’t feel embarrassed.
Mr Jones pulled the sheet further down and picked up the man’s penis, looking closely at it, scrutinizing it.
Oh dear, thought Maud, this might be a step too far.
‘Right, no obvious sign of any venereal disease, so most likely the obstruction is a stone, or it could be some growth in the bladder. There is only one way to find out. Sister, do you have a probe?’
‘Yes,’ said Sister, handing him a long, thin metal tube.
Taking the man’s penis in one hand and the probe in the other, Mr Jones slid the tube up what Maud now knew was the urethra.
‘Right, everyone,’ said the surgeon, ‘complete silence.’
So they all stood holding their breath, and there was complete silence in the theatre, apart from the buzzing of a single fly that must have come in through the open window.
Maud watched Mr Jones move the metal tube gently in and out and she could hear a faint chinking sound, like the distant sound of a teaspoon on a china cup … chink, chink, chink.
‘It’s a stone,’ said the surgeon, breaking into a smile. ‘It’s quite a size, but we should be able to have a go at it.’
Then withdrawing the metal tube he asked Sister for ‘the box’ and she lifted a large wooden cask up off the floor and opened it on a side table. Maud glanced in: it contained a collection of what looked like instruments of torture.
Mr Jones selected one of the instruments and brandished it in front of Maud’s face. ‘This wonderful instrument is a lithotrite. It has been designed to crush up the stones in the bladder. Clever thing. It grasps the stone and then we can use it as a drill. This bit here,’ he said, touching the end of the metal instrument, ‘this ingenious device drills into the bladder stone and breaks it up, and if we can break it up fine enough then it can be expelled from the body when our man here passes urine.’ Mr Jones spent a few moments gazing almost lovingly at the instrument and then he said, ‘This piece of metal has revolutionized the treatment of bladder stones and the outcome for the patient. Many patients used to die when we had to cut into ’em to get the stones out.’
Maud could only hope that he was right and that the new instrument would produce the miracle that her patient needed.
‘We used to have to cut them open and fish around to get the stones out; now we just slide the lithotrite up the urethra and crush them up. So much better for the patients. They used to haemorrhage or die from poison to the blood, and before anaesthetics the procedure was very painful.’
Maud was relieved when she saw Mr Jones stop brandishing the instrument and use it in the way that he had described. It took some time before he was satisfied that the stone had been broken up into small enough pieces to be passed out of the bladder and at one stage there was a gush of dark brown urine that showed that at least now Mr Clifford could pass water. Maud felt so relieved for the man her legs momentarily went weak.
‘Are you all right?’ said Sister as Mr Jones withdrew the prized instrument.
‘Yes,’ said Maud firmly, pulling herself together and watching intently as the surgeon finished his work, taking it all in.
‘Right, Nurse Linklater,’ said Mr Jones, ‘you have impressed me and Sister again very much. I know you feel like you aren’t doing anything in here just yet – I know what you nurses are like – but let me tell you, the foundations of a good theatre nurse are her powers of observation and her ability to keep absolutely still.’
Maud saw Sister smile and nod, and she began to feel a glow of satisfaction.
‘For example,’ said the surgeon, leaning over the patient on the table towards her, ‘Sister Law sent in one of your compatriots the other week, the blonde one who always looks neat. A disaster. She didn’t seem to understand that one needs to watch carefully to learn in here and that you can’t just take over and assist. Sister, here, was up in a spin and I needed a stiff drink as soon as I was out through those doors. Granted the woman might be suited to other branches of nursing but you, my dear, seem to have the makings of this.’
Maud was still glowing when she emerged from the theatre with the orderlies as they carried Mr Clifford back to his bed. She couldn’t help but smile, but then she saw Nancy stop and turn, just for a moment, with such a look of pure hatred burning in her eyes that it almost made her feel sorry for the woman.
She knew that it was best to completely ignore Nancy, though she couldn’t help but feel her stomach tighten just a little. When, however, she was busy settling her patient in bed and she could see how comfortable he was, that moment with Nancy was forgotten. He was still quite sleepy and seemed slurred in his speech but she could tell how much easier he looked straight away. She saw him reach down and press his belly, and then he smiled because even when pressure was applied there was still no pain.
‘Right, Nurse Linklater,’ said Sister Law, appearing by Mr Clifford’s bed, ‘we need to make sure that he has plenty to drink. Go to the kitchen and get him some beer or some boiled water and get him to drink as much as he can. That way we’ll flush out the remains of the stone. Make sure you leave a drink by him at all times. This is very important to the patient’s recovery.’
‘Yes, Sister,’ said Maud, quick to follow her instructions. And so pleased to have been part of the whole thing and to be able to see the transformation of the man. He looked like a different person.
Whilst she’d been away in theatre Maud had forgotten about everything else: about Alice and her worries, and Nancy and … oh yes, the man in the opposite bed, Harry Donahue. Looking over there now she saw the bed was empty. He must have gone, she thought. But as she moved up the ward she was startled to see him walking in the opposite direction with a bit of a swagger. She tried not to look at him, to keep her eyes to the ground, but she just couldn’t stop herself. He was smiling at her.
‘You’re back,’ he said as they met half-way.
‘Yes,’ she said, puzzled by his familiarity: had he mistaken her for someone else?
‘It’s Maud, isn’t it?’
‘Nurse Linklater,’ said Maud immediately.
‘Well, Nurse Linklater,’ Harry said, ‘I asked your friend, that lovely girl … what’s her name?’
Here we go, thought Maud.
‘Alice, she said her name was Alice. I asked her where you’d gone. I wanted to say thank you for what you did for me yesterday. And she said you were in theatre with that fella. Poor bugger was awake and in agony all night long and now look at him. It’s like a bloody miracle. It is for sure.’
