Queens Nurse to Godzone

CHAPTER 1

I looked at the Toyota Corolla with alarm as the senior nursing officer handed me the keys. ‘Just follow me back to the district nursing rooms, Christine, and we can sort out the details of your employment.’

I got gingerly into the driver’s seat and looked at the gear lever; where the heck was reverse? I was used to driving a Bedford van while touring round New Zealand with my husband and young son, but this small car was rather different. Looking in the rear mirror I could see my new employer backing her car expertly from the car park and indicating a left turn. Frantically I crunched into what I hoped was reverse, and was relieved when the car inched out of its parking place at the panel beaters, where it had been having repairs done. With perspiration trickling down my back, I just managed to follow the rapidly disappearing green car. By the time I arrived at the district nursing headquarters, I was a nervous wreck. How, I wondered, was I going to cope with visiting patients in my new rural practice?

I thought back to my days as a district nurse in London in the early 60s. My transport had been a small ‘Moulton’ pushbike, with large baskets on front and back for my nursing bag and equipment. Although there were many cars about, it had been easy to manoeuvre around them and the distinctive ‘Queens Nurse’ uniform commanded respect.

I had always wanted to nurse in the community and as soon as I could after my general nursing training, took the Queens Institute of District Nursing course in London, where I had moved after I married. It had been an intensive four months, and after an exam we were let loose on the unsuspecting public. For a while I was under the supervision of a senior nurse but as staff were short, soon had my own district in Finsbury Park, North London, not far from Holloway where we had a flat.

Each day I had to cycle to the headquarters in Tollington Park and service my bag, pick up a clean apron and have my daily patient allocation. In the evening another ride back to write up notes, clean the bag and put in a new linen liner and leave it ready for the next day. Those were the days before pre-packaged dressings and sterilised instruments and syringes. We each had our own instruments and boilable syringes and needles. Needles were used again and again until they became blunt, or a hook formed at the tip. The trick was to run the tip over a piece of cotton-wool, and if it snagged a thread, it was decided to pension it off.

Dressings and cotton-wool balls were prepared and sterilised in metal biscuit tins in the oven; instruments were boiled at each patient’s house. A pan of boiling water, with a cup and saucer for lotion and dressings was waiting at the patient’s house. As the nurse arrived, she put her instruments or syringe into the pan and let them boil for five minutes, then drained the water away. By the time the patient was ready, instruments were usually cooled sufficiently to handle, though we all learned to harden our fingers, and for years afterwards I could hold hot dishes and plates when others burned themselves.

My area was quite large, and patients were often difficult to locate as it was a heavily populated part of London. There were many immigrants, mainly from the West Indies and Cyprus, particularly the Turkish part. At that time there was friction between the Turkish and Greeks living in Cypress and much of the discord was brought with the immigrating families. I mainly had dealings with groups of Turkish families and always found them pleasant and very hospitable; too much so when I had a lot of visits. It was hard to refuse the sweet, strong Turkish coffee accompanied by syrupy, sesame seeded pastries. I watched with interest the ritualistic preparation in copper, long-handled pans, while I was attending to my patient.I also watched my expanding waistline!

I found it difficult to communicate with the women who were usually kept away from Western influences and were not allowed to learn English. I had to use an interpreter, who was often a young schoolboy. As some of the treatment was relating to female problems, situations could get a little embarrassing for all concerned.

I had, of course had similar problems in my training in Birmingham, but now I was on my own, and nursing in a patient’s home.

‘Remember’, we were told by the district nurse tutor, ‘you are a guest in your patient’s home. You have no divine right to be there and you must always respect your patient’s belongings and way of life.’

CHAPTER 2

Those words were to return to me many times as a district nurse, both in London and New Zealand, though sometimes it was hard to accept the living conditions met in a patient’s home.

London in the early 60s still had many tenement buildings. Flats on the three or four stories led onto an open landing exposed to the elements and with a communal lavatory, usually overflowing, at each end. Lifts seldom worked, often smelling as if used as an addition toilet. Stairs were dark and echoing, but strangely we nurses never felt threatened or in danger, even during evening visits. There was still, then, respect for the medical profession.

Some houses we visited in London had been large family homes in Victorian times, now divided into apartment and bedsitting rooms, or ‘bedsits’. These consisted of a single room which doubled as bedroom and sitting room, often with a corner screened off as a kitchen. No microwaves in those days; a cooker and sink if you were lucky, but more likely a gas ring and jug and bowl. Toilets were shared and possibly a general bathroom with gas geyser to heat the water and a slot meter to give a few inches of tepid water for a bath. Occasionally there might be a house phone in the entrance hall, but more likely you had to look for a public call box that worked. Most of them did, too, as vandalism was not such a big issue, and in those days before mobile phones you never knew when a public phone would be needed.

Many of these houses were owned by immigrants, and they were overfilled with their relatives. I used to wonder how they ever survived, packed two and three families to a bedsit. Attending to their medical needs was a permanent problem, and privacy non-existent.

Most of the people were not well off and sometimes in the colder weather stayed huddled in bed.

One day I had to give an injection to an old lady that I had not visited before. I prepared the syringe, and called over to the bed, ‘Mrs Popolous, just stick your leg out of the bed, no need to come out in the cold.’ I duly gave the injection, but as I turned round to pack my things away, two more heads appeared from the mound of bedclothes. I hoped I had given it to the right patient!

Treating people in the tenement flats also had its problems as basic hygiene was difficult and sometimes abandoned altogether. One recurring problem was leg ulcers in the elderly. It was virtually impossible to keep them clean and sterile.

I was asked one day to call and see a lady who had ulcers on both legs. I found the door to the flat eventually and knocked several times. No answer. I pushed the door, which gave way and called the lady’s name, nearly gagging at the strong smell of urine that wafted from the rooms beyond.

‘In ‘ere, deary; ‘ oo is it?’

‘Queen’s District nurse.’

The patient was enormous, half sitting, half lying in a filthy chair, legs propped on a wooden box.

‘Sorry, can’t get up. It’s me legs, ye see. An’ ow is the dear Lady, then?’

I had become used to people asking after our Queen Elizabeth’s health and had to disillusion patients, by explaining that we had not just come hotfoot from Buckingham Palace.

I looked with horror at the swollen, weeping legs. Ulcers encircled each leg almost from knee to ankle, with dirty dressings draped around. There was a strong smell of urine, and I realised part of the moisture was from external contamination.

‘I can’t get down ye see; I catches me legs.’

I did the best I could and hoped I had made things a little more comfortable, but it was a little like trying to treat a gaping wound with a sticking plaster. I knew next day the situation would be as bad and nurses would be calling for years, never seeing any improvement. However Mrs Betts enjoyed the visits, and I was able to spend a little time chatting but I drew the line at a cup of tea.

Accepting refreshment was always a difficult situation. The basic hygiene so often was just that; very basic. Several of the houses had no running water, just a communal tap. Water had to be collected from a standpipe nearby for everything so its use was often minimal. It was difficult to refuse the odd cup of tea, especially when the patient had been looking forward to a daily visit from someone from the ‘outside world’, often the only visitor of the day. I had heard about the sociability of the London East End, but this was different. The population was not static, with comings and goings, and neighbours seldom communicating. My husband Ken and I lived in our flat for four years and never saw the people in the house on one side, though we did become friendly with the others.

As many of my patients lived alone, getting into the house was often a problem. Those that were on daily long-term visits often gave a key to the district nursing headquarters. Woe betide the nurse who forgot to collect a key at the beginning of her visits. It meant a long cycle back to the rooms to collect it.

I remember one lady I had to visit for the first time gave instructions that the nurse was to put her hand through the letter box, and locate the string that was hanging inside with the key attached and pull it through to open the door. What she omitted to say was that she had a large dog with her in the house.

Each time I opened the letterbox flap and started to put my hand through, the dog started to bark and I could feel his hot breath. After several attempts I was becoming frustrated and angry; I had a lot of visits to do.

I do not normally swear but suddenly shouted through the open letter box; ‘Oh b….ger off you stupid dog!’ He yelped and shot off under the patient’s bed, refusing to move until I left. After that we understood each other.

CHAPTER 3

Over