Chapter Nine - Gaining Experience
Working as a State Registered Nurse
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Trish wanted experience in a busy Casualty department, and Hull Royal Infirmary was certainly busy. When a Night Sister position in Casualty became available in 1967, Trish applied for it. Even on night shifts there were always a couple of doctors on shift, and several staff nurses. The Night Sister position covered the night shifts in Casualty from Friday to Monday, which suited Trish, as the weekends were generally the busiest nights of the week. Hull was a bustling fishing town, and fishing in the North Sea was dangerous work. Nightclubs had largely replaced the dance halls of the 1950s, and young people were experimenting with LSD and amphetamines. Sometimes those experiments landed late-night revellers in a bed in Casualty. The cases were interesting and varied.
One night, there was a commotion in Casualty as the staff received notification that several ambulances were on their way. They were carrying firefighters who sustained injuries while fighting a fire in a brewery. The acrid smell of smoke and sweat announced the arrival of the injured firefighters. As staff assessed the incoming patients, they learned more about the incident that caused the injuries. When firefighters first arrived at the brewery, they assessed the scene and saw that the fire was on the main floor. They determined they needed to get up to the next level with their hoses and spray water down on the flames. There was a conveyer belt in the brewery that, during normal operation, carried glass beer bottles from the main floor up to a second level. The firefighters turned off the conveyer belt, then walked up it toward the upper level, dragging their hoses with them. In the chaos, someone accidentally turned the conveyer belt back on. Several firefighters who were walking up the narrow track lost their balance and fell off, as many bottles had done before them. They fell into the broken glass below, many of them onto outstretched hands, and were badly cut.
The first patient assigned to Trish was a tall, burly firefighter. Aside from several nasty lacerations on his hands, he had escaped serious injury. After helping him shed his heavy outer wear, Trish asked him to sit in a chair across from her. She had positioned the chair near to her suture table, where a fresh suture kit was waiting. As Trish opened the pack, she noticed a shift in her patient. She looked up just in time to see him slump heavily out of the chair and onto the floor. Trish scanned her corner of Casualty for help, but everyone was busy with their own patients. Her patient’s pulse and respirations were normal now that he was laying on the floor. It was most likely he had fainted, probably at the sight of the forceps and other instruments inside the suture kit. The man was much too large and heavy for Trish to move on her own. She considered waiting for him to come around, then prompting him to get back in the chair on his own accord. Worrying he might faint again as soon as she got to work, she decided to just join her patient on the floor and sew him up while he was there. At least he couldn’t fall any further. The patient roused quickly once he was on the floor, and was rather sheepish about the situation. It took a long time to pick all the glass out of his hands, clean the wounds and suture the lacerations. Trish chatted with him to keep him distracted while she worked. When she had finished and bandaged his hands, there was another firefighter waiting with similar injuries. Trish again invited him to sit in the chair across from her, and he did so. Trish gripped the heavy top of the suture table and gave it a tug to move it closer to her. Rather than sliding along the floor, the top-heavy table tipped over and landed squarely on her toe. The suture kit went flying, and in the commotion of setting the table right, and getting a fresh kit, Trish didn’t give much consideration to her wounded toe. By the end of her shift, it was impossible to ignore her toe, it was throbbing. Trish considered the situation, even if she had broken it, there wasn't much she could do about it. It just needed to heal. Exhausted, Trish became singularly focused on returning to the nurses' residence, having a bath, and crawling into bed after the busy night. It was not to be. The Senior Casualty Sister stopped her at the doors to Casualty, instructing her to fill out an accident report and get an X-ray of her toe. Trish questioned if it was necessary to get the Xray, there was nothing that would be done with the toe, even if it were broken. The Sister insisted, so Trish wearily went to Xray. It took hours to get the Xray and see the doctor. The toe was broken, and nothing was done with it, just as Trish suspected.
Though that night had been exceptional, most night shifts in Casualty at Hull Royal Infirmary were busy and exhausting. Days off were always a welcome relief. In Hull, much like at Alder Hey, nurses socialized together when their schedules permitted. Even though Trish didn’t have close friends among her colleagues, as she did at Alder Hey, she still joined for outings from time to time. On one occasion, after a nice dinner of fish & chips at the hospital cafeteria, Trish joined a group of nurses for an evening out at the fair that had set up in Hull. The young women went on one of the biggest rides at the fair. They entered one of the passenger pods, strapped in, and the ride began. It didn’t take long as the pod spun wildly, and turned upside down, for the women to be relieved of their fish & chips. That experience alone was enough to make the outing memorable, but the women carried on, playing the various games the fair offered. For their efforts, three of the women won coconuts as prizes. Not having experience with coconuts, they eagerly took them home to the Nurses’ Residence to break them open. It didn’t take long to realize they lacked the tools to crack open the coconuts. One of them came up with the idea that they could simply drop the coconut from a third-floor window, and it would crack open nicely on the pavement below. One woman offered her prize and with the other women gathered around, she dropped it out the window. When they ran down the stairs and outside to gather the spoils, there was nothing but a wet spot on the pavement, with a smattering of brown grit in the area. The two remaining coconut owners were understandably resistant to offer their prizes for further experiments.
Although Trish enjoyed her work as a Ward Sister, she felt she wanted something more. In 1968, at 27 years old, she had risen through the ranks to where the next promotion would land her in a mostly administrative position. Most wards had junior and senior Sisters, the more senior the position, the less hands-on work they did, and the more time they spent managing the administration of the ward. Additionally, every hospital had about four Administrative Sisters, who oversaw the operations of the entire hospital. Moving up into more senior Sister positions was referred to as “rolling down your sleeves and putting on the hard cuffs”. Hard cuffs were part of the nurse’s uniform. They were worn when the sleeves of the nurses’ uniform were rolled down to the wrists, as they were when completing paperwork, walking through the hospital to the dining room, or doing rounds with doctors. When a nurse did hands-on work with patients, she rolled her sleeves up and secured them with a pair of soft cuffs. The more senior the role, the less time was spent with sleeves rolled up doing patient care. Trish had no interest in “rolling down her sleeves”, she preferred to continue with hands-on nursing. Despite her desire to stay in hands-on roles, she was aware of the press of fresh graduates moving up the ranks, waiting for staff nurse positions and Sister positions. Trish began investigating international options. She applied to a job in New Zealand, but when she received a response, it was rejection. The sender of the rejection letter advised her qualifications would not transfer to New Zealand, she would need to go back to school on arrival. Financially, that was not a possibility. She kept searching for opportunities in English-speaking countries. As she devoted more effort to looking for international opportunities, she noted that many of the positions advertised specifically mentioned midwifery training as a requirement.
In early 1968, Jean left her job in Hull and returned to a job in Manchester. She suggested Trish also take a position in Manchester. Trish considered it, it would be nice to live near her friend, but ultimately she decided against it. With restless thoughts about her future filling her mind, she instead returned to Alder Hey into a junior Sister position on the B3 Isolation Ward. She also applied to the Midwifery - Part I training program at Canadian Red Cross Memorial Hospital in Taplow, Buckinghamshire. She was accepted into a class that started a later in the year.
While she waited, she settled into her new job on the B3 Isolation Ward. The senior sister in charge was Sister Bowen, and Trish and Sister Bowen didn’t have an easy relationship.
One day as Trish entered the ward office, Sister Bowen turned from her position at the desk and demanded, "Would you whistle if you were entering the Matron's office?"
Caught off guard, Trish asked, "Was I whistling here?"
"You were!" snapped Sister Bowen.
"Well" Trish said, "I probably would then, as I wasn't aware that I was whistling here!" With a grunt of disgust, Sister Bowen turned back to her paperwork.
The B3 ward consisted of rows of glass cubicles designed to isolate patients with infectious diseases. The patients were often babies with severe gastroenteritis. On wards with babies, and B3 was no exception, staff routinely boiled the rubber teats for baby bottles after each feeding to sterilize them. Only a certain number of the teats were issued to each ward, and the admin staff were reluctant to replace them without just cause. Staff were expected to carefully maintain the teats to make them last.
One hectic night, a nurse placed the ward’s entire supply of rubber teats on the stove to boil but got distracted and forgot about them. The acrid smell of burning rubber soon filled the air, alerting everyone to the disaster! Trish pulled the scorched pan off the stove. She and the staff nurse exchanged panicked glances, eyes watering from the overpowering smell. They now faced two major problems: how to eliminate the smell before the Night Sister made her rounds, and more importantly, how to replace the ruined teats for the next feeding.
They inspected the pan, wincing from the smell as they did so. It was ruined - caked with a thick layer of smelly rubber. They needed to get the pan out of the building, but simply throwing it out the window wasn’t an option. Instead, they tied a piece of string to the handle and lowered the pan out of the kitchen window, letting it hang there to air out. Thankfully, the cover of night hid their improvised solution.
With the pan temporarily dealt with, they turned to the more urgent issue: finding new teats. The task fell to the junior nurse, who was sent round all the wards to beg for a spare teat or two from each ward. While nurses from the other wards sympathized, most were reluctant to share, knowing they could easily face the same predicament. Still, enough teats were collected to cover the next feeding. For hours afterward, every window on the ward was thrown open, and all available fans were put to use, in an attempt to clear the lingering smell.
Because of the prevalence of gastroenteritis in patients on the B3 Isolation Ward, the bottom sheets on the beds were covered by thick, rubber half-sheets that were in turn, covered with another cotton sheet. The rubber sheets functioned as draw sheets, being placed under the patients’ buttocks. They often became so soiled the regular laundry service would not accept them. Once staff stripped a soiled bed, they put the rubber half-sheets in a bath of carbolic water, then through a mangle to wring out excess water. Trish hadn’t been working on B3 for long when she developed an itchy rash on her forearms. She thought it might be the carbolic water irritating her skin, so she went to the Dermatology Clinic at Alder Hey for a patch test. The patch test involved exposing her skin to several allergens to see which ones she reacted to. Her reaction to the patch test showed she was allergic to rubber. It wasn't the carbolic water that was irritating her skin; it was the rubber sheets. The dermatologist who did the testing had a field day with the results. He told everyone he met, “Lewis is allergic to her underwear!”
Intended as a clever joke, it was actually true; the waistbands of most underwear were rubber elastic. As news of her allergy spread, Trish was the recipient of at least two six-inch nails, with the instruction that she should push them through her bellybutton and hang her knickers on them, front and back - she was very thin in those days. Another thoughtful colleague gifted her two half coconut shells fixed together with rope, in case her bra also gave her trouble. She received enough packets of safety pins to last a decade. She wondered whatever happened to patient confidentiality! The bigger impact of the news was Trish needed to delay her upcoming midwifery training. Midwives wore rubber gloves for much of their work, and the dermatologist recommended Trish wait six months to let her skin heal before she could safely wear gloves again.
Six months passed, and the dermatologist cleared Trish to attend Midwifery training. When she gave notice that she would be leaving her position on the B3 ward, she was surprised to receive a good report from Sister Bowen. It had seemed they had been at odds most of the time. When Trish questioned the report, Sister Bowen said “I wrote what I wrote.” There was no further discussion.
The Canadian Red Cross Memorial Hospital was a general hospital with a very busy maternity ward. As part of the training, midwifery pupils ran pre- and post-natal clinics in nearby Slough and Maidenhead, communities with large immigrant populations. During the practical component of the training, midwifery pupils had to first observe 20 births that were managed by a qualified midwife, then deliver 20 babies themselves. Once they had completed the requirements, they could take the exam. Where it wasn’t usual for medical staff to wear rubber gloves in a hospital setting, save the operating theatres, midwives did wear rubber gloves for their work. As Trish progressed through the required 20 births she needed to manage independently, she was relieved to find the rubber gloves didn’t bother her much. She also realized she didn’t enjoy midwifery, but she needed at least the Midwifery - Part I training for international nursing applications. She was keen to complete the Part I training but had no intention of becoming a fully qualified Midwife. Trish fulfilled the requirements of the Midwifery – Part I program and wrote the qualifying exams. She anxiously awaited the outcome.
To distract her from worrying about the exam, Jean invited Trish to a “Nurses Christian House Party”. Although Trish had been part of the Anglican church growing up - her mother had her baptized as an infant, and she had been confirmed at age 15 - she had struggled with the doctrine of the Church. Something was missing. She passed through the rites based on age, rather than beliefs, and wondered about the meaning of it all. Since meeting Jean, Trish had occasionally attended Jean’s Evangelical church and found the teachings resonated with her. People had a choice whether they believed in God. Being baptized was a choice; being a Christian was a choice.
Jean introduced Trish to the national organization called “Nurses Christian Fellowship” back when Trish was still in PTS, and Jean was a visiting nurse in her first-year nurses’ training. Nurses Christian Fellowship held events and gatherings for Christian nurses all over the country, often renting stately homes and hosting week-long get-aways. Jean and Trish attended several of those events over the years. Many of the events followed a similar pattern - a week with guest speakers, musical acts, and fun at the Herne Bay Court Christian Conference Center in Kent, or at Capernwray Hall in Yorkshire. Once, she went with Jean to the Annual Keswick Convention. The convention had been taking place since 1875, and by the 1960s it was so big it was held in several large tents, over the span of a week. Christians from all over the world attended to hear well known speakers and preachers. Trish and Jean met many other nurses at the convention, including nurses from Germany who they became friendly with.
Following Trish’s midwifery exam, at the Nurses Christian house party in question, Jean let it slip to other attendees that Trish was awaiting exam results. At first Trish was mortified, what if she failed and then had to explain that to all these women? Of course she didn’t fail, and instead when she learned her results, dozens of nurses congratulated her and cheered her success!
When Trish returned to Alder Hey, and moved into the Night Sister position in Casualty. She continued researching international job opportunities and in early 1970, she found a small advertisement in the Liverpool Echo for a remote nursing position in Canada. The United Church of Canada had placed the advert. Trish already knew that Canada would accept her training and hire her as a “Graduate Nurse” with a reduced salary. If Trish wished to become a Registered Nurse in Canada and receive a full salary, she needed to write the qualifying exams at the University of British Columbia.
She applied for the job and waited for a response. To her delight, she received a letter that was not a rejection, rather; it was a job offer! The offer letter stated her midwifery training, combined with her experience in Casualty made her application stand out from others. Even better, it said Trish’s travel to Canada would be paid for through an immigration initiative by the Government of Canada! Travel to Canada was expensive, and Trish wanted to have a bit of money in reserve, in case she needed it once there. With the cost of travel covered, there were no barriers to her accepting the job.
Offer letter in hand, Trish went to the immigration office in Manchester to obtain her travel documents. The immigration official behind the desk asked for all her information, including where she would work in Canada. Trish provided the offer letter, which said the job was in “Namu, British Columbia”. Turning to the wall map of Canada behind his desk, the official searched for Namu. He couldn’t find it, and Trish could offer no guidance, she had never heard of it before receiving the offer letter, either. The official sent her home, telling her he needed more time to confirm that Namu was an actual place, before he could provide her travel documents. He seemed reluctant to send a young woman to a location he could not locate on the map. A few weeks later, once he had done his research and learned that Namu was a commercial cannery on the west coast of Canada and there was indeed a clinic there, Trish returned to Manchester to collect her travel documents.
The last months at Alder Hey as Trish prepared for her departure to Canada were bittersweet. She loved the kids she was caring for, and the rest of the staff. Alder Hey felt like home, in fact, it had BEEN her home for nearly a decade, save the few years she was in Hull. Still, she was keen to see what the future had in store for her.
On her last shift at Alder Hey, Trish faced the most upsetting case of her career. It was a quiet night in Casualty. The doctor had gone to rest in the sleeping room that was provided for quieter nights such as this one, and the second nurse was in the dining hall for dinner. Trish was alone when the parents of a young boy arrived, distraught, carrying their unconscious child. When Trish approached them, they desperately shoved the limp boy into Trish’s arms. She immediately placed him on the nearest gurney and checked for a pulse and respirations – there were none. Acting quickly, she rolled him into the resuscitation room, pressed the alarm button to summon help, intubated the child, and began chest compressions. As staff arrived, they seamlessly joined the resuscitation efforts. Meanwhile, a nurse led the parents aside, and through their tears, they described what had happened. They had been saying goodbye to friends on the sidewalk in front of their home when their young son dashed between two parked cars and into the road. A passing car struck him. Instead of calling 999 for an ambulance, the panicked parents scooped him up and drove to Alder Hey. It was later revealed that Alder Hey had not been the closest hospital. The parents had driven for more than 20 minutes with their unresponsive child in his mother’s arms. Tragically, that delay meant the child had been without oxygen for too long. Resuscitation attempts were futile. The boy was pronounced dead.
Breaking the news to the parents fell to the doctor. At that time, the parents were in the waiting room, comforting the young woman whose car had hit their son. She had followed them to the hospital, shaken and distraught. When the doctor told the parents their son was dead, their anguish was terrible to witness.
Trish had trouble coming to terms with the fact there wasn’t a mark on that beautiful young boy, yet he had a fatal injury. The whole situation was tragic, and a grim send-off for what would be her last shift as a nurse in England.
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Author’s note:
We often see our parents through the lens of their roles in our lives— caregivers, disciplinarians, cheerleaders. Perhaps they are our role models or mentors, but who were they before they became these things to us?"
To better understand who my parents were before they were, well, my parents, I set about interviewing them about their lives before marriage and kids. I started with my mom.
Trish Lewis was 18 years old and desperate to escape a mind-numbing administrative job at a factory in Liverpool in the 1950’s. She made the impulsive decision to join a friend to interview for nurse’s aide training at Alder Hey Children’s Hospital. That decision changed the trajectory of her life and launched her into an interesting and rewarding career as a nurse.
Trish is my mom, and this is her story, as told to me in a series of interviews in 2024. The story is pieced together from Mom’s memory, photos, and documents. As we all know, memory is fallible. In the telling of this story, some names have been changed, either because they could not be recalled, or to protect the privacy of the person. The Journey is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
If you are enjoying this story, you may also enjoy reading my memoir, “Resilience in the Rubble: A True Tale of Aid and Survival in Kashmir”. The book shares my experience as a first-time medical aid worker in Azad Kashmir, Pakistan, after an earthquake devastated the region in 2005. It also tells the story of Nadeem Malik, a local teenager who lived through the earthquake, and his struggle to provide for his family in the aftermath.
The Journey is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.