‘Out here—’ she leads Adele outside to a door under the house—‘is the wash house. The old copper was used for washing before we graduated to a washing machine.’
They go back inside.
‘Luckily we get power from the Forest Service generators. They turn off about ten o’clock every night,’ Fay explains. ‘After that we’re on candles. You have to keep a torch handy. If you’ve got an emergency in the night, you’ll need to get the Forest Service to start up the genny for you. You can try ringing, but the telephone operator here at FitzRoy is hard to wake up. Remind me to tell you about the phones. So, you can try ringing or radioing the Forest Service mechanic, but probably you’ll need to drive around and wake him up. I’ll take you to meet the crew later on today. Don’t be afraid to ring them as they are really helpful. Oh, and remember to keep your door locked at night.’
Fay sees Adele’s face, and laughs.
‘Oh, no, no, no! There’s nothing like that. Nothing to worry about round here. It’s just that in an emergency people panic. If your door’s unlocked, they are likely to barge right into your bedroom to haul you out of bed. If the door’s locked, at least they’ll have to bang on your door and you’ll have a chance to get dressed first. What I do is keep a change of clothes laid out beside my bed so that I don’t have to fluff around in the dark. Once—must have been a bit more tired than usual—we had a bit of a drama and I threw on my clothes and it wasn’t until much later on that I realised my dress was on inside out and I’d forgotten to put any undies on! Can you believe that?’
There is a note of uncertainty in Adele’s laugh.
‘Adele, this is Gwen. Gwen, Adele’s going to be the new nurse. You and Myrtle will look after her, won’t you?’
‘Pleased to meet you.’ Gwen beams.
‘Gwen and her mum have been wonderful to me,’ Fay says. ‘You’ll see. I don’t know what I would have done without them at times. They’re always here if you need a cup of tea or someone to talk to. Also, Gwen can help you out with the wood stove, as it’s not as simple to operate as it looks.’
Gwen and Myrtle live on the main road at Okiwi. Myrtle keeps a little book in which she has written the names of all the nurses who have worked on the island, complete with the dates they arrived and departed. There’s a sort of a family tradition of taking the nurse under their wing.
‘My husband was third generation on the island,’ Myrtle tells Adele proudly. Myrtle is elderly, but still sharp.
Gwen says, ‘When I was a child, Mrs McLean was the nurse. She went on regular trips round the island, visiting people, and she used to stay with us whenever she came past. You even remember her horse’s name, don’t you, Mum?’
‘Tomi.’ Myrtle nods. ‘His name was Tomi. Of course I remember! Mrs McLean gave Tomi to me when she left the island. No cars in those days. So she used to ride Tomi all around the place. Her trip took a week or more to get to Tryphena and back again, and she had to open more than twenty gates on the way. Off the horse, open the gate, lead him through, close the gate, back on the horse. Twenty times! You don’t know how good you’ve got it these days!’
‘The phones!’ Fay exclaims. ‘I nearly forgot. Good thing you reminded me. Most people are on a party line, which means there could be up to ten other people all connected, each with their own ring tone. We are fortunate to have our own line. When you’re going to make a call all you do is crank the handle with one long twist. The whole system only works during the day so that the operator can get a bit of peace at night. But if it’s an emergency you do five longs and wait. If he doesn’t wake up, you can go across the road to the phone box. Make sure you take a torch, because there are no lights and it’s really dark in there. The phone box is switched over to Auckland, so as soon as you pick it up they’ll answer. They think you’re phoning from overseas, so they’ll say, “New Zealand here.” Just tell them you’re calling from the Barrier. They can connect you to anyone else you want, other exchanges on the island—if they wake up—or on the mainland.’
Adele is nodding slowly, trying to absorb all this.
‘Of course, lots of people don’t have phones, so the only way to get in touch with them, or for them to get in touch with you, is by CB radio—you know, Citizen Band. We keep the radio on all the time. I’ll show you how to use it—nothing to it, really. But remember, everyone can hear you. And don’t go presuming that you’re the only person on the telephone line, either. In wet weather, the lines can cross, meaning that other people might be able to hear your conversation—interesting for them, especially if they know it’s an emergency. On the radio it can be quite good, people listening in. All sorts of people pipe up and say they can help. But not good for patient confidentiality! There is a tongue-in-cheek saying that everyone knows everyone else’s business out here, and if they don’t they tend to make it up.’
This is the way it goes for the first week. It is hot, and the mānuka and ferns crowding the roadside are heavy with grey road dust. Fay and Adele go for long drives, the red Toyota Land Cruiser rattling and crashing on the corrugated and potholed dirt roads.
Fay introduces Adele to the locals and generally tries to show her the ropes. The detail seems overwhelming, but as time goes by Adele will come to appreciate just how hard it is to give another person a feel for the way of life that rural nursing is—the complex intertwining of your life with those in the community of which you are a part. Add to that the challenges of this particular post—the lack of reticulated power and water, the poor state of the roads, the even worse state of telecommunications—and you find you are treading a fine line between imparting useful information and sending your prospective colleague running for the hills.
The public health nurse at Port FitzRoy is not completely without professional nursing support on the island. Nancy Cawthorn is the part-time emergency nurse at the southern end of the island, and on the third or fourth day Fay introduces Adele to Nancy. Adele is heartened to have such a warm, supportive colleague to call upon if she needs her.
She knows there is a general practitioner on the island, too, and that he holds a clinic once a week at the nurse’s cottage in the north, but her employers have made it plain that, as he is in the ‘private system’, she is not to give him any assistance, nor is he to use any of her supplies. She asks Fay and Nancy about him.
‘Oh, Ivan’s great,’ Nancy says. ‘I have a lot to do with him—probably more than we’re supposed to, but things out here don’t always work the way Auckland thinks they do. Never mind the rules. Ivan’s there if you need him.’
At the end of the week, it is time for Fay to leave. She hands Adele a bunch of keys—the vehicle, the clinic and the cottage.
‘Keys to the kingdom,’ she says, a hint of something like regret in her voice. She squares her shoulders, gives Adele a hug, wishes her well and reminds her that she is only a phone call away (if the telephone works).
‘You’ll be fine,’ she says. ‘Just remember—’ She stops herself and laughs. If there’s anything she has not told Adele by now, it’s all a bit late. And, in the end, everyone coming to a rural nursing post has to find out much of it for themselves.
Once Fay has gone, Adele spends the afternoon going through the clinic, looking at paperwork and familiarising herself with the supplies. A sheet of paper in the unruly pile of papers catches her eye. It is entitled: ‘Safe Fish Hook Removal’.
That could come in handy, Adele reflects, and puts it in the growing pile of things she will read later. Also among the papers, she finds carbon-copied books of correspondence between head office in Auckland and the nurses who have preceded her in the last twenty years or so. This correspondence makes for interesting reading. It’s a litany of complaints about failing machinery, inadequate equipment, and supplies that have gone astray, being dropped at the wrong wharf or simply the wrong island. One makes Adele smile. The nurse asks after the parts she needs to repair her lawnmower. If they don’t arrive soon, she says, she will need to b
uy a machete to get from her door to her car. The replies from Auckland, while polite, seem unsympathetic, and, reading between the lines, Adele can sense the exasperation the island nurses are feeling dealing with the distant government department.
Two weeks after Fay leaves, Myrtle suffers a stroke. She is profoundly affected. Adele, Nancy and Gwen try to put in place a plan to care for her on the island, but it soon becomes plain that it is impractical. Myrtle is flown out to the mainland. It is a terrible thing both for Gwen and for Myrtle, leaving the island on which she has lived her whole life. She does not return, and does not survive long away from Aotea.
There is a knock on the door. Adele opens it and finds no one there. Even as she is peering round the frame to see if she can see who has knocked, there is a thumping at another of the four doors. Eventually, both Adele and the knocker meet at the same door. He is a solid man in a stained singlet and shorts, smelling strongly of fish.
‘Good,’ he says. ‘You are here. My mate has a fish hook in his hand. He’s down at the shop looking for you. I’ll go get him.’
While he is across the road, Adele frantically searches among the papers on the desk in the clinic. She finds the article on fish hook removal and scans it quickly. The level of technical detail is baffling and unhelpful, so she tosses the paper aside.
The patient and his mate arrive. The barb of the hook is deeply embedded in a finger of the man’s left hand.
‘I suppose you get a lot of these,’ the patient says, to cover up his nervousness.
Adele nods and smiles what she hopes is a competent and confidence-inspiring smile.
Step one, she thinks: make the area numb, so that no matter what you do, it will not be painful.
Once she has administered a local anaesthetic, she considers how to extract the hook. She supposes the trick is much the same as removing a hook from a fish’s mouth—push laterally away from the barb and sort of flick it out of the wound in one swift motion. She looks in the cupboard and finds a pair of unusually sturdy-looking surgical pliers. She is immediately grateful, because they have an important, purposeful look about them, which will help bolster the patient’s confidence. She grasps the shank of the hook and performs the flicking manoeuvre, familiar from half a lifetime of fishing expeditions of her own.
‘Great,’ says the patient, as a small drop of blood wells from the wound. ‘Lucky we struck someone who knows what they’re doing!’
Adele smiles, and both men go off happily to resume their fishing.
Thirty years later, she still has no idea what the proper function of those pliers is. It hardly matters: they have been her tried and trusted fish hook removal tool ever since that day.
After she has been on the island for six weeks, Shannon arrives, and it is immediately apparent that things are not going to be easy. They both wanted to return to live in a rural area near the sea, and figured some sort of employment would come along eventually, but it doesn’t happen immediately. He is used to working, so he sets up a small workshop in the garage at the back of the nurse’s cottage. All their married life they have had two incomes, and he struggles with Adele suddenly becoming the main income earner. Once his boat arrives from the mainland, he enjoys having the opportunity to fish and dive on a regular basis. The first time someone says, ‘Ah, you’re the new nurse’s husband,’ he takes it quite well. The second time, not so well, nor all the times after that. Adele, meanwhile, tries hard to keep a straight face, thinking of the generations of women who have been assured that they existed only in relation to their husband.
‘Don’t worry,’ Adele hears Shannon say. ‘She’ll lie down soon and go to sleep.’
She realises their house guest, a family friend, has been watching aghast as she has burst through the door, dragged the vacuum cleaner out of the cupboard and started maniacally vacuuming the house. Shannon is used to this kind of carry-on after she has come in from an emergency call-out. He has stopped worrying about it.
Adele, on the other hand, has been worrying about it, to the point where she even asked Nancy whether she used to experience the same massive surge of adrenaline that Adele gets every time she is called to an emergency.
‘Yes, at first I did,’ Nancy had replied. ‘But not anymore.’
‘How long did it take to get past it?’ Adele asked.
Nancy shrugged. ‘I can’t really remember, to tell the truth. But don’t worry. It will happen.’
Adele is an experienced public health nurse and midwife, and is skilled at the routine of working with families in these roles. However, she is less experienced or confident about emergency work. She has attempted to remedy this shortcoming by travelling over to Auckland for the occasional afternoon shift in the Emergency Department at Auckland Hospital, as well as a few shifts with St John ambulance. This has helped, but neither the work—nothing quite like the assortment of scenarios that might strike on Great Barrier Island arise in an urban environment—nor the approach can fully equip her for what she is already beginning to experience. After all, the St John staff have the comfort of knowing they have a fully equipped, modern hospital only a few minutes’ drive away from the scene of their emergency, and the staff at Emergency have state-of-the-art equipment at their disposal. In the northern part of Great Barrier Island, Adele is both first responder and primary health professional combined. Only in a serious emergency would she call for a patient to be airlifted out, and even then it would take an hour or more for the plane or helicopter to arrive, and the same to get back to the mainland—and that is if weather conditions would let them get off the ground at all.
Summer is a frantic time on the Barrier. By 1986 the permanent population has risen to 858, but in summer an armada of private yachts and launches arrive, along with holidaymakers on the planes and the ferries. The population can increase tenfold. This means the nurse’s cottage, in the north, is under siege day and night. People present with a range of injuries, ailments and afflictions ranging from the minor—sprains and stings and sunburn—to the more serious—broken bones, suspected heart trouble, respiratory and other infections. Others have forgetfully left their medications at home and imagine they will be able to get a prescription filled on the island, not realising that there is no pharmacy on the island.
It is not just the nature of the work. Adele and Shannon find themselves living in a fishbowl: people are constantly knocking on the doors of the clinic, and their own home becomes a kind of outpatient’s ward, where people are being monitored overnight or are awaiting transport off the island. Despite being well served with the quantity of doors—there are four—the clinic does not have a single door that will admit a stretcher or wheelchair, so occasionally patients lie on a stretcher outside while awaiting to transfer to hospital.
The relentlessness of being on-call 24 hours, seven days a week takes its toll. Added to this is the isolation from peer support—Nancy is an hour away at the southern end of the island—and the fact that some of her supervisors in the Public Health Nursing Department are apparently oblivious to the demands and challenges of island nursing. Adele soon realises they have no idea what it is like. On a clear day, you can see Aotea from Auckland. But, as the locals say, it is a world of its own.
Reading the stories of the nurses who have gone before, she notices that after Phyllis Wharfe, the ninth public health nurse on Great Barrier Island who served for five years in the 1950s, no one has lasted in the post for more than two years. Whether this is due to the personal choice of the women involved or to a Health Department policy, Adele can’t quite tell. She notices that some were even sent from the mainland to Aotea to recover from stress or illness—a testament, if ever there was one, to how completely the Health Department bureaucracy failed to understand what the life of an Aotea nurse was like.
After Adele has been on the island for a couple of years, she receives a visit from a woman who tells her she was a nurse on the island for a while in the 1960s. She is visiting on a yacht, and would love a ba
th. Adele is happy to oblige, and keen to hear her story.
Well, the woman says, there had been a series of incidents over several days, culminating in the birth of a premature baby and a man with a serious laceration requiring urgent attention. For some reason—probably bad weather—the plane couldn’t come and she had boarded a fishing boat with both patients to rendezvous with a Navy vessel in the Hauraki Gulf. The sea was rough and the transfer was difficult. Once the patients were handed over, she returned with the fishing boat to another harbour further down the island. The skipper of the fishing boat and his family tried to persuade her to stay the night, but, charged with adrenaline, she insisted on walking the forest road home. It is an arduous, up-and-down trek— four or five hours at the best of times. This was late in the day, after a series of long, hard days. Not far down the track, her footwear broke but, undaunted, she pressed on barefoot. Then it started to get dark. She was without a torch, and the depth of Great Barrier Island darkness has to be experienced to be believed. She cut her foot on a sharp stick on the track. By this time, the adrenaline had faded and fatigue had set in. As she walked, the wound on her foot became packed with dirt, and her certainty grew that she had contracted tetanus. By the time she reached Port FitzRoy and saw a house, she was quite distraught. The family who opened the door to this distressed, bedraggled, barefoot, muddy and bloodstained woman were thoroughly taken aback, and wasted no time in calling Auckland. A plane was sent to collect her the very next day.
Adele feels for this nurse, as she can completely understand how such a thing might happen. Challenging situations, plus the exhaustion and sheer physicality of the work on the island, can lead to what Adele now calls ‘mini-meltdowns’. Whereas Adele is fortunate to have an understanding husband to support her through difficult moments, she is aware that many before her, just like this nurse, have been on their own.
Island Nurses Page 2
