Part 7

Now the profession we have entered is, we are told, a noble one. We have been ranked shoulder to shoulder with the doctors, we have been compared to soldiers, we have been assured that our opportunities for doing good to souls are second only to those of the ministers. What more do we want? We want this, and we want it very much. We want the courage to accept our trials which must come if we are to have any glory. It is all very fine to be called a ministering angel, but it is pleasanter to minister to those who are appreciative. We can be heroic, in an emergency, but if we are not properly thanked, we do like to growl a little. It is gratifying to our vanity to be ranked with our masculine associates, but when it comes to the hard, thankless tasks which they accept without a murmur, then we proceed to show that we know what is what, and that our refined tastes cannot be so inconsiderately treated.

The trouble with these fretful nurses is that they are nurses. If they are not satisfied with the profession they have chosen, why do they not make a change and enter some other? Do they not know when they enter the work that it is hard, do they not hear on every side that it is exacting and confining? They knew it perfectly well before they began, why then do they complain? Why not say candidly, "I cannot have such enthusiasm for my fellow-men that I can forget myself," and then do something that is easier?

The Superintendent of the training school shows each new aspirant for the nursing profession that the life is not an easy one, that patience is one of the most necessary characteristics for the nurse. She tells her of the trials, the irritations, the unreason, the tiresomeness of sick people, and still women will come to the school, and forgetting the warnings, they will complain when some exasperating incident occurs. If a nurse, from overwork and the consequent weakening of her nervous energy, has lost her patience, she will be a wise woman if she drops out of nursing work for a year or more; this will probably help her, complaining never will.

Do you feel that your patient is cross or unreasonable? That is most likely, and is to be expected in nine cases out of every ten. Put yourself in your patient's place for a little while; try to realize what it is to have a pain, constant and sickening; to have it every minute of the twenty-four hours; try to imagine the fatigue of a respiration of forty; the ache and restlessness of a fever of 103 degrees; the agony of longing to change a position when it cannot be done; the despair of a hope for recovery growing daily less, or the realization of absolute weakness that comes with early convalescence; try to imagine yourself bearing some of these ills with nerves and brain weakened by disease, and you will not wonder that your patient is irritable, that he thinks the minutes of your absence are "hours," that the unevenness of the bed is "hard lumps," that the food is "slops," and the medicine "no good." Remember that he is a prisoner, and he has a cruel jailer; his bed is his prison, his disease is his jailer, and he suffers whatever torments his jailer chooses to inflict. Now prisoners are not, as a rule, a happy class of men; so bear with your prisoner and help him. Complaining about his shortcomings will never make them any the less. He is sick. Oh! the pathos of that short sentence, "He is sick;" that says all. You are well, or you ought to be; therefore bear with him.

You have chosen a hard profession, but we are told it is the noblest one a woman can follow. Why is it noble? Exactly because it is hard, and the hardness consists in your forgetting yourself and giving your strength to others. There are many hard lives that are not in the least noble, but there is no noble life that is not hard. A coal miner has, I suppose, a hard life, yet no one calls it a noble one; why? Because he works solely for his wages, and he complains and "strikes" when his wages and his hours do not suit him; but a doctor going from house to house, and in spite of all discouragements carrying cheer and hope; a city missionary going to the degraded, the ignorant, and by his own efforts helping his fellow-men to a better life, to a knowledge of God--these are noble lives. You can see I am sure the difference, and you will not gainsay me when I assure you that the doctor and the missionary, though they may not be satisfied with themselves, or with their manner of working, are happy men, happy because they live outside of themselves. The coal miner who is not content with his wages is miserable, because he himself and his needs loom up before him so large that every thing else is shut out. It is because you take a hard task and do it well, that so much praise is given to nurses. If you undertake a difficult task and fret over it all the time you are doing it, if you propose to benefit your fellow creatures and grumble because you have not comforts, or appreciation, or gratitude, where does the nobility go? Where is the heroism? If the task is easy, agreeable, delightful, the idea of heroism, of nobility, of all high aspiration dies directly. Did any one ever do a grand work and have an easy time while doing it? Did Florence Nightingale have all the comforts of life when she did her great work? Was it not by her indomitable perseverance, her great patience, and her enthusiasm for others that she won such an honored place for herself? You know almost before I say it, that there can be no loftiness of purpose, no enthusiasm, if there are not difficulties to be conquered, and you all know that complaining about sick people will never alter their characteristics, and that complaining about the nervousness of the relatives will never make less unreasoning, when they are fearful that a loved one is going to die.

Do we want gratitude and appreciation? We get it very often, and very often we do not; and when this last is the case, we may reflect that we are in very good company. How did the French reward Joan of Arc? The warmth of their gratitude led her to the stake. Galileo, as reward for his discovery, was put into prison and loaded with chains, as were also Christopher Columbus and Sir Walter Raleigh, a notable company these, and every one suffered from the ingratitude of their fellow-men. Many more examples you must call to mind, of ingratitude more base than any thing we shall ever be called upon to bear.

The profession of nursing is still one of the most recent that women have engaged in. The world had until the past few decades been so used to being nursed by the old-fashioned nurse, who was a servant, and who never expected any treatment but that of a servant, that it has taken some years to always remember that we are not servants, in the usual acceptation of the term; but no one will be convinced of the fact that we are ladies by our telling them so. If you are a lady, with a lady's refinement, every one in the house will know it, will feel it, and you will never mention the subject; they must feel it, then there will be no arguing on the subject. It must be demonstrated by your deftness, your quietness, your cheerfulness, your education, your intelligence, your quick appreciation of other good qualities. We must all of us show the world that it is being nursed by its compeers, that a lady can do even the most revolting service in a way that robs it of its difficulties; and when the hard part of the illness is over, when your patient is ready and anxious to be entertained, you can show that you are not a machine for carrying out the doctor's orders; that you are capable of something more than the ability to take temperature, pulse, and respiration.

We must remember that even yet we are, in a way, pioneers of one part of that great woman movement in the world. It is not enough to educate one family up to the realization that we are its equals; the next house we go to, the same work may have to be done over again; but each time it is done, and done well, the whole profession has been benefited, which is an aim worth striving for.

VIII

THE NURSE AS A TEACHER

It does not occur to every nurse, when she graduates, that she has been preparing herself, during all these strenuous years of study and hospital work, for the life of a teacher. She fondly imagines that she is a nurse, and only that; but after she has been doing private duty for a year or more, she realizes that she is generally a teacher as well as a nurse, and that often she is a missionary also.

Perhaps no private duty nurse needs to be told what subject she must teach; the patient or the patient's friends never let her rest until she has told the "why" of every thing she does, or does not. There are, however, some important subjects that the nurse- teacher should try to make very clear to every patient.

We will begin with the baby, as the babies are with us always, and if doctors and nurses, science and sanitation have their way, there will some time be no call but that of the baby, for nurse or doctor either. The ignorance of the young mother is proverbial; her wish to know about her baby and its care is pathetically earnest. The new life is so precious, she would take such good care of it, if she only knew how. Here is a pupil eager for knowledge, ready to do all that can be intelligently taught to her. The nurse should have very clearly in her mind all the mysteries of digestion, all the reasons for regularity in feeding, the necessity for fresh air, for long and uninterrupted slumber, for loose clothing, for regular bathing. She should be able to give the mother the rules for her own living that she may be able to provide the best milk for the baby, or, if the little one has to be artificially fed, the methods of preparing the particular food chosen should be explained, and the indications of indigestion pointed out. All this is real teaching, real missionary work, and if well done will help the mother immensely and probably save the baby many attacks of colic or worse. Washing the baby is usually regarded by the young mother as a terrible ordeal. No nurse should leave her young-mother patient until she is fully able to perform this task. Let the mother watch, a few mornings, while the nurse does all the work, then let her undress the baby, when the nurse can take him and finish the operation. Day by day let her do a little more, as her strength and ambition permit, until at the end of a week she is fairly used to handling the child and can, perhaps, keep him until the last finishing touches are put on. The nurse should always be near, to help, to advise, to take the child should the mother become exhausted. Finally, she should go into another room, and, leaving all things ready, allow the mother to perform the duty by herself, letting her know that at any time she will be relieved if necessary. In this way the mother becomes accustomed to the child, and the bath is always a pleasure to her. How many times have we heard pathetic stories of a young mother trying for the first time to wash the baby?--the tears of despair, the nervous blunders, the exhaustion when the performance was brought to a hasty close. All such stories mean that the nurse in charge was not a teacher and that her work when she left the case was not completed.

Suppose that this baby is the third or fourth, the mother knows what to do for the new little one, but how about the others? She is still anxious to do what is right, or perhaps she is not anxious, and her attitude toward the children is not what it should be. Perhaps she does not realize that she will be called to account for these souls intrusted to her care, that these bodies will do their part in life, well or ill, as she treats them wisely or foolishly. Here is true missionary work. A thoughtful, intelligent, judicious nurse can show a mother that an adenoid may be responsible for Johnny's inattention, as it causes dullness of hearing, how Mary's fretfulness is caused by too little sleep or by insufficient ventilation of her room at night. She can explain how irregular eating causes the children to be cross and irritable. She can show why the first teeth should be removed when the second begin to push towards the gum. She can teach the mother that the headaches so often met with, in children who go to school, are due, perhaps, to eye strain, and can not be corrected with pills, and should never be soothed with headache powders. She can show the evils of the gallons of soda water too many young women swallow, of the injudiciousness of allowing young girls to congregate in drug stores. These last two evils, "soda water and the drug store habit," the mother may know nothing about. She is busy at home with the "little ones," and the fourteen- or sixteen- year-old girl only too often is allowed to wander off "down town" with other young girls, and what she does there would astonish many a mother.

Every nurse should know how to teach her patient to guard herself and her children from tuberculosis. She should be able to show what the early symptoms are, what is then necessary to do, what care should be taken of the sputum, of the patient's food, of his eating and drinking vessels, his bed and bedding. She should know how to teach a tuberculosis patient to care for himself, how he can avoid giving his disease to others, if he stays at home; and where he will find proper hospital or sanatorium accommodations if he goes away.

Most mothers are very thankful for practical hints from one who is supposed to know, and who, during a four to six weeks' stay, makes herself one of the family, and offers advice in the right way and at the right time.

The great sex question is almost sure to be discussed at such a time. The advent of a new baby is such a wonderful thing that nearly always the other little ones want to know (very naturally) where it came from. Little folks are brimful of curiosity. It is Nature's way, I suppose, of teaching them. Every new thing fills them with admiration, with joy, and they must know all about it. "Oh, mamma, what a lovely new pony! Where did you get it?" "Is it really mine?" "Oh, papa, what a dandy, new sled! Where did you get it? Can't I use it right now?" "Oh, have we got a new baby? A real baby? Is it ours? Where did it come from?" "Can't I hold it?"

All are familiar with these expressions of wonder, of delight, of joy of possession, but how to satisfy the eager mind aright is a problem requiring our most careful thought. Books, papers, and magazines tell us what to say and how to say it. All this should be talked over, and, if the mother does not know, the nurse should know what books to tell her to read.

The medical world to-day is much concerned over the question of prostitution and its effect upon the coming race, through the transmission of syphilitic taint to an innocent wife, who is thereafter barren, or who bears syphilitic children. The folly of the double standard, purity insisted on for the wife, unchasity condoned in the husband; all these subjects are sure to be brought up, and the nurse who goes prepared on these and kindred topics can do an immense amount of good to the women she nurses.

She can show how useful the knowledge of chastity is to a boy-the strength that comes from self-control, the weakness that follows self-indulgence, the danger to himself and to those he really loves when he contaminates himself with prostitutes. A young man once said to a friend of mine, "Oh! if my mother had only warned me of the suffering I would cause myself and others, I never would have polluted my body and shamed my soul." The nurse should know how to instruct the mother as to the signs of self-abuse in her little boys, so that she may know what causes the nervous movements, the pallor, the fitful appetite, the dark circles under the eyes, the listlessness, the fondness for being alone--any one of which should call for extreme watchfulness. All these things a nurse should be sure to know, so that, as far as in her lies, she should be one more earnest woman striving to make the world better for her having lived and worked in it. A wise man has given this quaint description of a perfectly educated man: "When a man knows what he knows, when he knows what he does not know, when he knows where to go for what he should know, I call that a perfectly educated man." So with the nurse. When she finds a social problem with which she is not familiar, let her turn to this list of books, magazine articles, and pamphlets upon the subject: Chapman, Rose R., The Moral Problems of Children; Dock, Lavinia L., Hygiene and Morality; Hall, Winfield Scott, Reproduction and Sexual Hygiene; Henderson, Charles W., Education with Reference to Sex; Lyttelton, E., Training of the Young in the Laws of Sex; Morley, Margaret W., The Renewal of Life; Morrow, Dr. P. A., Social Diseases and Marriage; Saleeby, Caleb W., Parenthood and Race Culture; Wilson, Dr. Robert N., The American Boy and the Social Evil, The Nobility of Boyhood, 50 cents (contained in "The American Boy and the Social Evil"); Hall, Stanley, Educational Problems, Chapter on the Pedagogy of Sex, Adolescence, Youth; Northcoate, H., Christianity and Sex Problems; Janney, Dr. Edward O., The White Slave Traffic in America; Report of the 3 8th Conference of Charities and Corrections, in Boston, June, 1911, Sex-Hygiene Section; Kauffman, Reginald Wright, The House of Bondage; Summary of the Chicago Vice Commission, in the May number of Vigilance; Education with Reference to Sex in the August number of Vigilance (published monthly at 156 Fifth Ave., New York City, at five cents per copy); The Cause of Decency, Theodore Roosevelt, Outlook, July 15, 1911; articles on The Causes of Prostitution in Collier's Weekly, from time to time, since April 1, by Reginald Wright Kauffman; articles on the Necessity for Teaching Sex Hygiene, in Good Housekeeping, beginning with the September number; Dr. Dale's articles on Moral Prophylaxis, in the JOURNAL OF NURSING since the July number; Instructing Children in the Origin of Life, Elisabeth Robinson Scovil, in October JOURNAL OF NURSING; Leaflets and pamphlets published by American Motherhood, 188 Main Street, Cooperstown, New York; Publications of the American Association of Sanitary and Moral Prophylaxis, New York City, JOURNAL OF NURSING, February, 1912.

One last word and I have finished. Be careful, oh so careful, that your instructions are acceptable, that your pupil is anxious to be taught. Most mothers are anxious on these subjects; if one is encountered who does not care, first try to make her care (and this is a task, indeed), and then teach her what to do and how to do it.

CONVALESCENCE

One frequently hears the private duty nurse deplore the necessity of her remaining with a patient during convalescence. "I wish," such a one would say, "that I never need stay with a patient after the temperature has been normal for ten days," or, "I do not mind the first two weeks of an obstetric case, then there is something to do, but after that I am ready to leave," or again, "When my patient is ready to go out driving, I always wish she would drive me home; half-sick people are not to my taste." I have often wondered if this feeling is not caused by the atmosphere of the hospital which has, during training, been the nurse's home,--the hospital, where the patient leaves at the earliest possible moment of recovery, to make room for someone else. The pupil nurse gets used to the excitement of critical illness, used to the hard work of constant watching and fighting for the patients' lives, and that, and only that, it seems to her, is nursing. So when she goes to her private cases, and her patient has a long period of convalescence, she feels out of place, she does not seem to be doing what she was trained to do, and she frets over it, until some happy day when the doctor releases her, and she is at liberty to go once more to some one who is at death's door.

Nurses seem to feel that caring for a convalescent is not "nursing," but there they are mistaken. After a serious illness it takes a long time to restore the patient to perfect health, some function may need the close watching which only trained eyes can give, and it is not beneath the dignity of the nurse to remain, and keep watch until every part is once more in perfect working order. Many nurses feel that it is not nursing to amuse a patient, but it is nursing to help him on to the healthy plane from which he has fallen, to play games with an invalid and to watch him, to read with him, and to watch, to walk or ride or travel with him, and to watch, always to watch, that the dreaded symptom does not appear, that the one part which still needs care gets it.

A surgeon does not spend all day, every day, with his gloves on, and his scalpel in his hand; he is not always operating, or even arranging for operations; he can find time to see patients, to sit and talk with them, to advise them, to cheer them, even to tell funny stories to them, but all the time he is watching them. A lawyer is not always pleading in the court room, a clergyman is not forever in the pulpit. The lawyer when talking to his client is just as truly a lawyer; the clergyman, when visiting his congregation, is just as truly a clergyman,--the sermon on Sunday is the climax, if I may so express it, of his week's work. The lawyer's speech to the jury is the point to which all his efforts tend after, perhaps, weeks of preparation. So the convalescence of a patient is the post climax of the nurse's undertaking. She begins with the climax, severe illness, operation, or obstetric case, whatever it may be, gradually the stress lessens, the whole atmosphere of the house becomes natural as the patient progresses toward recovery; but the process is not complete, and the nurse's work is not done until the doctor pronounces her trained care no longer necessary; then she may go, and feel that her work has been thoroughly done-no small comfort surely.

I wish I could show my young sister nurses how good for them this period of the patient's convalescence might be. The delightful rest of regular sleep, and regular meals comfortably eaten at a table instead of in solitude from a tray, the opportunity for regular exercise--these things come as a real luxury when one has been nursing a critically-ill patient, and anxiety has been with one, night and day. This is the period when the nurse's nerves, strained to their utmost, can regain their tone, where the responsibility borne by the doctor and shared by the nurse is not so great a weight, and the knowledge of one more victory over death, one more human life saved, gives a joyousness to the day that is good to experience.

The satisfaction of knowing that by your help the patient has come, perhaps, from the gates of death; the pleasure of noting day by day the return of healthful sensations, the gradual ever- growing desire to once more take his accustomed place in the life work that has been interrupted--all these are missed by the nurse who flies from convalescents.

May it not be that the change in occupation has something to do with this unwillingness to remain with a patient when he is convalescing? When a temperature has to be taken but once a day, or when the doctor only makes visits twice a week, when all the routine of the sick-room gives way to a more natural atmosphere, many nurses do not feel at ease, they do not read aloud pleasantly, they do not care for books, and, if the patient asks for this amusement, the reading is a torment to the nurse, and I imagine it does not afford much pleasure to the listener. A nurse once gave me a graphic description of her efforts to read "Romola" to a convalescent typhoid patient. The poor nurse knew nothing of Florence or of the Italian language, and her struggles over the foreign words in that book must have been funny enough. Her patient was not much edified--of that I am certain. If a nurse does not read aloud understandingly, she should make every effort to learn. She thereby increases her usefulness, and makes herself more acceptable to her patients. She adds to her own value. She is worth more. No nurse can tell when this method of passing the weary hours will be required of her, as it is almost certain that a patient of intelligence will ask for some mental refreshment.