Worry is beginning to give way to panic. At home, Adele sits on the bed and forces herself to think what to do. With shaking hands, she picks up the phone and calls Bruno’s house.
‘You’re up late, Adele,’ Bruno’s wife, Sue, says.
‘Is Bruno home?’ Adele asks.
‘Yes, he’s right here, tucked up in bed.’
Adele struggles to get her words out. ‘Shannon’s not,’ she says.
There is a muffled exchange at the end of the line.
‘Bruno’s getting dressed. He’ll go looking.’
After Adele hangs up, she drives down to the wharf to wait. Shannon’s aluminium dinghy isn’t there, but she already knew it would not be. It seems like an age before she hears an outboard coming towards the wharf, and sees the phosphorescence flashing at the bow of Bruno’s boat. It is too dark to tell how many people are aboard until it is practically alongside. With a surge of relief, she sees Shannon sitting next to Bruno.
He is wet and cold—probably hypothermic—but he is alive. He is alive, and Adele waits until he is home and warm and dry before she asks him what happened.
‘I got hit by a wave on my way back from the barge,’ he says, and names a stretch of water en route that is exposed to the ocean swell from the entrance. ‘It tipped me over, and I couldn’t get the boat back upright again. So I was just hanging on. After a while, I decided to swim ashore, but I only went a little way before I realised it was a bad idea, especially with my gumboots on. I was lucky I found the boat again. And I was lucky the wind and the tide were with me. I worked out after a while if I hung on, I would wash up eventually. I ended up getting ashore a few bays around. I was pretty happy about it, I can tell you.’
‘I was terrified,’ Adele says. ‘I thought I’d lost you.’
‘I saw you!’ Shannon says. ‘I saw you driving up and down the road. But there’s no way up the cliff from the bay, so I couldn’t get to you. I was lucky Bruno came along. I had my torch, but I was lucky he saw me. It’s nearly out of batteries.’
Bruno lives in a bay with no road access, so he knows the harbour like the back of his hand. He took stock of the wind and tide and worked out where he thought Shannon would wash up if he had found himself in the water. His instincts were correct: in the second bay he checked, he saw the dim light of Shannon’s torch waving at him from the stony shore.
Adele refrains from telling Shannon off for not wearing a lifejacket (he draws his own conclusions: after this episode, he always wears one). But she cannot help asking why he kept his heavy gumboots on, especially when he decided he was going to try to swim ashore.
‘You must have been hypothermic when you made that decision!’ she says.
‘No, I figured I would have to walk quite a long way over rocks when I got ashore. Didn’t want to hurt my feet. I was lucky.’
Lucky, all right. Lucky, lucky, lucky.
In July 2000, Adele believes her luck has run out.
She is in the bathroom, sobs shaking her shoulders. She started crying silently in bed but did not want to wake Shannon, so here she is in the bathroom surrendering to the emotion.
A mammogram performed over on the mainland confirmed that the lump she had found in her breast was indeed suspicious, so she underwent a biopsy. The results were phoned through just this afternoon. It is malignant, and she has been booked in for a wide local excision (cutting the lump out), along with lymph node dissection (where the lymph nodes that drain the area are taken out and investigated for any sign that the cancer may have spread) and it is then proposed to offer her chemotherapy and radiation.
When she took the surgeon’s call, Adele was mostly numb with shock. But the numbness wore off as sleep eluded her, and was replaced with self-pity. She sits in the bathroom and wallows in it for a while. She is not even 50, and yet she might die. A new round of sobbing wracks her.
She has often told her patients that there is sometimes nothing like a good cry. After a while, the surge of emotion has rolled over and past her, and she feels calmer. From the moment we are born, she reflects, we have a finite period of time on Earth.
Do you have any regrets? she asks herself. What would you change?
No, she answers. Nothing.
Right then. It is off to war we go.
That is how she will treat it.
There are four tactics in the battle against the rogue cells in her body, best summed up as cut, burn, poison and starve. First, the tumour in her breast will be cut out, along with a margin of healthy tissue, in an effort to ensure that all of the cancerous tissue is removed. Then the area is subjected to radiotherapy (burned): cancer cells reproduce at a faster rate than normal cells, and fast-growing cells are more susceptible to radiation damage. At the completion of the course of radiotherapy, everyone can be reasonably confident the local area is free of disease. But to make sure of it, and also to target any cells that may have metastasised (spread) beyond the primary site, a range of highly toxic drugs are administered, once again to target fast-growing cells. Once chemotherapy is complete, the disease can be considered to have been eradicated. But because Adele’s particular cancer is enhanced by one of the hormones that naturally occur in her body, drugs to alter the hormonal cell wall to deprive any remaining cancer cells of the ability to utilise that hormone are offered. In effect, any remaining rogue cells are starved.
All of this will be pretty rugged. Because they target fast-growing cells, the radiation and the chemotherapy also affect some normal tissues that are also fast-growing, such as the linings of the mouth and gut and, of course, hair follicles (although, as it turns out, Adele is fortunate and does not lose her hair). The chemotherapy drugs have a range of side-effects: which ones she will suffer, and how severe they will be, is unpredictable, as it all depends on the individual. And quite apart from the routine demands of this regime, it will be made all the harder for Adele, of course, because she will have to travel to the mainland for each step of the process.
But as it always does, the island community draws around Adele as news spreads. A friend of the family tosses her an envelope in which there is a heavy object.
‘What’s this?’ she asks.
‘Keys to our place in Auckland,’ he says. ‘You’ll be needing somewhere to stay over there. And the car key’s there, too. Pretty hard getting around Auckland without a car.’
This is typical of the kind of support she gets. And when she wakes after her surgery, she finds her hospital bed surrounded by vases of flowers. A nurse brings in a big cardboard box full of get-well cards from the children of Kaitoke School.
The treatment regime is manageable, Adele does not focus on it: the side-effect of not undergoing it, as she explains to people who commiserate with her, is potentially death, so anything short of that is fine. People—professionals and well-meaning amateurs alike—give her articles on special cancer diets and foods to avoid at all costs. She should not eat sugar or dairy. She should avoid coffee—or drinking it, anyway: coffee enemas are in vogue. But Adele has seen too many people succumb to cancer while enduring coffee enemas and trying to live on beetroot juice. If she is going to die, she reasons, then she will do it enjoying all of the foods that she loves.
During the treatment period, Adele takes six months off work and focuses on recovery. She feels her strength returning. Soon she finds herself forgetting about cancer. After a year or two, she hardly gives it a thought. And, ten years on, she celebrates. She has won the battle. That particular cancer will not kill her.
Sometimes you feel that life on the island is just too hard. But the trips to Auckland, such as Adele’s trips for treatment, and the struggle there with traffic and the relentlessly fast pace remind us how fortunate we actually are. On Aotea, we can drive for 40 minutes along a road overhung by mānuka and ponga without seeing another vehicle. Each corner opens a new vista of mountain and bush and white sand, and a different perspective on the ocean and the horizon, the sea and the cloudscape. If you do pass another v
ehicle, the driver will lift a finger from the steering wheel as you lift yours. In the city, you notice how few people you know: on the island, you notice the strangers, and in winter there are few.
And life has got easier. The advent first of the Community Health Trust, then of Aotea Health, has blessed us with the resources that we lacked in the early days. We have access to equipment and people, and as a consequence we have a modicum of that thing that was the scarcest commodity when we started: time for ourselves and our families. We still work full-time, but we are not so constantly on-call, and nor do we live in such a fishbowl as we used to.
Our lives have changed, as the cycle of which we are a part has creaked around, as it inevitably does. Leonie and Ivan’s children have grown. Alastair was still a teenager when their younger two were born, and he is well established in his medical career these days. First Amiria, then Jordan, reached the age where the island no longer had the educational resources for them. It is traditional at this point for Barrier families to choose where their children will seek secondary schooling. The Howies had already arranged their option: to attend a public boarding school, and one by one, Leonie and Ivan packed their children off. It was a culture shock for both of them. There had been few choices open for Amiria’s secondary education: of the public schools that still offered full board, St Mary’s had closed, leaving Epsom Girls’ Grammar, which her aunts and cousins had attended. But she quickly found her feet there, thriving among the opportunities that a big school had to offer her to make friends and play sport. Jordan’s choice was probably made when he was still a baby, his dad being an old boy of Auckland Grammar School—every time they travelled past, Ivan would point it out, saying: ‘There’s Jordan’s school.’ Jordan suffered terribly from home-sickness at first—the regimentation, the uniform, the big city, the sheer number of other people were bound to deliver a culture shock—but we breed them tough on Aotea. Leonie and Ivan gave him the option during the worst times to return to the island but he stuck it out, and after the initial adjustment, he, too, began to thrive. Both are well along their own journeys now. Jordan is an engineering geologist, and Amiria followed down the medicine pathway. The Barrier has offered her its own, distinctive experiences. During her holidays through medical school she worked as a receptionist at the Health Centre. The locals soon cottoned on to the fact she was training to be a doctor, and rather than bother the qualified staff beyond the reception desk, they began consulting the receptionist on their ailments.
‘Look,’ one said, hitching up his shorts as Amiria hastily averted her eyes. ‘Know what this is?’ Amiria shuddered to think. ‘You’ll see a few of these. It’s a hernia scar.’
They viewed all this as part of her learning and wanted to help ‘educate’ her.
It took Shannon some time to discover the trick of standing upright on Aotea, but once he did, there was no shifting him. He retired in 2013, after 21 years as a mussel farmer and even longer as a resident of the Barrier and chief support to the Public Health Nurse, Northern Riding. And at the time of writing, Dr Ivan Howie is retiring too, after more than 36 years of service as a GP on Aotea, for many of them the GP on Aotea.
Adele has won the battle, but not, as it turns out, the war. A few years after her original diagnosis, one of Adele’s beautiful younger sisters developed ovarian cancer. From the outset, the prognosis was poor, but she managed to battle the disease for seven years, showing her family and friends how to be brave and strong every step along her very sad journey. Apart from when she first moved to the island, it was during this period that Adele felt the isolation of her life on Great Barrier more acutely than at any other time. Spending time with her family on the mainland meant finding a window among her midwifery obligations to the pregnant women on the island and finding cover for her nursing post, not to mention the disruption that had to be allowed for the operation of the mussel farm when the need to go away fell during the busy time. Then there was the erratic schedule of ferry and air services to reckon with. You cannot just spontaneously leave the island. As she was in the air heading to Auckland, her sister passed away. She left Adele and her three remaining sisters and brother with four amazing nieces as a constant reminder of what a wonderful mother, wife and sibling she had been.
As part of the diagnosis of her disease, Adele’s sister also underwent genetic testing, and it was found that the family carries the BRCA2 gene mutation. This means Adele and two of her three surviving sisters who have the mutation have a fifty to eighty per cent lifetime risk of developing breast cancer and a twenty to forty per cent risk of developing ovarian cancer. This elevated the chances of Adele developing cancer in her unaffected breast to thirty to fifty per cent.
She was considering prophylactic mastectomies—the complete removal of the tissue of both breasts as a precautionary measure—when she discovered a cancerous lump in her right breast, which had been previously unaffected. There is some research to show that cancers of the right breast are more aggressive than those in the left: regardless of whether this is true or not, this round of the disease is more aggressive than Adele’s first. But if the disease is more determined, so is she. There is no wailing or grieving this time. Instead, she is thankful that her tumour is in a place that was easier to detect early, whereas her sister’s hadn’t been. There are times when the treatment is like a ghastly step back in time, but Adele sees it through. She wins the second great battle for her life, but it is too early to declare the war to be over. It is now a waiting game. But then again, it is a waiting game for all of us, in the end.
EPILOGUE
The speeches are over. We have said our farewells to Jill, whom we have known as a patient, mother, daughter, partner, grandmother and, above all, friend. Others have known her, too, in many different ways, and each has their little fragment of the whole to show. The work of the gathering has been to stitch these together into a single whole, and as we leave we reflect on how well it has been done. It is something we can draw around ourselves when we remember her, this shared yet particoloured experience.
There was only one Jill, but there are many Jills: we know these people, the islanders, the Barrierites, on lots of levels, just as we know Aotea itself, through the intimate tread of our feet on narrow clay paths through the bush, or the business-like rumble of tyres on the gravel of the road, or the glorious panorama it makes from the high points, or from the air. We know the heat of the summer and the burn of the sun, the smell of mānuka and road dust, the rank smell of the raupō swamps and the tang of salt. We know the cold sting of the surf and of rainwater in the shower, and the raw bite of a winter sou’wester. There are the hard times, and there are the good times: we can remember all of them, and they have shaped who we are.
Adele reflects on her first meeting with Jill’s father, and then her first meeting with Jill. She thinks about the raw clearing that she chanced upon on one of her early visiting rounds, and the man who would become Jill’s partner and the father of her younger children. She thinks about the house that was built there, and the other families she has visited where successive babies have marked stages in their progress: from rough shelter, to simple house, to something more substantial, to something well and truly comfortable.
Leonie remembers Jill as she first met her, the very picture of the Barrier woman, staunch and practical and warm and hospitable. She aged as Leonie herself has aged, but it was the way of things that they would not grow old together, as Leonie had supposed they would. She feels her loss keenly, but she is also conscious of how lucky she is to have known Jill, to have shared her journey (even its bitter end) and to have known others in the same way.
This is what it is to be a nurse in a place like Aotea. You do not clock into the job and then clock out of it. It enfolds you, as the arms of Allom Bay enfold us now. It defines you, and it gives to you even as it takes away from you. You can walk away from it, just as we walk sadly up the clay track away from Jill and the stories that we shared with her. But it follo
ws you, like memory. It is with you, always.
RIGHT
Adele in Western Australia, where she and Shannon moved two years after she had completed her nursing training. They lived there for seven years.
BELOW
Adele (far right) quilting with friends. Adele learned to quilt when she arrived on Aotea, and these quilting sessions became a great source of emotional sustenance.
RIGHT
The Great Barrier Island Howies in 1991. From left to right: Alastair, Amiria, Ivan, Leonie and Jordan.
BELOW
The Howies’ first home and ‘practice facility’ (the caravan) in 1986.
OPPOSITE TOP
The health centre at Claris.
OPPOSITE BOTTOM
The nurse’s cottage at Port FitzRoy.
ABOVE
Jill visiting Ivan with her younger children in 1997.
RIGHT
Peter and Feral Cheryl ... before she grew into a gigantic sow.
OPPOSITE TOP
Some of the locals preparing a hāngī on Aotea.
OPPOSITE BOTTOM
Shannon and his business partner, Bruno, on the mussel barge in 1997.
RIGHT
The Auckland Rescue Helicopter Trust evacuating a patient from the health centre to the mainland.
Island Nurses Page 22