by Clark Nidaserialised here by permission of the author.

It was now Alan’s turn for Ward 15. Miss Arden was presently on-duty down there and Alan was due to relieve her at 5 o’clock. Mrs Wirral took him down a quarter of an hour early to show him the ropes. 

Miss Arden was sitting in a canvas-backed chair in the corridor, where she could see round the door of Room One which was slightly ajar. She looked up from her Bible and smiled as they approached, but no word was spoken. They crept past her as if they were in church. 

Mrs Wirral picked up a book from the table piled high with grubby old magazines. It was a bound manuscript book boldly labelled WARD 15. She opened the door of the office. When Alan was inside as well, she gently closed it. 

“When you come on the ward,” said Mrs Wirral, “don’t chat to the person already there. Don’t say things like ‘everything OK?’ – or ‘have you had any trouble?’ It’s not the sort of thing patients need to hear being said over their heads.”

She brandished the book she’d picked up. “Just read the ward book. That should tell you everything you need to know.” 

She opened the book on the office desk and beckoned Alan to stand beside her where they could both read it together. 

“Oh – and another thing. When you go off-duty, don’t say anything like ‘there’s been no trouble’ or ‘they’re no trouble’. It’s unlucky. The people coming on-duty might have trouble later.” 

She pointed to the most recent entries in the book. “There’s just one patient in at the moment – Mrs Codrington. Here’s what’s been written-up about her.” 

Alan read, in Miss Arden’s neat handwriting… 

Mrs Sheila Codrington.
Vomit: –, urine: iiiii, stools: –.
Confused and disorientated. Patient was unwilling to take a bath but complied eventually with the use of verbal persuasion. Patient offered no explanation for lesions observed on forearms. Complained that the ward was too hot and that noises in the overhead pipes prevented her from getting to sleep last night. On numerous occasions wanted to know the time and when her sister was coming for her. 

“So what would you make of that?”

“Nothing much. It all looks plain enough to me.”

“Does it now? Well there’s a lot of interesting things you can deduce from it. Things you need to know.”

“Like what?”

“This, for a start.” She pointed to the first entry. “Vomit, urine and stools. They’ve probably been telling you that nursing is all about bladders and bowels. You see plenty of that upstairs. But the same information is written in the ward book down here too.”

Alan squinted. “Do you have the same sort of trouble…?”

“No!” said Mrs Wirral scornfully. “Well – almost never. But it’s important nonetheless. Sister will want to know.”

She put her finger on the page. “Take the first entry. Vomit: –. This is what you normally see: nothing. If you see anything else – be warned! Know where the bowl is kept – and be sure to fetch it quickly if the patient calls out for it, or you’ll be changing the bed. I said just now that you don’t normally say anything over the patient’s head when you go off-duty – but it’s only fair to warn the person coming on-duty if the patient’s been vomiting.”

Alan grunted. 

“Now the next two: urine and stools…”

“Well that looks pretty obvious,” said Alan. 

“Well that’s just where you’re wrong. Pay attention carefully. When the patient wants to go to the toilet, you must accompany them there, and accompany them back again to their bed. Don’t let them flush the toilet themselves. You’ll notice there’s no chain on the cistern. You have to reach up and pull it. But before you do, note whether there’s urine or stools in the pan, or both. Take note of the condition of them. Constipated? Loose and offensive? Is the urine a funny colour? Any blood?”

“Why all that?”

“Because it’s important to know. Sister will look at the information to decide whether the patient needs a laxative, or a suppository. Whether they’re getting enough to drink. If the urine is strongly coloured, maybe they’re getting dehydrated. If there is any sign of sickness, the house doctor has to be informed. Perhaps they’re reacting badly to their drugs. When Assistant Matron comes round, she will want to know what’s being done about it. It’s up to you to know the answer.” 

Alan felt chastened. It was all pretty obvious in hindsight. 

“When you’ve accompanied the patient back to their room and seen them in bed, go and mark up the ward book. Note how we do it. There’s a ‘one’ for each time they pass urine or stools. There’s a bar over all the ones, and they’re all dotted. That’s how nurses write numbers.”

“Haven’t they learnt Arabic numerals yet? It’s a very clever system…”

Mrs Wirral ignored him. “Each time they go to the toilet, just stick another ‘one’ on the end. It can get quite long…” She flipped back a few pages and pointed out an entry which manifestly indicated a patient with diarrhoea. The unary numeral following the words “stools” looked like a centipede with a lot of heads. 

“Unless you’re told otherwise, only mark down the vomit, urine and stools. There will always be someone on-duty upstairs more senior than you to write up the report for the day. Leave notes on a separate bit of paper if you must. Normally it’s enough to just tell someone as you go off-duty.”

…to be continued.


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