P James: Shroud for a Nightingale

“Body temperature, Sister, 38° C.”

“Correct And as our patient is conscious and able to swallow we are giving her this feed by mouth. Don’t forget to reassure your patient Nurse. Explain simply to her what you are going to do and why. Remember this, girls, never begin any nursing procedure without telling your patient what is to happen.”

They were third-year students, thought Miss Beale. They should know this by now. But the twin, who no doubt would have coped easily enough with a real patient found it embarrassingly difficult to explain her procedure to a fellow student Suppressing a giggle she muttered a few words at the rigid figure in the bed and almost thrust the esophageal tube at her. Nurse Pearce, still gazing fixedly ahead, felt for the tube with her left hand and guided it into her mouth. Then shutting her eyes she swallowed. There was a convulsive spasm of the throat muscles. She paused to take breath, and then swallowed again. The tube shortened. It was very silent in the demonstration room. Miss Beale was aware that she felt unhappy but was unsure why. It was a little unusual perhaps for gastric feeding to be practiced on a student in this way but it was not unknown. In a hospital it might be more usual for a doctor to pass the tube but a nurse might well have to take the responsibility; it was better to learn on each other than on a seriously ill patient and the demonstration doll wasn’t really a satisfactory substitute for a living subject. She had once acted as the patient in her own training school and had found swallowing the tube unexpectedly easy. Watching the convulsive movements of Nurse Pearce’s throat and swallowing in an unconscious sympathy she could almost recall, after thirty years, the sudden chill as the tube slid over the soft palate and the faint shock of surprise at the ease of it all. But there was something pathetic and disturbing about that rigid white-faced figure on the bed, eyes tight closed, bibbed like a baby, the thin tube dragging and wriggling like a worm from the corner of her mouth. Miss Beale felt that she was watching gratuitous suffering, that the whole demonstration was an outrage. For a second she had to fight an urge to protest.

One of the twins was now attaching a 20-ml. syringe to the end of the tube, ready to aspirate some of the gastric juices to test that the end of the tube had reached the stomach. The girl’s hands were quiet steady. Perhaps it was just Miss Beale’s imagination that the room was preternaturally silent She glanced across at Miss Taylor. The Matron had her eyes fixed on Nurse Pearce. She was frowning slightly. Her lips moved and she shifted in her seat Miss Beale wondered if she were about to expostulate. But the Matron made no sound. Mr. Courtney-Briggs was leaning forward in his chair, his hands clasping his knees. He was gazing intently, not at Nurse Pearce. but at the drip as if mesmerized by the gentle swing of the tubing. Miss Beale could hear the heavy rasp of his breathing. Miss Rolfe sat bolt upright her hands folded loosely in her lap, her black eyes expressionless. But Miss Beale saw that they were fixed, not on the girl in the bed, but on the fair and pretty student. And for a fleeting second the girl looked back at her, equally expressionless.

The twin who was administering the feed, obviously satisfied that the end of the esophageal tube was safely in the stomach, lifted the funnel high over Nurse Pearce’s head and began slowly to pour the milky mixture down the tube. The class seemed to be holding its breath. And then it happened. There was a squeal, high-pitched, horribly inhuman, and Nurse Pearce precipitated herself from the bed as if propelled by an irresistible force. One second she was lying, immobile, propped against her mound of pillows, the next she was out of bed, teetering forward on arched feet in a parody of a ballet dancer, and clutching ineffectually at the air as if in frantic search of the tubing. And all the time she screamed, perpetually screamed, like a stuck whistle. Miss Beale, aghast, had hardly time to register the contorted face, the foaming lips, before the girl thudded to the floor and writhed there, doubled like a hoop, her forehead touching the ground, her whole body twitching in agony.

One of the students screamed. For a second no one moved. Then there was a rush forward. Sister Gearing tugged at the tube and tore it from the girl’s mouth. Mr. Courtney-Briggs moved resolutely into the melee, his arms wide. Matron and Sister Rolfe bent over the twitching figure hiding her from view. Then Miss Taylor rose and looked round at Miss Beale.

“The students… could you look after them please? There’s an empty room next door. Keep them together.”

She was trying to keep calm but urgency made her voice sharp. “Quickly please.”

Miss Beale nodded. The Matron bent again over the convulsed figure. The screaming had stopped now. It was succeeded by a piteous moaning and a dreadful staccato drumming of heels on the wooden floor. Mr. Courtney-Briggs took off his coat, threw it to one side, and began to roll up his sleeves.

Muttering gentle encouragement, Miss Beale shepherded the little group of students across the hall. One of them, she was not sure which, said in a high-pitched voice: “What happened to her? What happened? What went wrong?” But no one replied. They moved in a shocked daze into the room next door. It was at the back of the house, a small, odd-shaped room which had obviously been partitioned from the original high-ceilinged drawing-room and which now served as the Principal Tutor’s office. Miss Beale’s first glance took in a business-like desk, a bank of green steel filing cabinets, a crowded notice board, a small pegboard fitted with hooks from which hung a variety of keys, and a chart along the whole of one wall showing the teaching program and the progress of each individual student. The partition wall cut the mullioned window in half so that the office, unpleasing in its proportions, was also inconveniently dark. One of the students clicked down the switch and the central bar of fluorescence began to flicker into light Really, thought Miss Beale, her mind clutching desperately at the comfort of its normal preoccupations, it was a most unsuitable room for a Principal Tutor, or for any other tutor, come to that.

This brief remembrance of the purpose of her visit brought a second’s comfort But almost immediately the awful reality of the moment reasserted itself. The students-a pathetic and disorganized little bunch-had crowded together in the middle of the room as if incapable of action. Glancing quickly around Miss Beale saw that there were only three chairs. For a moment she felt as embarrassed and nonplussed as a hostess who is not sure how she is going to seat all her guests. The concern wasn’t altogether irrelevant. She would have to get the girls comfortable and relaxed if there were to be any chance of keeping their minds off what was happening next door; and they might be incarcerated for a long time.

“Come along,” she said brightly. “Let’s move Sister’s desk back against the wall, then four of you can perch there. I’ll take the desk chair and two of you can have the easy chairs.”

At least it was activity. Miss Beale saw that the thin, fair student was shaking. She helped her into one of the easy chairs and the dark, sulky-looking girl promptly took the other. Trust her to look after number one, thought Miss Beale. She busied herself helping the other students to clear the desk and push it back against the wall. If only she could send one of them to make some teal Despite her intellectual assent to more modern methods of combating shock, Miss Beale still put her faith in warm strong sweet tea. But there wasn’t a chance of any. It wouldn’t do to upset and alert the kitchen staff.