‘What the Night Snow Knows’ By Wendi Bradshaw
As far as I could tell she was part of the furniture, the infrastructure of the place. Ancient she seemed then – probably no more than 45 years old, to my reckoning from now. Although, the few wisps of soft hair that were visible beneath her tight, starched cap were tinged with grey. Her face was perpetually wrinkled with the tired lines of chronic night duty and she held an austere, serious expression. She was known to be strict, with high expectations of her staff. This was a hospital, after all. She was Sister Mouse, the long-term SNO; the rank and title known colloquially as the “Snow”, cold and unforgiving; officially, the Senior Nursing Officer. This one aptly named too by the way her lightly-whiskered chin twitched in thought whenever there was an issue, of either staffing or more dire clinical concern. My first encounter with her had the potential to lead on to a long and dubious relationship – although by the end of that first evening her kind, more charitable side peeped through.
This was my very first stint of night-duty, after passing Preliminary Training School (PTS), in training to become a nurse. That initial two-month probationary period had already weeded out three disillusioned, young people who were glad to leave. In all honesty, I actually wondered why I’d stayed on myself. I wasn’t sure at all if nursing was really for me. Yet I’d been relegated to the orthopaedic ward, had passed PTS with good marks, so decided I’d just see what happened next.
In those days you weren’t taught so much as you were ‘trained’ (yes, there’s a difference). The expectation was pretty much to just pay attention and ‘catch on’. ‘Sink or swim’ or, more disastrously, ‘get thrown in the deep end’. The theoretical sessions taught the very practical bits about how to wash someone in bed, how to give enemas, do dressings and such. Yet the reliance on mastering the day-to-day nursing challenges and workloads was heavily-placed on the few clinical educators and other busy nurses. The more senior student nurses and the few registered nurses (RNs) called ‘Sister’ (even the few male nurses) supposedly taught the finer skills. Specifically-set critical assessments kept all up to standard. Some staff were kind, many were strict, and often they were just too busy to actively teach anything. And for someone who had an overwhelming and huge respect, bordering on fear of any kind of authority – being at the bottom of the hierarchical structure as a very junior person was daunting.
Back now to my first ever shift of night duty, on the orthopaedic ward. A place full of motor vehicle-damaged young men in traction and frail, fractured geriatrics. It’s just after 1.00 am, I’m trying to stay awake, when from an invisible shadow the Snow quietly glided in and startled me.
“Good evening … Nurse…. Crumb…” (squinting to read my name tag.) “…It seems quiet at the moment – care to do a round?”
“Er, of course, Miss. Ma’am”, I stuttered, caught in the sudden stress of hoping to recall the diagnoses of my patients.
“It’s Sister, not Miss,” she sternly corrected, “And I’m no Madame.” Slightly trembling, I put down the patient’s file I was trying to decipher, picked up my hand-over notes and started to lead her around my eight patients, most of whom were sound asleep. Stating who was in with what condition and which ones had theatre in the morning. At the end of the eighth patient, I breathed a quiet sigh and said “That’s it.” And mentally, momentarily, relaxed.
“What about the rest of the ward?”
“Oh, they’re not my patients” I retorted – “I don’t recall anything about them”.
Suddenly the air seemed thick enough to choke on – and through the dim light I could see Sister Mouse was momentarily speechless.
“I beg your pardon, Nurse Crumb? What do you mean?? Every patient on this ward is your patient” she intoned, slightly louder than before. “Now, please hand-over the rest of the ward.” I picked up my sheet, torch in hand, and we resumed, me reading off my list, until all the patients had been reviewed.
As we finished the round, she looked at me with a tiny frown, then smiled. “See? That wasn’t too bad, was it?” Then more sternly, “Never forget, Nurse Crumb, you must always, always, know every clinical issue about every person under your care. Lucky it wasn’t Sister Crotchett here tonight – for each patient she expects you to remember every detail: Age, medical team, marital status, previous history and religion. Now go back to your work and tell the Sister I’ll pop by later. Good night, Nurse Crumb.”
Now shaking with relief, and very awake, I resumed attention to my tasks; with minimal guidance that night as it turned out, as the Sister was busy. Student nurses frequently seemed to be a burden on the Sister’s workload. Yet, I tried to help, pay attention – and thanked the stars that Sister Crotchett hadn’t happened to be the Snow rostered on that night.
As the years progressed Sister Mouse and myself developed a respectable and professional friendship at round times. I was always conscientious and tried to recall as much clinical detail as I thought she’d need to know for hand-over, very soon realising that it was all pertinent. As I became more senior, I’d mention the concerns that may arise, the care and actions we should possibly pre-empt for certain patients. She appreciated this and was quietly encouraging. It also came to pass that other senior staff who knew her well got in with the ‘gossip’ – so to speak. Whilst Sister Mouse was too professional to pass on inappropriate information amongst general staff, occasionally an unusual story would filter down from the ranks. This suggests to me now how varied the issues and dramas of the lives contained within the hospital really were. Way beyond the simpler tangles of diagnosis, surgery, medications and therapy. In a concentrated form every aspect of human existence including family, living arrangements and work were invariably affected from the moment of admission through the progress of the patient’s stay. For most people illness and hospitalisation were a sudden interjection whose effect ranged from an annoying inconvenience to a grave and painful reminder of mortality.
One evening the ED was frantically busy. There’d been a bad motor-vehicle accident and it was raining heavy too. Whenever it rained a myriad of homeless ‘park fellows’ sought refuge in the ED, to have their chronic conditions considered; now, the place was full. Other dramas too, were unfolding. One of the third-year student nurses popped up on her break to share a story.
“Okay, so, the liner has just got in, just docked, from Naples. This Italian bloke was rushing down the gang-plank, eager to see his family, and he trips, falls down at the bottom – fractures his femur. Lots of drama, and finally he’s ambulanced in to ED…”
This had all happened later this afternoon, she enthused, before continuing,
“… By the time theatre’s arranged old Crotchett’s covering Snow, and they have the bloke pre-medded and waiting in holding bay. Then his wife arrives. Yelling, ‘Giovanni, Giovanni …’ and we can guess who she’s looking for. Crotchett stops her, says ‘sorry he’s waiting for theatre, he has a nasty leg break – you can’t see him now’… and the woman starts crying. Howling, really loud. Then her husband hears her, the commotion, he yells out “Mari-ya, I’m in-a hee-ya”… and the woman pleads with Crotchett to let her in to see him, before he goes to theatre. Relenting, she says ‘well ok, but just for a few minutes. He’s had sedation.’ And then, you’ll never guess … The wife slips in to the cubicle, and weird, loud noises are heard from within. Crotchett just goes up and opens the curtains, then whips them shut… goes up to the covering MO and says “do you know what they’re DOING in there??? Her shock gave it away – they were full-on, having it off! … wife on top, both of them going for it … apparently, he’d been away for three months! Crotchett doesn’t know what to do – ‘this is a hospital for goodness’ sake!’ Then she asks the MO to sort it out … he retorts, laughing “well, you said she could go in, I reckon you can sort it out!”
Despite its name, ED could occasionally be a place for human connections. Another evening a young gent fronted triage with an obvious injury to his face, slowly blackening eye and puffy cheek. He was deaf and didn’t speak but indicated very clearly that he’d been punched in the face. An x-ray was arranged and sure enough, his zygoma (cheekbone) had been fractured – ice was applied, a small cut dressed, and he stayed for a while before discharge. This story was relayed by Sister Mouse, by way of the triage nurse later that night. She continued,
“An hour or so later, another fellow, also deaf and apparently mute, came in to be seen. Now this seemed more than a bit coincidental. We haven’t seen a deaf person in ED for a while….”, she guessed. “Funny thing was, he had a badly swollen hand, and a dislocated knuckle…. He had to stay to be seen by the covering surgeon and then in the small hours the bloke with the black eye returned… no surprises that they were actually friends, and a little shy about things. After the second fellow had been examined they met in the hallway. They looked each other up and down, frowning. Then after some brief, silent gesticulations, they seemed to make up. Last I saw, they were waiting for the x-ray report. Hopefully they can get out of here soon – maybe pop up to the ‘Cross for a nice breakfast.”
When I first began my nursing training the three years ahead had loomed vast with the silhouette of an indomitable mountain. But suddenly, I was nearing the end of my term. During one very frantic night shift, several mad, ridiculous events transpired to give the illusion that we were really working in a battle zone poorly disguised as a hospital ward. Those desperate hours stretched long yet suddenly it was morning and I was disorientated with exhaustion. It was a relief to hand the drama and subsequent strategies over to the comparatively fresh morning team. As I walked out the back hospital door it was a striking surprise to see that the world still actually existed, the air was fresh, and the sun had risen. I dragged myself, wearily and overtired until I’d finally walked the short distance back to the nurses’ quarters.
At the entrance to the foyer was Sister Mouse, alighting from her ride back with someone else. She waved them goodbye, then approached me.
“Nurse Crumb, you look quite shattered”, she said. “Do you have time for a cuppa, before you retire?”
I didn’t feel like being polite and didn’t have the energy to chat with anyone – I needed to shower and crash. Knowing if it came at all, sleep would be fitful and restless. Yet for some reason I heard myself agree. We moved to the small dining space at the quarters, sourcing a vacant table in the near-empty room, near the hot urn and teabags.
“I saw you briefly – you lot were a bit preoccupied” she said, “Busy night, wasn’t it? That fellow should’ve gone to ICU… yet we weren’t to know…”
“Yes, not the best of nights”, I admitted.
“You don’t have long till you finish, do you?” She enquired.
“You’ve done very well through your time here, and I think you’ll be great as a registered nurse.” She said, briefly and sincerely.
“Actually, you know,” I responded, “I’m thinking after I do complete the training, I’ll have a break from here. From nursing. May try something else… but I’m not sure what. It can occasionally be good, but I don’t know if this is really for me – after all.”
She pondered this for a minute, and said that it was wise to recognise when a break was needed. Then she shared a final story, all the more profound for being true.
“A few years back there was a third-year nurse who had a particularly bad day. Now this happened just before I started working here, and you may have heard the story already – I got the details from the matron not long after. The nurse had actually finished her official training – she was just making up her sick-leave time, so she had maybe three weeks till she was set to leave. You know, staffing levels are quite good these days, but in those years it wasn’t unusual to have a ward run with only one RN, the rest being students. On this particular day, an RN, the third-year nurse herself, and a new PTS nurse were the only three nurses rostered on for the morning shift. The Sister had rung in sick. This was on Ward Ten, twenty-four beds, a busy surgical ward. It was a Monday. By 9.00 am surgical rounds had started, and the surgeon was in a particularly nasty mood. He wondered out loud who was in charge… wanted full hand-overs for all the afternoon cases and demanded to know why several things hadn’t been attended. He became belligerent, started yelling at the intern and at the third-year. She took it well and tried to see to his demands, yet she also had her own workload and all the medications to give – obviously the PTS wasn’t allowed to administer these – and it looked like the morning was only going to get worse. Just before lunch she took herself off to the bathroom, looked over the balcony – and apparently up at the sky. Later she said she noticed the sun was shining, and she was surprised to see how nice the world really looked outside. So, she left. Just walked out. Down the fire escape stairs at back. She didn’t tell anyone, walked back to the nurses’ quarters, packed her bags and by early afternoon she was on her way to Queensland. She needed to get away. But, at what cost? She left that PTS nurse to cope with all that, on her own.”
“What about admin?” I asked, “Why didn’t they do something – how was that allowed to happen?”
“Well, obviously they were alerted by the PTS – actually I believe the intern told them. Really, however, those workloads weren’t unusual… then…”. She paused.
“However, that isn’t the end. About three months later, the nurse returned – looking tanned and relaxed. She made an appointment with nursing admin and said to them she’d like to continue with her training, finish the last few weeks, and then finally register.
‘Well’, they told her – ‘we’ve decided to make an example of you. You can’t continue your training. If you want to be a nurse you’ll have to start over again.’”
I didn’t know what to say. I imagined the stress the third-year must have felt, in reflection to my awful night. Things would have to feel pretty dire, to just walk out, I thought.
Sister Mouse read my mind.
“I know”, she said. “They were pretty cruel to her I think, in not recognising or supporting her. But imagine how the PTS felt?”
We sipped our tea in silence for a few moments.
“I guess my point is,” she continued, “it’s important to be in constant touch, actively aware of how you’re feeling, and learn to recognise your limits. This job isn’t always easy and everyone has their strengths – and their breaking points. Get to know yours, and learn how to recognise when you’re reaching them. Who knows what may have happened if the third-year had stayed? What if she’d given the wrong medication, or dose? She could have killed someone. Yet, what she did could also have had awful ramifications for the patients – I don’t believe there were any – but it could also have ended really badly for the PTS nurse who in turn may have decided never to return. With less to lose from that point on – but really, a lot to lose. Her potential career. We’re only human. ‘Awful’ really can be dreadful- yet awful shifts do end. Find good supports, your friends, and learn more about yourself – especially how you feel. And you know, I reckon you’ll be fine.”
“Hmm…” I said after another moment, “I’m actually feeling really tired right now… and you know, the thought of lying in a nice cool, soft bed suddenly seems really good,” I smiled. I thanked her, and we left. That’s the last conversation I recall having with Sister Mouse. When I finally did head to bed that morning, I slept at a lot better than I ever imagined possible.
Afterwards when I finished my training, I went overseas. A nice long break travelling half-way around the globe. Had some memorable adventures in amazing places with interesting people, and made some great friends. I actually have the good fortune to know many terrific people I call friends, but my nursing friends are special. They’re always there. They don’t judge and they really appreciate, understand, how good and how bad it can be. Life. Drama, illness … and sometimes death. The many tragic and celebratory bits in between. Us humans, coping with it all. Getting by.
And the Night Snow – she knows them, too.