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 The John Carpendar uniform struck her as interestingly out of date.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?”
“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
