Beyond Bed Pans: The Life of a Late 19th-century Young Nurse

In this autobiographical account of the life that awaited new nursing recruits in 1893, former nurse Mary Roberts Rinehart painted a vivid portrait of the daily obstacles that stood between nurses and the professional status they hoped to attain. Rinehart described the “simple, plain hell” faced by the young nurse, a description that challenged conventional expectations about professional work.

In August of 1893, then, at the age of seventeen years and six days, I entered the Pittsburgh Training School for Nurses, and a world so new, so strange and at times so terrible, that even now it hurts me to remember it. Not the hospital itself, a fine institution magnificently managed; not even the labor, although it finally destroyed my health and broke down my young body. But here was all the tragedy of the world gathered under one roof.

I had no preparation for it, nor for the human wreckage I was to encounter. I had no knowledge whatever of brutality, or cruelty, or starvation. They were words to me, and only words. Even childbirth still remained more or less of a mystery. But I served my probationary period of three months, and I ran the course as best I could. By the time I was ready to graduate—and I did graduate—there was no phase of human life and human suffering which I had not touched. And there was born in me something which has never died, which cannot die; a terrible and often devastating pity and compassion, for the weak, the sick and the humble. A sort of fierce resentment, too; that these things happen, apparently must happen, and that the world is powerless to prevent them.

Those years in a hospital entirely changed my sense of values. There is no credit to me in this. It is simply that I know what others must only surmise. But as time goes on I grow a little selfish, a little more detached. I cannot cure the pain of the world. Very often it is easier to close my eyes and ears to it; to sit here in my quiet study, and lock it out beyond closed doors.

For I think, were I to listen, that I should go mad.

I must be a little careful here. I want no sympathy for this girl, willfully and against opposition going into that hospital. But if for a few hours I can let you see this new world through her eyes, perhaps it will be helpful. She herself was but a small and unimportant center, around which took place the great adventures of birth and death. And sometimes there were miracles, too, and the dying lived or the wicked repented. For a hospital may deal in bodies, but sometimes it must treat a soul.

That first night duty was simply plain hell. Nowadays, when I have occasion to employ a nurse, she talks of eight-hour shifts, of a dozen things I do not understand. That hospital of one hundred and fifty beds, and with emergency operations day and night, was staffed with thirty nurses, all student nurses. We ran the wards, the private rooms, the operating rooms—two of them—the general dispensary, and the eye and ear clinic. Such a thing as a graduate nurse coming in to care for a private patient was unknown. Instead, during the second year of training, a small number of seniors was sent out on private duty. What was paid for them went to the hospital, not to them.

What is more, we followed our dead to the mortuary, with its strange silence, its stained-glass windows. An isolated room, very scary at night, where we bathed those poor bodies, clothed them in decent shrouds, and covered them with fair white sheets.

I had three wards, C, D, and E, on that night duty. Also I had the emergency ward—E, however, was a convalescent ward, and gave no trouble. But D was a nightmare. It was the men’s medical ward, and to it came the delirious typhoid cases, an occasional delirium tremens, any sick man who needed help. Not only was typhoid still raging in the city that year, but the aftermath of the panic of '93 which had ruined my father had filled the wards. Disease was fostered by ill-nourished bodies, and unemployment was still rife. That winter the bread lines wound for blocks around the city streets and men lay at night for shelter on the bare floors of the station houses. When they were brought in, injured or sick, they were ragged and filthy, their bodies gaunt. Sometimes they tried to kill themselves and we got them, dazed with drugs, writhing with poison, wet from the river.

The drug cases were very bad. If the drug had been a narcotic they had to be kept awake, roused from coma; they had, as soon as possible, to be walked about. One interne had a heroic method. He knotted towels, dipped them in ice water, and beat them to keep them awake. Then, an orderly on one side, himself on the other, he walked them up and down, up and down. They would stagger, go to sleep on their feet. More ice water, more walking. When they reached the walking stage they lived.

A small record which I kept for many years shows that I had eighteen deaths during that night duty. Several of them, of course, were in the emergency ward. In the wards proper the routine never varied. When the patient began to sink I sent for an interne, and he would come up in a dressing gown over his pajamas, with rumpled hair and heavy eyes; the internes, like the nurses, never had sufficient sleep. He would give some orders and go away, and I would be alone.

In the darkened ward I would place screens about the bed, and spend such time as I could behind them. Sometimes a night orderly would take my place there, but he had an entire floor, private rooms as well, and had little time. Long before the end the patient would become unconscious, and the passing was never painful. Indeed, in all that wide experience of death, only once did I see a man conscious to the end—a member of a fanatic religious cult which believed in immaculate conception for the human race, and whose followers were trying to convert me as he died.

I began to take death as a matter of course. In its ordinary manifestations it no longer disturbed me. But death by violence I resented, and still fear and resent, with a bitterness that is hard to put into words. The victims of man’s indifference, when caught in gigantic flywheels and broken, miners caught under falls of slate in badly shored cuttings; victims of passion, men and women, beaten, shot, cut.

One night a half dozen policemen carried in and laid on a bed in the emergency ward a man who had killed his wife and then cut his own throat. It was a ghastly wound, which I need not describe. They stood around, those policemen, watching me while the interne was on the way.I said nothing. Why save him, for that? If death was the answer, why not let him die then and there? But he was saved, incredibly saved, and after long weeks in the hospital they took him away one day, and before long he went to the gallows. It was strange to think of him, as he lay in his bed, knowing that he was being saved to be hanged. He had a tube in his throat for a long time, and even after that was gone he could not speak, for he had injured his vocal cords. So he went dumb to his fate. He had been drunk that night. He did not even remember what he had done.

Sometimes a delirious patient would escape. One of my men got as far as the street one night, clad only in his night shirt, and with the long roller towels which had confined him to his bed trailing from his hands and feet. These towels were used only in case of real need. Slip knots were made around wrists and ankles, and the other ends tied to the metal framework of the bed.

I was in the linen room at the time, recording treatments, when I felt that some one was behind me. I turned to see that tall gaunt figure, eyes blazing with fever, towels trailing. He was just behind me, but as I caught at him he turned and ran. I ran too, but he was too fast for me. He leaped down the main staircase and was out the front entrance before the orderly caught him.

After the four o’clock temperatures were taken, however, there would be as a rule two hours of quiet. It was then that the agony of sleep almost overcame me. I would get up, walk about, fight it desperately. To lay my head on the table would have been fatal, for I did not sleep in the daytime. I would stand at the small window looking out into the courtyard, and almost pray for dawn. I could not read, I did not think.

Indeed, I did very little thinking at all, and as little feeling as possible. Already I had become a sort of machine, functioning as best I could. When I felt I suffered, so I set up a defensive mechanism; don’t think, don’t feel. But this was not the result of any conscious effort. It was automatic.

Even in those bad hours before the dawn, however, I still had a sense of drama. Had I not been so weary perhaps I could have written then. But I could only have written of the hospital. It was my world. I had exchanged the world of the city and the country lanes for this smaller one, bounded by its brick walls, the stable, the fire engine house, and the disorderly houses across the street that contributed their own share of sickness and violence to us, their crimes of passion, their suicides.

For by that time I knew more about disorderly houses. Girls were brought in to us from them; sometimes they were only drunk and hysterical, sometimes they had tried to kill themselves, and sometimes they were ill. It was a poor district, and most of them were ignorant, pathetic. One girl had calloused feet, and she said she never wore shoes, except when she went out. But one day a college girl was brought in. She had taken poison.

All day the houses were closed and shuttered, but at nightfall they began to live. Then, at a window for air, one saw furtive figures walk up the street, hesitate, ring a doorbell. On holidays there were many such figures, and perhaps a wagon stopping and cases with bottles being carried in. Then the noise would rise, penetrate into the hospital itself. Sometimes there was a fight, and some man or woman would be brought to us, cut and bleeding.

On one such holiday night two women were carried in to me, in the Emergency Ward. They had quarreled, and slashed each other badly with razors. They lay side by side on the two narrow beds of that ward; each rather handsome, each with the bleached hair of the profession. They appeared to hold no rancor for what had occurred.

“I guess I was drunk, Nellie.”

“S’all right. So was I.”

I was still seventeen.

There were times when I felt that I could bear no more. It was the Emergency Ward which almost broke me. I stood one night beside a man who had been caught in a flywheel, and whose body felt like jelly. I wanted him to die quickly, not to go on breathing. Oh, stop breathing. I can’t stand it. Die and stop suffering. I can’t stand it. I can’t.

Source: Mary Roberts Rinehart, My Story (New York: Farrar & Rinehart, 1931), 45–46, 65–69.