Part 6
“The other day a soldier called me an imbecile, and that’s exactly what I am, Amelia, a proud, presumptuous, ignorant little fool! But I never dreamed how dangerous it is to be so ignorant. The nurse gives you some mean, insignificant little job that does not seem to amount to a hill of beans, and in the end it turns out to be something horribly important, fraught with terrible consequences. For example: The other day a man had a relapse and all but died simply because I couldn’t find something quickly for him to vomit into. The first consequence was that we had to change his bed. The second consequence was that the extra effort fatigued him so he couldn’t eat any lunch. The third consequence was that, having eaten nothing, in the afternoon he had a relapse. For a while I thought he was going to die. Those were dark hours for me, Amelia! That night I offered to sit up with him--to make it up, you see. But the ward doctor said, ‘No, let’s give the poor devil a fighting chance!’ That was horrid, wasn’t it? He’s atrocious, that young ward doctor, and he never loses a chance to intimate what he thinks of my presumption in offering my untrained services. He says my nerve, if he could get an X-ray of it, would make the celebrated Colossus of Rhodes look like a pygmy. He asked me seriously if I wasn’t ashamed when I woke up in the middle of the night ‘to be so dumb--not damn, but dumb--ignorant!’ And I am, Amelia. But I really think I’m beginning slowly to learn. There’s a sick soldier they’ve set me to watch right now. So horribly pale! So still! One----”
At this point Miss Greenhorn’s pen trailed off and she sat bolt upright, staring before her into space. A sudden thought had smitten her, almost with the force of a blow. Why was he so pale? Why was he still? Why, in short, had she been set to watch him? She rose rather hurriedly and went to his bedside. She would ask him what was the matter. Really it was an inspiration!
“How are you?” she questioned gently.
“_J’ai froid_,” came the faint murmur from rigid lips.
“Ah! Cold, are you? Then I’ll get you some hot-water bottles and they’ll make you warm. Nice and warm!” And Miss Greenhorn sped away on her mission, delighted to be of service. “_Voilà!_” she cooed soothingly a few minutes later, slipping the heated bags into the foot of the bed. “Now you’ll soon be warm! Nice and warm and cozy!” And she leaned above him solicitously, still vaguely troubled. Certainly he was ghastly pale!
It was at this juncture that the ward doctor, a busy, brusque, discerning young gentleman, blew into the room with a--
“Hullo, Miss---- How’s that fellow----” A single glance at the fellow in question stopped the words as if a sudden hand had been clapped over his mouth. He sprang forward and threw down the covers. The soldier lay in a pool of blood. “My God! Hemorrhaging! Why didn’t you call me?”
He wheeled on her savagely. But Miss Greenhorn’s face had blanched almost as white as the counterpane. Her hand went up to her trembling lips.
“I--I--I didn’t know!” she whispered. “He complained of feeling cold, and so I--I gave him hot-water bottles.”
“Yah! In case of hemorrhage, when a man’s bleeding to death, for first-aid apply hot-water bottles! Fine! Where’s that tourniquet? I tied it onto the foot of the bed myself.”
“The--what?” stammered Miss Greenhorn, immeasurably terrified. She quailed before the look in his eye.
“Tourniquet! That piece of rubber tubing.”
“O-o-oh! That terra-cotta rubber thing, you mean! It made the bed look untidy and so I undid it. Let me see. Where----”
But the door had already slammed upon the doctor, who returned immediately with a tourniquet from the adjacent ward. Fortunately it was not an arterial, but a slow, oozing hemorrhage, and so the man did not die; but that was not Miss Greenhorn’s fault. And the doctor did not spare her:
“Why did you suppose his bed was tilted up so that his feet were higher than his head? Don’t you know that in itself is a sign of hemorrhage? Why did you suppose that tourniquet was tied to the foot of this particular bed? Do you see it on any of the other beds? That’s another sign! And what did you suppose you were set to watch him for anyhow? Zeppelins? You’ve been here a week now. Tell me, are you solid ivory from the neck up?”
I am not going to repeat the remainder of his scathing remarks, for he was angry and his nerves were none of the best. In justice to Miss Greenhorn it must be said that she took her whaling like a gentleman. She did not once glance at the doctor, but kept her eyes fixed on the French soldier whose life she had jeopardized by her criminal ignorance. And in that moment she jettisoned the last fragments of her ministering-angel dream. Cool hands, fevered brows, the kiss-me-for-I-am-dying business--all the false, sentimental rubbish with which she had stuffed her romantic young head she let go by the board forever.
And that, for us, is the end of Miss Greenhorn, save to mention that she is a real person. She told me the tale herself six months later, with tears only half of laughter in her eyes. And then she affixed the moral, which in brief is this: That not all of France’s enemies are behind the German guns.
From this solitary episode one may deduce most of the qualifications, both natural and acquired, that a volunteer nurse’s aid should possess before ever she sets foot inside a war hospital. First of all she must have health. She must have the kind of health that does not break or crack or crock or show signs of wear in bad weather; the kind of health that can pile one hard day on top of another hard day, and one hard week on top of another hard week, and one hard month on top of another hard month, and keep right on without flagging or asking the captain to stop the ship so she can get off and walk. Every auxiliary signs on for a period of at least three months, preferably six months; and in some hospitals abroad they sign on for the remainder of the war. The work is too severe for a delicate constitution; it has been known to put a crimp in a tough one; and it is unfair both to the soldier and to the hospital plant to have human machinery that is apt to break down any minute. This implies youth, resiliency, reservoirs of stored strength, the unspent increment of physical endurance; and, therefore, anyone outside the ages from twenty to forty should ponder deeply before entering this most exacting branch of the service.
Aside from good general health, the volunteer aid should possess what physicians term a high threshold to disease. She should not catch things readily. Microbes should be unable to obtain a foothold. In this respect even healthy people vary widely. One person will take the mumps if there is a case in the next county; another may sleep in the same bed with the victim and go unscathed. There was a young woman in our ward who caught everything. Every little pirate microbe that sailed the invisible seas of air with his jolly skull-and-crossbones flag knew her for a friendly island, had her marked down in his log book, and put in for food and repairs, sure of safe harborage.
Tonsillitis, grippe, infected finger, swollen glands, infected eye, tonsillitis again--she had them one after another as fast as she could, and she finally came home with the jaundice!
But let us suppose that the candidate has passed her physical examination with flying colors; that her back is strong; that her feet have not the slightest tendency to fallen arch; that she can eat stewed horse without a regretful pang; that she sleeps like the traditional top at night, and rises from her slumbers fresh as the traditional daisy. There are still other natural qualifications to reckon with: She must be able to subordinate herself to the will of others, to take orders, to take hard, disagreeable, and often what she may consider unjust orders from her superiors without opening her mouth to complain.
In the first year of the war the hospitals were nearly swamped by the sudden rush into them of grand ladies who were naught but little Miss Greenhorns in more arrogant guise. These women had not the faintest notion of subordination, or of the mental and spiritual discipline involved in nursing. Their conception, in a word, was the unreal conception of Miss Greenhorn. They, too, were devotees of the Florence-Nightingale-Mary-Pickford canned brand of dream. They had not left their beautifully appointed homes to carry slops, et cetera, but to nurse the gallant British and French lads! And for a time doctors and nurses were driven almost to insanity under the double pressure of caring for the wounded, and training--or quietly assassinating and smuggling down a well some dark night!--these ignorant ladies who descended on the hospitals like an Egyptian plague. Nor were all of the untrained, emotional incompetents of English origin. America sent her quota--women who from infancy had never obeyed anything outside of their own vagrant fancies, who were congenitally incapable of sinking their own personalities and becoming privates for the good of the cause. They wanted to be colonels at the very least or they wouldn’t play, and a field-marshal’s baton was even more to their taste. Boss was the middle name of every one of them. They had elephantiasis of the mind. Such a person in the minor position of nurse’s aid can disrupt the entire ward of a hospital, which, more than any other branch of service, resembles the army in its authorities, its hierarchies and gradations of rank, and the severe monotony of the daily routine.
For a time there was such a Great Person in our ward at the American Ambulance, the sort who “my-good-man’s” the soldiers. As for the rest, she blandly did what she pleased, and set the nerves of all of us on edge in consequence. For what she didn’t please to do, we had to, you see!
One afternoon the head nurse said to her:
“Mrs. X, will you disinfect that bed?” And it was none the less a command even though it was issued mildly in the interrogative form.
Mrs. X responded in her best drawing-room drawl:
“Oh, my deah Miss C., I am so sorry! But it is my tea time! And besides, really that is not my bed, you know!” With which piece of insolence she drifted languidly off to tea.
“What am I to do with her?” exclaimed the head nurse despairingly to the ward doctor, who had witnessed the insubordination.
“Shoot her at sunrise,” he suggested jovially. “This is a military organization. Shoot her at sunrise, and put over her grave: ‘Here lies a deserter. Shot for refusing to obey a superior officer in action.’”
Of course he was right. That is precisely what should have been done to her. And I would have joined the firing squad with pleasure--for I had to disinfect that bed!
To be strong, healthy, adaptable, able to sink one’s identity and to take orders--these are some of the natural qualifications of a successful volunteer aid. In addition she must be prepared for disagreeable tasks. The sight of blood, of poor fellows smashed to pieces, the hideous stench of gangrenous wounds, the screams of the dressing hour--these are the inevitable concomitants of a surgical ward in war-mangled Europe to-day, and are sufficiently disagreeable. But these are not what I mean. I mean the monotonous, prosaic, inglorious tasks that everybody loathes but somebody has to perform. And that somebody, eleven cases out of ten, is the nurse’s volunteer aid. For you have not read thus far without discovering that the position of an auxiliary resembles closely that of a printer’s devil. Not his the high responsibility of getting out the paper or deciding the politics of the editorial page; his not to reason why, his but to be on the living, red-hot jump every second of the time or get sacked by his irate boss. In one respect, however, the printer’s devil has the haul over the nurse’s assistant, for he receives a weekly envelope, while she labors for love.
As a specimen of these monotonous tasks, an English volunteer aid confessed to me that for two months in an English base hospital, three miles behind the lines, she did nothing all day save carry heavily loaded trays of food from the diet kitchen to a certain table in the corridor. Day after day, from eight in the morning until seven at night, back and forth, back and forth, remote, solitary, with aching shoulders, this plucky young private drudged. Never a wounded soldier did she see. At times the hospital shook under German bombardment; but so far as romance and illusion were concerned, she might as well have been a slavey in a twilight basement restaurant beneath the dull roar of the Sixth-Avenue elevated trains. Another young woman told me that for six weeks she carried nothing but bedpans. And at the American Ambulance, the _auxiliaire_ who roomed next to me had a job of which I did not envy her the possession. Every evening she used to offer to trade it in even barter for mine. And every evening I refused to take a cowardly advantage of her generosity. The position which my friend was so generous with was up in the operating room. And it was her particular duty to carry off the amputated members in a basket.
The points thus far in the natural qualifications of a nurse’s aid are health, resiliency, ability to take orders and to stick at mean, disagreeable jobs. Let us add a final one that is really the keystone of the entire arch. For without it the others are as sounding brass and tinkling cymbals. Nor is it acquirable: it is a grace, a gift. Some successful doctors and nurses possess it to a high degree; others, lacking it, turn into dried-up turnips. There was a certain young surgeon in the hospital who undoubtedly possessed this qualification. Whether he was an expert technician I do not know, for he left the hospital before I arrived and it was only the soldiers’ memory of him, the reflected echo of his personality, that I received. But that was sufficient. They loved him. “Ah, mees,” they would exclaim, “do you know Docteur James d’Amérique? _Non?_” And they made me feel that not to have known him was a profound personal loss. “Ah, how he was kind! How he was good!” they would murmur fondly, and they would drag forth a tiny snapshot of him for me to look at, and laugh with delight at beholding his face. “See, mees! Here he is! Aha! Bonjour, Docteur James!” They wished me to share with them the fragrance of that memory. One could not ask for a better epitaph than the tribute paid by these _poilus_ to the unknown Docteur James d’Amérique! Another did not possess this gift. Brusque, impatient of address, he would pull away the gauze sticking to an infected wound with an abruptness that invariably raised a howl; and exclamations of “_Brutal!_” “_Imbécile!_” “_Sale cochon!_” followed his ministrations down the ward. “Oh, shut up! Shut up! Shut up!” the doctor would retort in English. Now the soldiers did not know exactly what “Shut up” signified; without doubt in their minds it was some extremely naughty English profanity. But they had their revenge. They nicknamed him “Docteur Shut Up.” That was his epitaph.
A nurse who failed in this one respect they dubbed the old _mitrailleuse_. I have seen them sham sleep when she approached their bedsides for a chat. There was one, however, whom they loved. She was a slim, gold-haired Scotch miss, not much higher than the bedposts, but a grenadier for all that, and the quality I am speaking about rayed out from her in an almost visible aura. Not that she was “soft” or easy with the men. On the contrary, she cracked a whip over them and made them walk a chalk line of discipline, which they did with an open, unabashed delight in her. They would feign all sorts of ailments to lure her to their bed for a chat and massage.
“I suffer bad here, mees!” they would begin. “No, not there--higher up. No, _chère_ mees, not there. No--yes! _Voilà! Parfaitement!_ A-ah! _Mais, continuez, continuez!_” And not a thing the matter with the frauds! But they sunned themselves in her presence and all but fought for her smiles. That little Scotch miss had a way with her. Moreover, she loved her job. She loved it from the ground up, over and under and beyond and through. She loved it in all of its aspects and ramifications; she loved it in all the hours. She had the faculty, the gift I have been attempting to describe. She had a vocation. And unless one possesses in some degree this natural delight in humanity, in sick, diseased and often dirty humanity, the hour soon strikes when nursing begins to pall.
Thus far I have dealt only with the natural qualifications that a young woman should possess if she desires to do volunteer nursing in this war. All those who, after searching their inmost hearts with sincerity, cannot pass on the above-mentioned points with an all-round grade of at least seventy-five per cent, need waste no further time on this article. They may get out of the procession right now and go round next door and sign in for canteen cooking, or join the hoe brigade. Step lively, please!
At the present moment there does not exist in the Red Cross organization any course of instruction that has for its direct and primary object the training of volunteer nurses’ aids for work in surgical hospitals here or abroad. There does not exist in the Red Cross curriculum, as it is now constituted, any course that is adequate for the present crisis. The teaching manuals are the same that were in use before the war, unrevised, unchanged. They were not written with war in mind. Their purpose and goal is not our purpose and goal. And, as the textbooks have remained unaltered, it is inevitable that the various courses of instruction based upon them should be more or less beside the point, congested with material that is useless or irrelevant, and barren of certain fundamental facts which every volunteer aid should know. Sometimes when these lessons are given by nurses or doctors who have seen actual war service they are of more value, but these are exceptional, random cases; and in general the courses, instead of hitting the bull’s-eye of to-day’s grim necessity, are faced off in another direction and shooting at an imaginary mark.
There are four courses of instruction in the Red Cross curriculum that have a bearing, more or less indirect, on the subject of volunteer nursing in surgical hospitals during the present war. Let us glance at each in turn.
Most popular of all is the course in First Aid. This is the course that nearly every woman in the land flew at and swallowed down whole at the outset of the European conflict, and, it is safe to say, with very slight benefit. This is not surprising, for First Aid was not the proper choice. To teach nursing is not its object. The punishment, so to speak, does not fit the crime. Almost purely educational in character, it is designed for the accidents and emergencies of our ante-bellum, peaceful past rather than for the precise, up-to-the-minute scientific requirements of our belligerent present.
And from the point of view of the nurse’s assistant there are entire chapters that should be ruthlessly scrapped. Methods of resuscitating a drowning man; cures for snake bite; the way to tell an intoxicated gentleman from one who has merely fallen down in the street in a fit--these matters are interesting and valuable in their place; but their place is not in a manual used to instruct in the art of nursing under present conditions. It would seem advisable that the First-Aid manual be taken in hand by some eminent surgeon who has seen war-hospital service during the present year--for example, Dr. George W. Crile, head of the Cleveland Hospital Unit, that was recently ordered to France--and blue-penciled unsparingly with actual conditions in mind. The residue, plus a chapter on the recent discoveries and improved methods in caring for wounds, such as the treatment of burns from liquid gas, and the Carrel-Dakin system of antiseptic irrigation of infected wounds, to mention but two examples, would form an invaluable nucleus of instruction.
The second course in the Red Cross curriculum is that known as Elementary Hygiene and Home Care of the Sick. “The primary object of this course,” according to the pamphlet, “is to teach women personal and household hygiene in order that they may acquire habits of right living which will aid in the prevention of sickness and the upbuilding of a strong and vigorous people, and to give them simple instruction in the care of the sick of their own homes which will fit them to render intelligently such service as may be safely entrusted to them.” Admirable three years ago in peace times, but not at all what we are after now. Here again, so far as the purpose of the volunteer nurse is concerned, the emphasis, as in First Aid, is on the wrong foot from the start-off. There are entire chapters that might be omitted with profit, such as the house, the care of the house and the laundry, the household medicine closet, the hygiene of infancy and childhood. They should be dropped, and a more thorough, intensive and leisurely training be given in actual conditions prevailing in war hospitals of to-day.
In addition to these courses there are two others of minor importance. One in Home Dietetics is entirely too elaborate for the simple requirements of the nurse’s aid, who needs to know only the general food values and the compounding of invalids’ drinks. Three or four lessons in connection with the nursing course should amply cover this field. The fourth course, the Surgical Dressings, is practical but limited.
These are the popular courses given under the auspices of the Red Cross to-day. Each, taken by itself, has grave defects; and even when all four are combined there is such a ponderous dead weight of irrelevant material, pre-war nursing and medical junk, that for practical purposes it would seem better to throw them all out of the window and devise another course, a course compounded of the valuable elements of all four, but thorough, scientific, modern, and above all specifically adapted to the actual conditions of the present fight.