Chapter 26 Welcome to Adulthood

                                                         CHAPTER 26  Welcome to Adulthood

Mum's friend, Betsy Role, had been a nurse, many years before in Melbourne. Insisting she could help, she gave me tuition at her home, starting with how to give a patient a hot water bottle. Hot water bottles were used extensively for warming beds. (and I hadn’t even heard of air-conditioning!) Betsy went into the technicalities thoroughly. In case of leakage the outlet pointed to the bottom of the bed to lessen the chances of the patient getting burned.

    "It is an unforgivable sin, dear, to burn anybody!" Dad thought the obviousness of this statement was a huge joke.

    Another thing that was apparently an unforgivable sin was to cover anybody’s head up with the sheet. 

    "The only time you cover a person's head dear, is when they are dead."

    The main thing she insisted upon, however, was that the nurses’ uniforms must be down to mid calf in length. “Ooh, they won’t allow you to have them too short dear! They are very strict about that!”

    So Mum bought many metres of white cotton head cloth, and made the uniforms from a simple sketch the matron had given her at our interview. It beggars belief that she did not give us an indication of where the uniforms could be purchased in Brisbane. I guess she just assumed we were too poor to afford ready made uniforms. We, in our turn, assumed there was no choice but to make them. A fashionable length for a young woman’s dress at the time was just below the knee.

    I started nursing three weeks after I left school, just before Christmas of 1961. The matron, very strict, gave us all our first year or general nursing lectures. As a junior nurse we really started at the bottom, fetching bed pans, urinals, and sputum mugs as necessary. Mainly given pan room duty, we scrubbed down the wooden benches of the pan room with disinfectant, and boiled all stainless steel items. Any patients in the wards who had a productive cough would be given a clean stainless steel sputum mug each day. The pan room nurse collected them each morning, scrubbed and sterilised them, and replaced them by the patient’s bedside.

    We always had at Assville hospital, a nearly-waist-high wooden padded pyramid, which was used for any patients with a chest complaint who were coughing. Positioned face down over it clutching a kidney tray, the patient received a rhythmic back and lung patting. The postural drainage was very useful. After a while I developed quite a good technique, effective in shifting the mucous from their chests. The hospitals I worked in were never graced with physiotherapists at that stage.

    Each morning the day shift started at six a.m. This was a totally new life for me, waking up to an alarm clock. Mine woke me half an hour before the shift started and I jumped out of bed to go to the bathroom to wash my face and clean my teeth. I dressed in a starched white uniform from the nurses uniform cupboard where they were delivered by the laundry ladies. On our heads we wore starched white caps with one, two or three blue stripes. The three or four day-shift nurses gathered in the big country kitchen around a massive range. The night nurse had cut thick slices of white bread and dried it out  in the oven ready for toasting. We ate tea and toast before starting work.

    The junior nurse’s first duty was the patient's bed sponges and making their beds. A senior nurse took me with her and taught me strictly the correct procedure for sponging a patient in bed. We paid close attention to false teeth, ears, fingernails and between toes etc. We didn’t wear gloves, and we kept the patient covered with towels or blankets until each part was washed. Every bed was equipped with two towels and soap on the bedside locker.

     Glass water jugs and glasses were then collected from the bedside lockers, washed,  and refilled. The metal topped lockers were polished to a shine, and all was replaced, ready for the matron's inspection at 830a.m.

    For our first exam, general nursing lectures were given by the matron. These included  everything that took place on a daily basis in the course of our duties, including the precise art of bedmaking. Whether we were replacing the bedlinen or not, a bed had to be completely stripped before we attempted to make it fresh. A strict format was followed including the legendary art of mitreing corners. Each locker held a metal ring supporting a stainless steel hand basin, and a metal soap dish was provided. When not in use, the handbasin swung out of sight into the locker cavity. White quilts with a bright blue border adorned the beds in neat rows. Bed tables at the ends of the beds were also kept neat, clean, and lined up. The patients dare not mess up their beds before the matron's round!

    All patients knew who they were speaking to. Fourth-year nurses wore a veil tied at the back, and a sister, or registered nurse, wore a starched white veil made of voile. And of course all the uniforms were white, starched by the hospital laundry. The nurses oozed efficiency and I remember drawing a lot of comfort from that starched white uniform when I was a child in hospital. They smelled of starch and regulation, and they instilled confidence.

    Everyone knew the matron. You could pick her out by the way she walked, with her hands together in front of her. She commanded respect just by her appearance and the way she held herself. She rarely had a crease in her uniform, not even where she sat down. She visited staff and patients every day and demanded high standards from the nurses, 'her girls'. When a junior nurse addressed a more senior staff member, she stood with her hands behind her back or stiffly at her sides. She never, but never, put her hands in her pockets or stood with her arms folded, as you might see on television. 

    When you were given an order you replied, "Yes Matron," or "Yes nurse." It was made clear to us that we were not allowed to diagnose. Our job was purely to carry out the doctor’s orders, which is why the ward sister accompanied the doctor with her clipboard on his rounds, writing down every new order. Of course the doctor recorded the orders in the patient’s file.

    If a nurse couldn't find any work to do she tidied the beds. (I refer always to the nurses as ‘she,’ because there were no male nurses.) Many times I tidied linen cupboards, refolding the towels so that the neatest part of the fold was facing out, lining them up in perfect rows. I did the same with the sheets, and the face washers, and the gowns etc. At Assville hospital we had lots of spare time. If everything had been tidied and my shift still wasn't finished, I tidied the box room, where spare equipment such as wheelchairs, shock blocks, and vases, were stored.

    In my first year of nursing I learned how to administer drugs safely, give injections, prevent bed sores, and treat pediculi, (head lice). Patients’ hygiene and the prevention of pressure areas was paramount in our training. There were no air-beds or other such luxuries to prevent bedsores. We did the job ourselves, on patients’ backs, hips or buttocks,(sometimes elbows and shoulders) by giving two hourly pressure care, first washing the areas with soap and water and massarging with a soapy hand. After rinsing and drying, those areas were then massaged with spirit. Then they were powdered and the patient’s position in bed changed. I saw patients admitted with huge  pressure sores after being nursed at home, but I never saw one develop in hospital.

   It seems to me that everything in hospitals today is disposable, or unbreakable plastic. For nurses, finishing ‘care plans’, (oops, pardon me, ‘service delivery documents’, (we mustn’t use the word care) is a priority. That often feels like a priority over the client’s care. with the patient waiting up to  thirty minutes just to have their call button answered. Technology is a wonderful thing, but it has totally replaced nurture.



    Besides starched white uniforms and caps, nurses were expected to wear brown leather lace up shoes and brown nylon stockings with a seam up the back. And if the seams were not straight you were sent to straighten them. All stockings came with seams in those days and pantyhose hadn't yet been designed. Being 5'8" tall, I was one of the tallest girls around and always bought long leg stockings, which were held up with a suspender belt. You could also buy long or short-leg corsets which had suspenders on the front and back inside the legs, I wore those when I went on an outing to hold in any unseemly bulges! (and hold out any probing hands.) I lived in fear my bottom might wobble! Any girls who had varicose veins wore support stockings, which were thicker and more elastic. I wore Halls Nursing shoes, and they were probably the most comfortable shoes I ever owned.
   
     In my first year at Assville I learned how to give an enema and how to pass a catheter. One-day I learned how to treat someone for shock and how to make up a shock bed, because a farmer arrived in the ambulance with his hand badly torn by an exploding petrol drum. Within weeks of starting I learned how to maintain a clean mouth for a helpless hemiplegic patient by giving a mouth toilet with glycerine and borax. And I could just about take someone's temperature and pulse in my sleep. And measuring blood pressure and syringing ears were everyday jobs.

    Dressing wounds two or three times a day required experience and careful asepsis by the treatment nurse. Senior nurses were strict and insistent about hand washing and the procedure for caring for wounds. Washing of hands at Assville Hospital was an art form in itself. We were required to scrub with a scrubbing brush and sunlight soap for two minutes from fingertips to elbows, paying particular attention to the fingernails. In the cold, dry, unforgiving winter, my fingers cracked and bled at the corners.

     Because Assville was such a small hospital, we also assisted at the birth of babies in our first year. I was still sixteen when I learned how to do a complete pubic shave, give postnatal wash-downs, check for postnatal haemorrhage, and watch closely over newborn babies-- colour, (for oxygen depletion,) behaviour, and integrity of umbilical cords.

      When it came time, a small class of junior nurses walked across the show-grounds from the hospital to the high school, to be taught invalid cookery by the domestic science teacher. Clearly, I was never meant to be a chef, but we were all taught what meals were suitable to offer a recovering patient, and how to arrange a meal-tray to encourage the appetite. Foods considered suitable for an invalid’s delicate digestion included barley water and beef tea, coddled eggs, steamed fish and gruel, (sieved porridge). We were taught to offer small amounts at a time, gradually increasing as the patient's desire for food returned; and the meal had to be arranged attractively on a tray, perhaps with a little vase of flowers and a pretty tray cloth.

   Unfortunately today, one occasionally hears about cases where the patient didn’t get fed despite the fact their arms were paralysed, or they were too sick to sit up and help themselves.

                                                              
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    In my second year at Assville hospital I was taught to operate the huge steam autoclave that we called Bertha, which hissed steam and clicked and clattered as it went through its cycle. Cloth drapes of all sizes, glass syringes and needles, theatre gowns, caps and overshoes, and trolley covers were all folded neatly and wrapped in tight bundles before being packed into the autoclave. It was important to remember how to fold theatre linen, otherwise things could be unsterilised while it was being unfolded prior to an operation.

    Surgery usually required both doctors, the matron and two nurses to be scrubbed to assist during operations, and another nurse, not scrubbed, acted as scout. After I’d mastered the art of being a scout, I was put on the suture table, which I found most stressful, as it was necessary to thread the needles with the correct sutures and put them into the doctor’s hand. I  was privileged to assist with tonsillectomies and other minor procedures in the minor-Ops Theatre, as well as hernia operations, laparotomies and other major surgical operations in the larger theatre. We referred to the tonsil and  adenoid ops as T's & A's. After an operation was finished and the theatre was cleaned up, all the cakes of sunlight soap used for scrubbing hands were put out into the sun for some hours to dry.

    It was usual at the time for almost every baby boy to have a circumcision within a couple of days of birth. These were done in the minor-ops theatre too. I never actually saw one performed, as it only required the sister from the maternity ward and the doctor. Of course there must have been initial pain for the baby, but it only seemed to last a few minutes, and the doctor applied a small cotton wool dressing soaked in a solution (possibly potassium permanganate,) which was removed after a day or two. By the time the baby went home the wound had healed. Mothers took their babies home after about seven days.

    There was one particular sister at the Assville hospital who had been there for years. Known as a bit of an old battle-axe, she growled at the nurses, and the maternity ward was her favourite lair. She never let the post natal mothers get away without doing their bike riding and pelvic floor exercises. Soon after a birth she would hound the nurses about the woman's blood loss and the baby's cord. It was possible if a cord wasn’t tied off tight enough, that as it shrunk, it could haemorrhage. In the labour ward, we kept white cotton cord ties soaking in methylated spirits. Tying the cord was always the sister's duty.

   The nurse had to be sure to position the baby on its side, or even on its abdomen, for it was feared that if they were lying on their backs they could choke on their own vomit. New babies were watched very closely for signs of choking.

    It was unusual in Assville to have a premature birth, but there was one while I was there at the hospital. The doctor put the baby into a humidicrib and all the staff came to admire the little girl through the glass window. She weighed only four pounds. The mother was a  pretty single girl of eighteen. A group of us went off duty one afternoon and as we walked out through the maternity ward we all stopped for a last look through the glass partition at the tiny little pink cherub. We squarked over her like a gaggle of geese. To our shock and horror when we came on duty the next morning the humidicrib was empty. The little baby had died in the night and the doctor later told us that it was a staph infection of the lungs. We all grieved for the little lost soul and I’ve never forgotten her.