Making Good on Private Duty Part 6

In the first place get together everything you will need for the bath and subsequent dressing. Have the clothes all laid in order over a chair-back before an open fireplace, or over a radiator, or if no better expedient suggest itself, fill bottles with hot water, or get a hot water bag and fill that, and lay it _over_ the clothes arranged in the order you will need them, beginning the pile with the dress and having the band the last.

Have _two_ large, soft towels and keep them warm. If possible, have an ap.r.o.n made of rubber cloth to tie about your waist.

At your side, on the floor, have a small blanket ready to lay over the rubber ap.r.o.n when needed. Put your baby basket where you can reach it, be sure that it contains all the things you will need--sponge, soap, powder, pins, vaseline, etc., and an extra diaper or two. Now get the tub (tin) and pour in the water until it is about four inches deep. Have the water no warmer than 100 degrees F. Bath thermometers are made that are quite cheap, and a great convenience; one should always be at hand, as no nurse should ever trust her feelings as to whether the water is hot enough or not.

Always test any water to be used for the sick or the delicate with a thermometer. Another point a nurse should be most careful about, is to be careful that her hands are warm before she takes the baby, as her cold hands on his warm flesh will surely make him scream.

All being now ready, take the baby and sit down with him, spreading the blanket over your knees as you do so, and having the tub just in front of you on another chair. The sponge is best to use for the washing, but a piece of old table damask is very good.

Wash the eyes very carefully first, then the face, and dry on the towel. Now hold the baby's head over the tub and give that a good washing with soap on your bare hand, and rinse it well with plenty of water, always holding the left hand under the head and neck.

Bring him back on your lap and thoroughly dry his head, then wash and dry the ears carefully.

When you get this far you may undress the baby completely, being most careful yet not taking any unnecessary time. When he is quite ready for the tub, grasp him firmly with the right hand, letting the b.u.t.tocks rest in the palm of the hand, the fingers being outspread, and the thumb coming up almost to the pubic bone. With the left hand hold the head and shoulders. Lower him _very_ gently into the water. Any sudden movement is most injurious, as a baby must never cry when the band is off, if it can be avoided. He will often put out both hands as if trying to catch hold of something. If he seems frightened at the same time, and cries violently, let the b.u.t.tocks rest on the bottom of the tub, and with the right hand hold both of his, and he will be comforted.

I think it well to wash the whole body with your bare hand, well soaped. Be careful to wash under the arms, in the bend of the elbows, the groins, and under the knees, rinse him with the wash cloth or sponge, and now lay one warm towel on your lap, and take up the baby just as you put him in, slowly, and without shock, and lay him in the warm towel. Lay the second one over him, and draw over all the blanket, wrapping him up warm and snug. Put your hand inside the blanket and dry him. This can be easily and quickly done without at all uncovering the child. Pa.s.s the hand with a slight squeezing movement over each arm and leg, and over the front of the body. When this is done, you must undo the blanket, and take the upper towel and dry most carefully all the creases, and powder everywhere, especially if he is very fat. Get down to the very bottom of every crease, and be sure it is dry and powdered. Lay over the navel a compress of absorbent cotton, unless the child is over four weeks old, and over this the band, which should be unhemmed, and wide enough to extend from the hip to the armpit. Lay the palm of your right hand firmly over band and pad and turn the child carefully, holding your right hand still under him, and with the left, clear away all damp towels, and then straighten out the band that is wrinkled under one side.

Keep your knees close together. Now take away the right hand, and see that the baby's knees are on the right side of your knee, and the elbows well over the other side of your lap. Now you have the baby where he can kick, but he can't wriggle or spring off your lap. See that the back is dry, rub it a little with your hand, and powder. Look carefully in the deep dimple just at the coccyx and see if it is clean. Now pin the band snugly, but not too tight.

Use the smallest safety pins, and never pin directly over the spine. Sometimes the abdomen is very large and it will be necessary to make two little tucks in the lower edge of the band in front to make it fit snugly.

While the baby is still on his stomach, lay in place the diaper, and next the shirt, which should be open in the front, and the pinning blanket. Lay all of these just as they should be, as regards the back, and turn him, being careful to hold all the clothes in place. If he is liable to chafe, or the movements of the bowels are in any way irritating, use vaseline about the b.u.t.tocks. Now put the arms in the shirt sleeves and tie or b.u.t.ton it up, and then pin the petticoat or pinning blanket. Lay an extra diaper folded many times under him, and fold the pinning blanket just in three, bring the hem up to the waist and pin in place.

The dress goes on feet first. Slip it on over the pinning blanket, and pa.s.s the right hand up under the b.u.t.tocks, and with the left, pull the dress into place, put the little hands in the sleeves, and get it perfectly straight and smooth over the chest. Now pa.s.s the fore-finger of the left hand down inside of all the clothes, beginning at the neck, until you find the band (the first garment), take a small safety pin or any small ornamental pin, and pin thoroughly through everything. This last pin I consider most necessary, as it keeps the dress, shirt, band and all in place.

Turn the baby over once more and put a similar pin in the back of the dress, being very careful to get at the band. While the baby is in this position put the blanket he wears during the day over him, and a final turn brings him around, and he is washed and dressed all but his mouth, which must be carefully washed with clean, warm water or borax and water. This should be also done many times each day, if the mouth is sore, and always a sharp watch kept for white patches on lips, cheeks and tongue. If the baby has hair to brush, it is well to brush it. It makes him look very cunning, but if he is tired or sleepy, do not trouble him.

This washing and dressing should not occupy more than twenty minutes, I have done it in fifteen where the baby was very well behaved.

Be sure that the room is warm and that the windows and doors are kept closed. Do not allow admiring relatives to come and go, opening and shutting the doors as they do so. If they want to see the operation, let them come and stay. A baby should never be bathed in a tub until the stump of the cord is off and the navel well and strong. If there is any inclination to pouting of the navel, wash the child on your lap and do not take off the band until the rest of the baby is all washed, dried, and powdered.

Then take off band and compress, and put on fresh ones as quickly as possible, turn the child and pin as before directed.

In taking the clothing off, it is not necessary to turn the child at all, the band being the only thing pinned in the back.

N. B.--This method of bathing is for a normally healthy child, from the time it is one week old, until it is six months or more.

Until the stump of the cord has sloughed off, a baby should never be put into the tub. If after the stump has sloughed there seems to be any protrusion, or indeed any ulcerated look about the naval, it is best to bathe the child on your lap. In all such cases undress the baby as previously directed, until you come to the band (flannel belly band). Wash, rinse, wipe and powder him, being careful to make every part absolutely clean and dry. If the band is soiled or wrinkled, or out of shape in any way, remove it and put on a fresh one--looking every day, after three days, to see if the stump has come off--and if it is still adherent, being most careful not to disturb it in any way. Apply the fresh band immediately. Turn the baby on its stomach, and when the back is exposed, wash and rub the back gently with your warm hand. If the band does not need changing, unpin it, rub the back, pin it up again, and proceed in dressing as before. When the cord is once fairly off, and the navel smooth and clean, you can put the baby into the tub, very gently, slowly, and cautiously, remembering that a sudden movement on your part may, in fact, always will make him scream, and screaming with no band or compress on is for a baby a very frequent cause of umbilical hernia. If the cord is small when the child is born, there will be less danger of hernia, but if it be a large one, then beware! It will not always be your fault if the baby's navel is not small and flat when you are leaving your case, but you will always be blamed for it, if it is not. Notice carefully every morning when you bathe the child if there is any umbilical protrusion, and report it without delay to your doctor, if there is any, no matter how slight. This is not, however, the place to treat of umbilical hernia, and we will go on with the washing, If the child's skin is very tender, chafing easily, wash with castile soap suds, rinse and dry carefully, after every time he urinates, as well as when you bathe him.

Powder with talc.u.m powder. Sometimes no powder will do it any good, then try vaseline. If that will not do, ask the doctor if you can try oxide of zinc ointment. Ordinarily, extreme care in washing, drying and powdering will be sufficient, but it must be done every time the diaper is changed. In this, as in other things, eternal vigilance is absolutely necessary.

When the baby is about two or three weeks old, it is a good plan to put some alcohol into the water in which he is bathed--two or three ounces to the amount of water used in bathing. Have a small bowl of cooler water, 70 degrees to 80 degrees, for the face, and after that is washed, add a tablespoonful of alcohol to that also, for the head. It helps to toughen the skin, and prevents the baby from taking cold so easily.

If the baby seems much frightened by being put into the tub, spread a bath towel or small thin blanket over it and have someone hold his hands, so that he will not clutch so wildly at everything, then lower him into the water, towel and all, and he will not notice it so much.

I know of no place where deftness of handling shows to such advantage as with a baby. He knows well enough if he is handled properly or not, and his fretful cry, or violent screams, will tell you without delay if he is not comfortable.

Once more, let me impress upon the minds of all who read this, the necessity of having everything used about the tub and subsequent dressing, warm. Anything cold will make the little one scream, and I think all nurses will agree with me, that there is no more nervous work than washing and dressing a baby who is crying (and once he begins, he is only too apt to keep it up during the entire time). This is especially true if a weak, ignorant mother is made nervous by the noise, or a doting grandmother hovers about, making remarks about "new fashioned ways," and wondering why this child should cry when his mother was always so good, as a baby, in her bath.

Now, as to the time of washing a baby. The morning is unquestionably the time, but if the baby be very young (less than two weeks) and has been wakeful during the night, I would let him have his nap, even if it did delay you and interfere with your plan of work. If he sleeps he is comfortable, and, unless for some more serious reason than the bath, he ought not to be disturbed.

This, for babies in private practice. Hospital babies cannot be so tenderly cared for. When there are ten or eleven to be washed in one morning, choose, of course, the ones that are awake, as far as you can, but there will always be one or two sleepy, warm little ones about whom you will have some twinges of conscience as you begin to wash their faces, but the work presses so, it must be done.

A baby should not be bathed just after nursing, or when he is hungry. Yet, most little babies go to sleep at the breast, and very often do not waken until they are once more ready for eating.

This seems like stating a difficult problem, and I know it is not always easy to select just the proper time, but the best way, I think, is this.

If the baby is nursing from the breast, tell the mother, after this nursing you wish to wash the child, and not to let him go off for sound sleep. She can prevent it, and keep him for the twenty minutes or half an hour it is necessary to wait after his meal, meantime you have time to get everything in readiness for the bath. It is a great mistake to attempt to bathe a baby when he is hungry. He will scream for his food from the beginning to the end of the performance, hesitating occasionally when something warm touches his mouth, and he eagerly seeks his meal, only to redouble his cries when not satisfied. Nothing is so persevering in its endeavors, as a hungry baby. Satisfy its appet.i.te first and wait a reasonable length of time, wash him deftly and quickly, and he will be so sleepy by the time you are through, you can lay him in his bed and he will be asleep in a moment, when you can pick up all the soiled clothing and the general "mess" of the bathing operation, and leave the room once more tidy.

And just here, let me say a little about the washing of the baby's clothes. Of course the dresses or slips, skirts, and the diapers go to the laundress. Begin every morning on an entirely new, that is newly-washed, set of diapers. Gather up all that have been used the past twenty-four hours and have them washed. Perhaps they may not be ironed, but washed they should be, every twenty-four hours, even if you have to do it yourself, and I do not think a nurse should ever be called upon to do this. Still, I would rather do it than use a diaper over and over again.

But it is of the little shirts I particularly wish to speak. I think the nurse should wash these, also the socks when they need it, and the knitted shawls most babies wear. It takes very little time to do this, and if you know how, you will do it much better than any laundress. The best way to wash these things is in cool borax water, and if there is any one place the baby has vomited on, put a little dry powdered borax on (the place being wet), and rub it in. Then wash by plunging it in the water and squeezing it out. Do this again and again until the garment is clean. Rinse in clear cool water, and wring as dry as possible in a towel; then pull in shape and lay it on a clean towel to dry. It is a good plan to lay it on a folded towel over a half shut register and place a single fold of towel over. It will dry very soon. If you are washing a baby's knitted shawl, be very careful about the wringing. Lay a large towel (bath towel is the best) out flat, and, having squeezed the most of the water from the blanket, lay it carefully on the towel and roll both together, and wring very tightly. If this towel gets wet take a second. When you are satisfied that it is as dry as you can make it, lay it out on a folded sheet on the floor, in some room not much used, and pull and arrange it into its original shape and size.

Anything made of Germantown wool stretches terribly, but you can arrange it as it ought to be. It will look ruffly here and there and ridgy all over, but when it is dry it will shrink down all right. Only do not hang it up, and when it is dry you will be surprised to find it looks as good as new. If you are ever consulted beforehand as to what would be nice for the baby, use all your eloquence against _any_ color being put into these knitted shawls. Germantown wool is the best to use, and plain knitting or brioche st.i.tch is the best to wear and wash, and these things must be washed with the most careful handling. On the nicest baby they will become dirty, and the delicate blues and pinks become the dismalest wrecks when washed. Therefore, tell your patient not to put any color in these first plain little comfortable shawls. They should be a yard long by about three- quarters wide. Two or three will be all you will need, and do not use any of the fancy blankets sent in by friends. Lay these all away, with a sachet bag or two, in some convenient drawer, and never take them out unless the baby is required to look very fine for a brief display to some friend. These delicate, fancy trifles when once wet through or vomited on are ruined, and it should be your aim to leave everything as good as you found it when you go from the house. There will be plenty of time after you have left, for the fond mamma to spoil all the pretty things, and as she does so she will appreciate more and more your care of them.

XIII

THE VALLEY OF THE SHADOW

I suppose that no nurse deliberately chooses to go to an incurable case, yet most of us who have done private nursing have found ourselves at some time caring for one who slowly, and painfully, creeps nearer day by day to the great End. We have gone perhaps to stay a few weeks, for some acute disease, but symptoms have changed, and instead of recovery, a long, slow decline is to be faced, the nurse feeling she is needed, decides to stay and do what she can for the poor failing body, and so the weeks drag on in the dreadful monotony of that one sick room, until we feel that we have been left out of the real nursing world, that we are stranded with our patient upon an island of pain, that there is no outlook but the one dread Valley, no moving object but the river of Death, and no hope for the life we are guarding. Each week we grow more and more rusty as to our hardly-won surgical technic, more out of touch with those who come and go to one patient after the other, and who not unnaturally count upon so and so many victories over the very enemy who we know will overcome the life we are fighting to save. Yet we realize that all our care will never bring victory, all our skill can but help to smooth the rugged pathway, down which the feet must tread alone. The endless repet.i.tion of the same symptoms is wearying, the only possible variation being some new pain, which indicates another stage in the development of the disease. An improvement hardly cheers us, as we know it is but temporary, and maybe followed by an exacerbation of the trouble.

Often the actual nursing calls but for a portion of the day, but that portion is so necessary that the nurse's presence is imperatively demanded. The remainder of the time little is to be done, except perhaps a guard maintained over the failing strength, a watch kept for untoward accidents that might snap the frail thread that binds the spirit still to earth. Probably the bedroom must be kept tidy, and the patient's clothing cared for, and the nurse feels she has degenerated into a servant.

One who has gone through with an experience like this, and who has courageously remained with her patient to the end, has pa.s.sed through a training more severe than any she has had in her hospital life, and she has earned a new diploma.

There are some things which the nurse may do to lighten these dark days, some things which may help both herself and her patient, and these I will try to show.

_Firstly_, it is well to study your case from a pathological view point. Find out the heredity, the manner of the daily life, the first manifestation of the disease, what circ.u.mstances led to it, how it was treated, what success the treatment seemed to have, what symptoms can now be noted, what complications have shown themselves, and their influence on the original disease. A careful history could be written embracing all of these points, and as new symptoms appear they should be observed and noted. All this should be valuable and should help some future day to show some one who has but started on the dreaded pathway, how to avoid what will surely be a fatal disease. Many a valuable paper could be written in the long hours when the nurse feels she is losing her time, if she would intelligently study her case, and write the story of the disease, what led to it, and how it is being combated.

Perhaps, if it could be arranged, the nurse might be spared part of a day once or twice a week, and she could go to her hospital out patient department, or to some dispensary and do some work that carries a little feeling of success with it; work in a babies milk station, or almost any of the numerous charitable activities, would rest and refresh one who has for months been with the same patient.

_Secondly_, as a psychological study. We all know we must die, we feel that we talk to people every day who perhaps will not be alive a twelvemonth hence; but we are not actually certain that ourselves or any of our friends will so soon be dead, and we habitually act and speak as if we all were to live on indefinitely.

So to be closely a.s.sociated with some one who we know is drawing closer and closer to the life beyond the grave, is a very solemn thing; whether the sick one knows it or not, the nurse knows it, and such an one must be viewed with peculiar interest.

She is so near to knowing the great Mystery. She will so soon see those who have gone before. The present helplessness will so marvelously become Life Everlasting. It seems, as the end comes nearer, and yet more near, as if, perhaps, one could send a message to some of our own loved ones gone on before, "If you see some of my dear ones, on that other sh.o.r.e, bear them a loving greeting from me, tell them I am trying to live as they would have me live." Such a thought trembles on the tongue, so near does the unseen seem to come to us.

In the face of these things, how small do the thoughts of our own dignity seem. It is all _service_, and service is what we were made for.

"I pa.s.s this way but once, if, therefore, there is _any_ service I can perform for my fellow man let me do it now, for I shall not pa.s.s this way again." This quotation is familiar to all, and especially does it come to mind when we minister to those who are to die. When they are gone there will be no bringing them back to explain duties slighted or left undone. "We pa.s.s this way but once."

_Thirdly_, from a religious point of view. It is quite impossible to say, what exactly is the nurse's duty as regards the religious side of her ministration, though the wish to help must be often in the mind of every thoughtful nurse who has charge of an incurable case.

The patient may not know her condition, and the doctor may not wish her to be told, then, of course, the nurse's lips must be sealed, as to any allusion to the dread truth. The religious views of the patient and her friends may be different from anything that the nurse knows, or perhaps the family pastor comes frequently, and instructs and comforts the sick one, and the family.

A patient will sometimes _ask_ for the reading of some portion of the Bible, and unless the part is specified the nurse may be at a loss just where to turn. Some parts of the Scriptures are so generally known and accepted, that they can hardly fail to give hope and comfort, no matter what the religious teaching may have been heretofore.

I will suggest then _in case_ readings are asked for. The Psalms are full of beautiful comforting thoughts and prayers. The 23d has helped many a poor soul about to take its last journey, the 37th, which begins "Fret not thyself," shows that those are truly blessed who trust in the Lord, the 51st, "Have mercy upon me, O G.o.d," teaches repentance, the 42d, "As the hart pants after the water-brooks, so longeth my soul for Thee, O G.o.d," shows the desire of the soul for G.o.d.

In the New Testament, the 14th chapter of St. John's gospel is a universal favorite, on account of its comforting thoughts "In my Father's house are many mansions." In St. Luke's gospel chapter 15th, verse 11, we have the parable of the Prodigal Son, to show how complete and perfect is G.o.d's love, and His forgiveness, when sin is forsaken. In 1st Corinthians, 15th chapter, verse 20, we have a masterly argument for the resurrection from the dead, and a life beyond the grave. In Revelations, 14th chapter, 13th verse, is a very comforting thought for those who have led a strenuous life and are in much suffering.

These few references will help, I hope, if any nurse is called upon to read the Bible, and she feels a little nonplussed as to exactly where to turn.

There are of course innumerable pa.s.sages besides these, that could be found by the aid of a concordance, and which it would be wise to note on a slip of paper, ready for any call. Sometimes a patient will ask for a prayer, and it is not often that a nurse would feel competent to kneel down by the bedside and make an acceptable extemporaneous prayer, so I would suggest buying a volume of "Prayers for the Sick."

Very tiny, dainty little books can be purchased at the church book stores, full of these prayers.