Patients are often accused of being able to “do much more when nobody is by.”  It is quite true that they can.  Unless nurses can be brought to attend to considerations of the kind of which we have given here but a few specimens, a very weak patient finds it really much less exertion to do things for himself than to ask for them.  And he will, in order to do them, (very innocently and from instinct) calculate the time his nurse is likely to be absent, from a fear of her “coming in upon” him or speaking to him, just at the moment when he finds it quite as much as he can do to crawl from his bed to his chair, or from one room to another, or down stairs, or out of doors for a few minutes.  Some extra call made upon his attention at that moment will quite upset him.  In these cases you may be sure that a patient in the state we have described does not make such exertions more than once or twice a-day, and probably much about the same hour every day.  And it is hard, indeed, if nurse and friends cannot calculate so as to let him make them undisturbed.  Remember, that many patients can walk who cannot stand or even sit up.  Standing is, of all positions, the most trying to a weak patient.

Everything you do in a patient’s room, after he is “put up” for the night, increases tenfold the risk of his having a bad night.  But, if you rouse him up after he has fallen asleep, you do not risk, you secure him a bad night.

One hint I would give to all who attend or visit the sick, to all who have to pronounce an opinion upon sickness or its progress.  Come back and look at your patient after he has had an hour’s animated conversation with you.  It is the best test of his real state we know.  But never pronounce upon him from merely seeing what he does, or how he looks, during such a conversation.  Learn also carefully and exactly, if you can, how he passed the night after it.

[Sidenote:  Effects of over-exertion on sick.]

People rarely, if ever, faint while making an exertion.  It is after it is over.  Indeed, almost every effect of over-exertion appears after, not during such exertion.  It is the highest folly to judge of the sick, as is so often done, when you see them merely during a period of excitement.  People have very often died of that which, it has been proclaimed at the time, has “done them no harm."[17]

Remember never to lean against, sit upon, or unnecessarily shake, or even touch the bed in which a patient lies.  This is invariably a painful annoyance.  If you shake the chair on which he sits, he has a point by which to steady himself, in his feet.  But on a bed or sofa, he is entirely at your mercy, and he feels every jar you give him all through him.

[Sidenote:  Difference between real and fancy patients.]

In all that we have said, both here and elsewhere, let it be distinctly understood that we are not speaking of hypochondriacs.  To distinguish between real and fancied disease forms an important branch of the education of a nurse.  To manage fancy patients forms an important branch of her duties.  But the nursing which real and that which fancied patients require is of different, or rather of opposite, character.  And the latter will not be spoken of here.  Indeed, many of the symptoms which are here mentioned are those which distinguish real from fancied disease.