So Adele has been encouraging Serena to have her baby on the mainland. But, when she is performing an examination just before Serena is due to leave, she learns that she will be quite alone in the Greenlane Hospital Nurse’s Home awaiting the birth: her partner has just started a new job and simply cannot afford to accompany her, given the whole birth and recovery might take two to four weeks. By now, what is more, Adele has become convinced of the rightness of giving birth in surroundings where you are comfortable and in the presence of people whom you choose.
This is ridiculous, she thinks, so she asks Serena’s mother and grandmother what their births have been like.
Both shrug. ‘No problems at all,’ they say.
Adele suggests to Serena that she talk through with her partner, mother and grandparents the possibility of staying and birthing on the island. All are excited at this prospect, so a plan is made. They will use the nurse’s cottage—Serena and her partner live in a shed on the property next door to Adele. It has no running hot water, electricity or heating.
So in the early hours of the very next morning, there is a knock at Adele’s door and the young couple are standing there with big smiles to say that labour has started.
As with many first births, it is a long and arduous labour. But Serena copes remarkably well—so well, in fact, that late in the afternoon, after she has birthed her daughter in the presence of her partner, Adele and Ivan (who has come to assist), Adele decides it is worth considering first births on the island in future, if the women are certain that they want to do so.
The birth of her daughter is not the last occasion on which Adele witnesses Serena’s typical island stoicism and resilience. Around two years after that birth, Adele is sitting writing up her notes. A woman off a boat presented a little earlier with a medical emergency and has just been helicoptered off. Adele happens to glance out the window in time to see Serena walking up to the clinic. As she watches, she notices that Serena is doubled over in obvious pain.
Having seen first-hand how staunch this young woman is and how high her pain threshold, Adele knows this must be something serious. She helps Serena into the clinic and examines her. Serena’s description of her symptoms—sudden onset of increasing pain in her pelvic region, a few spots of blood—together with the fact that she has missed two of her periods convinces Adele that they are dealing with an ectopic pregnancy (a potentially life-threatening condition, where a fertilised egg implants somewhere other than in the womb, usually in a fallopian tube).
‘You’d best pack your bag,’ she tells Serena. ‘I’m pretty sure you will be off on the helicopter.’
It is a big deal for most of the families on the island to go to the mainland, let alone for Serena’s family. To be sure she is not putting her to the expense and inconvenience unnecessarily, Adele sends her to Claris so that Ivan can give her a second opinion.
As it happens, Ivan has no hesitation in agreeing and the helicopter is summoned back to the island for its second mercy dash of the day.
The stoicism that in part alerted Adele to the seriousness of Serena’s condition almost costs her dearly on the mainland. Once on the ground in Auckland, an ambulance takes her to the hospital, and when they arrive, it is to find that there are no wheelchairs.
‘How far is it?’ Serena asks. ‘If it’s not far, I’ll just walk.’
The sight of a suspected ectopic pregnancy arriving on her own two feet makes the hospital staff sceptical; every other ectopic pregnancy they have ever seen has arrived groaning in agony on a stretcher. As she is sitting in her cubicle with the curtain drawn, Serena hears a doctor discussing her case on the phone.
‘This is the second one we’ve had from the Barrier today. The last one did have an ectopic, but this one probably only has indigestion.’
A doctor puts in an IV line, and then Serena is left to her own devices for several hours. She goes to the toilet and faints, but recovers and returns meekly to her cubicle again. The second time she gets up to go to the toilet, bending over with the intense pain in her lower abdomen, she collapses again and this time, it is noticed. She is immediately rushed first for a scan and then straight into theatre.
‘You and Ivan were right, Adele,’ she says, upon her return a few days later. ‘The scan showed an ectopic pregnancy and apparently, I had a litre of blood in my abdomen. They didn’t waste the helicopter on me like they thought.’
Of course, hospital culture has changed since those days, and patients (and rural nurses) are treated with respect. Communication has improved out of sight—although getting quality information from the hardy islanders about the seriousness of their condition remains an art.
It is often noted that the concept of ‘health’ is different for people from rural areas and people from urban areas. In rural areas, people tend to think that if their body is performing the function they require it to perform—and mostly this equates to being up to whatever their work demands—then they are fit. You will look a long way before you will find too many of the ‘worried well’ people whom you might expect in any other community.
Back in the very early days before we were equipped with an X-ray machine, Adele and Ivan felt that orthopaedics—the diagnosis and treatment of musculoskeletal problems—was their Achilles’ heel. In the absence of X-ray imaging, it was often difficult to tell whether a patient might need an expensive trip to Auckland.
One weekend, a young man presented to the nurse’s cottage with a shoulder injury.
‘I was riding my farm bike and I canned off and landed right on this part here. Something went pop in my shoulder.’ He indicated the point of his shoulder.
He was very sore, and carrying the shoulder strangely. He could not raise his arm above shoulder level without severe discomfort, and there was also some distortion, with a lump visible at the end of his collarbone. Adele knew that something was wrong, but had no idea what or how serious it was. But as she was talking to the patient, she saw a man walking down the road whom she thought she recognised.
‘Wait here, if you don’t mind,’ she told her patient. She jumped in her car and pursued the man down to the wharf.
‘Excuse me,’ she said, hurrying up to him. ‘I’m sorry, I can’t remember your name, but you’re a doctor, aren’t you? I recognise you from somewhere.’
‘I am a doctor, yes,’ he replied, much surprised.
‘Sorry to bail you up like this, but I’m the nurse here. I’ve got a man in my clinic who has injured his shoulder and I wondered if you would be able to have a look at it and give me an idea of what the injury might be?’
‘Well, I am a doctor—’ he smiled— ‘but I don’t think I’ll be much use to you. I’m an obstetrician.’
Suddenly Adele remembered where she knew him from. She had met him when she was working as a midwife.
‘I am here just about to meet a friend off the seaplane. He’s an anaesthetist. He’ll probably be able to help.’
Adele returned to the clinic, and soon after the sound of the seaplane was heard, the two doctors appeared at her door. Adele led them into the clinic, where they examined the local man’s shoulder.
‘This is a sprung AC, do you agree?’ the anaesthetist said.
‘Yes.’ The obstetrician nodded. ‘I am confident you’re right. Shall we call a helicopter?’ they asked Adele, who told them that she would discuss it with the local doctor.
Armed with a diagnosis, Adele had a way forward. She phoned Ivan, who consulted his orthopaedics textbook.
‘Acromioclavicular joint separation,’ Ivan read. ‘Typically occasioned by impact on the back of the shoulder . . .’
He read out the clinical signs. Everything matched.
‘Nothing much to be done for it,’ he said. ‘Put it in a sling and rest it. It might heal with a slight distortion, but this is cosmetic.’
Adele relayed this information to the patient.
‘Would you like to go to Auckland so that they can X-ray it to confirm it?’ she ask
ed.
‘No,’ he snorted. ‘If you reckon you know what’s up, that’ll do me.’
‘You might be left with a bit of a lump there,’ she said. ‘Are you worried about what it looks like?’
The patient laughed. ‘Of course not! So long as I can use it . . .’
These days, we have an X-ray machine (courtesty of the Great Barrier Island Community Health Trust), and Ivan is licensed to use it. Orthopaedics quickly became our forte over the years. We have had numerous orthopaedic cases to deal with.
‘So,’ he is fond of saying, as he examines people’s X-rays, ‘you’ve come to the Barrier for a break, then, have you?’
Sometimes, the islanders can take self-reliance too far.
‘Ma’s finally gone and done it,’ says the voice on the other end of the telephone at 11.45 pm.
Adele fumbles for her torch and shrugs into her dressing gown. She goes downstairs so that she can turn on a light and have a conversation without waking Shannon.
‘What happened?’ she asked.
‘She went out on to the back porch to pull the cord that turns off the generator and it broke. She tripped over on the concrete. I think she’s broken her left hip because she can’t get up and she says it’s really hurting.’
Only on the island would a medical first responder be consulting a tide chart right now, but that is what Adele is doing. It’s a 20- to 30-minute boat ride to Stellinmark, the property from which the call has come, and whether Adele will be able to get access will depend on the tide.
‘Tide’s low, isn’t it?’ she says.
‘Yep,’ Sven confirms. ‘I can’t get the boat out to come and get you. Do you think you could send the helicopter? It can land right in front of the house.’
Adele leans to look out at the sky. There’s a full moon hanging low over the hills and silvering some high cloud. There’s no wind whatsoever. It might be possible to get the helicopter in.
‘I’ll see what I can do about the helicopter,’ Adele tells Sven. ‘I’ll come first myself. Make sure you keep your mum warm, and give her two paracetamol, if you’ve got them. Not too much water, though. They’ll want her to have nothing in her stomach when she gets to hospital, just in case they want to operate. I’ll be there as quick as I can.’
Adele phones a neighbour who has a fast launch and asks if he would mind running her down the harbour to Stellinmark. He doesn’t hesitate to climb out of his warm bed, row out to his boat and bring it alongside the wharf to collect Adele. Meanwhile, St John confirms the helicopter will be despatched: control will contact Adele at Stellinmark for detailed directions and give her an estimated arrival time.
Adele dresses warmly and slips her gumboots on. She leaves a message for Shannon and changes the emergency message on the answerphone. Then she sets off. The launch is waiting at the wharf for her, the engine idling.
‘Nice night for it, Adele,’ the skipper says. Once she is aboard, he casts off, motors out into harbour, swings the bow to the south and opens out the throttle. The boat comes up on the plane, the spray shining phosphorescent in the darkness.
Adele knows her patient quite well. She always stood out—she was in her mid sixties when Adele first came to the island, and she would often come to Port FitzRoy for supplies for the remote farm on which she lives with Sven, her son. Adele would see her expertly bring her boat alongside the wharf, tie up and climb ashore, dressed in practical clothes—trousers and gumboots—but also giving off an air of sophistication with her makeup and jewellery. Adele has heard her story bit by bit over the years: her patient is the daughter of a wealthy Wellington businessman, is highly educated and accomplished. She married her cousin, Dion Stellin, who was expected to take over the running of the family business. But Dion seems to have been something of a wandering soul, and when he chanced upon the Barrier it captured him, as it has a tendency to capture such souls. He initially purchased Okiwi Station in 1957 and, when he judged the time was right, he brought his wife and three children over to join him.
She had no idea what to expect of the island. Perhaps she had been wooed by the stories Dion had told of his days on the islands of the Mediterranean during the Second World War, and in the Pacific and South East Asia since then. She told Adele that she wore her good dress and carried a parasol on the trip over. The Barrier was a culture shock! Sven says that when Ma arrived on the farm and Dion showed her the ramshackle, leaky homestead in which she and her three children were to live, she cried for two weeks. Her father was so horrified at the conditions into which her husband had dragged her that he withheld all financial support. Later, they purchased and moved to a property that was farmed by the Flinn family and occupied the peninsula at the southern end of Port FitzRoy harbour. Life was consequently hard, especially when Dion badly injured himself in an accident on the farm. She had to do all of the work in the house and on the farm—and all of the work was hard—but she coped, as islanders do. She was an accomplished equestrian, an avid reader and could hold up her end of a very sophisticated conversation. On Aotea, she added the ability to dig a garden, fish, operate a chainsaw and split firewood as well as muster sheep on horseback. But, once Dion was able to work the farm again, she took her children back to the mainland to complete their secondary schooling.
After finishing secondary school, Sven returned to the Barrier in 1973 to help his dad with the farm, which was just about completely overgrown with scrub. Instead, two years later, he found himself running the farm when Dion died of cancer. He was just nineteen. He received a bequest from his wealthy uncle and went, as he has put it, from being ‘an impoverished, ignorant farm boy’ to being ‘a very wealthy, ignorant farm boy.’ By his own admission, he made some questionable choices and soon ran through his money. His ma shifted over to help him with the house and the farm and to keep an eye on him. The two of them had been trying to make a go of it ever since.
Just after one in the morning, Adele and her boatman tie up at the jetty at Stellinmark. Adele clambers up a rickety steel ladder on their small wharf and walks up the path to Sven’s house—the new home barged over after the Flinn homestead burned down in the family’s early days—checking for tree limbs and overhead wires that will pose a hazard for the helicopter. She finds Sven watching over his ma, who is in a great deal of pain. She has been lovingly draped in blankets, and Sven has wrapped a shawl around her head, because it is a cold night.
‘What have you done?’ Adele asks her.
‘Oh, I feel so silly,’ she replies. ‘I went to give a great big pull on the generator cord and it snapped. I lost my balance and fell on my hip.’
Adele examines her. It is clear she has indeed likely fractured the neck of her femur. She doesn’t seem to have broken her wrist, which sometimes occurs when a hand is put out to break such a fall. Her blood pressure, pulse, respiratory rate and temperature are all satisfactory. Adele puts in an intravenous line so that she can administer some stronger pain relief.
The telephone is a relatively recent addition to Stellinmark, as the family re-christened the farm. Until quite recently, they had only a CB radio with which to stay in touch with the outside world. That would have added another layer of difficulty to this situation. Instead, Adele contacts St John and the control centre patch her through to the helicopter pilot, who is already in the air. She gives him the GPS coordinates from the boat’s chart plotter and can assure him there are no landing hazards. Around 2 am, the throb of the rotors can be heard.
Adele and the paramedic who has accompanied the helicopter finish splinting the leg, and at 2.50 am, the helicopter lifts off for the trip to the hospital. Adele reassures Sven and gathers up her gear, clambers back down the rickety ladder, and the boat heads back up the harbour with the moonlight sparkling on the water. She is in bed again just before 4 am.
Now, one year on, the almost unprecedented situation has arisen where we are off-island completing postgraduate study in Dunedin. In order to be able to go, Adele has talked a colleague—
a nurse and midwife—into standing in for her. She was nervous, but Adele assured her it was a quiet time of the year and that the others in the team would back her up.
Adele’s cell phone goes just before we are about to go into a lecture.
‘I’ve got some sad news, Adele,’ her colleague says. ‘Sven phoned. His mother died in her sleep last night.’
This is not unexpected, although sooner than we thought. She had been in gradual decline since returning from hospital. Our main focus has been palliative care. The nurse will have to attend, and the doctor from Claris will have to examine her and issue a death certificate. Adele phones Shannon to ask him to provide the necessary transport by boat.
A few hours later, her phone rings again.
‘You won’t believe this,’ her colleague says, sounding panicky. ‘I just went down to Stellinmark with the GP to do the death certificate. Sven says he’s going to cremate his mother himself!’
Adele doesn’t believe it, although she remembers all of the times that Sven has said, ‘I’ll just burn Ma up right here on the farm when the time comes’, and she has laughed.
‘Does he seem serious?’
‘Well, he’s out there with his bulldozer digging a hole, and he has a friend there stacking firewood beside it. I’d say he’s serious!’
Adele phones Sven.
‘I hear you’re planning to cremate your mum. You’re not really going to do that, are you?’
‘Yes. That’s my plan. Always said I would.’
‘You know it’s illegal, Sven, don’t you?’
‘Yes. Been reading up on it, Adele. The offence is called “interfering with human remains”, and it carries a maximum penalty of a two-hundred-dollar fine.’
Adele tries a different tack, and explains that crematoria are specially designed to create a fire that reaches the fantastically high temperature you need to consume a human body. Try burning a body at a lower temperature, and the results could be horrific.
Island Nurses Page 17
