Island Nurses

by Howie, Leonie; Robertson, Adele;

  One day, when she is visiting Gwen, Gwen puts down her cup of tea and picks up what Adele recognises as Myrtle’s little book of Aotea nurses.

  ‘Look,’ says Gwen.

  There, in Myrtle’s shaky handwriting, is Adele’s name, with the date of her arrival and a dash followed by a blank space. Adele looks at that space and wonders what date will one day be written there.

  Chapter 2

  ON CALL, ON EDGE

  These days, health and safety and risk minimisation are a kind of mantra in most areas of life, not least emergency medicine. St John teaches its trainees that for those attending an emergency, safety at the scene is your first consideration. In Adele’s early days on Great Barrier Island, the island’s doctor and nurses were usually the scene coordinators as well as the first responders and, in the often isolated scenes of an emergency, not much in the way of extra manpower was always available. However, as long as locals were present situations that initially seemed tricky and insurmountable were generally solved in a practical way. We have faced the same difficulties throughout our career practising on the island, and we still occasionally face them today.

  Still, some of the stories of how intrepid the early nurses were put anything we have had to face into the shade. When Adele first told her sister that she was taking up a post on the Barrier, her sister looked concerned.

  ‘You’re brave,’ she said. ‘I heard a story that one of the nurses out there had to visit a patient on an island and, because the boat couldn’t land, she had to strip off and swim ashore!’

  Adele snorted.

  But after she had been on the Barrier for a number of years, she told this story to a group of locals, expecting them to laugh. Instead, they nodded.

  ‘Yes, that was Mrs Mence,’ one said. ‘She was the nurse here back in the seventies. She received a call via radio link one day to say the caretaker on Rakitu Island—an older man living by himself— had badly injured his back. The hospital wouldn’t approve a helicopter evacuation unless he’d been seen by the nurse, so Mrs Mence boarded a boat on the eastern side of the island at Whangapoua Beach. You can only land at Arid Cove, and that day it was pretty rough, with the wind blowing surf on to the beach, and the only dinghy ashore was damaged. So she did the decent thing and stripped down to her underwear and swam ashore. Nancy was a good swimmer, but it still would have been taxing as it was a long way and the middle of winter.’

  ‘What happened to the patient?’ Adele asked.

  ‘Oh, we fixed the dinghy while she was seeing him, then we took them back to Port FitzRoy, where Nancy called for a helicopter to come get him later that day. He was able to return to the island a few weeks later.’

  We hear these stories from time to time where, in the challenging environment of Great Barrier Island, needs sometimes must.

  The call comes at midnight. It is the manager of a lodge across the bay and he is reporting an accident—a vehicle off the road. Adele drives gingerly down the wet clay road as light rain falls. When she decides that the track is marginal even for her four-wheel-drive Land Cruiser, she gets out and walks, slipping and sliding through the mud in her gumboots. The pale boles of kauri trees gleam in the beam of her torch on either side of the track. She can hear screaming.

  She sees the flash of another torch. There is the lodge manager who made the phone call, sending the beam of his torch down a 30-metre bank to where the underside of a Land Rover can be seen in the tide. There is a young woman crouched in the water beside the vehicle. The screaming is coming from inside.

  ‘It’s a local girl,’ the lodge owner says. ‘She was driving. She’s trapped in there.’

  ‘Anyone else involved?’ Adele asks.

  ‘There were two passengers, but they’re both fine. One of them got out and climbed up to tell me. That’s the other one down there with her.’

  Adele is wishing, not for the first time, that she wasn’t a nurse on Great Barrier Island.

  ‘Do you want me to try to find a way down for you?’ the lodge manager asks.

  Adele nods gratefully, and without further ado he sets off down the near-vertical bank. About halfway down, he calls back up.

  ‘Probably best if you go back down the track to the head of the bay. You’ll be able to wade around. It’s still quite shallow.’

  ‘What’s the tide doing?’ Adele asks.

  ‘It’s on its way in,’ he replies from down the bank.

  Adele walks back down the track, the rain dripping from the trees. She makes her way to the water’s edge and then begins walking around the rocks. The water starts flooding over the top of her gumboots. It feels surreal, because, besides the screaming coming from the Land Rover, there is the sound of music, laughter and the clink of glasses. There are dozens of pleasure boats at anchor further out, and the usual holiday festivities are underway aboard them.

  Once she reaches the vehicle, she discovers that, apart from having her lower leg pinned, the young woman seems uninjured. She is panicking, however. Her ankle is pinned somewhere around the top of the door frame—she can’t have been wearing a seatbelt—and the water is creeping quietly higher. Adele is more worried about the passenger who is waiting with her, as her teeth are chattering and she looks pale and shocked in the torch beam.

  The lodge manager arrives at her side.

  ‘We’re going to need help getting her out,’ Adele says.

  ‘I’ll see who I can round up,’ he replies.

  ‘Best take her with you.’ Adele indicates the passenger. ‘She needs to get warm.’

  The lodge manager and the shivering girl slosh away.

  ‘Get me out. Please get me out,’ the young woman sobs.

  ‘It’s OK. We’ll get you out,’ Adele soothes her. ‘Help is on its way.’

  Listening to the carousing going on out in the bay, Adele hopes that whatever help arrives is sober enough to be useful.

  She doesn’t need to worry on that score. When the lodge manager returns, he has a group of fishermen with him who have been too busy smoking their catch to drink.

  ‘The Forest Service are sending a truck with a winch,’ the lodge manager reports. ‘And I’ve phoned your neighbour. He’s on his way.’

  Adele is pleased, because the mechanic and her neighbour must be two of the few locals who were not at the Boat Club that night.

  Headlights can be seen through the trees above. It is the Forest Service truck, but the mechanic calls down that the strop from his winch isn’t going to be long enough to reach. He can’t get any closer.

  Oil and petrol have been oozing from the vehicle, and Adele is up to her waist in oily water. While it is summer, the water is cold. The young woman has been in the water longer than Adele has: she will be getting hypothermic. They need to act.

  ‘We need to get the weight off her leg somehow,’ Adele says.

  ‘We could try lifting it,’ the lodge manager suggests. ‘What do you think, guys?’

  There is a general murmur of assent, so the plan is for the men to position themselves around the vehicle and to lift, while Adele attempts to free the young woman’s ankle.

  Adele positions herself so that she can grasp the leg as close to the ankle as possible. This entails crouching in the water up to her neck.

  ‘Ready when you are,’ she says.

  ‘OK. On three. One. Two. Three!’

  There is the sound of exertion. The vehicle moves and Adele gently pulls the young woman’s leg upward. The young woman screams, and points of light wheel across Adele’s vision. She is briefly afraid she is going to faint, but at that moment the leg comes free and the woman floats out of the cab. The men let go of the vehicle, which thumps back into the water.

  One of the men carries the relieved young woman to his vehicle as Adele walks beside them.

  ‘I’ll drive you to the nurse’s cottage so you can look after her on the way,’ he says. ‘We’ll get your vehicle back to you tomorrow.’

  The following morning, the girl wh
o climbed up the bank to raise the alarm presents herself to the nurse’s cottage. She has a bad laceration on her lower leg that should have been attended to the previous night. Adele has a habit of going over and over every incident and working out what she would do differently next time. She should, she tells herself, have checked both passengers over the previous night. But, with time, she learns that every situation is unique, and the next one is likely to throw up a completely different set of challenges to be negotiated.

  The men in the local community go out at low tide, tip the Land Rover the right way up, tow it back on to terra firma and, after it has been hosed out and had new battery acid, engine oil and petrol tipped in, it fires up again—if not quite as good as new, at least adequately restored.

  Adele is not quite so lucky. She writes to the Auckland Hospital Board to inform them that she has ruined an entire set of clothes in attending an emergency and would like to claim reimbursement. Her employers cannot seem to imagine circumstances under which they would be obliged to dip into taxpayers’ money to supply a nurse with a full set of clothes. This exchange, Adele reflects ruefully, would not look out of place in the historical correspondence register.

  Adele and Shannon have an overnight guest. He is an infant who arrived earlier that evening with his father from one of Aotea’s inhabited outlying islands. He presented as very unhappy with a high temperature, ragged breathing and a wet, painful-sounding cough—plainly a respiratory infection. Adele administered paracetamol and antibiotics, whereupon it became a waiting game. The little boy’s dad agreed to leave him at the clinic overnight so that Adele could monitor him, and she has spent the night sitting beside him, listening to his breathing and occasionally checking his temperature. A little before dawn, his breathing has noticeably eased and his temperature has dropped into the normal range. Adele decides she can afford to get a couple of hours’ sleep.

  When he wakes up, the boy is bright and alert and ready for his day. Adele is already dressed in a skirt and T-shirt—it is going to be a scorcher. She has fed the toddler and organised the medications for his family to take back to their isolated home. It is 9 am. There is a knock at the door. A woman is standing there, looking very anxious.

  ‘It’s my husband,’ she says. ‘He’s not very well.’

  The symptoms she describes are alarming. Adele phones the shop and asks if someone can mind the toddler until his dad arrives. One of the young women races across the road to take over, so Adele slips on a pair of jandals and jumps in the car with the woman. It is only a short drive—50 metres—but the emergency equipment is in the back. The woman indicates a dinghy pulled up on the boat ramp. Adele loads the gear she thinks she will need and they push off. The woman starts the outboard and, after a short ride, they are at the yacht.

  Aboard, Adele finds the woman’s husband sitting on his bunk, clammy and nauseous and complaining of severe, crushing chest pain that is radiating down his left arm. She wraps the band of the blood-pressure cuff around his upper arm as the sunlight reflected from the water paints patterns on the roof of the boat’s cabin.

  ‘Have you ever had heart trouble before?’ she asks, and the patient nods. His history and chest pain, together with his blood pressure, which is very high, puts the diagnosis beyond doubt. It is obvious to Adele that he is having a myocardial infarction—a heart attack—and the pain is caused by the death of muscle tissue that is being starved of oxygen by a blockage in a coronary artery. This is a very serious situation. At this time on the island, Adele has only a limited range of drugs; if the man’s heart stops, she will have to perform CPR (cardio-pulmonary resuscitation) in a very confined space. The boat has a radio but reception in the harbour is poor, and she has no other means of communicating with Auckland Hospital. High-tech gear, such as a portable defibrillator, and even items that will one day be taken for granted on the island, such as a cell phone or VHF radio, are nothing but a twinkle in some electrical engineer’s eye at this point.

  Adele has fitted an oxygen mask to the patient’s face and is in the process of inserting an intravenous line so that she can administer drugs as efficiently as possible when she hears the seaplane approaching, followed by the characteristic splash and surging roar of the engines as it lands and threads its way through the moored vessels to the beach. The yacht rocks gently in its wash.

  Soon afterward, there is the sound of an approaching outboard, which cuts out close to the boat. There is a bump and a series of thumps on the hull. The face of one of the more colourful locals appears in the companionway.

  ‘Ah, there you are, Adele. You right? Mike on the fuelling jetty thought I better check on you, because you’d been gone a while.’

  Adele is very pleased to see him. ‘I have an emergency,’ she says. ‘Can you ask the pilot of the seaplane if he can assist me by taking a patient to Auckland, please?’

  ‘Of course,’ he says, and disappears. His outboard starts and fades.

  ‘I really need to go to the toilet,’ Adele’s patient says. She is not keen to let him go, because the toilet is down a couple of stairs in a tiny little cupboard called the head. If his heart failed there, CPR would be an impossibility.

  Soon the local is back.

  ‘Plane’s right to take him to the mainland. The pilot says he’ll come alongside. We can use my boat to get him across.’

  (Adele only learns later that he had sped up and grounded his boat next to the seaplane, leaped ashore and yelled authoritatively, ‘The nurse is commandeering this plane!’ Oh, to have that sort of power, she reflects.)

  They are going to have to get the patient on his feet and make him climb in and out of boats. Adele decides that letting him go to the toilet is not much more of a risk. He makes his slow way to the head. There is the intermittent sound of running water, but as minutes pass and he does not reappear she begins to wonder what is keeping him. He is taking ages.

  ‘Are you all right?’ she calls.

  ‘Fine,’ comes his muffled reply.

  When he finally emerges, Adele sees that he has washed his face and combed his hair neatly.

  ‘I feel fine, now,’ he announces. ‘No pain whatsoever. No need to send me to hospital.’

  ‘Let me check you again,’ Adele says. She checks his vital signs. His blood pressure has dropped alarmingly low, and his pulse is rapid and weak.

  ‘You definitely need to go to hospital,’ she tells him. ‘The reason your pain has gone is that part of your heart muscle has died. You are still at as much risk now as you were when you had the pain.’

  It is a difficult exercise getting him off the yacht, into the boat and then on to the seaplane. Adele boards the plane with him and suggests he lie down.

  ‘No.’ He waves her away. ‘I’m fine. I’ll sit like everyone else.’

  He is still very pale and unwell-looking. Adele watches him anxiously for the duration of the 30-minute flight. When the plane lands at Mechanics Bay, Adele asks her patient to stay sitting until the ambulance that is waiting can drive over to the plane. But it stays at the gate. She walks over to ask them to come closer, so that he is spared as much exertion as possible, but when she turns around she sees the patient being escorted to the terminal by a couple of Sea Bee Air staff.

  She rushes over.

  ‘What going on?’ she asks.

  ‘Oh, we’re just taking him into the terminal to get a few details.’

  ‘I’m fine,’ the patient adds.

  ‘No, really. It’s best he comes in the ambulance now,’ Adele says firmly. ‘I’ll give you his details later.’

  ‘I really don’t know what all this fuss is about,’ the patient protests as he is loaded into the ambulance for the short ride to the hospital. And, when they arrive and there is no wheelchair available, he insists on climbing out and walking under his own steam. In the cool of the air-conditioned hospital, Adele is acutely conscious that she is not wearing a bra. She is surrounded by health professionals—her colleagues—in their neatly presse
d white uniforms and here she is, standing in her jandals and dressed in a T-shirt and skirt with her nipples poking out. It is hard to maintain an aura of professionalism under these circumstances. She is feeling pretty rustic. It takes her right back to her days in outback Australia, where she often showed up in the sanitised Emergency Room covered in dust and dirt and with streaks of baby poo on her uniform. Adele is spinning out at this point: she knows she has witnessed a man having a heart attack—he is lucky his heart hasn’t stopped—but she is afraid she will not be believed.

  Happily though, Auckland Hospital is expecting a cardiac patient, and his insistence that he is perfectly well falls on professionally deaf ears. The nurse lies him down and hooks him up to an electrocardiogram. She watches the trace for a few minutes, and then strides over to a telephone on the wall. The room rapidly fills with personnel and equipment. Adele is happy to step into the background. As the adrenaline fades and the relief washes over her, the long night spent watching over the sick baby begins to catch up with her.

  ‘Look, this is all some kind of mistake,’ she hears the patient say as she prepares to take her leave. ‘There’s nothing wrong with me. Can’t I just go home?’

  ‘You are not going anywhere,’ the doctor replies shortly. ‘You’ve suffered a major heart attack. You are lucky to be alive. We’re admitting you to Coronary Care.’

  Eventually, one of the nurses notices Adele and invites her into the staff room for a hot drink. Adele sips her coffee gratefully, but wonders how she will ever summon the courage to ask someone for the loan of enough money to get to the airport. She had not thought to bring a purse or even any money; she is standing in Auckland Hospital exactly as she walked out of the door at Port FitzRoy that morning.

  She never does manage to pluck up the nerve. But she remembers that, when she was working at St Helen’s Maternity Hospital, she and the other midwives often went by ambulance to Auckland Hospital with women and babies. All they had to do to get home was to present themselves at the orderlies’ office and ask for a taxi voucher. So, when she has finished her coffee, she walks along to the office.