by Eileen E Brown 0BE
Liverpool Royal infirmary 1945– 1949
On a misty, murky afternoon in January 1945, accompanied by my father, I boarded a Wallasey ferry boat and crossed the river to Liverpool. The 6A tram took us through the town, up London Road and on to Pembroke Place. Alighting opposite the Royal Infirmary we stood for a moment. Then, after bidding farewell to my father, I picked up my suitcase and crossed the road, turning to wave before hesitantly ringing the bell of the nurses home next door to the hospital.
I waited with a mixture of apprehension and excited expectancy. Answering footsteps grew louder. They stopped. A heavy door was opened– just wide enough for me to cross the threshold before shutting decisively behind me.
I was 18 and my four years training as a nurse had begun.
My father, standing alone in the gathering gloom outside the funeral directors opposite, thought “she’s gone”. And in a sense I had. In those days there was no question of “living out”. We all lived “in”.
Once inside, the person ( later identified as Peggy, the senior dining room maid) who had opened the door, told me to wait. She then disappeared.
As I stood there alone, suitcase by my side, I was relieved to be approached by someone in a navy dress, white cap and apron whom I rightfully took to be a Sister. After brief introductions I was then escorted ,via the lift ,to the fifth floor and shown to a bedroom which, I was pleased to note, was to be mine alone.
I was instructed to change into the uniform laid out in readiness on the bed– Blue and white striped dress, stiff white collar, starched white apron and detachable starched white sleeves to be pinned to the short sleeves of the dress. My own black stockings and shoes completed the outfit – apart from the cap. The cap was a white rectangle of starched cotton which had to be completed on the wearer’s head to make it fit. At first this manoeuvre was virtually impossible to manage on one’s own head although the skill was gradually acquired. On this first day, assistance was given by the sister who had shown me to my room. The apron and sleeves were to be changed every day, the cap and dress once a week.
It was not until I emerged from my room ,self-consciously wearing my unfamiliar garb, that I found there were six other uniformed newcomers. As we tentatively eyed one another at that first tea in the nurses home, none of us had any conception what lay ahead.
After tea we were taken on a tour of the home . Apart from the sleeping quarters there were attractive communal rooms ,rarely used except for the dining room, the least attractive. At the back was a quadrangle, planted with shrubs, from which the top of the mortuary was just visible.
There was also I recall a cell- like smoking room on the ground floor. The theory was that if the nurse wished to smoke when off duty (no smoking on duty of course) she was required to change into mufti, retire to the smoking room and smoke a cigarette. In those pre- smoking can kill- days the laudable aim was not to save life but contain the smell of cigarette smoke. Later however I discovered that on the wards the men were permitted to smoke for one half-hour after meals. Incredible as it may now seem in these days of equal opportunity, no smoking at all was allowed on the female wards.
The tour of the home ended at the preliminary training school ,abbreviated to PTS ,which was to be the centre of our daytime activities for the next two months. Henceforth, in our year, we were known as the January PTS. We discovered that the sister who had accompanied us so far was the Tutor of the preliminary training school. We found that she was gentle soul who looked after and protected us and taught us anatomy and physiology- but not male anatomy. Years later Sister Laura ,as she was affectionately known, said she “just couldn’t do it”.
In the PTS we were also taught hygiene (MRSA unheard of) and theory of nursing. Hospital etiquette was taught in the latter, great emphasis being placed on correct relationships between nurse and patient.
There were to be no “terms of endearment “ or familiarity in the form of using Christian names when addressing adult patients or nurses on duty. However, patients at all times were to be treated with the courtesy, kindness and consideration that would be extended to visitors in our own homes. These precepts together with the sense of responsibility instilled into each one of us formed the core of our development as nurses.
Practical work included cookery–carefully warming milk to blood heat before adding rennet to form am anaemic looking but easily assimilated food; spreading antiphlogistine on lint to make a poultice, preparing an icepack, using a hatpin to crack the ice. Bed-making was practised with the indefatigable model “Mrs Brown” as patient. In the second month of PTS we spent one half day each week on a ward.
I was sent to a men’s medical ward and my first task on the first occasion was to feed a man whose arms were completely immobilised with rheumatoid arthritis .Even today I can remember the trapped look in his eyes and how sorry I felt for him.
Then came a great day when we finally left the security of the preliminary training school and were thrust into the mainstream of hospital life.
I was sent to the men’s medical ward where I had spent half days in PTS. This was one of the round walls, so called because it was completely circular in shape. Nineteen beds were arranged around the circumference, the foot of each pointing inwards. In the centre was a gigantic pillar leading to the chimneys. In each side of the pillar was a fireplace for the coal fires which heated the ward.
At the far end the ward was divided by the entrance leading to the sluice and bathrooms, while opposite was the corridor leading from the ward. Off this corridor were various rooms– kitchen, functional dayroom and, unbelievably, the day sisters bed-sitting room, so even when off duty or asleep sister was “on the ward”.
Throughout the hospital the staff was composed of state registered nurses or nurses in training. There were no state enrolled nurses, no auxiliaries, no orderlies and certainly no male nurses. Each ward, however, had a cleaner who was responsible for the floors throughout and for washing dishes. Some cleaners had worked at the hospital for years and sometimes seemed to be invested with as much authority is the ward sister herself. Nevertheless, even during the detested weekly cleaning day when, every Wednesday, all the beds were pulled into the centre of the ward, all of the lockers thoroughly washed out after being emptied of their contents and ward routine completely disorganised, much of the daily cleaning was carried out by the nurses.
In all the wards each probationer was allotted a certain number of beds and was responsible for the general tidiness and personal nursing care of the patients occupying those beds. In the round wards ,of which there were four, each of the two probationers was responsible for one side.
The first morning on the ward I was industriously dusting lockers on ‘my’ side when the other probationer, senior by two months whispered piercingly in my ear “don’t be so thorough. We’ll never get through”. “Getting through” was a phrase with which I was to become very familiar. We used it to each other negatively in despair, “we’ll never get through” or encouraging me “we’re getting through” when it seemed we might be finished on time. Our whole life seemed to be geared to getting through.
Many routine duties were divided between the two probationers. Week and week about each was responsible the care and cleanliness of the kitchen or the sluice. The kitchen nurse was required to keep the kitchen tidy, set the trolley with crockery and cutlery, put plates to warm in the oven (without allowing them to become too hot– A crime) butter bread and boil eggs for breakfast.
These would be either the occasional supply from the main kitchen or the patient’s own, naming them in pencil before putting them in the pan. Dried egg was still being used and trying to scramble it into a dish fit to eat was a challenge.
The kitchen nurse was also responsible ,under supervision if necessary, for special diets .These were usually either for gastric cases why who required a milk feed every two hours or for diabetics. Although for the latter I think some meals were sent from the main kitchen, sometimes it was left to the nurse to use her ingenuity in cooking an egg or a weighed piece of cheese.
On one occasion, I was quite proud of some really tempting looking toasted cheese and hurried into the ward with it before it got cold. Unfortunately in my haste it shot off the plate landing on the floor– Thank goodness right side up – a few feet ,away. Trying to restrain my mirth, I quickly retrieved it and return to the kitchen. However, as there was literally nothing else for the patient to eat and as he had to eat following an insulin injection, food hygiene notwithstanding, after a suitable interval the toasted cheese reappeared in the ward.
The sluice nurses first morning task after bed-making, in which we all shared, was to set out used sheets and towels in piles for Sister to count, before sending them to the laundry. Then the main task is cleaning the sluice and all its accoutrements. No utensils were disposable so all bed pans and urinals had to be thoroughly cleaned. Patients were confined to bed much more and for longer periods than today so closing the ward was quite an item. There were no individual bed curtains, only heavy wooden screens. If any patients required privacy or was receiving treatment the screens had to be carried one by one to the bedside. In an emergency “screens nurse” was a command to be obeyed at once.
General nursing was an important part of the duties of all probationers. Each was assigned a number of patients– her patients – and was responsible for their daily daytime wash, weekly blanket bath, cleaning of teeth and care of pressure areas. The appearance of a pressure sore, which rarely occurred, was indicative of negligence from which no nurse, however junior, dealing with that patient was exempt from blame. Even if off duty at 2 pm for a half day we were expected to see to our patients before we went, whereas normally some of these tasks would be carried out in the evening. Sometimes, one of the other nurses would offer to help. Otherwise, if every detail were attended to the nurse might not get off until 2:30 p.m. or 3 p.m. or even later. Fortunately, most patients were very understanding and tried to be as cooperative as possible to enable one to “get through”.
My first encounter with death came very soon after leaving PT S. I was behind screens attending to one of my patients when, while turning him onto his side, I was aware there was a subtle change. His expression became fixed and he appeared to be staring into space. Alarmed, I felt for a pulse but could feel nothing. Emerging from the screens, I reported to Sister who, after one brief examination, at once drew up and administered an injection of coramine, a heart stimulant and the only form of resuscitation at that time. To no avail– the man had died.
Sister, whom I had regarded as a rather unapproachable person, was surprisingly understanding. Realising that for me this was a completely new and unexpected experience, she allowed me to sit in her room for a while and assured me that what had happened was in no way due to my handling of the patient. I appreciated this and thereafter saw Sister in a new light, but I also remember feeling not so much shocked as very solemn – one-minute life, in the next death.
Off duty had just been increased prior to my advent of the hospital. As probationers we received a half day off one week, a day, preceded by a half day the following week and alternate Sunday half days. Otherwise, hours of duty were 7:30am to 8pm with three hours off morning or afternoon which included half an hour lunch or tea as the case may be. Supper was at 8pm.
When returning from a half day day or day off all nurses had to sign in by 10 pm unless they had a late pass for 10:30pm. This was the hour at which the Home Sister made her round of the nurses home. She knocked peremptorily on any door where the light shone above the glass pane above. Later, Night Sister switched off all the lights on each floor of the main, although lights on the stairway and in the lifts were left on.
This did not mean we were all in bed. I remember when there was a craze for dabbling with the occult. After supper, perhaps six or seven of us, dressing gowned and ready for bed, would assemble in one of our rooms.
The letters of the alphabet were written on small squares of paper and ,using the polished floor as a Ouija board, arranged in the circle broken only by the words ‘yes ‘ and ‘no’ positioned opposite to one another. An inverted glass tumbler was placed in the centre. We then sat round in a circle all resting a forefinger lightly on the base of the glass and proceeded to ask questions– About the future, our romances, anything that came into our heads. Slowly at first, but gradually gathering momentum, the glass would slide to individual letters spelling out a word or to an outright ‘yes’ or ‘no’. Sometimes the glass would whirl about in a frenzy. We all vigorously denied pushing it. This activity was addictive and when we heard Sisters approaching footsteps we would switch off the light and stay quite still, almost holding our breath until the footsteps receded. Then out would come the torches and we would continue until the small hours. In retrospect this all seems rather silly but then it was just a harmless diversion in our strictly regulated lives.
Even pay day was an ordeal. We were paid monthly in cash. In our first year it was ,I think, £4 per month, increasing to 9 pounds in final year. The money was placed in small brown envelopes and after queueing outside her office, given to us individually by Matron. Matron was a diminutive figure who wore a tall, white starched rather like the bishops mitre which only served to emphasise her small stature. She walked quietly and never raised her voice but her capacity to strike terror into the hearts of all, from the most junior probationer upwards, would be hard to emulate.
We actually felt nervous whilst waiting for our turn to enter to the office knowing that Matrons penetrating gaze would fall on each of us and any slight discrepancy in our appearance– too much hair showing, maybe a button replaced, how ever unobtrusively, with a safety pin– would be noticed and commented upon. When the ordeal was over and clutching our brown envelopes ,we were glad to escape and return to patients.
It was the same on the wards. Every day there was a ward round when one of the administrative staff ,including Matron ,would visit every ward in the hospital. The ward sister accompanied the person making the round as she paused at the end of every bed and spoke to the occupant. However, the ward round also included noting the general tidiness of the ward and inspection of the kitchen and sluice. When Matron was expected there was a general air of anxious anticipation. The folding of the corners of the counterpanes was given special attention to achieve uniformity and flowers checked to ensure red and white flowers had not been placed in the same vase (thus signifying an impending death). When Matron left the ward there was a palpable sense of relief.
Nevertheless, Matron had served at the front in the 1914–1918 war and we knew that she knew about nursing. In spite of our trepidation in her presence Matron was respected throughout the hospital.
Following the general rule I was put on night duty at the beginning of the second year. The hours were 8p.m. to 8am with two nights off a week. No cooked meal was provided during the night. After our “breakfast” at 7:30pm we collected from the dining room hatch an enamelled dish containing our sustenance for the next 12 hours. This might be an egg or two forlorn looking sausages. On Sundays a piece of cake was included– always the same variety that fortunately was quite palatable.
Night staff were not allowed to leave the ward. If there was only one nurse on the ward a relief nurse came to enable the ward nurse to cook her sausages in the kitchen. When two nurses were on night duty on the 30 bedded wards they took it in turns to cook a meal. Sometimes, resident doctors came to the kitchen for a cup of tea, providing night sisters round was not imminent that, in view of Day Sister sleeping on the ward, such activities had to be kept very quiet. Incidentally, soft soled shoes were compulsory for night duty.
Are uniform remained the same until we reached our fourth year and we became “charge nurses” and went into “frillies”. These were not a glamorous type of underwear but attractive net caps gathered into a frill at the back. Combined with a mauve dress instead of the blue and white stripes, everyone’s appearance was enhanced. The frilly hats however, did not cover the hair nearly as well as those we had worn hitherto and this we could never understand as the senior nurses were more likely to be carrying out procedures such as dressings and the chance of cross infection was always present.
Speaking of dressings– there was no such thing as a sterile dressing or sterile packs of any kind. All dressings had to be cut, folded or made into balls as appropriate, packed into tins and sent out to be autoclaved. All instruments or equipment used in dressings or other procedures were boiled or sterilised in spirit. This included syringes. Penicillin was in its early stages, having to be injected every three hours, night and day. I remember one man from Ohio who had come to England for holiday. Unfortunately, he developed an inflammatory heart condition. He was the first patient I can remember to be given penicillin and he bore the injections uncomplainingly. We were delighted when he seemed to be improving, only for our hopes to be dashed to the ground when, unexpectedly, he collapsed and died.
This wife was a delightful woman. Before returning to America she gave me a pair of nylon stockings. Everyone came to my room to see them drying overnight as, in Britain, nylons were still a rarity and of course tights had not yet arrived.
Visiting times are extremely limited. The only visiting us from 6- 7 pm on Wednesdays and 3-4 pm on Saturdays and Sundays. No children were allowed and the ‘only two at a bed at a time’ rule strictly adhered to. However evenings was short. Lights over the patients beds were put out at 8 pm, followed by prayers with day and night staff grouped round Sisters desk, illuminated by an overhanging light which, as with the other main lights, was draped with a dark cotton shade.
We did, of course, have lectures on different subjects but no block system was in operation. One of our chief causes of complaint was that if the lecture coincided with off duty, even a day off, we were expected to attend. Even when on night duty, we had to stay up to go to the lecture or get up early if it were in the evening. I remember the day I went into frillies. I was on night duty but had to get up to attend an eye lecture at 5pm. During the lecture I dropped off to sleep only to be awakened by a stamp of the foot of the consultant giving the lecture, followed by the words “sorry if I woke you up”. Covered in a certain amount of confusion, I was glad the Sister Tutor thought the culprit was one of a group of visiting nurses sitting in front of me!
Joining the theatre staff was an experience. The Sister in charge known throughout the hospital as “Auntie Ivy” was a redoubtable lady with a mass of red hair ,which she wore piled on top of her head under her cap. Her opening gambit to newcomer was “as long as you do what you’re told and not what you think you’ll be alright”. During operations the first task allotted to a new addition to the theatre staff was to lay out swabs as they were removed from the site of the operation. At the end of the operation, these had to tally with the number of swabs used, which was chalked up on a blackboard. Eventually, one might graduate to “taking” an operation, it involved handing the surgeon instruments as he required them, whenever possible anticipating his needs. There was a special way of handing instruments to reduce the possibility of them being dropped in transit.
Some nurses were eminently suitable for theatre work. I was not one of these. Nevertheless, I was elevated to the position of “theatre night nurse”. This was a slightly misleading title as part from Wednesdays and Sundays when I did not have to report for duty until 11pm, the hours were 1pm – 9:30pm, then on call until 8am the next morning. This meant that should there be an emergency operation between 9:30 PM and 8 AM I would have to stay up or get up if I had gone to bed.
Strangely, I remember very little about this period, except that one night, when assisting at an operation, I cannot have been following the usual procedure because the surgeon asked– “and whose method is this”–to which I could only reply “mine sir”.
Casualty – todays A & E– was another special department.
Some nurses loved being on casualty, never knowing what one would be called upon to deal with next, having to act quickly in an emergency. “Security” consisted of one rather elderly man in the little office– the Lodge – by the front entrance of the hospital. Casualty was very busy and, on a Friday and Saturday night, even the corridor outside the Department reeked of the mingled odours of beer and blood. Yet I never remember any nurse or doctor being attacked by a patient, either verbally or physically. The only policemen we saw were those bringing in the casualties.
Some patients I shall never forget. One of these was Maureen. Maureen was a nine year old whose mother died and lived with two aunts somewhere off Scotland Road. Her father was still serving with the army in North Africa. On bonfire night–it must have been 1946 –Maureen was crossing a piece of waste land and some boys threw a lighted firework at her. Her clothes caught fire and she suffered severe and extensive burns ,particularly over her back and abdomen. There was no children’s ward in hospital so Maureen was brought into the female surgical ward where for days her life hung in the balance.
A new treatment was tried. She was enveloped in a waterproof bag filled with normal saline solution which obviated the need to change a painful dressings. Nevertheless, Maureen did suffer great pain.
As she improved and was able to take solid food, she was allowed to have whatever she wanted (if we had it) and when she wanted it. However, her favourite food was fried eggs and somehow, her aunts managed to obtain a constant supply, so all times of the day and night the smell of frying eggs emitted from the kitchen. Maureen’s father had been granted compassionate leave but, after several weeks, it seems as if his daughter’s recovery was certain and he returned to his unit.
The following Sunday Maureen was taken to the operating theatre to have her bag changed under anaesthetic. Sunday was chosen as in the absence of the usual weekday activity there would be less chance of infection.
I was off duty that morning and when I returned I expected find Maureen back in bed. But I was met by the staff nurse whose eyes filled with tears– Maureen had died under the anaesthetic. Her gallant heart had given up. The whole hospital was plunged into sadness, even more poignant with her father’s return to Africa.
We were not encouraged to have boyfriends, engagements were frowned upon and, as to marriage– impossible! The philosophy behind this seemingly rigid approach was that, if the nurse became deeply emotionally involved with another person, she would be distracted and her work would suffer. Nursing was a vacation and nothing must be allowed to interfere with it
Yet, in spite of all its privations, hidden assets sustained us. The shared experiences of living-in brought real companionship. There was always someone to laugh or to cry with and many lifelong friendships were forged even from PTS days.
This solidarity was never so apparent to me as at the end of our third year when results of our final examinations came out. The results were due out on the particular Wednesday, which happened to be my day off. As I travelled over to the hospital in the evening, as usual by bus, ferry and tram, I reflected on how traumatic it would be to fail and especially if one was the only one to do so. Because I had always been quite successful in examinations I suppose I didn’t really think that person would be me.
,Reaching the nurses home, Home sister, an Irishwoman came from her office to meet me. She looked upset and it seemed to have some difficulty in telling me something. At last I understood. I was the only one who had failed!
I thanked her and slowly made my way upstairs where I found all my fellow nurses, not just from my PTS but others from the same year, congregated in one room. They had all passed but instead of being jubilant, they were sad– because I had failed. I really felt the strength of their support but felt I had to make a light of my disappointment in order to cheer them up!
Once back in my room, the Sister Tutor, a down to earth Scotswoman, came to see me. She was more annoyed than sympathetic and told me I had passed in the two main written examinations but failed in the practical and oral nursing section. This meant I should have to retake these and also the general nursing written paper.
Later, going over the practical and oral examinations in my mind, the only possible grounds on which I could have failed where my answers to the question, what is the antidote to an overdose of morphia? My answers of black coffee, walking the patient up-and-down obviously not sufficient.
The correct answer should have been another drug– Atropine, which has the opposite properties of morphia. However, six months later came the opportunity to take the examinations again and, this time, all was well. Later still, in spite of my shortcomings, at the annual prize-giving, I was delighted to be awarded the silver metal of the year.
In the end, only three from the seven young hopefuls who had begun training on 6 January 1945 were still there on 5 January 1949. One had to leave after a few weeks on the ward as she developed an allergy to Dettol, the only antiseptic then in use; another became ill with scarlet fever followed by complications. A third, always something of an enigma, suddenly and mysteriously disappeared. We were told she had gone to London but never discovered why. The fourth, quietest of us all, after 18 months had the temerity to marry a patient she met on the ward and so had to leave.
That left three– Olive, Josie and me. After a few years, Olive and Josie both went to live in New Zealand, one to the north, the other to the south. Although I have met each of them only once since leaving England we still keep in touch and I know those early experiences of “getting through” left such an indelible impression that they are as fresh in their memories as they are in mine.
Sadly, since completing these memories both Olive and Josie have died.