Island Nurses

by Howie, Leonie; Robertson, Adele;

  Then, abruptly, the wife draws a deep, shuddering breath, dashes the tears from her eyes. She stands, smiling grimly at Leonie.

  ‘Come and look,’ she says mischievously. ‘Just in case,’ she adds.

  Leonie is wary, trying to fathom this sudden change of mood. But she follows, and looks where indicated: in a high cupboard, she can vaguely make out a key tucked unobtrusively in the corner.

  ‘He told me he didn’t want me to be held responsible if he was found dead. This scared the living daylights out of me,’ she says. ‘So I took anything poison we might have and hid it. He’ll never find the gun-safe key up there. Problem solved.’

  Leonie is reeling with the implications of this when the GP appears, still wearing a wise, sad smile from her conversation with the dying man.

  ‘Don’t worry about what he is saying. It’s a cry for help,’ she says. ‘It is quite understandable, really. He’s afraid. He is afraid of the things you might expect him to be afraid of—pain, death—but he is also afraid of losing control and he is afraid of being even more of a burden on his family. All I’ve done is talk those fears through with him, and he is calmer now. We will need to be careful, but I think he’s in a better space now. Leonie, he wants to talk to you now. He wants to be reassured that you can help his wife.’

  Leonie returns to the bedroom and forces her own anxieties to the background while she simply listens as he pours out his anguish. The written material she brought to give to him she keeps to herself: it’s superfluous. She knows that suffering comes in all guises, not merely the physical. This form of suffering is harder to palliate, but it is no less real.

  Over the next few days, he settles back to his old self.

  ‘He hasn’t said anything like that again,’ his wife says. She, too, seems steadier. She trained as a nurse, and her husband has asked her to take care of him in his last days. He really wants to die at home on the island, the place he loves best. This she has devoted herself to doing, supported by their amazing son.

  The end when it comes a few short weeks later is peaceful and natural, and he is laid to rest in the Barrier’s rich soil in a coffin lovingly crafted ‘for the old bugger’ by his son in their garage.

  Leonie takes a deep, shuddering breath.

  ‘I can’t believe it,’ says a stunned husband. ‘Just an hour ago, she was so . . . alive. Now she’s . . . gone.’

  As they kneel together, the still, warm body of his wife lies on the floor between them, the marks of the sticky defibrillator pads still visible on her chest along with a warm pink tinge where hands have repeatedly tried to bring her back to life.

  ‘It’s all such a shock,’ he says. ‘She just got back from hospital . . . I thought she would be all right now.’

  The GP has already removed the breathing tubes from her airway so that the husband can kiss and hug her one last time while she is still warm to his touch. Tears run freely down his face as he struggles to stand again. The newly arrived St John paramedic steps forward and takes him in his arms. They hug.

  Leonie moves about, quickly gathering up the packaging and debris scattered beside the needle sharps container. It is time to remove all the medical paraphernalia before the rest of the woman’s summoned family arrive.

  Slowly, with time, the atmosphere settles. The rest of the health team have drifted back to work and the St John ambulance has returned to its depot. The husband has made his important phone calls, and a cup of tea has been pushed into his hand.

  ‘Shall we lay her out together now? Is that all right?’ Leonie asks him, and he nods.

  After death it is our island practice to ‘lay out’ the patient. Together we encourage and assist family members or friends to wash the body and gather their favourite clothes. This has become a meaningful ritual for families to farewell someone they love—a completion, a caring act. It is also necessary, in the absence of a funeral director, that the body is carefully aligned or positioned before rigor mortis sets in so that it can later be placed in the coffin.

  The woman’s friend is quietly standing beside Leonie and has borne witness to the entire event. She is keen to help—a final gift of friendship.

  Her husband quietly watches and directs as Leonie and the friend gather her newly purchased clothes.

  ‘She was looking forward to wearing that skirt,’ he says.

  ‘Those are the knickers she would have wanted,’ her friend adds. ‘They were to be her special-occasion ones. I guess that’s what this is.’

  They all chuckle.

  Leonie misses the daughter’s presence. She is on the next plane and so cannot be part of the intimate circle yet. She will soon be here, along with her brothers and the wider family.

  As her husband looks on, Leonie and the friend work to an age-old rhythm, washing and caressing her limbs and body. Like childbirth, it is an ancient ritual—women gathering to perform the tasks that are necessary. Both birth and death forge and strengthen the bonds that tie a community together.

  They chat with her about all manner of things.

  ‘Bad enough calling my gluten-free pastry “crap” that I especially made for you. But this is ridiculous.’ Her friend half laughs, half sobs. ‘She wasn’t happy with my pastry treat,’ she explains to Leonie. ‘It had got stuck to the roof of her mouth. She’s trying to unstick it and then next thing I know she’s had a stroke and toppled over and taken me down with her. Really, it wasn’t that bad!’ she teases her friend. ‘Did you have to go this far?’

  With her body lovingly cleansed, Leonie and the friend dress her in the chosen clothes and stroke her face and brush her hair. Soon it is done, and everyone has taken their first step along the long road to acceptance.

  ‘Thank you,’ her husband says, as he hugs Leonie and the friend. ‘She looks so peaceful.’

  It is time now to greet the arriving family and friends.

  Adele and Shannon are at the Port FitzRoy Boat Club. As usual, the men are down one end of the room, while the women are at the other.

  ‘Your husband’s just had an argument,’ someone says to Adele.

  ‘What?’ she says. ‘Who with? What over?’

  It turns out the storekeeper—Serena’s granddad—has bailed Shannon up and told him his chickens have been scratching up his garden. Adele inherited the chooks from Fay: they were kept in a small run at the back of the nurse’s cottage. But when Adele and Shannon moved to their new house a couple of kilometres down the road, the chooks remained. They have become a bit feral and instead of their chookhouse, they are roosting in the mānuka and, it seems, raiding the storekeeper’s garden.

  Adele looks around for Shannon, but he is nowhere to be found. She drives to the nurse’s cottage and finds him standing under the mānuka, trying to coax the chooks down with a broom. They are not having a bar of it. Each time he swishes the broom, they cluck and flutter a little higher in the tree. Soon they are well out of broom range and simply ignore him.

  (‘Did he use fowl language?’ Ivan typically asks, when he hears about the episode later.)

  ‘What would you do if you got them down, anyway?’ Adele asks Shannon.

  ‘I’ll wring their necks and hang them outside the shop. That will sort them out.’

  Adele persuades him that this might be a problem best tackled in the morning. The next day, they resurrect an old cage at their house and move the chickens into new accommodations with their necks intact, ensuring the storekeeper’s garden is safe from their marauding and the family’s friendship with Adele and Shannon is preserved.

  Some time after this incident, and soon after he has embarked on what he has been hoping will be a long and fulfilling retirement, Adele is distressed to learn that the storekeeper has been diagnosed with terminal cancer. His wife is determined to nurse him, and Adele assumes the role of supporter to her, the primary caregiver, stepping in each time his disease enters a new phase and intervention is required. Sometimes, she calls at the house to listen; other times, she offers adv
ice and reassurance, and more often than not, she does little more than have a cup of tea and sit in companionable silence with her friend and his family. On a couple of occasions towards the end of his six-month decline, they call her out at night, and she brings her sleeping bag to the house. But they always insist she return to her own home, and she finds herself crying as she drives home, remembering how supportive of her they had been, and the parts they have played in each other’s lives these last twelve years.

  As the end approaches, he tells Adele that he would rather she was present when he passes, as he does not want his wife to be alone. Consequently, one Friday afternoon, Adele is there when her friend gently slips from this life and ends his long struggle with his disease. She feels privileged to have been there and to be able to perform a last caring act, bathing him and laying him out on his bed dressed in his favourite clothes. It is Ivan’s day off, but he willingly comes over to share in this day of sorrow and to begin to prepare for the service at which he will officiate. Telephone calls are made, and family, friends and food begin to arrive.

  On Saturday, the shopkeeper’s son-in-law and two friends dig a grave in the old private cemetery, in a grove of trees near a stream. Another son-in-law borrows a van to pick up the coffin made to order by a local artisan—it is of oiled macrocarpa, and smells of the bush. In the afternoon his son, a close friend and Adele lift him into the coffin and settle his favourite beret on his head. Here, according to Barrier custom, he is visited by friends and family as they gather to mourn and to be thankful for the life he lived.

  On Sunday afternoon, Adele gives a woodscrew to Serena and to each of the man’s three other grandchildren and to his two children, and they sadly use these to close the lid. The coffin is then taken to the garden of a friend to celebrate his interesting life. Afterwards, as he is laid to rest, Adele thinks of a few lines from a favourite John Masefield poem, ‘By a Bierside’:

  Death makes justice a dream, and strength a traveller’s story.

  Death drives the lovely soul to wander under the sky.

  Death opens unknown doors. It is most grand to die.

  No more than year later, her friend’s house is sold to a young couple, and Adele finds herself assisting at the home birth of their third child. Ka pō, ka ao—it is night, it is day. The cycle continues.

  One aspect of rural nursing that our careers have borne out is that, as a rural nurse, you are not so much serving the community as participating in it. You are part of the lives of the people among whom you live. Inevitably, this means that we have a lot to do with the tangata whenua: everyone who has come to live on the Barrier finds themselves more or less enfolded in the rhythms of taha Māori. The very first Pākehā who came here—the whalers, the bushmen, the gumdiggers—vitally depended on the tangata whenua, and, for their part, Māori often worked alongside Pākehā, participating in the new way of life that the Pākehā brought. This laid the foundations for the way of life that we have on the island today, where community is at the heart of things, and there is a strong sense of the importance of ritual in the lives of the people. There is a holism about the Māori perspective that aligns well with the ethos of nursing, and with rural nursing in particular.

  Leonie is of Waikato-Tainui descent. And of course, many of our patients—approximately nineteen per cent—are Māori. The tangata whenua, Ngāti Rehua—Ngāti Wai ki Aotea whakapapa back to some of the earliest people in Aotearoa. It has been a joy and privilege for us to share part of their life journey.

  The whare stirs Adele each time she drives into Motairehe. It is a white weatherboard bungalow with a back porch and a front verandah. It had been shipped to the island to replace an old whare that burned down. It is beautifully situated with the river on one side and the glittering waters of Katherine Bay spread out before it. Adele grew up in houses just like it: it reminds her of her childhood, and it holds other memories, too. Even now, Adele hasn’t quite got used to the sight of the empty porch. A few years ago, it was the home of the sister of the man she’s going to see, and it seemed she was always there to call out.

  ‘Where are you off to, Adele? Is someone sick? Or are you here to see the babies?’

  Each time Adele stopped to talk to her, she would come away with a new collection of stories about the people and the place around them.

  Adele remembers the day she first looked for her on the porch and missed her.

  She was inside, lying peacefully on her bed in the lounge. Like all these older New Zealand houses with their high ceilings and their lack of insulation, this one was cold in winter. Her whānau had installed a woodburner for her in the lounge and she had taken to sleeping there in that warm place. Her sisters were gathered at her bedside, along with other whānau. Her son was upset. He had been outside that afternoon mowing the lawns, and by the time he came in that evening to check on her, she had passed away. She was lying there, her Rātana Bible open on the bedside table to the last verses she had been reading.

  ‘I should have been here,’ her son said. ‘She shouldn’t have been alone.’

  ‘No, you couldn’t have been doing a thing better,’ Adele consoled him. ‘She went to sleep knowing you were close by and doing something for her.’

  Still, he cried, and Adele cried too. Everyone cried and mourned the loss of a mother, grandmother, sister, aunty, mentor and friend.

  She was the first. All three of the sisters who were at the bedside that day have gone to be with her now. And now it is their brother’s turn to pass on.

  Adele and her colleague Denise wait solemnly with a number of others at the waharoa (entrance place), quietly talking among themselves. Across the road, in a haze of smoke from the hāngī fire, is a group of young men with shovels and piles of dirt—preparations are underway for the hākari (feast) to be held later.

  ‘OK,’ someone says. An indication has been given that all is ready and the group tightens up, wāhine in front and tāne at the side and towards the rear.

  ‘Haere mai rā, haere mai, haere mai . . .’

  A karanga rings out inviting the manuhiri—the visitors—on to the marae. The caller, the kaikaranga, stands dressed in black, fluttering her hands. The woman who has been appointed kaiwhakautu (the senior woman among the visitors) stands out in front of the manuhiri and replies: ‘Karanga mai, karanga mai, karanga mai . . .’ and the manuhiri walk slowly forward. It is an ancient ritual, with every word and movement replete with meaning, tying the present generation to the past, the living to the dead. It is a human cycle to match the natural cycle to which we are all subject. Adele feels the welling of emotion that she always feels during the karanga. It is always such a spiritual moment.

  The manuhiri pause at the door and there is a shuffling as everyone takes off their shoes. They walk slowly across the whāriki (woven mats), past the tangata whenua along the walls of the house. Adele stops for a moment, remembering her own father, as well as all the people to whom she has previously bid farewell on this marae and pays a quiet tribute to the tūpāpaku (body) before her. Then she moves on to greet the whānau pani (bereaved family). Some she knows well. Some she knows rather less well, or not at all.

  She pauses beside the casket and addresses the man lying within it, his face made gaunt by illness but relaxed in his final rest. As is the custom, Adele says her last words to the dead man, in the belief that his wairua (spirit) lingers and will hear her.

  ‘They’ve brought me home to die,’ he had said when Adele dropped in to visit him. He had been a tall, well-built man, and although cancer had diminished him, stripped the weight from him, the spark of his humour was still all there. ‘They reckon I’m going to die, but I’m not, you know.’

  ‘Glad to hear it,’ laughed Adele.

  In spite of his defiance, they both knew he was terminal. He had been sick for a long time and was on palliative care back in Auckland before his whānau decided it was time to bring him home. Adele was sad, because he was the last of his generation. The girls—his s
isters—had all gone.

  One summer’s Saturday afternoon, he phoned. ‘You know, Adele, there are all these young folk kicking a ball around on the beach. None of them will help me mow my lawns or get firewood. What’s wrong with this generation?’

  ‘I’m your nurse, not your social worker,’ Adele replied. ‘Don’t complain to me, because I can’t even get one of them to help me wash my car. Anyway, they’re probably too scared, because they know they couldn’t do it to your standards.’

  They both laughed.

  By the time he had begun his final decline, it was winter and cold outside. Yet the interior of his house was filled with the warmth of love and caring. He was content. A nephew dropped in regularly with his favourite food: kina, mussels, oysters and fish. Each time Adele visited, she found him beautifully groomed and snugly wrapped in blankets, sitting up on his La-Z-Boy chair. He had no need of drugs: he was cocooned in aroha and surrounded by his whānau.

  After a hymn and karakia, the whaikōrero starts—always first acknowledging the Creator, the whare, the earth mother, the marae, the first caller of the day (the kaikaranga), the dead (the ancestors behind the veil)—before moving on to the living and the most recently dead. The speakers intersperse humour with their oratory. The laughter is a relief from the sadness, the sadness is a reminder that there is sorrow amidst all the joys of life. After each speaker, people get to their feet and a waiata is sung. The sound of the singing is beautiful and uplifting.

  Adele is not fluent in te reo. She can follow some of what is said, but does not try too hard. She is content to be lulled by the sound of this poetic language and the answering murmurs of the listeners. And as she half listens, she looks towards the photos that are propped up around the coffin, reminders of the whānau now deceased. With a mild shock, Adele reflects that when she first came to the island, she didn’t know who any of these people were. Now, after all this time, many of the people in the photos are known to her, and the photos bring back vivid memories. She realises that she is rapidly becoming a part of that older living generation herself.