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  This morning, her usual irritability was sharpened by a deep sense of injustice. She had been nursing the feeling of injustice for weeks now, and if she had thought about it at all, would have expected the feeling to remain unchanged this morning. But it was worse, worse even than it had been on the day of the final selection committee meeting, when she had been told that she had not been appointed to the matronship.

  She had applied for the post as soon as Miss Biggs’ retirement had been announced, quite certain that she would get the job. Was she not a Royal Gold Medallist? Had she not spent almost the whole of her professional life in the place? But it had been Elizabeth Manton who had snatched her rightful due from under her nose. Miss Manton, an outsider, an unknown quantity.

  It was, in a way, the nurses’ own fault that Dolly was more sharp eyed than ever this morning, even quicker to pounce on them. In common with every other student in the hospital, they had come on duty this morning looking neater than usual, more alert, conscious of the new matron in her office, ready to look their best for her first round. Even if Dolly had not wanted the matronship for herself, this would have hurt her feelings. She cared very much indeed about her nurses, desperately wanted them to be the best set of nurses in the hospital, wanted them to be immediately recognisable as her staff by their tidiness and efficiency, and much of her nagging and bad temper was directed at creating this image. And they had produced just the effect she wanted this morning, but not for her. She knew this, knew it was because of Miss Manton that they were a credit to the department today, and the knowledge rankled.

  Casualty was not a comfortable place to be on Miss Manton’s first day in office.

  By half past ten, the theatres were well under way. The tonsil list in the second theatre was running smoothly, each flushed loose-mouthed post-operative child on his trolley passing the incoming patient at the door with the precision of a planned choreography; surgeon and table nurse, anaesthetist and runner nurse moving along their organised routes with the ease of long practice. In the main theatre, the Indian registrar on the general surgical team was delicately and tediously working through a simple appendicectomy, while the anaesthetist half dozed at the head of the table, and the senior staff nurse, her brown-gloved hands resting against her green gown, yawned behind her mask as she watched the slow movements of the surgeon’s hands. He took at least twice as long as anyone else to do any operation, and this was a comfort. With any luck, the staff nurse would still be in the theatres when the new Matron arrived to do her first round, and that would be a very good thing.

  In her office, Daphne Cooper put down the phone as soon as Miss Baker had explained that ‘Matron would like to see you after lunch, if you don’t mind, Sister,’ and relaxed. She could have taken the registrar’s list after all, but it didn’t really matter. The staff nurse would have to take Mr. Jamieson’s list this afternoon too, and Jamieson would have to put up with it, like it or lump it. She smiled a little. He wouldn’t like it a bit, but she could handle him. ‘I’m afraid I must see Matron, Mr. Jamieson. Her first day, you see. I’m sure staff nurse will look after you very well——’

  Clearly there would be no Matron’s round this morning, not before the sisters had met her officially at their reporting session after lunch, so she quickly changed her theatre cap for her usual frilled and bowed one, and hurried out towards the big double doors.

  ‘If anyone wants me, Nickolls, tell them I’m in O.P.D., will you? I want to check on the waiting lists for tonsils. We might have to fit in an extra list if there are many on it,’ she told the theatre porter, whistling as he changed oxygen cylinders on the spare anaesthetic machine, and escaped before anyone could stop her.

  And Nickolls, who knew more about what went on in the hospital than anyone else, apart from the head porter, told the staff nurse as soon as he could that ‘Sister’s gone down to O.P. for a gossip with Sister Phillips, and Gawd ’elp anyone who bothers her.’

  In out-patients, there was noise, lots of noise. The big tiled waiting hall with its rows of tubular steel and canvas chairs was like an echo chamber, making the smallest sound reverberate against the ceiling, turning the clatter of trolley wheels into a cacophony, making ordinary human speech sound like roars of anger.

  Because it was impossible to be quiet there nurses were noisier than they needed to be. It was pleasant to be able to shout patients’ names above the din, to enjoy stretching one’s lungs to their utmost, to be able to clatter across the terrazzo floor without fear of being told off, as one was on the wards. And one could talk quietly of the most private things without fear of being overheard, something the patients well knew as they exchanged symptoms and surmise about treatment while they waited their turn on the uncomfortable chairs.

  It was because of the noise that Susan Phillips ran her department from her office, a tiny cubicle tucked away behind the lifts on the far side of the big waiting hall. She hated noise, hated the din that was so much a part of the day, and spent as little time as she possibly could out of the office. She would have been much happier, in one way, to have been a ward sister, to have a job where she could enjoy quietness, but a ward had its drawbacks. Only in O.P.D. could she be sure of having every evening off duty, every week-end, like Daphne Cooper did. Because she was in O.P.D., she and Daphne could spend more time together, and that was the way she wanted things to be. So, she was an out-patient sister, and spent her time in her office, stretching the paper work that was so much a part of her department to fill the day, while the nurses contentedly ran the clinics and clattered and shouted in the waiting hall.

  Daphne put her head round the door, and grinned at the bent fair head at the desk before coming to perch beside the pile of clinic lists on which Susan was working.

  ‘I’ve come for some gen about the tonsil waiting lists,’ she announced. ‘In case I might need to shove in another list in the theatres.’

  Susan’s wide blue eyes lit up with laughter. ‘The coffee’ll be in in about five minutes. I had a feeling you’d be needing the tonsil lists—or something——’ and she giggled delightedly.

  ‘Well, dammit, lovey, what’s a girl to do? Can’t wait for a natter till lunch time, can I? Not with East sitting there looking like Dracula’s grandmother, turning you off your grub.’

  ‘Poor old East. You can’t help feeling sorry for her.’

  ‘I can! Her and her big ideas. Honestly, Pip, just think what today would have been like if she had got it—don’t bear thinking of, do it?’ And Daphne’s mock cockney accent made Susan giggle again.

  ‘We wouldn’t have had her at meals, mind, if she had got it. Or in the Home. No more banging on the wall after ten o’clock at night if she was Matron, all tucked up in her flat in the hospital——’

  Daphne snorted. ‘I much care about East banging on the wall. She’s just jealous, anyway. Hasn’t a friend to call her own, and loathes us because we have.’

  ‘Lucky us,’ Susan said.

  ‘Lucky us. Lucky Manton. Poor old East.’ There was a tap on the door, and the O.P.D. orderly appeared with a tray of coffee.

  When the woman had gone, Daphne said, ‘Have you been told not to report till after lunch?’

  ‘Mmm.’

  ‘Wonder why? Just to show she’s new—you know——I’m boss now, and I’m doing things my way? La Biggs saw everyone at ten on Monday morning, so I’m going to be different?’

  ‘Sweety, I couldn’t care less, to put it mildly. She can’t make changes here, or in the theatres, can she? The consultants wouldn’t wear it. So she’ll go sweeping around the wards, and much I care.’

  ‘Oh, I’m not particularly worried—well, not much. Not for me. But she might try a rota, you know, with non-specialists.’

  ‘A rota?’

  ‘Make the sisters change round like the student nurses do. They do that in some hospitals, these days. Except for specialists, like theatre, and maternity, of course. Cotton and me, we’d have to stay put. But the rest of you—well,
you might find yourself on a medical ward any day now. Who knows?’

  Susan put her cup down and stared at Daphne in horror. ‘Oh, Daphne, she wouldn’t! I’d only get two or three nights off a week if she did that, and every other week-end! We’d never get out together any more!’

  Daphne threw her head back, and roared with laughter.

  ‘Oh, Pip, your face! If you could see it!’

  ‘Daphne Cooper, you’re a villain! You’re just trying to stir me up, that’s what you’re doing——’

  ‘I know, lovey. You always rise so beautifully! Silly Pip. I don’t suppose she’ll do any such thing, not for a moment. She’d have a riot on her hands if she did. But just think how they’d all flap if we told ’em at lunch we’d heard she was going to! Shall I?’

  Susan produced her little girl giggle again. ‘It might be fun, at that. Go on, Daph, let’s. I’d love to see Cramm’s face if you said it——’

  Sister Tutor closed her file of nurses’ reports, and folded her hands quietly on her lap, and looked across at Matron behind her desk.

  ‘I think that’s about all, Matron. Unless you can think of something I’ve forgotten?’

  ‘No, I don’t think so. It’s all quite clear. The wastage doesn’t seem any worse than anyone else’s—though the recruitment figures aren’t all they might be.’

  She stood up, and began to walk about the room, her hands clasped in front of her.

  ‘You know, you’re the only sister I’ve seen this morning, apart from Night Sister. I’m not seeing the others until after lunch. And I’ve done this for a very good reason. I wanted to talk to you in particular first.’

  She came back to her desk and leaned against it, so that she was close to the other woman.

  ‘This is a lonely job, you know, Sister. One can’t—talk—as much as one would like to one’s staff. But I think I can talk to you. I need, of course, to be sure that any discussion we may have about some of our problems will be personal to us?’

  ‘I take my meals in the school with the students in block, Matron. Quite apart from my lack of inclination to chatter, I’ve little opportunity.’ Sister Tutor was a little chilly.

  Miss Manton smiled. ‘Thank you for your assurance, Sister. Well, then, I would like your opinion about something I have in mind. You may know that I’m a trained psychiatric nurse, among other things. I have some experience of psychology on a practical level.’

  ‘Yes, Matron.’

  ‘There’s a technique we used in my last hospital that had a profound effect on the staff, and on their approach to their work. As a result of it, nurses were much better able to help their patients, and it had an extremely useful side effect——’

  ‘A technique?’

  ‘Group therapy. We held weekly discussions among the senior staff—the sisters—during which we talked in some depth about our needs, our motives, our approach to our patients and our colleagues. And, one effect of this was to make the sisters much more sympathetic towards the needs of the young students. We had less wastage—and our recruitment undoubtedly rose.’

  ‘People talk——’

  ‘Exactly. People talked outside the hospital. Girls told their friends how pleasant it was to work there, that the sisters weren’t battle axes, that we were understanding about their needs for a private life, that we were approachable, and so on.’

  ‘I know about this, of course. There have been reports in the journals. It sounds to me like a very useful idea.’

  ‘Would it work here?’

  ‘Here? At the Royal?’

  ‘Yes.’

  There was a long pause. Then Sister Tutor pursed her lips doubtfully.

  ‘As I said, I don’t know the sisters quite as well as I might. They—well, apart from my being married and living out of residence in consequence, they think I’ve a cushy number.’ She looked indignant for a moment. ‘Sometimes you’d think I did nothing but sit and read for my own pleasure all day, to listen to them.’

  ‘But you know them better than I do, all the same. And if I am going to start this, I think it would be better to start at once while everyone is on edge, waiting for the new broom to sweep around, than try to push it through when I’ve been here a few months and they’re used to me. While I’m still an unknown quantity, people will be less likely to oppose me just for the sake of it. They might well do so later, when they think they’ve got my measure.’

  Sister Tutor chuckled suddenly. ‘You have got your psychology taped, Matron.’

  ‘I need it, Sister.’

  ‘Put like that, I think you could start here. As I say, I don’t know them all that well—but—er—if I might offer one suggestion——’

  ‘Please do.’

  ‘I would make it a voluntary thing. If they feel they’re being forced they might oppose automatically. Certainly one or two would.’

  ‘Who?’

  ‘Oh, please, Matron, I’d much rather not——’

  ‘Come, Sister! We’re talking in confidence.’

  ‘Well, I don’t like tattling——’

  ‘It’s hardly that. Simply your advice.’

  ‘Sister East, then, for one. Certainly Sister East.’

  ‘Sister East. Casualty. She—applied for my post, didn’t she?’

  Sister Tutor nodded, embarrassed. ‘I should—I expect she feels rather—sore about it. She trained here, you see. Gold Medallist. She was hurt, I imagine, by your appointment. Anyone would be.’

  ‘Has she much of a following among the others?’

  ‘Not very much. She’s a bit sharp tongued. But they know her, you see, and for all her faults—well, there may be a kind of inverted loyalty.’

  ‘Then I accept your advice, Sister. I will start the therapy, but it will be a voluntary thing. It will depend on how I word my invitation, I think. I must think about that very carefully.’

  ‘Yes, Matron.’ Sister Tutor stood up, and collected her file from the desk. ‘Er—there’s just one other thing. If you particularly want me to, I’ll join in myself. But I’m not sure that—well, I’d be much use to you. It’s this marriage thing, you see. I’m non-resident—a bit of an outsider. I can’t imagine people talking as freely as they might if I’m there. And that’s what you want, isn’t it?’

  ‘That’s what I want. Yes, Sister, I see what you mean. Very well. If there is any question about your absence, no doubt I can find a convincing reason for it. If I’m careful, it shouldn’t come up. Thank you for your help, Sister. I’m most grateful for it.’

  And Sister Tutor went away, leaving Miss Manton, thinking carefully about her plans for group therapy for the sisters while she tidied her hair and face, ready for her meeting with the consultants.

  TWO

  The Royal was rather proud of the Board Room. It was a relic of the days fifty years before when the Royal had been a more important hospital than it now was, when the consultant staff had included two peers of the realm, men who were doctors to the royal family themselves.

  In those days, when doctors had been real autocrats and when the matron had been someone who had been trained by a pupil of Miss Nightingale, a living embodiment of the Best of British Nursing, there had been some point in having this richly panelled room, with its portraits in heavily gilded frames, huge mahogany table, velvet upholstered chairs and deep red turkey carpet. Now, however, when the real power in the hospital had shifted from the consultants and the matron to administrators in a government-controlled office, the Board Room seemed somehow pretentious, an embarrassing reminder of loss of status, but despite this, the Royal retained its pride in the room. It gleamed with polish and loving care from the domestic supervisor’s own hands. Individuals might consider it an anachronism, might even think it would be better used as an office or an extra waiting room, but none had the heart to say so. They shared a corporate pride in the existence of the room, and really rather enjoyed using it on special occasions like today’s.

  Even those consultants who profes
sed themselves to be above interest in such a minor matter as nursing staff changes felt that today was special. A new matron, after twenty years, could mean big changes, changes that might affect the consultants, and it was worth making an effort to please Miss Manton, to make sure she was aware of her duty to please them. So, they were all there, even old Sir Peter, the Chief of Staff, who rarely came to the hospital for social occasions of this kind, only appearing at committee meetings, where he could remind his colleagues of his importance and undoubted seniority.

  Miss Manton timed her own appearance in the Board Room carefully. To have been too prompt would have been an embarrassment to those consultants who were late; to have been too dilatory would have been an insult. She came through the door at ten past eleven, holding her head high, her face carefully composed into an expression of alert and friendly interest, with an underlying hint of her realisation of her importance. She looked neither subservient nor overbearing, and the impression she gave to the men who turned to look at her was all she could have hoped it would be. She looked intelligent, capable and sufficiently attractive in a physical way to make one or two of them straighten their shoulders unconsciously.

  Mr. Heston, the hospital Secretary, detached himself from a group of men by the tall windows and came hurrying across to greet her.

  ‘Miss Manton!’ His voice was rich and warm, practised in the art of public speaking, making him sound, even in direct conversation, as though he were presenting a report.

  ‘Miss Manton—good morning! I’m so glad you were able to join us here. I’m sure you must have a great deal to do, finding your way about your office this morning. We appreciate your preoccupations on your very first day at the Royal, I assure you. Now, may I introduce everyone? Mr. Jamieson, of course, you have met. He was one of the selection committee which so wisely appointed you. And may I present Sir Peter Jeffers, our Chief of Staff——’