Island Nurses

by Howie, Leonie; Robertson, Adele;

  ‘Oh, I know his name. I’ve been hearing his name hereabouts,’ one older local says of another, with whom Leonie is sitting. ‘But we’ve never actually realised who the other is.’

  ‘It’s true,’ the other confirms. ‘Probably because he lives in the south and I am more in the centre of the island.’

  ‘How long have you lived on the island?’ Leonie asks.

  ‘Ooh, it must be about twenty years,’ replies the first.

  ‘It would be,’ says the other. ‘I first heard your name about twenty years ago, but I’ve been busy working on my land.’

  She learns that Tryphena was named after a Sydney-built sailing vessel that used to ply between this sandy bay at the island’s southern end, Auckland and various other international ports, mostly trading kauri logged from the island’s forests. She learns that the building she is in was built in 1884 and served as the local school until 1939, when a new school was opened. Salted throughout the conversation are the names of some of Aotea’s oldest families: the Medlands, the Blackwells, the Sandersons, the Grays and others. There are families with those surnames still living on the island. Locals use names as though Leonie will have heard of them already.

  She is called away from one fascinating story by Ivan, who asks her to suture a wound while he is attending to the deep gravel graze on another limb. She quickly finishes this task and looks around for the autoclave to sterilise her instruments, forgetting for a moment where she is. Then she spies the water bath steriliser ‘of sorts’ and remembers.

  Leonie raises her eyebrows, but she recognises a practical yet sterile arrangement when she sees one. She and Ivan are eking out a living, their total income considerably less than Leonie was earning on the mainland.

  On Wednesday, they drive in Ivan’s iconic and durable light blue Holden HQ up north to the nurse’s cottage in Port FitzRoy for the northern clinic. The car bumps and rattles its way over the saddle beside Hirakimata (Mount Hobson). At this time, in the mid-eighties, it takes the Howies just under an hour to reach Adele’s clinic. Although it is a relatively small island (the Barrier covers 27,360 hectares, and is roughly 40 kilometres long and 10 kilometres wide at its widest point) with a population at that time of just over 850. Getting around is hard in the mountainous terrain. The drive along the winding metal road, through the native scrub and forest that covers 88 per cent of the island, seems to take forever. And Leonie has already seen enough to realise how little most of the population has in terms of income. Some are farmers or fishermen, and given everything costs more than on the mainland, and given the high costs of getting your produce to market, the returns are significantly less than on the mainland, and are often marginal. Leonie will often hear it said that farming or fishing out here is a way of life rather than a way to make a living. Most of the islanders are working hard to survive. Those fortunate to receive a steady income are aware of the privilege.

  Adele is away doing Well Child home visits when they arrive at the nurse’s cottage for the clinic, as she often is when the Howies make their regular visits. By contrast with the Tryphena Medical Clinic, Leonie finds the clinic attached to the nurse’s cottage well equipped, and she notes with some envy that Adele has an entire room within which to work.

  The Port FitzRoy clinic lasts most of the morning. Leonie really enjoys having the one-to-one time with the islanders. A good number of the FitzRoy people have come by boat from isolated valleys, bays and offshore islands. Leonie is bewildered with all the talk of these unfamiliar places. She resolves to get herself a good map and try to put places to the names at the earliest opportunity.

  At the end of the morning session, they loop north of Port FitzRoy to reach Karaka Bay, just around the point from Rarohara Bay, where a large community named Orama Christian Fellowship is sited. A lunch is laid on—and then the Howies hold a clinic in the community’s purpose-built sick bay. The community is a mixture of full-time residents and people who have come to Orama—which takes its name from the Greek word for ‘vision’—to recharge their spiritual batteries. It is an ideal place for this, situated as it is behind a wide, tree-fringed lawn at the head of a beautiful, sheltered cove. But it is for the more secular comforts it provides that Leonie will come to love her visits to Orama. In the early years, the laundry facilities and the hot showers she can enjoy at the turn of a tap are bliss compared with what she has at home—a kettle boiled on the wood stove or a solar-powered shower (a bag laid outside to heat in the sun), or a cold shower, or a dip in the surf with a bar of saltwater soap.

  When they are not at the southern and northern clinics, Leonie and Ivan are based at their ‘practice facility’, centrally located at Claris. Ivan was not joking when he indicated that the hub of Great Barrier Island’s primary medical facility was a caravan. It is not even a new caravan but an older-style one, small and painted two-tone moss green. Ivan had pointed out that in its previous incarnation it had been the local fast-food outlet. He has set it up to suit his needs. He has a locked filing cabinet for all the clinical records and a hidden cupboard—also locked—for his supply of medications. Instruments are boiled over a gas burner in a stainless-steel lidded container for the requisite twenty minutes for sterilisation. There is a foldaway table that is almost never folded away, as it is usually littered with textbooks and assorted other papers. There are various cubby-holes and lockers, and each is filled with medical supplies.

  Its other distinctive feature is the slight musty smell it perpetually has. There must be a leak somewhere—never bad enough for actual water to become obvious, but just bad enough to ensure there is always a damp smell. Ivan’s attempts to locate and fix it have been to no avail. Over the years, Leonie’s own occasional search will be fruitless, too.

  The caravan is positioned directly beside the front door of their little house, so Leonie becomes accustomed—as Ivan already is—to their home being used as a waiting room or a sleep-over space for those needing to be cared for overnight.

  From the huge window in their upstairs bedroom, they have a view of the airstrip way out over the sand dunes, so Leonie and Ivan can check the visibility during rough weather and at night. Sometimes they are called upon to report flying conditions for the mainland, and even provide a sketchy weather forecast. As Ivan explains to Leonie, if you can see the summit of a particular hill at the end of the beach, the cloud ceiling is high enough for a plane to get in.

  Not that communications are any easier than they are for Adele at Port FitzRoy. Leonie and Ivan are on a party line, and one of the ten subscribers on their line is the public phone box at Medlands Beach.

  ‘The operators always seem to know where I am,’ Ivan explains. ‘It’s uncanny. I don’t know how they do it.’

  Leonie soon discovers the same. If there is an emergency, no matter where the Howies are, the phone will often go and the operator will ask the person who answers for Ivan or Leonie. And on the occasions when neither she nor Ivan is close to a phone, the operators simply hold messages until they get home or are in a position to receive them. Answering machines are just coming into vogue on the mainland; not long after arriving on the island, Leonie decides that the island system is far more efficient.

  The downside, as Adele has found, is the lack of privacy for their patients. In order to maintain medical confidentiality on their party line, Leonie and Ivan often wait until eight o’clock, when the exchange is closed and the Claris public pay phone is switched over to the New Zealand international exchange.

  One starlit night soon after Leonie took up residence on the island, an emergency arises that requires the patient to be urgently evacuated to hospital. Ivan treks up to the Claris phone box as usual, only to find that the operator has forgotten to switch the phone over. It simply rings in the empty exchange. Finding and waking the operator will take too long.

  Fortunately, the local policeman lives close by. Ivan rouses him to see if he can help break into the exchange.

  ‘Yes,’ the policeman says with
out hesitation, and he jumps in the car and Ivan retraces his journey back to the exchange.

  ‘Won’t you need tools? A hammer or something?’

  ‘Watch and learn, Ivan. Watch and learn.’

  The policeman is in the process of showing Ivan how easy it is when they hear a car approaching.

  ‘Oh no!’ the cop hisses. ‘Get down!’

  They both drop and wait until the car has passed by. Both of them know it would take some explaining if the island GP was found breaking and entering under the expert tuition of the local policeman!

  They ‘effect entry’, as the policeman would put it if he were writing the burglary report, the phone is switched over and Ivan is soon listening to the international operator saying, ‘New Zealand here.’

  The next day, they fess up. It would have been obvious for a detective anyway, as the doctor’s and the policeman’s sticky fingerprints are plain to see all over the glass. Fortunately, after that night, Ivan will never need to use his new-found burglary skills.

  Just like Adele, Ivan and Leonie have a CB radio on at all hours of the day and night. The drawback is that the Taiwanese long-lining fleet, well over the horizon much of the time, are on the same frequency, and the radio will often squeal into life with no warning in the small hours of the morning with a staccato burst of rapid speech in a slightly off-key foreign language.

  And of course, if they have no way of reaching them by telephone, the locals know where their doctor and nurse live, anyway. The method of contact of last resort is to bang loudly on the door.

  Soon after her arrival on the island, Leonie wakes to just such a banging on the door. Her torch lights up two people, a young man leaning on an older one, who turns out to be his father.

  ‘You’ll be all right now, son,’ the dad says. ‘Doctor’s got you. See you when you get back. I’m off!’

  Before they can react, he has jumped in his truck and driven off into the night.

  ‘Dad figured you would be shipping me off in the morning,’ the lad says, noticing our confusion. ‘He wanted to get back to sleep.’

  ‘What happened to you?’ Ivan asks.

  ‘I crashed my motorbike,’ he replies. ‘My knee is really sore and I can’t walk on it.’

  They manoeuvre their patient into the caravan and, while Leonie holds the torch, Ivan cuts away the young man’s jeans. The knee is badly swollen. Ivan examines it thoroughly, then applies a rigid splint and gives him something for the pain.

  Leonie excuses herself and goes to make up a bed on the floor of their sitting room. Ivan helps the lad over and settles him on the bed, and just before she goes upstairs Leonie asks if he is going to be warm enough.

  ‘I’ve got a jumper in my bag,’ he replies. ‘Would you mind grabbing it for me?’

  She rummages in the backpack he was previously wearing and pulls out the jumper. Something falls on the floor, and she shines her torch on it. It is the biggest jumbo box of condoms she has ever seen! Leonie cannot help but glance at the patient, who is wearing a wry grin: he plainly had a far better evening planned than the cold one he is going to be spending on a makeshift bed on the Howies’ floor.

  Embarrassed for him, Leonie quickly stuffs the box back in the bag.

  ‘Goodnight,’ she says, and beats a hasty retreat.

  ‘Night,’ he replies, still grinning.

  Soon Leonie becomes attuned to the sound of cars coming to the end of the road, which is inevitably followed by a pounding on the door. Late one night, she hears a vehicle arrive at a good clip, a reliable indicator of an emergency. There is a knock on the door. A man has brought his neighbour in. He is sitting in the vehicle with a blood-soaked towel clamped to his face.

  Ivan leads him slowly into the caravan so he can examine the damage to his face. When the towel is removed, it is plain he has a horrific gash diagonally across his face, involving the bridge of his nose, his lips and cheeks but mercifully missing his eyes.

  ‘He was up a tree using his chainsaw,’ the neighbour explains. ‘It kicked back on him. Then he amazingly got himself down and called for help. It was a bit of a drive to get him here.’

  ‘You should have brought a photo of your favourite movie star!’ Ivan tells the patient. ‘Let’s get started putting it all back together again.’

  He numbs the affected area with local anaesthetic and then, with Leonie holding the gas lamp as steadily as she can, he begins laboriously stitching the shredded skin together, reconstructing the face. Leonie can only admire his handiwork, especially under the conditions: the patient is lying on one of the caravan seats. Ivan is half sitting, half squatting beside him and Leonie is leaning over his shoulder to provide the necessary illumination.

  Leonie often has occasion to be pleased with her ability to detect late-night incoming cases, because it gives her a head start on waking herself up and getting dressed. Ivan is like a coiled spring and is out of bed the moment he hears a noise that is out of the ordinary. But it is a blessing that becomes a curse on the rare occasions that they travel off the island. Sleep becomes impossible in the city, as they wake every few hours whenever a loud car passes by.

  The locals understand. They show their appreciation for Leonie and Ivan’s dedication the way Barrier locals always do: they drop in with gifts of kai moana—crayfish, scallops and snapper—and even wild pork. Ivan and Leonie look after them; but more importantly they are looked after in their turn.

  ‘He says he caught it in a winch,’ George Mason relays by phone. ‘He says he’s lost one of his thumbs.’

  ‘I need more detail please, George,’ says Leonie. ‘First ask him specifically where the amputation is.’

  There is a short pause as George puts down the phone handset and picks up the radio hand-piece. Leonie can imagine many ears about the Hauraki Gulf listening to the drama unfolding on the public radio channel.

  ‘The doctor’s wife wants to know how far above your knuckle you’ve lost the thumb,’ George says.

  Leonie feels like rolling her eyes. George hasn’t manned Great Barrier Marine Radio for all that long at this stage, taking over from his wife, Moira—but in all that time he hasn’t stopped referring to Leonie as ‘the doctor’s wife’. It is a continual blow to her professional pride, but she has learned to live with it. George Mason has always been unfailingly polite, and he is a wonderful man: he has a long history of service to the island, being a farmer, a policeman and, most recently, a radio operator providing support to those boats in the waters surrounding Aotea and its constellation of outlying islands. But Leonie does sometimes wonder how much credibility she has as ‘the doctor’s wife’ when she is relaying complicated medical advice through George. Do they assume she has any medical expertise of her own? Do they even follow her instructions?

  ‘George says it’s completely gone above the knuckle,’ George relays. The fact that the commercial fisherman who has suffered the injury shares a first name with the radio operator has made the usually complicated three-way radio conversation even worse than usual.

  ‘OK. Please ask him to cover the stump with a clean dressing and then elevate the hand as high as he can to stop it bleeding.’

  ‘George, the doctor’s wife wants you to keep your hand elevated and keep pressure on your thumb to stop the bleeding. Over.’

  ‘And, George, ask him to bring us the amputated part of the thumb. Keep it cool somehow. Ideally, wrap it up in a clean dressing and place in a clean plastic bag and cool it with a slurry of ice.’

  ‘George, the doctor’s wife wants you to bring her the bit of the thumb that’s come off. She wants you to wrap it in plastic and put it in the freezer. Over.’

  There is a pause as Leonie raises her eyes to the ceiling, wondering how she can politely repeat the correct instructions to George without everything becoming a shambles. Freezing the thumb will be disastrous, as it will damage the tissues.

  ‘No,’ says George to Leonie. ‘George says a goony bird swooped down and took the thumb.’<
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  Leonie can imagine the delighted reaction to that piece of news broadcasted.

  It is always a tricky balancing act between patient privacy and the need to know specific details when asking a patient to tell you exactly what is happening over the airwaves. And Leonie knows she is not just being paranoid when, for a week or two after this episode, boaties are sidling up to her and saying, ‘So how did George get on? You know, George with the thumb . . .’

  Many years later, Ivan and Leonie will eventually buy their 10 acres across in another valley, away from the beach—realising a deep-seated dream of Leonie’s, who has remained a farm girl at heart, that her children can grow up as she did, surrounded by animals. The added privacy will be welcomed. When not on-call, they will be able to retreat from their busy lives on to the land and their new home. It will be a great change in their lifestyle.

  Until then, Leonie feels they live in a fishbowl. Their home, of necessity, is always open to locals and visitors requiring their professional skills. Some days she feels, like Adele, that she is perpetually either working or being called out. There is no time for sailing or fishing—both too far from a phone. The idyllic Barrier lifestyle is right there, but hovering somewhere just beyond reach.

  But, even during the frantic periods, Leonie knows that she has something special, and she will be confirmed in that knowledge as the years pass: she and Ivan share a unique partnership. Together they live and work all day, every day, the classic doctor–nurse story and yet as equals. They would not exchange this life together for anything.

  Chapter 5

  ARRIVALS

  One thing that we have achieved on Aotea since Adele and Ivan attended their first home birth is the expectation that, in the absence of any indicators that the birth will be difficult or dangerous, it will happen on the island and probably at home. Not that we can take credit for this achievement: at all times, as in the birth process itself, it has been the mothers who have taken the lead. Some writers on the subject describe women who plan to give birth at home as ambassadors of good birth. The practice of home birth reminds the rest of us that birth at its best is natural, safe and healthy.