Island Nurses

by Howie, Leonie; Robertson, Adele;

  We hurry back into the sitting room, where Cathy is very close to delivering her baby.

  ‘Push,’ Leonie urges her quietly, and so fully is she in the moment with Cathy that she finds herself bearing down in sympathy, her hands on her own rounded belly and drawing and holding her breath forcefully. She wills herself to breathe normally and to focus on Cathy. It would not do anyone any good if Leonie gave birth right next to Cathy!

  The delivery is straightforward, and Leonie feels empathetic tears welling in her eyes as the baby emerges. Cathy and Dennis are dazed and glowing with the wonder of it. Cathy greets her baby and, after a few minutes, looks at Leonie.

  ‘What were all the shenanigans next door?’

  ‘You have a local as a guest who is unwell. Things have stabilised now, though,’ Leonie reassures her. After all the drama of the emergency and the birth, all is quiet. Cathy asks for her parents to be woken—they have slept through it all—so that they can be introduced to their bonny 10-pound grandson, Jason. Sunlight—the first dawn of the baby’s new life—is streaming in the windows as the cork is eased from a bottle of champagne for the traditional wetting of the baby’s head.

  Dennis offers us a glass and we both shake our heads.

  ‘Drat.’ We grin at one another.

  Leonie produces the birth-day cake and we all bask in gratitude for the little one’s safe arrival. In the middle of it all, there is yet another knock on the door.

  It is Cathy’s neighbour.

  ‘Did you get your car going?’ Ivan asks.

  ‘Unfortunately, no.’ She shrugs. ‘Had to walk, but a lovely morning for it.’

  ‘Adele, it’s Cathy. It’s all on! My waters have broken, and the contractions have started and become more regular.’

  It is two years on, now. Cathy’s boy is a robust two-year-old, and she is about to have another baby.

  After she finishes talking to Cathy, Adele phones Leonie. It is 8 pm, but we can do this now. The old manual telephone exchange system has been replaced by the same automated system that practically everyone else in New Zealand has been enjoying for some time.

  ‘Cathy has started contracting,’ she says. ‘I’m heading off shortly.’

  ‘I don’t think you should go,’ Leonie says. ‘You need to look after yourself. That’s the most important thing, Adele. Why don’t you stay home?’

  ‘No, I can manage,’ Adele says. ‘I told Cathy that I would be there. She’s relying on me.’

  ‘You need to look after yourself,’ Leonie reiterates.

  ‘Actually,’ Adele begins, then stops. She struggles to control her voice. ‘Actually, I would rather have something to do. I can cope. I’ll have to.’

  There is a long silence.

  ‘OK. I’ll come with Ivan, then,’ Leonie says. ‘We’ll see you there.’

  The concern and empathy in her voice nearly starts Adele crying again. But after she has hung up the phone she gathers her gear. The familiar routine steadies her. She loads the car, gets in, takes a deep breath and sets off.

  Leonie’s mum is staying with them, as she has been doing every summer since first Amiria and then Jordan were born. Summer is a crazy time: the resident population is swamped by an influx of holidaymakers, and Ivan and Leonie would be busy enough without being the parents of two small children and their older brother, Alastair. Jordan is just five and a half months and still breastfeeding. The rising tide of their belongings is an indicator that there is also a busy, enquiring two-year-old Amiria about. Alastair is currently sprawled on the couch, absorbed in a book.

  Leonie rushes about gathering gear as her mum helps by ticking items off on a checklist. Leonie had not been counting on attending this birth as a midwife due to Jordan’s needs, but she wants to support Adele. Her mum straps a sleepy baby into his car seat, as they carry the midwifery gear and the baby gear out to the car. Jordan simply smiles drowsily. Leonie and Ivan set off on the familiar twenty-minute drive to Cathy and Dennis’s new house in the Tryphena bush.

  The roads rock Jordan back to sleep.

  ‘I don’t think we should take him inside,’ Ivan says. ‘We don’t want him waking up and distracting Cathy in the middle of the birth. Let’s leave him in his car seat. We can park the car right up by the window so we can see him if he wakes up.’

  Leonie is happy with this arrangement, so Ivan and Dennis start manoeuvring vehicles so that their own is just 30 centimetres from the window of the room where Cathy is. Leonie takes her gear inside.

  There to greet her are Cathy, who smiles, flushed and dishevelled—the labour is progressing quickly—and Nancy, whom Adele has asked to attend until Leonie arrives, in case Cathy’s birth is fast.

  Leonie can see Jordan through the window of the room and the window of the car. It is a grandstand view. The light spilling from the room lights his face as he sleeps.

  Cathy is feeling the contractions intensely now. Similar to last time, she is positioned on a mattress on the floor. She is bundled up in Dennis’s Swanndri and breathing hard through each contraction. Leonie listens to the baby and is reassured by the regular heartbeat that all is well. Leonie believes Cathy is in transition, and that the birth is imminent.

  Cathy is very pale. ‘I think I need to push now,’ she pants.

  With several pushes and a soft groan or two, a big baby girl slips into the world. Her colour is slightly dusky and she is a little floppy, which is a cause for concern. But, as she lies on Cathy’s chest, she quickly pinks up, and her heart and lungs sound normal. Cathy lies back, shocked and shaking with the speed of it. But after a few minutes, sipping the hot drink that Nancy brings her, her own colour is returning too.

  Leonie sneaks a look out of the window. Jordan is still sleeping peacefully.

  Lights shine up the drive and a car arrives. It’s Adele. She enters the room with a sad smile.

  Leonie makes sure that Adele sits in an armchair and watches as the placenta is delivered. It is intact, and all seems normal. It is time for Leonie to clean up and to present her customary birth-day cake, and for Dennis to open the bottle of champagne. Cathy proudly announces her ten-pound daughter’s name.

  ‘Johanna. Her name’s meaning is Gift of God in Hebrew,’ says Ivan.

  Leonie checks on Jordan, and then turns her attention to Adele.

  We share a long, strong hug. The significance escapes everyone but Ivan.

  After eighteen years of marriage, Adele got some aspect of her family planning wrong. She was initially devastated when, a couple of months before, she had looked at the pregnancy test and it read positive. However, she and Shannon eventually talked themselves around to accepting the situation, and even looked forward to being parents—which is why this has been one of the hardest afternoons in her life. The symptoms of the pregnancy, which had been very strong, had slackened over the last couple of days, and all doubt vanished earlier this afternoon when Adele started cramping. At 4 pm, she miscarried.

  We had talked on the phone several times—both of us crying—before Cathy’s call came. Leonie had been trying to persuade Adele to take some leave off-island and, at the very least, to let Nancy, Ivan and Leonie attend Cathy’s birth, when it happened. But Adele was adamant that she would be there for Cathy, as promised.

  Leonie had hung up from the last call feeling a terrible, impotent grief for her friend and something resembling guilt at the joy she had in her own two happy, healthy children. But during the hour-long drive from Port FitzRoy to Tryphena, Adele had time to reflect. It was all part of it, she knew. The same circle of renewal that saw her making this drive the length of the island again for Cathy was the cycle that had both given and taken away her own pregnancy. Death is part of life.

  Now, in this room filled with Cathy and Dennis’s joy, with Leonie stealing glances out of the window at the angelic, softly lit features of her sleeping baby, Adele feels a kind of peace. She thinks about one of her patients, an older Aotea resident, who told her about the series of miscarriages s
he suffered at a time when such things were not spoken about. She feels a deep empathy for that woman, and all women who have had to bear such grief alone. She is thankful that she will be supported in her loss in the same way and by the same community as Cathy and the other mothers of Aotea are supported in the joyful delivery of their infants, and that thought is an immense comfort to her.

  That weekend, Adele sits in the quiet of her home and stitches together a quilt for Cathy’s new baby girl. As she does so, she celebrates the strength of women and the bonds that are created in shared birth experiences and of the miracle that is childbirth. She thinks with love about the baby. As her needle passes in and out of the fabric, she smiles through her tears.

  Chapter 7

  ONWARDS, UPWARDS

  One of the stories that highlighted how badly change was needed didn’t happen to us; it was Nancy who was in the hot seat. It was on one of the rare occasions when Leonie and Ivan were off-island. They seldom went away because it was no easy task getting a general practitioner to come and locum, working from the caravan. Nancy clearly recalls the chain of events.

  One starry night, she got a call from the very worried wife of a 40-year-old local man. He had, she said, a ‘sore stomach’.

  Knowing the couple well, Nancy knew they wouldn’t be calling her unless it was serious. Nancy’s instincts were to attend immediately.

  She moved her vehicle as close as she could to the man’s house, parking her small four-wheel-drive at the bottom of the steep, winding track that was the only access. She made the ascent by torchlight, and arrived to find a very worried woman hovering at the door.

  Her husband was pale and sweaty and clearly in agony, and had been vomiting brownish, granular material for hours. Nancy gave him a quick examination, and found his blood pressure to be low and his pulse fast and thready. It supported what she already suspected: he was probably bleeding from a stomach ulcer. The ‘coffee grounds’ that he had been vomiting were altered blood—blood affected by gastric juices. He urgently needed to be transferred to Auckland Hospital. She cranked up the phone and asked the operator for Auckland Hospital so as to facilitate a speedy admission. It took a while, but eventually she was connected with a doctor who was prepared to accept a rural nurse’s diagnosis and to authorise admission.

  Nancy’s relief was short-lived.

  No sooner had she put down the phone than her thoughts suddenly turned to the steep track to the road. She surveyed her patient: he was a big man, and the combined strength of his wife and she, the not-so-young nurse, was never going to be enough to get him down it.

  That was the first thing that struck her. The second was that, while she knew it was vital that he be administered fluids to replace the volume he had lost through vomiting in order to stabilise his condition, she had never inserted an intravenous line before.

  Nancy felt pretty alone at this point.

  Priorities, she thought. She inserted the line by the wavering light of a torch as though she had been doing it all her life, and soon she had normal saline snaking into his vein from a bag his wife was holding aloft.

  Now it was time to address the evacuation issue. She needed to find at least four strong men, and it was early in the night. When she cranked up the phone again to ask the sleepy local operator if he could rustle up some help for her, the best he could come up with was a contingent from the local Barrier Social Club.

  Time was of the essence, she thought. Great Barrier Airlines were already preparing for take-off from Auckland.

  Loud crashing and the odd giggle announced the arrival of her stretcher-bearers. Three short figures from the club and one tall neighbour emerged from the inky blackness at the top of the track. They had the scoop stretcher from Nancy’s car with them, and the patient was soon secured on it with straps around his torso and the blanket tucked tightly around his legs. With Nancy holding the IV line aloft, and when all seemed in order, the bearers hoisted the stretcher. With one much taller than the other three and (it became clear) one of them pretty inebriated, Nancy could tell the patient, even in his distress, thought it was odds-on he would be tobogganing most of the way down the hillside.

  With Nancy following and shining her torch on the IV line, which she was sure would be ripped out somewhere en route, the party set off. The track switched to and fro down the hillside. The patient swore at regular intervals and, despite being well strapped in, gripped the sides of the stretcher with white knuckles.

  Somehow, they made it to the road without mishap. Another volunteer had opened the tailgate of Nancy’s four-wheel-drive and had been struggling manfully with the mechanism that reclined the seat backs. He thought they were jammed. There was no way the stretcher would fit in the interior without being able to lie the seats flat.

  The locals scratched their heads and mulled over the options. Eventually, someone had the bright idea of fetching the school bus. Someone jogged off to rouse the driver.

  Everyone stood about for a few minutes, with Nancy checking her patient. Then the sound of a diesel motor could be heard and headlights splashed across the canopy of the trees. The elderly school bus hauled into view. It crawled past the group, stopped and then the reversing siren started and the patient on his stretcher was lit in the ghostly glow of the reversing lamps. The driver clearly aimed to get as close as he could to spare the patient as much discomfort as possible.

  Everyone watched for a moment, chatting idly. Then the conversation stopped and there was a flurry of anxiety.

  ‘Stop! Stop!’ several people frantically yelled, including the patient himself, immobilised and watching the wheels on the bus going round and round and ever nearer.

  The bus jerked to a halt.

  As soon as the doors hissed open, someone realised that the stretcher was wider than the aisle between the seats. Another committee meeting was convened to decide where to put the stretcher, and it was finally decided to secure it across the top of the seats. Nancy had visions of emergency braking, the stretcher launched through the windscreen like a missile . . . But there was no time to devise better arrangements, and soon the bus roared off over the metal roads, drip miraculously still intact, on its way to the airfield, 30 minutes away. Nurse Nancy was much relieved.

  Evacuation from the airstrip at night, in the late 1980s, was still very much dependant on a fixed-wing plane and local support people. Only the most experienced commercial pilots were permitted to fly to the Barrier by night, and even then the Civil Aviation Authority limited this to emergency evacuations for patients who could not be left until daylight. The grass airstrip was unlit, so locals were roused or gathered from the local clubs to provide runway lighting. Strategic cars would park along the runway with their headlights on. One night—it may even have been that night, since it was that sort of night—on the instructions of a new policeman who thought his grid layout to be an improvement, the cars were duly arranged. The locals, not wanting to disappoint him, obliged, only to hear the plane circling above instead of landing. Everyone looked at everyone else and wondered what the problem was.

  Soon afterward, a car arrived at speed. It was the Tryphena telephone operator, who had been woken by Great Barrier Airlines ground control instructing him to race over the hill and get the clowns whose lights were dazzling the pilot on his approach to turn in the opposite direction. The Claris exchange was closed, and this was long before cell phones. Orders were issued and cars rearranged—to reveal a lone car, headlights off, in the centre of the runway. An urgent investigation revealed that the driver was fast asleep in his seat.

  It is amazing what you get used to, and what you can come to consider normal. Leonie and Ivan managed to find a bigger, racier, more modern caravan than the green one, although their new orange one was still pretty elderly. Leonie politely asked Ivan that it be sited further from their front door and closer to the roadway, to give everyone—both them and their patients—a modicum of privacy when they had visitors. So, Ivan and his assistants wheeled the ne
w caravan to and fro with much grunting and studying of angles. When they thought they had it organised, they chocked the wheels and boxed it in to stay. Leonie was pleased with the new position, at first. The shortcomings only became obvious to her the first time she was performing a well-woman check (she had begun to offer cervical smears and antenatal checks as part of her evolving nursing-midwifery role) and she heard male voices. Ivan had intercepted their next patient at the front gate and had detained him there, chatting, while Leonie knelt, torch angled, performing a gynaecological examination. Although the new caravan was bigger, it still only had a narrow bunk on either side of a cramped aisle: the poor female patient had to lie on the bunk, legs spread, while Leonie knelt in the aisle. If someone were to open the locked door, there was no way anyone could retain their dignity, let alone their modesty.

  Everything professional seemed to be a struggle. The culture on the island is very much one of making do, as it has to be. We simply had to follow the islanders’ lead with what we could provide. Nevertheless, it seemed wrong to be offering such a third-world service only 30 minutes’ flight from the modernity of Auckland.

  One night, after they had been in their larger caravan for a while, Ivan and Leonie had an emergency. A man had been brought to them unconscious and Ivan, on his hands and knees on the caravan floor with a torch in his mouth, was trying to secure the patient’s airway using first an oropharyngeal airway (a short tube that is fed from the mouth into the patient’s windpipe) and then connecting this to an Ambu bag (which can be used to manually ventilate a patient who is not breathing adequately for themselves). Leonie knew what he was trying to communicate around the torch, even though the words were unintelligible: he wanted an extra pair of hands. The trouble was, with both Ivan and the island’s solid policeman crowded in the space around the patient, there was simply no room for Leonie to assist.

  Somehow, Ivan got the patient intubated and organised for evacuation. After he had been sent off on the plane, Ivan put his head in his hands and said, ‘I can’t do this anymore—the community deserves better.’