P James: Shroud for a Nightingale

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 each 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 practice 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 laryngectomy 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-colored hair clumped in a thick fringe above remarkable blue eyes Their caps, the pleated crowns as small 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 were 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 Godale, 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 esophageal 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?”