There is one consolation, however; hopeful cases are usually far less dangerous than advanced ones. The refusal of sanatorium treatment is a loss to the individual only. Furthermore, we have this grim solace—when they finally consent to go, after weeks and months of delay, they do so, too late to help themselves, it is true, but at a time when they are most dangerous to other people.
Sanatorium Outfit. When a patient enters a sanatorium, the nurse must see that he is supplied with clothing heavy and warm enough for outdoor living. If he has money, he should be instructed what to buy. If he has none, these things must then be procured through some charitable association. No patient should be permitted to enter a sanatorium unless properly equipped, and frequently his decision against going is due to lack of such equipment.
In winter, he naturally requires much more than in summer. Roughly speaking, his wardrobe should contain at least two changes of flannel underclothing, a sweater, overcoat, woollen cap, woollen gloves, overshoes, flannel night clothing, a dressing-gown, toilet articles, and a hot-water bottle. Some institutions have a printed list of the articles required, which is sent to the patient when his application is accepted. A steamer rug is usually necessary, a cheap substitute for which may be found in the large horse-blanket, sold in saddlery shops.
Return from the Sanatorium. When a patient returns from a sojourn in an institution, he may or may not be better, but he has certainly received a liberal education in what to do, and how to take care of himself. Often, however, he is totally unable to apply this knowledge, or to adapt his home environment to his needs. So carefully is the institutional life planned, and so smoothly does he fit into it, that he has no conception of the time and thought that have gone into this planning. When he comes home, he knows theoretically what to do, but in comparison with the institution his home surroundings seem so poor and so inadequate, that he becomes hopelessly bewildered and confused. It is at this point that the nurse has her great opportunity. She teaches him to apply what he has learned, and how he may approximate sanatorium conditions and routine. She goes to work much as she does upon her first visit to the home, but this time she is working in a soil already ploughed. The patient himself may be almost as helpless, but he will follow suggestions, and co-operate with an intelligent enthusiasm gained through his sanatorium education.
Work for the Arrested Case. When a patient returns from the sanatorium able to work, the question of employment is a serious one. Our experience has been that of Dr. Lyman:[[8]] as a rule, unless it is an exceedingly injurious employment, it is better to let him return to his former occupation than to seek a new one. He understands his old work, and for this reason it will be easier for him than one to which he is unaccustomed. The difficulty of finding suitable employment for arrested cases, and the number of relapses that occur in consequence, serve once more to emphasize the value of prevention rather than cure.
[8]. Dr. David R. Lyman, Wallingford, Connecticut.
There is one point which must always be brought out. It is not so much what the patient does with his working hours, as what he does with his leisure hours, which determines his ability to hold his own. An arrested case may work eight or ten hours a day, in office, factory, or shop, and still remain well, provided he spends the remaining hours of the twenty-four in a proper manner. The ex-sanatorium case, rejoicing in his apparently restored health and in his regained liberty, feels that he can resume life on exactly the same terms as before. This he can never do. He has tuberculosis, and he always will have tuberculosis, although it may be latent at the moment. The fact that it is quiescent does not mean that it will not light up again at the slightest indiscretion. He must bear this fact constantly in mind and order his life accordingly. If he expects to work and remain well, he cannot burn the candle at both ends, even in the mildest manner. He must forego late hours, moving picture shows, poolrooms, saloons, dance halls—everything, no matter how harmless in itself, which places an extra strain upon his vitality. At the end of the day’s work he should rest quietly, preferably in the open-air. Eight or ten hours’ sleep at night is a necessity. The most critical time in a patient’s career is that which follows his return from a sanatorium, and it is at this particular moment that the nurse’s supervision and encouragement are so greatly needed.
Light Work. Many patients return from the sanatorium, unable to work at their former occupation, yet sufficiently strong to do “light work,” if such a thing can be found. In my experience, suitable “light work” for these cases has yet to be discovered. We all know of patients who have been given easy positions as night watchmen, elevator-men, corridor-men, office work, gardening, and so forth, and who have done well at such employment. The number of such positions, however, is so small and so out of proportion to the number of those who seek such occupation that it forms no adequate answer to the question; what light work can we find for the arrested case? Our present industrial system, which produces the class of people from which the consumptive is so largely recruited, also fails to provide proper employment for him after his so-called recovery. The pressure of this system makes it sufficiently difficult for an able-bodied man or woman to find work that pays, or even any work at all, but to find such work for the handicapped is almost impossible. Light work means light pay, and light pay means an insufficiency of food, clothing, and shelter, all three of which are needed for the maintenance of health. In these days when the physically fit cannot always earn a living wage, what chance has the poor consumptive?
Outdoor Work. Another favourite fallacy is the advantage of outdoor work for the returned patient. The sole value of outdoor work lies in the opportunity to breathe fresh air, but this benefit may be more than offset by the strain of long hours, exposure to heat, cold, and rain, the lifting of heavy weights, and so forth. All these objections apply to farm-work, driving delivery or freight waggons, the occupation of motorman, conductor, and so forth. Now and then, patients undertake work of this character and do well at it, but we cannot but believe that this is in spite, of, rather than because of, their occupation.
In summing up the nurse’s value to these discharged cases, we find her able to give immense assistance at a most crucial period in the patient’s life. By this help and advice, she can often prevent his relapse, or at least delay it for a long time. Her supervision provides incentive and encouragement, and her careful watchfulness, both of the patient and his household, is of value in detecting further danger signals. If, as too often happens, he is eventually swept under by currents too strong for him, she is still on the spot, tried counsellor and friend, to make safer and easier the downward path.