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- Making Good On Private Duty - 3/15 -


be all he wishes you were, but still such as you are, _there_ you are, he knows what you can and what you cannot do; and it is a great piece of impertinence for a nurse to go away unknown to the doctor, leaving a stranger in her place. The consequence, so far as he is concerned, will most likely be to have her name crossed off his list as "unreliable"--so be careful.

As to your records, keep them faithfully; the doctor usually looks them over very carefully, but sometimes you find one who passes them over in a lofty manner, rather trying when you take such pains with them. You may conclude that it is not necessary to keep them accurately in such a case, but this same doctor may ask you some day how long ago it was that the patient's temperature took such a sudden rise, or how many days it is since she first had solid food, and if you have accurately kept and carefully preserved your records, you can tell without a moment's hesitation. It is better, more business-like, and every way to be commended, that the nurse should keep, and be exceedingly particular about these records. If the doctor will write his orders on the fresh daily record at his morning visit, it is a great help to the nurse, but very often he is in a hurry and you must write them yourself. If you have to do this, take your record and write as he tells you, _when_ he tells you. If the orders are at all intricate it is your only way of being absolutely sure you have everything correct. It is a protection to you also, if the family are inclined to criticise.

A nice little point for you to remember is always to leave the doctor _alone_ with the patient for a few moments, if it is at all possible, at each visit, Wait until he has asked all the questions he wishes, or until you have told him all that is necessary to tell before the patient, and then on some errand, real or imaginary, leave the room. Of course, if the patient is desperately ill, you cannot do this, nor will it then be necessary.

It is a good plan to wait for the doctor at the head of the stairs, or at the foot, if you are likely to be over-heard, and tell him there all you could not say before the patient as to her condition, etc. He likewise may have something to say,--some final instruction to give, some caution he would not wish the patient to know of. This is also the time to speak about yourself if you are sick or tired, or unhappy in your position. Perhaps neither of you have anything to say, and a friendly nod and a "patient is doing nicely, nurse," will send you back to the sick- room feeling that your work is appreciated, which always goes a long way toward making the hard places easy. Your patients may be very curious as to what you have to say to the doctor, but you can readily and truly tell them that there are many things you have to say to him, that would be hard for you to say before them, and hard for them to hear too, and these are things you arrange outside.

Always be sure to have on a convenient table, if your doctor be of a homoeopathic school, a little covered tray, and on it two glasses, clean, and turned upside down to keep them from dust, teaspoons and covers for the glasses, also a small pitcher of fresh water. Many doctors of the old school also use some medicines in water, so it is best to have glasses always at hand.

Do not sit down when the doctor is making his professional call, unless he or the patient requests it. He will probably sit at the side of the bed, your place is at or near the foot. If the doctor knows the patient well, as a friend, and is inclined to stay a long time, chatting, you can go quietly to another part of the room, and take up your work or reading, but be sure the doctor has finished asking you questions before you go.

Use sparingly technical terms. If your patient's feet are oedematous, tell the doctor they are much swollen; if he _ask_ if they are oedematous tell him "yes," but do not volunteer to name the peculiar kind of swelling. If the abdomen is tympanitic, tell him it seems much distended; and if he questions much further, answer the questions fully and intelligently. If your patient has the symptoms of phlebitis, tell him of the rise of temperature, the swelling of the leg, the tenderness along the course of the vein, and he will know that you know and appreciate the gravity of the disease; but be sure you do not attempt to give the symptoms a name, that is not your place.

I would have you be very careful as to what instruments you carry; have them of the best. Let your thermometer be of the very best make.

There is nothing more trying in a small way than to have your thermometer doubted, and if you _know_ it is the best the market affords, if you take it to the instrument maker and have it tested once in a while, you need not fear, when you find an unusual temperature, and report it to the doctor, and he quietly proceeds to test your thermometer by his, which of course is always correct. Be sure that your hypodermic syringe will work; if the piston slips loosely after much using of brandy, aromatic ammonia, etc., take it to be repaired, and see that the needles are sharp, they become dulled very quickly; keep also the tiny wires pushed through them. It is just as well to keep this syringe in the room, its little case is very small and unobtrusive, and if you keep it near your thermometer in some safe, handy place, you will have it when some unforeseen emergency arises, and you do not want to lose time going to your room for it.

III

THE NURSE HERSELF

It is just as necessary for the nurse to be careful of herself as of the patient, though her care must be manifested in a far different way. Always remember that to do really good work you must have really good tools. No man owning, and intelligently working a valuable machine, would keep it going at its highest speed all the time. He takes care of it, keeps it clean, renews defective parts, oils it; and then he expects it to run for so many hours, and to run well,--to do its work thoroughly. But with all his keeping it in order he does not make it work night and day for weeks or months. Such folly is never heard of in an engineer; but with us human beings, who own and manage a far more wonderful machine than any steam engine, we hear of it often, and always, _always_ the tale winds up with the inevitable catastrophe. The business man develops paresis, the clergyman loses his voice or his eyes, the nurse contracts some disease that incapacitates her for work, in every case mother Nature makes the careless or ignorant owner of the wonderful machine pay the penalty of the misuse. It does not matter to Nature what the reason is for our breaking the great laws; we can kill ourselves with philanthropic work just as surely as with over indulgence. One trouble is, that it does not always _kill._ A paralytic may live for years, so does a man with paresis. When the wonderful God-given machine works badly, or stops entirely, we look on, and sometimes wonder why it is that those who are so helpful, such fine examples of courage, of skill, of virtue, so hardly to be spared, are the ones to be taken away. Do _we_ wonder, we who are nurses? Do we not know what did it? Ah! yes--we know, we know, that such and such a nurse was tired out when she went to still another case-- and when we heard she herself was ill we were not slow to say, "Foolish girl! Did she suppose she was made of wrought iron and sole leather?" But will _we_ take heed, and not do likewise, or will we wonder, with the unthinking ones, why it is that the good, useful people are always taken away? Do not deceive yourselves; they are not "taken away," they take themselves away, for God will not reverse His wise laws because we (no matter how good we are) act in defiance of them.

Please remember I am only speaking now to the good nurses--the enthusiastic ones,--poor nurses, lazy nurses have no temptation to overwork themselves. They may die of indigestion, but they will not die of exhaustion.

It seems to you so natural for others to be sick. You have seen the sick by scores in the hospital, and have waited on them, felt sorry for them, sympathized with them; but have you thought that it was within the bounds of possibility that _you_ could ever come into such a pitiable condition? You go from house to house in your private nursing, always you find the sick, and it seems natural, quite the proper thing. You care for them, they get well, or die--and on you go to the next--but reflect on what made them sick, and though you _know_ you are made of like flesh and blood, do not conduct yourself as if you were not. "Oh, yes" (how often have I heard it said), "I know she worked too hard, but I am so strong, you never heard _me_ complain; I can nurse a fever case for two weeks and never go out of doors for air or exercise." Is it not foolish? Is it not wrong for any sensible woman to talk thus?

Now listen to some few practical hints as to how to keep yourselves in good working order. In the first place, then, never go to a case unless you are feeling well. It is far wiser, as far as you are concerned, and better also for the sick one, for you to say so frankly, if you are not well. Tell the one who comes for you, that you could not do justice to the case, as indeed you could not. Sick people are as sensitive as babies to the subtle influence exerted by the one who is so constantly over them. If you are in full health and strength, your rubbing will be quieting and effectual, your very presence, if you are careful and gentle, will be soothing. On the contrary, if you yourself are suffering and are using the nervous force you ought to be giving your patient in hiding your own malady, your presence will not be so eagerly welcomed; your patient will not know what is the matter, but she feels rather a relief when you are absent. Going to a case feeling perfectly well, the next thing is to keep well.

Be careful about your _eating_. Your meals will of necessity be often irregular, that is unavoidable, but eat only wholesome things. Do not eat candy; and at dinner, which you will probably have in the evening after the family are through, avoid patties, and rich puddings, ice cream, and such like. You will always find plenty of plain food and fruit in the most luxurious homes; eat these and let the rest alone. If you want to keep your stomach and whole digestive apparatus in good order, you must care for it, and not overtax it. If you have a pretty good stomach it will bear a good deal of abuse, but in the end it will grumble, and a dyspeptic nurse is not an attractive object. As to your night suppers, which you should always have, should your case require constant watching, I would recommend plenty of coffee, tea, or cold milk, if you can drink it, bread and butter, cold meat and fruit. Never eat candied fruits, cake, or pies at night. Have eggs if you care for them, and pickles if you like. Remember, the plainest food, the most easily digested, the most nourishing is


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