Yes Sister, No Sister Page 13

  ‘Hello. I’m Sylvia Cotswold, in second year. Is this your first day?’

  ‘Yes. How long have you been here?’

  ‘A month. I love it! I’m sure you will too when you get used to it. Has Daisy given you the set test yet?’

  ‘After coffee. Why do you call her Daisy? Isn’t her name Pamela Jackson?’ I ask.

  ‘Oh, some story about her riding on the back of a tandem down the main corridor when she was first a theatre sister. She’s been known as Daisy ever since. They’re all crazy, you know. It gets very tense in here. The surgeons have temper tantrums and throw instruments at the walls and the sisters hold trolley races and fool around.’

  ‘Have you taken anyone yet?’ Judith asks.

  ‘Yes, a few times. We don’t take the consultants of course but when the registrars operate, the sisters usually give them a student.’

  ‘What’s it like?’ Mackie says.

  ‘They’re very patient – ask for what they want and don’t get their knickers in a knot if you can’t find the right instrument stat. [at once].’

  ‘What’s it like looking inside an abdomen?’ Barton asks. ‘I’m afraid I might faint.’

  ‘Most of the time you can’t see a thing. You’re too busy scurrying around picking up swabs, changing washbowls or autoclaving. The first case I took was on a knee so it wasn’t sick-making at all.’

  We finish our coffee and Daisy, as we now call her, leads us back to the instrument room. As promised, she up-ends the crate and shuffles the instruments around. ‘Right,’ she says, ‘Who’s first?’

  We all look at Judith who promptly selects two Rampley sponge forceps, two Mohnihan clamps, two Parkers clamps and so on, as she puts the set together.

  ‘Well done,’ Daisy says. ‘You’re very quick.’ She up-ends the set again and I have a go. I name the instruments correctly but mix up the order a bit. ‘Well done,’ says Daisy again. After Mackie and Burton manage the task, she says, ‘I’ve never had a group as quick as you. Usually it takes a whole day for students to learn the general set. Now I’ll show you how to use the autoclaves.’

  We put on masks, which are made of two layers of cotton with a piece of cellophane between them, to enter a sponge room. Daisy explains how the knobs and dials of the giant autoclaves work. They make me think of submarines with their tightly closed doors, hissing steam and wheel-like handles. We are shown how to remove sterile instrument sets with tongs and place them on round trolleys with removable sterile tops.

  We go for dinner after we have changed back into our regular uniforms and as we have to change again when we return, our dinnertime is reduced to 20 minutes. When we return we are each sent into a theatre where the runner is to show us what to do.

  Over the next few days we learn how to be a runner, our primary role. We hear stories about Mr Stephen Penfield, a plastic surgeon. I have seen his tall, elegantly dressed figure many times, striding down the main corridor, hands behind his back, muttering to himself. On the wards he has a reputation for being charming and courteous to patients but in theatre he is so impossible, no theatre sister will take him permanently. Each theatre sister has her own surgeons that she always takes unless she is away or sick. There is a roster for Mr Penfield who complains to Daisy weekly that he hasn’t a permanent sister.

  ‘If you would behave yourself, Mr Penfield, I might persuade a sister to take you on. As it is, no one will. I can’t say I blame them. Why only last week you threw a Babcock at Sister Hale.’

  Judith is the first one to run in Mr Penfield’s theatre with Daisy scrubbed up. ‘What was he like?’ I ask Judith over supper at home.

  ‘He’s a right sod!’ she says. ‘He stands on a swab so you can’t pick it up or else he hides one by leaning against it.’

  Swabs are gauze oblongs about 18 × 4in, which hold a small metal insert so they can be detected by X-ray. They, as well as the instruments and needles, are counted before being used and again before the wound is sewn up, to be sure that nothing is left in the patient. A mobile rack with rows of ten pegs is part of the equipment and on it we hang used swabs. At the end of a case, the rows of dangling, bloody swabs look like a bizarre form of Christmas tree.

  ‘But I got the better of him,’ Judith went on. ‘He complained his wash-hand basin water was too cold. When I added hot water, it was too hot. So I went for a sterile thermometer, took it and two jugs of water into theatre and asked him exactly what temperature he would like his water. He glared at me over his mask and I glared back. I don’t think he knows the temperature of water so he just said it was OK.’

  The next morning, Daisy says to Judith, ‘Well, Nurse Horsfall, you certainly made an impression on Mr Penfield! He thinks you’re very intelligent and wants you as a permanent runner.’ She laughs when she sees Judith’s face. ‘Don’t worry, I told him students have to rotate to gain experience. Then he wanted to know if you would like to perm in theatre. He’s still hoping someone will take him on. Would you like to perm here?’

  ‘Not if it means working with him, thank you.’ Judith says. ‘I suppose that’s flattering but I can imagine no worse fate.’

  The four of us who started on the same day, and Sylvia Cotswold, try to have coffee together, but as we can only go when the sister and surgeon decide to break, it is not often that we can. We have a greater chance of meeting at teatime in the afternoon when the majority of operations have been done and we spend our time cleaning. At this time we exchange stories about the peculiarities of surgeons.

  Mackie sits down one day and says, ‘Have any of you run for Mr Pearson?’ We shake our heads. ‘He’s urology isn’t he?’

  ‘Yes. He looks just like Oliver Hardy of Laurel and Hardy. He’s nuts! I know they are all nuts but he’s nuttier than the rest.’

  ‘Why?’ Sylvia asks.

  ‘After he scrubs up, he holds his arms straight out in front of him like Lady Macbeth.’ Mackie walks round the room with her arms extended and a gormless, ghostly look on her face. ‘Then he says to his theatre sister, “The surgeon will have the instruments in the usual order,” like a Shakespearean actor. But you know what? He says it every time – for every single case. He would drive me crazy!’

  ‘Me too,’ Sylvia says. ‘I’ve run for the other urology surgeon, Mr Cokes. He’s nuts too but not that bad. He’s quite polite usually but when anything upsets him, he yells, “A thousand bloody hells, ten thousand bloodier hells,” at the top of his voice.’

  One of the perms sits with us one day and tells us to be very careful about what we say in theatre. ‘One student is still famous, two years later, because she walked up behind a registrar whose gown was undone. She pulled at his belt and said, ‘Everything that dangles should be pulled.’ She was never allowed to forget it!’

  We all laugh though I am not quite sure why it is funny.

  ‘Yes,’ the perm went on. ‘A sister put her foot in it too. Her patient, a man, was in lithotomy position and draped so that only his genitals were showing. Well, she was over at the desk reading the chart, saw his name and said, “Oh, I know this man.” The anaesthetist heard her and the story was all over theatre in a flash.’

  ‘I still think Mr Penfield gets the prize for sheer lunacy,’ Judith says.

  ‘Well, at least he’s polite,’ Burton says. ‘I ran for Mr Cartwright yesterday and he tells dirty stories the whole time. I couldn’t hear all that he was saying but he was talking about his son’s girlfriend. I did hear him say, “If she fell out of a ship she’d come up on Neptune’s prong.”’

  The day comes when I am down to run in Mr Penfield’s theatre. Sister Goodrich is taking him. I have run for her before and I get a great charge out of the way she soon has her set all mixed up, then has to rummage like a cat in a litter box for an instrument. Last time I was with her, the surgeon, impatient for a clip, made the mistake of reaching for it.

  ‘Get off my instrument trolley,’ she shouted at him. ‘Leave the buggers alone.’

  We start th
e list and my mouth is ready to smile under my mask. I don’t have to wait for long. Mr Penfield says something to her that I can’t hear, but her reply is clear and concise. ‘I do have an opinion but I don’t have a medical degree so you’ll have to make your own mind up.’

  After that, nothing untoward happens. I am disappointed, as I want to go to the dining room with a Penfield story. The last case is a baby for repair of harelip. One of the sterile requirements is an 8 × 4in tin of Vaseline gauze. At the end of the procedure, Sister Goodrich cuts a one-inch square from the beginning of the 10 yards folded in the tin and Penfield places it carefully on the sutures.

  He is about to stride out when he turns and says to Goodrich, ‘Will that tin of Vaseline gauze be used again?’

  ‘Yes, after it has been sterilised again.’

  ‘I’ll make sure it isn’t,’ Penfield says, picking up the tin. He hands it to me. ‘Here, hold this.’ He grabs a pair of forceps, takes hold of the end of the gauze with them and runs round and round the theatre until there is 10 yards of sticky Vaseline gauze draped over everything.

  Goodrich is furious. ‘I’ll report you to Sister Jackson for this,’ she shouts, but the tall figure has already marched out of the swing doors. ‘When he dies, I’ll see they plant the bugger, or burn him.’ We start to clean up. ‘And I’ll tell Daisy that if I have to take that sod again, I’m leaving!’

  It is early Monday morning and it is Burton’s turn to run in Penfield’s theatre. She is nervous at the best of times but she is especially shaky today, as we have told her what he is like. She brings the three-legged trolley into the sponge room and places it ready to receive the sterile upper tray and the set of instruments out of the autoclave. I am doing the same thing for the theatre next door. As the wheels of the trolleys are always stiff, Burton exerts some pressure to push hers into her theatre, but instead of its usual arthritic movement, the trolley develops the limbs of an athlete, flies across the theatre, bumps into Mr Penfield as he scrubs up and spews the instruments, container and tray all over the floor. There is a noise like a thousand metal dustbins falling from a height that seems, like an echo, to take an eternity to diminish.

  Daisy is scrubbed and waiting for the instruments. Mr Penfield stops scrubbing to stare and Burton and I stand in the entrance of their theatre in a state of shock.

  ‘Oh dear,’ says Daisy quietly, ‘We had the wheels of the trolleys oiled this weekend and perhaps they are a bit too smooth. Never mind, Nurse Burton, just bring me another set before you pick up this one.’

  ‘I’m not having that woman in my theatre,’ Mr Penfield growls. ‘She’s dangerous.’

  ‘You will have whichever nurse I see fit to put in my operating theatre, Mr Penfield. Now perhaps we can proceed with this case.’

  Good for you, Daisy, I think as I push my trolley into my theatre – very carefully. Poor Burton. It really wasn’t her fault, but she is so unnerved that Daisy tells her and me to change places. Nothing happens though. Mr Penfield seems a little subdued and doesn’t even stand on swabs.

  I am the first of the four of us to go on nights. Theatre works out its own off duty and we each do a week of nights while we are there. My main job is to wash, dry and powder mounds of rubber gloves, and pack them ready to be sterilised. First I have to blow each one out and inspect it for holes. If I find a hole, I repair it like the inner tube of a bicycle wheel. Then I powder each one, make sure I have a pair the same size, and lie them side-by-side on a cloth which I fold into a packet and place in a drum.

  It is pretty boring work and I long for an emergency. Just as I am giving up hope we get word that there is an acute appendicitis coming in and Jack Moulton, a surgical registrar, is to operate. The sister-on-call is brought in from the Nurses’ Home, where they sleep when on call. Sister Brodie, a nice woman, is on call and when she arrives she tells me to scrub up. I am to take the case and she will run. I am thrilled.

  I scrub my hands and forearms with a sterilised nailbrush following the pattern I have been shown. Then I rinse, dry my hands on a sterile towel Brodie hands me, pick up my sterile gown, insert my arms into the long sleeves and hold the ties out so Brodie can tie them behind me. I put on rubber gloves and walk to my table of instruments holding my hands up. There should be a chord from a full orchestra at least, or a camera crew ready to record my triumphant moment.

  Jack Moulton finishes scrubbing and Brodie ties his gown. ‘This is Nurse Ross, Jack,’ she says as he walks over to the table. ‘This is the first case she’s taken, so be kind to her.’ He winks at me over his mask and then asks the anaesthetist if he can begin.

  The patient is a young woman with many stretch marks on her abdomen. ‘How many children has she had?’ Jack asks Brodie.

  She goes to the desk to look at the notes. ‘Five, and she’s only 28.’

  ‘No wonder her abdomen is so flabby,’ Jack says as I hand him a sponge holder and a swab soaked in iodine. He swabs the abdomen, then sheets up as I give him towels and towel clips. Then I hand him a knife handle into which I have slid a blade. He makes an incision.

  I seem to float in time as I pass him instruments and peer into an abdomen. Jack points out the various organs as he explores their condition. Then he locates the appendix and brings it to the surface. I can see that it is enlarged and inflamed. I do not feel at all sickened; the opening into the abdomen surrounded by sterile cloths does not seem to be connected to a human body.

  He crunches off the appendix and asks for a ligature. I find the glass phial of catgut, wrap it in a towel, snap the phial and cut a length to hand to him. I am warm under the huge round light. The atmosphere is tranquil, not like days, and the only sound is the whoosh, whoosh of the anaesthetic machine. I hardly notice the anaesthetist, as he is screened from me, so I am startled when a deep voice suddenly says, ‘Can we get some bacon and eggs when we’re done?’

  Brodie says, ‘Yes, I’ve already ordered four plates and they’ll be up in twenty minutes. And I’ll make tea.’

  Jack sews up and I put a dressing on the incision. Then we all transfer the patient on to a trolley and wheel her into the corridor.

  ‘I’ve phoned for a porter and the ward nurse,’ Brodie says. ‘They’ll be here in a minute.’

  ‘I’ll go with her until she is round,’ the anaesthetist says, ‘but make sure my bacon and eggs are still hot for when I come back.’

  He isn’t long and we sit in the sitting room enjoying toast, bacon and eggs and tea. I am glad of the meal as I missed tea but my main enjoyment is the sense of camaraderie. I feel like an accepted member of a team. No matter that I am the one who goes back into the theatre to scrub the instruments and mop the floor, the feeling stays with me until morning. When Judith comes on, I crow about being the first to take a case and go home feeling important.

  Chapter 16

  BACK ON DAYS again and I find that I am not down for any theatre. I look for Daisy. Has she forgotten that I am on? I find her in the instrument room and ask her what she would like me to do.

  ‘Ah yes, Nurse Ross. I want you to help Bob today as several anaesthetic machines need a good clean. He’s in the store room.’

  Bob is a theatre technician who sees to the lights, adjusts the operating tables for each surgery and services the anaesthetic machines. The storeroom is a large room lined with shelves that house everything that no one knows where else to put. Bob is muttering over three Boyle anaesthetic machines that are heaped with instruments and cloths.

  ‘Bugger PA,’ he says. ‘It’s all very well trying out heart operations on weekends but does he have to make such a bloody mess?’

  ‘Never mind, Bob,’ I say. ‘I’ve been sent to help you.’

  ‘I told Daisy I’d never have these machines ready for use today if I didn’t get any help. Now one of the autoclaves is playing silly devils and I have to go to the basement for some more tanks.’

  ‘Well, I’ll clean these machines for a start. How on earth did they get like this?’ I loo
k closer at the blood and dog hair clinging to most parts of the machine.

  ‘It’s Philip Allison – he’s trying to work out how to stop the heart long enough to operate on it and keep the blood flowing. So he experiments on dogs. Though how he makes this mess, I don’t know.’

  Philip Allison is a thoracic surgeon with a reputation for improvisation. A few years ago a woman inhaled an open safety pin and PA designed an instrument to remove it prior to operating on her. Nowadays, he uses two eggbeaters he bought at Woolworth’s for 1s 6d each, as chest retractors. I have not run in PA’s theatre as heart surgery is so specialised. He has his own team of nurses, both in theatre and on the wards. They are able to do mitral valvotomys, which take all day, and which involve freezing the patient, but PA is anxious to do more.

  I wheel the first Boyle machine closer to the sink, which I fill with soapy water. The machine is a two-tiered trolley with shelves about two feet square. Beneath the lower shelf is a drawer for different sized rubber masks and attachments. A rack on the side holds small tanks of oxygen, air and nitrous oxide, and these are controlled by glass flow meters, which rise from the top shelf.

  As I scrub, I am wondering if this is history in the making and if PA succeeds in operating on hearts, whether I, who scrubbed an anaesthetic machine free of dog blood and hair, will be remembered. I imagine a movie’s list of credits rolling by: Philip Allison is the star, there is a supporting cast, and there, in tiny print, Manual Labourer – Jennifer Ross.

  After I finish cleaning the machines, I seek out Daisy to find out what I am to do next. ‘Put on a mask and go round the anaesthetists to see if there is anything they need. Take the DDA (Dangerous Drug Act) book with you and record the pethidine, or anything else they’ve used,’ she directs.

  I always forget the anaesthetists and how important their work is. They sit quietly beside their patient’s head and as they don’t act like the prima donnas at the operating table, they fade into the background. They are all very pleasant as I replenish their supplies. One of them asks me to watch his patient while he goes for coffee.