At the end of the speaking, there is a final, loud outpouring of grief. The casket, Adele knows, is being closed. Soon it is carried by, and Adele too cries as he passes.
A procession forms behind the casket. For his sister’s burial, the walk to the urupā (cemetery) entailed a long walk across the creek, along a treacherous track around the point, whereupon everyone would have to pick their way up the steep track that climbs the mountain behind the next bay. Everyone made that long, arduous walk behind their caskets, and on each occasion, Adele used to pack heart and respiratory emergency medications in her backpack for this journey in case any of the mourners fell by the wayside. They never did. The views from the top out over the bay are breathtaking. The urupā is surrounded by a white picket fence, with some very old head-stones marking the graves of previous generations who have been laid to rest there. On this day, everyone follows the whānau up the hill at the back of the marae to a newer, more accessible urupā. It is still a little demanding: even though the clay path has been overlaid with pine needles, Adele is glad she wore her gumboots.
The graves here descend the gentle hillside. He is to lie in peace at the top with some of his sisters and other family members, gone before, flowing down the hillside below. There are flowers, gentle sobbing, a rousing haka and finally karakia, a blessing and waiata. Everyone files past the open grave and acknowledges the whānau pani, then slowly makes their way back down the hill, pausing to wash their hands at the gate. Everyone sits on the grass back on the marae, talking and waiting to re-enter the wharenui for the final blessing. After that, the hākari will follow.
As one of the speakers eloquently put it: ‘Kua hinga te tōtaranui o Te Waonui a Tāne’ (a great tōtara has fallen in the sacred forest of Tāne). He was instrumental in building and maintaining the wharenui, where he lay and from which the final journey of his body began. He was also instrumental in building and maintaining his community, and he will live on in the people who are gathered here in his honour, too. These are the legacies he has left behind: the wharenui and the people.
Māori traditions have been woven into the warp and weft of community life on Aotea, and this is nowhere more obvious than in our attitudes towards dying and the rituals after death, how the body is cared for by the family and the ‘form’ of a Barrier funeral. Family members coming from off-island often remark on the positive difference in the way we do things, and they are almost always approving and appreciative of that difference. They experience being drawn into the community through the ‘ties of love, respect and sorrow’ as they mourn. This is what happens in the traditional tangihanga, and in our own, acculturated version of it. It is common that, when someone dies, they lie in state within the family home. Family and friends visit and share stories about the person’s life. It is a time of being surrounded. The funeral gatherings are open community occasions when everyone draws together to celebrate the life of the person who has died. To tell anecdotes, pay tribute and express their grief with other mourners, bringing real comfort to the family. This is a time of strengthening relationships and creating interconnectedness.
While Barrier funerals are creative, so too are other aspects that lead up to the day. There are no actual funeral directors on Aotea, so the health team are charged with caring for the body until burial. In years past, there was pressure on families to create a coffin quickly as well as to assemble a team to dig the grave by shovel. There have been memorable coffins: friends of a local who died without on-island family took the dinghy he was building and created a lid to seal his remains inside. The coffin arrived at the graveyard on the back of a fire truck, flanked by Rural Fire Force volunteers and with the fire chief helmet that the community had given him on his eightieth birthday proudly affixed. In another, the owner of a building supplies company was laid to rest in a coffin fashioned to look like a ‘packet’ of timber. Families sometimes adorn the coffins with artwork and words of farewell. On the death of his partner, a local contractor had his own coffin made to match. It stood in their bedroom for years: he knew it would come in handy, sooner or later.
Transporting bodies to Auckland for cremation used to be problematic—there is little that can be done to disguise a police-issue black polythene body bag. In the mid-nineties, the Health Trust asked a local wood sculptor/artisan/builder to build coffins for emergency use, so he added ‘coffin-maker’ to the long list of his other occupations. The beautiful streamlined, unadorned casket he devised—one size fits all, and with carved wooden handles—has become known as ‘the Barrier Coffin’ and soon became the thing to use when someone died on-island. There have even been occasions when a Barrier Coffin has been shipped to the mainland on the request of off-islanders. Occasionally the plain coffin is personalised with additions, such as hoarded kauri pieces, lovingly carved, but it is most often the interior that is customised, with quilts or special blankets over the hygienically sealed base. The ritual screwing down of the lid by family members and friends is part of the farewell journey.
Aided by the Ngāti Rehua—Ngāti Wai ki Aotea, Ivan—partly because of his public health role as general practitioner, but also partly as a funeral officiant—assiduously lobbied for a proper mortuary. His main concern was for the tangata whenua—how much time and money was involved in sending a body to the mainland for embalming so that it could be returned and laid in state for tangihanga. It was also quite common for funerals to be delayed while off-island family made arrangements to come across for the funeral, and in hot weather this could be problematic, in the absence of somewhere cool.
Auckland City Council agreed and built a discrete three-room mortuary: an embalming room equipped with a chiller, a room where family may sit and be with the departed and a garage space for an ambulance or funeral hearse. It is from this mortuary, nestled among mānuka trees a short distance from the aerodrome, that caskets set off for the marae or their final resting place—when they are not lying in the deceased’s home. We have never felt the lack of a purpose-built hearse: in fact, all types of vehicles have served in this capacity, including the four-wheel-drive health team vehicles. Often ferns will be laid beneath the coffin, and flowers laid on top. The trip to the graveyard is usually the shortest leg of a journey that may have begun weeks, months, even years before. It is a time in which the families have reflected on their own relationships and have needed support. There is an interconnectedness of life in such a small community—members passing down knowledge and skills, helping each other. It has been our privilege in so many cases to have made this journey alongside the islanders, shoulder to shoulder with others.
Chapter 12
BOLTS FROM THE BLUE
The medical and nursing councils give clear advice on treating those close to you, especially family members. But as health professionals on an island, Ivan and Leonie had to decide in the early days whether one of them would leave the island for the 24-hour turn-around with a sick child when there were many people unwell in the waiting room who needed immediate care. As tempting as it might be to bring your skills and training to bear when family members are involved, the recommendation is that you consult another GP colleague. Even Ivan has his own off-island general practitioner. So much for the biblical instruction: physician, heal thyself!
Leonie is working alone in the health centre when the phone rings. Her heart skips a beat when she hears her daughter’s name mentioned on the other end.
‘It’s Amiria,’ the wavering voice says. ‘Her face has been ravaged by a dog.’ That caught Leonie’s immediate attention. ‘Cherie is on her way.’
An image of her daughter’s face, the smooth skin glowing with health, flashes before Leonie’s mind’s eye, but she banishes it.
She takes what details she can, hangs up and takes a deep, steadying breath.
She phones Ivan at the nurse’s cottage, where he is conducting the Port FitzRoy Clinic. They talk briefly, and he is on his way, abruptly leaving the last patient to Adele. Then there is nothing to do but wai
t.
For some reason, although Cherie lives on the beach not far from the health centre, the wait seems interminable. A car finally arrives. Leonie is outside to meet it, and she gets her first look at Amiria’s bloodied face. There is so much blood it is initially difficult to determine the extent of her injuries. Leonie is calm, partly because this is how she is trained to be, and partly because she needs to be for her daughter’s sake.
As they go inside, she learns that a gaggle of children were eating a batch of Cherie’s raisin buns, fresh from the oven, when a visiting dog ambled over for his share. Amiria was just taking a bite of her bun when the dog leaped at it.
Most of the blood seems to be coming from the vicinity of Amiria’s right eye. Leonie begins to clean it away with sterile gauze, and discovers that there is thankfully only a small puncture wound in the white of her eye and a gash beside her eye. It is bleeding freely, but on superficial inspection both do not seem serious.
She keeps the relief at arm’s length, just as she had earlier controlled her fear, but she finds it easier to perform the methodical tasks—cleaning the wounds and directing Amiria to keep pressure on the wound while she herself assembles the equipment she will need to suture the gash and perform a more thorough inner eye examination.
There is the sound of a vehicle arriving at speed. Leonie has forgotten about Ivan! A car door bangs, and Ivan bursts through the back door of the centre. He is pale, and his eyes are still wild with the adrenaline of his frantic hoon from Port FitzRoy. He will always describe this as the worst journey on the island he has ever made. In the absence of cell phones, at this time, Leonie could not allay his fears en route.
Leonie goes to brief him—one health professional to another—but suddenly the mum in her will be denied no longer. She bursts into tears.
In an ideal world, Ivan would allow someone else to review Amiria’s eye injury and do the suturing of the small wound, but he is the only doctor on hand. He does it, although he phones a doctor on the mainland to seek moral support. There is no damage to the eye, and the only faint risk is from infection, which is easily averted with antibiotics.
For her part, Leonie is left shaking with relief and reflecting on how vulnerable we are on our isolated island. As nurses, we are trained to be objective and unemotional: she has coped, but she knows she will be haunted by that first glimpse of her daughter’s bloodied, ‘ravaged’ face.
‘Ivan.’
Leonie is sure she has heard something. She is busy preparing dinner, but something like a voice has intruded on her consciousness. She looks out of the front door, but there is no one there. She listens hard, but hears nothing further.
Then Ivan puts his book down and looks out the window, frowning.
‘Did you hear anything?’ he asks Leonie. ‘I think I heard someone calling out.’
He opens the door again and has a look outside. Nothing but the hiss and suck of cicadas in full throat: it is high summer—New Year’s Day is only a few days hence—and the sun is blazing outside.
‘Oh well,’ he says, shrugging. ‘Must be imagining things.’
We both jump as there is a loud blast on a vehicle horn. It is from the other side of the house, where the garage is. Ivan looks out and sees a ute parked there, and even as he looks, the driver’s door opens and a man topples in slow motion on to the lawn.
He and Leonie rush out. It is Greg, one of the locals.
‘What’s going on, Greg?’ Ivan asks, kneeling next to him.
‘Throwing up . . . pooing . . .’ Greg groans, and then mysteriously adds, ‘John Dory.’
He retches violently, but only thin, yellow bile comes up.
Greg lives by the beach, and naturally he enjoys nature’s bounty in the form of the abundance of kai moana that is on his doorstep. He loves mussels and pāua, and he fishes for snapper. But he has learned the hard way that some seafood doesn’t agree with him. If he eats kahawai, he experiences nausea and vomits. He is wary of trevally, tarakihi, scallops and (there is always a note of regret in his voice when he says so) crayfish.
This morning out fishing, he caught his first ever kuparu (John Dory). These are very good eating, and he was looking forward to sharing it with friends who were coming over. Everyone agreed it was delectable.
It was only 90 minutes later, as he was arriving at the sports club, where he was to play tennis against a friend, that he began to regret eating the fish. His opponent arrived to find Greg leaning against the wall of the building and being violently sick.
‘Gee, you’re in no state to play tennis,’ his friend said.
‘No, sorry, mate,’ Greg panted. ‘Tennis is off.’
‘You poor sod,’ his friend said. ‘Will you be OK?’
‘Oh, it’ll settle down,’ Greg said.
But after his friend had driven away, it became clear that Greg’s reaction to a protein in the fish was escalating. His head was whirling with nausea, and to make matters worse, he now found himself with a violent need to defecate. The sports club toilets were locked, so Greg hurried into the bushes nearby. He just managed to get his shorts down and to squat when his guts cramped and he emitted a stream of diarrhoea. Cramp after cramp assailed him, and he passed out.
When he came to—he had no idea of how much time had passed—he was weak and confused. There was no let-up in the bouts of vomiting, and his bowel was still cramping. But he knew he could not stay where he was. He knew he needed urgent medical attention.
Ivan, he thought.
He struggled to his feet, yanked up his shorts and stumbled, doubled over with abdominal cramps, to his ute. Somehow he managed to drive to the Howies’ place.
Leonie and Ivan get this story in fragments, as Greg is in a bad way. He is pale, clammy and in a state of collapse. His vital signs are worrying: his pulse is fast and weak and his blood pressure is low. He is plainly grossly dehydrated and in shock.
After administering initial first-line treatment medications, Ivan and Leonie manhandle Greg into his ute and Ivan drives it rapidly up the road to the health centre. It is late afternoon but still very hot, and the stench makes Ivan gag, too. And when they arrive at the health centre, it is shut up and the interior temperature is sweltering. Leonie sets about opening every door and window to try to cool the place down quickly: the last thing Greg needs in his state is to bring on vasodilation—the widening of his capillaries as a response to the heat.
‘Were you in the shower before you came?’ Leonie asks Greg, but he shakes his head. He is literally bathed in sweat.
Between them, Ivan and Leonie have already established two IV lines and have begun administering saline to try to reverse Greg’s dehydration. But as quickly as they can infuse fluids, his blood pressure drops, and drops, and drops.
‘His chest is clear,’ Ivan reports, listening with his stethoscope. ‘And there is no sign of rash or angioedema. It is just the gastrointestinal and cardiac systems involved. Best try to contact anyone else who ate the fish, just in case this is a toxic reaction.’
In between assisting Ivan, Leonie gets on the phone. She learns that no one else has been affected. This is a relief, in some ways: instead of dealing with the effects of an unknown toxin, they are dealing with an allergic reaction. But still Greg’s blood pressure falls. Ivan supplements the saline with extra volume expanders—it is possible to survive major dehydration as long as the blood pressure can be maintained so that oxygen still reaches vital tissues, and volume expanders assist in this.
‘Still falling,’ Leonie tells Ivan. She speaks calmly and precisely, and he answers in kind. Each knows their role intimately and they work together efficiently and purposefully.
They have infused nearly three litres of fluids: the circulatory system of your average adult male contains approximately five litres of blood. They are also nearing the maximal doses suggested in the primary context (that is, outside a hospital) of the drugs they are using.
‘What do you think?’ Ivan asks Leonie. Together, t
hey review their protocols: what may be tried, what they have tried, and the rapidly diminishing options available to them.
‘My head,’ says Greg weakly. ‘My head’s killing me.’
‘I’m afraid that’s a side-effect both of dehydration and of the treatment,’ Ivan tells him.
Leonie checks her watch. The emergency fixed-wing evacuation plane is still a long way off. The fluid is pouring off his skin, and he is clammy to touch.
‘I feel better,’ Greg says. ‘I feel super calm.’
Leonie looks at Ivan. ‘What does that mean?’ she asks.
He shrugs.
‘I’m drifting away,’ Greg announces.
Ivan phones Accident and Emergency to seek further advice from the emergency physicians.
‘Not much you can do but keep tipping in the fluids and the expanders,’ they say. ‘And repeat the meds. You’ve got to keep his pressure up. We’re preparing for his arrival.’
That sounds ominous.
Leonie has replaced the bag of fluid twice, and a fifth litre begins trickling into his arm.
‘It’s really peaceful,’ Greg says. ‘I’m not worried at all.’
It dawns on Leonie that they really are losing him. She checks her watch. Each minute on the dial equates to tens of kilometres of empty ocean between themselves and onrushing assistance. She is conscious that panic is not far away, so she redoubles her efforts to concentrate on the tasks at hand. She checks his vital signs again.
‘Greg’s blood pressure, though low, is stabilising, Ivan,’ she reports. ‘His pulse is improving too.’
Island Nurses Page 20
