‘I just woke up and I went to look at Pitokuku.’ She names the hill beside her home, the prospect of which she has always called her favourite view. ‘I was just looking like I usually do at the clouds—you know, to see what way the wind’s blowing, if there’s rain. I always do that. But this morning I couldn’t see it properly. I ducked my head under the blankets and popped it out again, but I still couldn’t see properly.’
In reply to their questions, she tells Ivan and Leonie that she can see normally out of her left eye, but when she covers that eye and tries to look out of her right . . . darkness. Maybe there are dim shadows, grey patches, but otherwise everything is black.
‘So I woke Charlie and told him, “I can’t see”, and he told me not to be so damn stupid. But maybe he did care, because he disappears and fetches our daughter.’
Their daughter is a trained nurse. She knew this was serious, and sent them to the health centre at once.
‘Is there any pain?’ Ivan asks.
‘No, thankfully not. No pain. I just can’t see out of this eye.’ Her voice wobbles, and a tear trickles down her face. ‘When I try to look out of only my right eye it’s like being in the bush at night and trying to look up and see the sky. It’s all so dark. It’s like trying to look out from a room when all the windows on one side are blanked out . . . That’s the only words I have to describe it.’
Leonie is called away again—it’s a very busy Saturday morning in January at the health centre—and when she comes back, Ivan has put drops in the woman’s eye to dilate the pupil. He is taking a history, and she is answering his questions with good-humoured impatience.
‘No, Ivan,’ she says. ‘There’s no history of diabetes in my family. You know that. Everyone in my family’s one of your patients.’
‘High blood pressure?’
She rolls her eyes—the good one and the one from which she can’t see. ‘No, Ivan. No high blood pressure.’
Ivan is consulting her notes.
‘Yes, Ivan. I turned sixty-six in October. No, I definitely have not taken up smoking.’
Her blood pressure and pulse are normal. Ivan darkens the room and explains the eye examination he is about the perform. She sits still and compliant. Her eye shines like a jewel in the concentrated light of his ophthalmoscope. He leans this way and that, viewing from different angles, and Leonie imagines what this examination would have been like in the caravan.
‘OK,’ he says, rocking back on his heels. ‘I’ve been looking at the back of your eye. It looks to me like you’ve got a central retinal vein occlusion, which is a blockage in one of the blood vessels that supplies blood from your retina. I’m not a hundred per cent sure, because there is a pale optic disc back there too, and I don’t know why. It’s not typical of a vein occlusion.’
‘What does all that mean?’ the patient asks.
Ivan frowns. ‘I’m not sure, until I’ve talked to the eye specialists at the hospital. Can you remember what you were doing yesterday? Was it stressful?’
She is momentarily at a loss.
‘Oh, I remember,’ she says. ‘We had a stall at the New Year’s Picnic. What a carry-on that was. I was flat-out all day, you know, organising everything and then running the stall. Makes me tired just thinking about it. But, oh, yes . . .’ She pauses for a moment. ‘When we got home, it was dark. I distinctly remember standing outside with my granddaughter and we just looked up at the glorious night sky. The stars were terrific. It seemed like I could see forever. I thought, How special is that?’
Ivan phones Auckland Hospital as the patient lies on the couch, trying to make sense of the technical terms she overhears. She begins to cry again, the tears spilling down her face.
The hospital doctors want Ivan to keep her under observation for the rest of the day. He gives her an aspirin, to help with thinning the blood and reducing any clotting. Leonie makes up a bed for her in the ‘ward’, which is an adjacent room where there are mattresses on the floor at this time of year to cope with the big influx of patients over the period on either side of New Year’s. The patient lies there drifting in and out of sleep all day, Leonie or Ivan checking in from time to time, with her family dropping by to visit. Late in the afternoon, she is given a final orbital massage, as prescribed by the hospital, and Ivan performs another full eye examination.
‘The hospital can see you on Monday,’ Ivan says, after he has phoned the mainland to report his findings.
The patient looks dismayed. ‘Don’t they want to see me straight away?’ she asks.
‘No, they feel we can wait,’ Ivan replies.
He and Leonie can see the significance dawning upon her. The tears start again. They try to allay her anxiety but she tells them that this is the scariest thing that has ever happened to her.
‘You can go home. I would like you to come back tomorrow morning so we can review your eye again. And, in the meantime, Leonie will make you up a dressing that will make you look like a pirate.’
The patient smiles through her tears.
The outcome, as Ivan had feared, was the confirmation of a central retinal occlusion and the complete loss of vision in that eye. There was no reason found for the pale optic disc, though it was of interest to the specialists. It was suggested that the previous day’s stress may have contributed to the event. With all the empathy in the world, you cannot really appreciate the impact of a sudden loss of this magnitude unless you have experienced it.
This would have been a terrifying and isolating time for this woman. Word got around about her misfortune, as it does in the island community, and the excavator driver did not hesitate to step forward and offer his wholehearted support. After all, he had walked the same dark path.
On a day when she was feeling her loss particularly, he gave her a neck massage and listened as she poured out her fears and regrets and gently reminded her that her life would go on, and that, with time, she would adjust.
And adjust she has.
‘You should see me trying to thread a needle, Leonie!’ She laughs. ‘And if someone over there—’ she gestures off to the right— ‘talks to me, I’ve got to turn my whole body around to look at them. And I’m a shocker for clipping people as I walk past them. They must think I’m awfully rude. I tell them I’m sorry, but I’m glad we don’t have big crowds on the Barrier. Imagine me in Auckland! My grandson holds my hand crossing the road.’
She shows Leonie her range of walking sticks. The paddocks on her farm are far from even, and she has to be careful. And when she is mustering she has to constantly turn her head or even turn completely around to make sure her dogs have not left any sheep behind.
‘I get dizzy, too,’ she says. ‘If I move suddenly, everything spins for a minute. The others tell me they get that too. It took me a few falls to get my head around that one.’
‘But you are OK?’ Leonie asks.
‘I’m OK,’ she replies. ‘I can still work the farm. I can still do my quilting.’ She pauses, and a range of emotions cross her face. ‘And I can still look at the stars with my granddaughter,’ she says.
________
* Not his real name.
Chapter 9
PROGRESS
Probably the greatest challenge for the island’s health professionals is the sheer relentlessness of being on-call. For the best part of the first fifteen years after we each began, Adele was on-call for those in the isolated north of the island while Leonie and Ivan cared for the bulk of those in the middle and south of the island. With solid support from Nancy (and, after her retirement in 1991, her replacement, Peter) this was of course on top of our full daily clinical load—cradle-to-grave primary healthcare.
While one of the major attractions of life on the Barrier is the outdoors—the bush and the sea—we were unable, for a long time, to make the most of it, as we were obliged to be constantly contactable. You couldn’t have a day at the beach without letting someone (usually, at first, one or other of the telephone operators) know exact
ly where you were. And even at night you were always on-call.
In the period just after the births of Amiria and Jordan, Leonie’s children, life was pretty intense. Leonie had to juggle breastfeeding with full-time work and being on-call. It didn’t help that the island was experiencing a minor baby boom all of its own, with around 30 pregnancies a year requiring antenatal and postnatal care and, in many cases, midwifery services at the birth (compared with the more usual ten per annum nowadays). The silver lining of the workload that this entailed is that Leonie shared the journey through the infancy of her children with other mothers who (life on Aotea being as it is) were also juggling multiple responsibilities—breastfeeding, home-based businesses, part-time employment and the simple, hard, diligent effort it is to cook, clean and do laundry in the absence of reticulated electricity, and using alternative energy systems like wind, solar and hydro, which are at the mercy of vagaries in the weather.
This group of young mums shared a common bond. Leonie revelled in the support of like-minded women, and she also appreciated several meaningful relationships based on her Christian beliefs. They laughed and cried together, and ultimately were empowered by the experience of sharing some of the special moments in one another’s lives.
It is all very well that nurses, like everyone, are encouraged to lead a balanced lifestyle, keeping a proper work–life balance; this all goes out the window in a remote place like Aotea. And island nursing can be difficult enough without having to wear the yoke of perfection. Balancing the roles of ‘good nurse’, ‘good wife’ and ‘good mother’ can be tricky. It is easy enough to put your patients’ needs before your own, but it is hard to put them before your children’s interests. This is exactly what the job often required Leonie to do, and her bad case of the working mum’s guilts became even worse when Ivan was called out alongside her. But on-call work can also be intensely rewarding; some of Leonie’s most satisfying nursing moments have come when she and Ivan have been on-call.
When the children were very young, Leonie and Ivan perfected the art of waking them, grabbing their pillows and a blanket, and racing off to the health centre, where Amiria and Jordan quickly learned to snuggle down in a quiet space on the carpet and fall back to sleep. On one memorable occasion, the children were woken by the squall of a newborn baby: a mother had given birth before her due date. Far from being put out, they were excited. This was a break from routine! They loved saying hello to the wee baby.
One night, when her daughter Amiria wasn’t quite two, Leonie spied on her through her bedroom doorway and watched, bemused, as she ferreted through a drawer, strewing clothes on the floor, before she seemed to settle on a selection, which she carefully stacked on the end of her bed.
‘What are you doing?’ Leonie asked.
‘These are what I want to wear tomorrow,’ Amiria replied in a very grown-up voice.
As Leonie tucked her into bed, she suddenly realised what was going on. She, too, was in the habit of placing a stack of clothes at the end of the bed, just in case she was called out in the wee hours. Amiria was simply following suit.
Years later, when Jordan skipped home from school one Friday, he looked at Ivan and said, ‘Are we on-call this weekend?’
When Jordan was around three, a local woman named Cherie approached Leonie and Ivan and told them how much she enjoyed Jordan’s company. ‘Would you like some support?’ she wondered. ‘Would it be OK if Jordan—and perhaps Amiria too—spent time with my family?
Would it ever!
Cherie became the Howie children’s ‘other mother’. It has proved to be a great relationship for both families. Both Amiria and Jordan relished the opportunities that being part of Cherie’s family provided, and being able to make the absolute most of the outdoor heaven that the Barrier provides—surfing, swimming, fishing, biking, trail-biking, going rabbiting. Cherie thought herself lucky that the children enjoyed all the things she loved doing. Cherie played a large part in providing Jordan and Amiria with an idyllic childhood—so much so that their big brother, Alastair, would comment how lucky they were. He spent every school holiday that he possibly could on the island, but by now he was at university. He loved the island and would disappear for hours mountain-biking, swimming or just walking, revelling in being a Barrierite again whenever he returned. These days, when the two younger Howie children return to the island, Cherie’s home is one of their first ports of call.
Many was the time that Ivan and Leonie found themselves unable to take the children with them on a call-out. At such times, they were always able to fling Jordan and Amiria at Cherie and her family, no matter what time of the day or night.
The children were, as children are, very adaptable. They didn’t seem to mind sharing their parents with the community. They learned to be creative with their time. Once, when they were in their twenties, Leonie asked them whether they minded growing up as part of the Howie Health Team.
Both merely shrugged. ‘It’s all we knew. No problems, Mum,’ they answered.
Leonie let out a sigh of relief. Both had normalised their growing-up experiences.
And, in fact, they occasionally remind Leonie of the little ways in which they have been useful to the health team.
‘Remember when the Health Trust bought the new ear microscope, Mum, and we became the guinea pigs?’ Jordan says. ‘You and Dad had us up on the table practising looking down it.’
‘Actually,’ chimes in Amiria, ‘I remember when the man was demonstrating to Dad the finer points of the ultrasound machine. I ended up with all the ultrasound gel on my stomach.’
‘Did we do that?’ Leonie says. ‘How awful! I am sure that must be unethical—doing medical experiments on your own children.’
‘Oh, that wasn’t so bad. The worst was when Dad decided to burn off my warts with the frecator when he was showing the other GP how to use it.’
The islanders understood perfectly well what being on-call meant for us, and both of us can remember occasions where we knew for certain that people had put off seeking medical attention just so that we were not called out after-hours.
Leonie remembers one Monday morning, for example, when an elderly gentleman presented himself to the clinic as the very first patient—in considerable pain.
‘What have you done to yourself?’ Leonie asked.
‘My daft draft horse has trodden on my big toe,’ he replied. ‘Hurt a bit, I can tell you.’
‘When did this happen?’ Leonie asks.
‘Saturday morning,’ he replies.
Predictably, the toe is crushed and beyond repair. Ivan explains that it will need to be amputated.
‘Why didn’t you call us sooner?’ Leonie asked.
‘Oh.’ He smiled serenely. ‘Well, the toe wasn’t going anywhere fast.’
Leonie was blessed to have a number of close, loving friends from the mainland who became an anchor during stressful times. They would arrive laden with treats—‘Red Cross parcels’—from across the Hauraki Gulf and save the day. And Leonie’s mum, Isabel, herself a rural nurse earlier in life, would visit for four to six weeks over the busy summer season, when the huge visiting population meant everything would become frantic and Leonie’s workload would more than double.
Isabel was the matriarch of the Taylors until she died in her early nineties. She had not only cared for her own extended family in Northland, but she had for a time also worked in the local maternity hospital to supplement the income from the family farm. She understood Leonie’s nursing values, as they replicated her own. She understood implicitly whenever Leonie disappeared to ‘nurse’. Her summer visits to the Barrier were often to her own, personal cost—either her cat would disappear, or her neglected garden would shrivel up under the blazing Northland sun. She would miss out on wider family gatherings at the bach and fail to connect with her childhood friends who returned to their families for the holiday season but would be gone when she returned in February.
Essentially, she would run the Howie
household, caring for the children, preparing the meals and entertaining any visitors. She never neglected her post, even when invited out by a persistent, on-island suitor she had somehow acquired. Amiria and Jordan adored her. When Aotea Health had reached the point where it was no longer an inexcusable extravagance to hire a locum, Leonie, Ivan and the children would holiday up at her home on the family farm at least once a year.
Adele spent much of this period of her life in the north of the island juggling responsibilities, too. Soon after she and Shannon started their mussel-farming venture, they commissioned the building of a seeding and harvesting barge in cooperation with two of the other new mussel-farm owners. Around the same time, Adele entered the joint venture with Ivan and Leonie in the formation of Aotea Health Limited. She found herself running the books for the mussel-farm ventures and for Aotea Health, as well as working full-time as a rural nurse and midwife.
Mussel harvesting often took place on the weekend, and Adele came to dread early-morning phone calls, as these days it was less likely to be a woman in labour than someone phoning to say they could not come to work on the barge that day. On such mornings, Shannon would ask her to get out of bed and come and help on the marine farm.
‘No! No! I already have a job!’ she would groan.
Once she got out there in the still of the bay, with birdsong floating across the water from the bush, Adele usually found herself enjoying the work, along with the repartee among the crew—to say nothing of the steamed-mussel sandwiches they had for lunch.
But being in charge of the books exposed Adele to the grinding anxiety that is making a living in primary production. She and Shannon once had the unenviable experience of watching, sick at heart, as the news on national television carried pictures of 40 tonnes of their mussels being dumped in a Tauranga landfill due to a toxic algal bloom. Or she would note the rise in the Kiwi dollar against New Zealand’s export partners and see a season’s hard work and a bumper crop realise next to nothing. Or the exchange rate and the market price would both be favourable, but for some reason or another—poor seed uptake, snapper attack on juvenile seed, overgrowth of black mussels—they would have a meagre harvest.
Island Nurses Page 14