Part 4

When you go for your rest, be sure to leave carefully written directions for the one who is to take your place, just as you do when in charge of a hospital ward, you leave your orders written out when you go for your "off duty." Show her how to keep the sick-room record, and be sure she understands it all before you leave.

As for the visitors, they are often difficult to manage, and here again you must have the family help you. Of course no visitors are allowed until the doctor gives permission. So far all is easy, but when they are admitted you will do well to make a little plan with the family. Tell them the patient may be seen at such an hour. Perhaps between eleven and twelve, perhaps between two and three, just as you consider her brighter in the morning or afternoon. Ask them who of the first and dearest friends is the quietest and most discreet, and then say that if they will kindly arrange for one visitor only to come each day, it would be so much better for the convalescent. The friends can always do this and they never object. They tell Mrs. Jones to come on Monday at two, and stay just fifteen minutes. On Tuesday Mrs. Smith can come, and so on, until by the end of the week the arrangement ceases to cause any comment, and soon, if all goes well, and the convalescence goes on without interruption, your rules and extreme care can be relaxed to suit the patient's own fancy.

Always carefully note if any visitor tires your patient, and manage so as not to let her come again until the sick one has more strength. It is better, I think, to sit in an adjoining room when your patient has a visitor. This gives you a chance to come into the room when the person has stayed long enough, and generally your entrance tells her very plainly that she ought to go, and she departs without you saying a word. If she does not, you will have to tell her that the doctor is very particular about not letting the patient talk too much, etc., etc., and get her out in that way. Be careful, when the visitor has gone, not to sit down and talk at length yourself. Give the patient a little nourishment, turn over her pillows, and if she seems at all wearied make her comfortable for a nap and let her sleep.

As to the servants they require pretty careful handling. Above all things, keep on the right side of the cook. If you have to go to the kitchen to do any of the cooking, do not make a mess, or, if you do, don't run off upstairs and leave it. Gather up your utensils and put them into the sink, and let the water run over them, and ask for the dishcloth: and if you do it pleasantly, the cook will probably tell you to "Niver need thim things," and you will thankfully obey her. If you really cannot stop to make all tidy after your cooking, you can say, "I'm sorry to make you extra work with these dishes, but I must hurry back upstairs." Some such little speech, with a pleasant smile, will make all things easy for you below stairs, and for the sake of all the friction it will save you, it is well worth the trouble. Often the cook will be glad to do the cooking if you tell her how; be careful to tell her, if it is eaten and enjoyed; and never let her know if it is rejected. Get rid of it upstairs by some contrivance, and be sure not to order that dish again. In many cases of course the cook will know all the little dishes the sick one will fancy, and you will have very little to do with her. Such instances are somewhat rare, and very delightful when they occur.

If there is much extra washing, you may have to use much diplomacy as regards the laundress; and if it is very disgusting washing, it is well to have a large pail, with a cover, upstairs. Thoroughly disinfect the clothes before you send them to the washing, as the odors are often sickening, and the laundress, like other servants, is very much afraid, usually, of clothing from a sick-bed. Carry or send the clothes to the washing as soon as possible after removing them from the bed; never, on any account, allow them to remain in the room.

The nurse cannot be too careful as to the amount of clothes she sends to the laundry. She should of course keep herself and the patient scrupulously clean; but she must reflect that private families do not have an unlimited store of towels and sheets, and if she is extravagant in this matter it will seriously detract from her acceptability.

In concluding, let me remind you that all these hints are intended for nurses going from one strange place to another, as you would in nursing fevers, or short surgical cases. Nurses who have chronic cases need none of these rules. They fall into a routine, and if they are detained in the family for any length of time, that shows that their work and methods are right, as far as that patient and family are concerned. But let them be careful when at last they leave the case, and go amongst strangers. The ways of one family are not the ways of another, and they must exercise much discretion to accommodate themselves to the new environment.

GENERAL REMARKS ON FOODS AND FEEDING

Always have all food presented to an invalid as tempting as possible. Use pretty china and glass, if you are permitted to do so, yet not the very finest the house affords; that might make the patient nervous lest some evil befall it. Absolutely clean napkins and tray cloths, a few green leaves about the plate, a rose on the tray; the chop or piece of chicken, the bird or the piece of steak ornamented with sprigs of parsley, the cold things really cold, and the hot ones hot, these are necessities of invalid's feeding, that mark the nurse who has a proper appreciation of a sick person's delicate sensibilities. Have all plates, cups and saucers hot, when they are for the reception of hot toast, coffee, tea, etc. Hot water plates are very convenient, and easily procured at any large china shop; but if they cannot be found, put the hot plate containing the chop over a bowl of boiling water, and cover with a hot saucer, fold a napkin around the baked potato, and you can carry the tray containing the dinner through cold halls and up staircases and it will arrive at your patient's room hot. Be careful not to fill the bowl so full of hot water that it will spill. Never fill a cup so full that it will spill its contents over into the saucer, it makes a disgusting looking mess. Have all fruit cold, oranges and grapes especially. Always look over a bunch of grapes and cut off the soft ones before you hand them to a patient. If you have foreign or California grapes, hold them for a moment under the cold water faucet and let the water run through the bunch, and all the cork dust will then be washed out.

If you peel and quarter an orange for your patient never let her see you do it, unless you are perfectly sure you will not get your hands covered with juice. Wash your hands before you bring it to be eaten.

Be careful not to have any suspicion of grease about the beef tea, broths, etc. A quick and easy way to remove all grease, is to fill a cup or bowl brimming full, let it stand a few moments that the grease may rise to the top, tip the cup a very little to one side, and the grease, to the last atom, will flow over the side of the cup; pour your broth carefully into a clean hot cup, and serve. Beef juice is more palatable with a little very brown toast.

Remember, that an invalid hardly ever likes any food made sweet. No matter what the taste may be in health, in sickness, sweet things are nauseous; for this reason ice cream bought at confectioners' is often rejected. Salt also must be used with caution, if the mouth and lips are tender, as is often the case; use the salt sparingly in all broths, etc.

If your patient cannot take milk, when, as in typhoid fever, the doctor wishes the diet to be wholly or for the most part of milk, try at first to remove the thick, bad taste by giving a little pure water or carbonic acid water after it. If that will not do, mix the carbonic acid water with it, and have both nice and cold. If a glass of milk is too much (and it will be in nine cases out of ten, especially if it is cold), give half a glass; if that is still too much, give quarter of a glass, or put more water with it. Never repeat a dose (of food) if it nauseates the patient. Make some change in quantity or quality, and you will, if you watch carefully, find out the right proportions.

A person lying flat down in bed cannot, of course, drink from a glass or cup, and a feeding cup is apt, by pouring too freely, to cause choking. A bent glass tube is the best arrangement, the patient can drink easily through this, and can regulate by sucking, the rapidity with which the food is taken. The tube should be cleaned immediately after each using, and if any beef tea or other food cannot be dislodged by letting water run through it, pass a string with a knot tied in it, through. Make the knot big enough to touch all sides of the tube, have it thoroughly wet, and the cleansing will be easily and quickly accomplished. If a patient prefers drinking from a glass, and can be raised in bed, always lay a napkin under the chin before you give the drink, and on no account have the glass or cup more than half full, if you do, it will surely spill.

In giving medicine that tastes very bitter or unpleasant in any way, bring, at the same time with the medicine, some water, milk, or whatever may be preferred, to take after it. Also a napkin to wipe the lips, especially if the patient be a man.

Always keep milk, beef tea, etc., covered in the refrigerator, and, if you can, see that this is cleaned every day. But this might cause the cook to feel aggrieved, so I put it as a suggestion merely. But if the refrigerator has a smell, and the cook seems touchy, the milk, etc., better be kept upstairs on some sheltered window-ledge, and carefully covered.

If you have your own little refrigerator upstairs, see to it that it is cleaned every day. Never put away anything in tin pails; always use earthen or china bowls or pitchers.

BEEF TEA.

Beef from the round, finely chopped and free from fat. Proportions, 1 lb. beef to 1 pint of water, cold. Let the beef soak in the water, stirring occasionally, for two hours; then put it on the stove and heat it until the red color disappears; never boil it. Skim off all grease, salt to taste.

BEEF JUICE.

Round steak cut an inch thick; slightly broil like beefsteak for the table, cut into squares of an inch, squeeze in a lemon squeezer, skim carefully and salt. Serve either very cold, or place the cup containing the juice in a bowl of boiling water, stir carefully, and as soon as the juice is warm serve. If left a moment too long it is spoiled, as it curdles. One pound of beef makes an after dinner coffee cup almost full of juice.

BEEF TEA IN A BOTTLE.

Put into a Mason's preserve jar, tightly corked, one pound of beef chopped as for ordinary beef tea. Put this into a kettle of cold water, with a saucer on the bottom, let it come slowly to a boil and boil for an hour. Take out of the bottle and squeeze the beef.

SCRAPED BEEF.

Take a piece of lean round steak, scrape with the edge of a spoon until the place scraped has no more meat on the surface, but only the white fibre, cut this off with a sharp knife, exposing once more a fresh surface. Season, and spread raw on bread and butter, or make into little cakes and broil slightly, according to the doctor's orders, or your patient's taste.

MUTTON BROTH.

Mutton from the neck. Proportions, 1 lb. of mutton to 1 quart of water, put the mutton and the water (cold) on the back of the stove, let it come slowly to a boil, boil until the meat is ready to fall from the bones. After straining out all the meat etc. add one tablespoonful of rice or barley. Simmer half an hour after adding rice or barley.

CLAM BROTH. NO. 1.