II
THE NURSE AND THE DOCTOR
I suppose no nurse goes through a training school without being duly impressed by all the doctors on the staff of lecturers that they, the doctors, are the generals of the campaign. She and her fellows are the aids, and that she will be kind enough to remember this fact, and not make suggestions to him, the doctor, or give him the fruits of her ripe experience of three years in a hospital, and more or less time, as may be, since she has graduated. But though this I think you all know, there are some points of your connections with the doctor which may not be quite so clear.
In the first place, then, remember that you are his aid, you are to help him in every way you can, you are never to work against him, never weaken the patient's confidence in him. If you do not understand why he does thus and so, ask for an explanation, if you know him pretty well, and if your questions are reasonable ones, and intelligently put, he will be glad to answer you, and explain all you wish explained; but if you do not know the reason of a certain order, and, moreover, if he will not tell you, do not assume that he does not know, or that he is cross; it may be some very uncertain, delicate experiment is being tried, and all he wants you to do is to tell him, with a free unbiased mind, what you see. Always, however, be loyal to him with the patient. When you are asked a thousand questions as to, "Why doesn't the doctor do this, or why does he do that?" you can always say that he does it, or does it not, for the patient's best good, of that you are assured, and they must be also.
You collect the facts and put them in an orderly way before the doctor; upon your observations and reports he bases his theories of the disease in many cases. You can see what perfect faith he must have in you, and how true you must be to him in order to secure your patient's best good. I have often heard doctors say, when speaking of a favorite nurse, as if it was the only virtue worth mentioning: "I am perfectly certain that when I am not present she will faithfully carry out my orders." Entire faithfulness takes precedence, I think, and deservedly so. Your accomplishments may be many, but if you have not this faithfulness, this obedience to the doctor as a rudder to the ship of your professional character, no matter how great may be the load of learning and accomplishments and good intentions, your self-will and vanity will bring you to the rocks where ruin is inevitable.
Do not fear losing your own individuality and independence. "He who obeys well, governs well," is a very old, and a very true saying, and your responsibilities will never cease. The more faithful you are to orders, the more trust and confidence will be reposed in you. You will have not only your patient, but the entire family looking to you for directions, for, upon your faithfulness, and the tact with which you administer your authority, will depend much of your success as nurses.
Be careful not to sever your relations with any patient unless your doctor knows all about it. Never leave your charge, no matter how urgent the reason may be, unless you tell him. You may be sick, or the place may be unsuited to you, or you to the place, and you may know that it is best for you to go. But speak first to the doctor, tell him candidly why you wish to go, and take counsel of him how you should act. If he tells you you may go, and you know that your place must be filled, do not offer as your substitute your best friend, or anyone else. If he wishes your counsel he will ask, and then you may tell him of anyone you think will suit the position, but do not offer your friend, as he may have some favorite of his own to put in your place. Of course the patient or her friends must know about the contemplated change— that I take for granted. Having consulted the doctor, will make everything satisfactory to the most careful practitioner. So, as said before, never go away from your patient, leaving in your place a nurse whom the doctor does not know. He has, in most cases, selected you for his patient, and he wants you, you may not 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.