Always save whatever has been vomited by a patient for the doctor to see, and be able to give information as to when the vomiting took place, whether directly after food or liquid had been taken, or not; notice whether there was much straining or retching before actual vomiting occurred, also if it was preceded by pain, and the situation of the pain. Remove the vomit from the room immediately.
In the case of coughing, observe whether it comes on in paroxysms, or is incessant; whether it is dry and hard, or moist and accompanied with expectoration; whether it is worse at any particular time, and is attended with pain. If there is expectoration, this should be kept for the doctor’s inspection. If blood is brought up, note whether it is coughed up, vomited, or brought up from the back of the throat or mouth; remark whether the expectoration adheres to the side of the spitting-cup, or flows easily.
The number of times the bowels are moved in the 24 hours must be noted, and whether the motion is attended with pain, griping, or straining; also the colour of the motion, and, if the patient passes worms, whether they are round or flat, tape, or small and thread-like. Note in what quantities urine is passed; also how often, whether with any discomfort or pain either before or after, its colour and consistence, and if there be any deposit, its colour also.
Do not forget to give messages of inquiry, as sick people think much of such kindnesses. Do not read letters out without reading them to yourself first; you may come upon some passage about the patient that you do not care to repeat, and your hesitation will make him anxious and uncomfortable. In convalescence books are often a difficulty, and require most careful choosing. Something not exciting, but thoroughly amusing, is generally the best thing—the lightest novel you can find. In any case, be careful not to read too long at a time; the strain of listening and attending is very tiring. In extreme weakness, when there is nothing to be done, say something from time to time to take off the sense of loneliness, but do not ask unnecessary questions or touch your patient—it is very tiring; and never at any time lean against the bed and shake it, and do not put anything heavy over the patient’s feet; the weight tires, and a hot bottle warms much more effectually.
Remember that the process of settling for the night takes a long time, and be sure to begin early. Some people sleep better in the first part of the night, and you should notice the hour at which the patient gets sleepy, and arrange accordingly; if kept awake long past that hour, a restless night will be the consequence. It is never wise to wake the patient, even to give medicine, except by the doctor’s orders. You should have a small tray arranged with all the things you are likely to want in the night, except medicines. By means of the judiciously-placed screen, anything that has to be brought in can be quietly handed over the top without a sound. Door-hinges and handles should be carefully eased and oiled.
Real quietude means the absence of all excitement, and it must be remembered that anything out of the common will tend to excite the mind of a sufferer. Do not, therefore, walk on tip toe, for this, in addition to its unusual elaboration of the gait, invariably causes a certain amount of creaking. Speak in low tones, but do not whisper. A whisper will often awake a sleeper who would not be disturbed by an ordinary conversation; and never say “hush!” Let your clothes and foot covering be of as noiseless and unobtrusive a character as possible, and instead of gliding and tottering about like a rickety ghost, do not hesitate to walk. If you have occasion to say anything in the room, say it so that the patient can hear it if he wishes, and do not let him be aware of your conspiring privately with the others, especially at the door. The door has much to answer for. If it be visible from the bed, people open it cautiously, put their heads in and slowly withdraw again. If, as is more frequently the case, it is screened by the bed curtains, mysterious openings and shuttings are heard, unattended with any apparent ingress or egress, and sotto voce colloquies going on outside. When you enter, do so honestly and at once. Do not spend 5 minutes in turning the handle, thereby producing a series of irritating little clicks, finally terminating in a big snap, with which the door flies open. If the latch be at all rusty, a handle that is slowly wound back in this way will often stick, and either require to be rattled back in position, or, if left as it is, may start back suddenly, after a time, of its own accord, with a report like a pistol shot.
A bracket or table on the landing or in an adjoining room, where one can keep a basin, water, and a cloth for washing cups, &c., can nearly always be managed; and even if one has to carry everything up and down stairs, the comfort to the patient of systematic, dainty cleanliness more than repays the trouble. Some nurses seem to think it enough to place anything used outside the sickroom door, trusting to a chance maid seeing it and carrying it off. But this proceeding often worries the patient most exceedingly. He or she lies there and fidgets over the chance of that stray cup being whisked over by a passing skirt, with an ominous clatter and smash; and though this probably does not happen, the expectation of it keeps the mind on tenter-hooks, and prevents needful rest.
Let visitors sit between the door and the patient, getting the benefit of the air and not between him and the fire, thus getting in the direct current of foul air rushing towards the fireplace; they should be well in sight of the patient, and never admitted at meal times. While talking to the patient it is better to sit by the side of the bed and as near the pillow as possible, so that you may converse easily, while your face and body are turned in the same direction as his. By this means you can make all necessary observation of his features without enforcing the arrest of his eyes on your own, which is so embarrassing and disagreeable to one lying in bed, and is almost unavoidable when facing him. Keep him in as comfortable a position as possible, by all means, but do not be too demonstrative in smoothing the pillows and little offices of that sort. Fidgety attentions will worry and do more harm than downright neglect.
The Bed
The Bed.—The best kind of bed for the sick is a small iron bedstead, about 3½ ft. wide and not too high, with firm, level, spring mattress, and light warm covering, avoiding large heavy linen counterpanes, which, though oppressively weighty, give but little heat. It should be placed in such a position as will be most out of draughts, and at the same time convenient for the nurse in performing personal services for the patient. It must never have either side against a wall, nor be between the door and the fire. It is a point of some importance, especially in cases of long illness, to arrange the position of the bed so that the sick person can see the fire or look out of window. A second bed, or hammock, or stretcher on wheels, is often very useful for shifting the patient on to while airing and making the other bed.