Island Nurses

by Howie, Leonie; Robertson, Adele;

  She checks again five minutes later, and sees with relief that it has even risen a little. Time is slowly passing.

  ‘Do you have one of those bottle things?’ Greg asks. ‘I really need to pee.’

  Leonie looks at Ivan and they grin at one another, relieved. Greg isn’t out of the woods yet, but the need to urinate is a sign that his bodily fluid volumes are normalising and his kidneys are being perfused.

  ‘I feel extremely super calm,’ Greg says again.

  Neither Ivan nor Leonie know how to interpret these statements. It is certainly not something they can recall from their text books.

  The welcome buzz of the aircraft engines is heard, and soon the Great Barrier Island Airlines plane bounces to a stop on the airstrip—a welcome sight. A St John paramedic joins them and they update him on Greg’s condition. He is satisfied he is stable and ready to evacuate, and it pleases the pilot that they can turn around quickly, too: he has been called away from the bedside of his wife, who is about to have a baby. When the plane finally lifts off into the sky, lights flashing, it is nearly dark. It has been three hours since the drama began. We are both physically and mentally exhausted, but we are pleased with the outcome. Thankfully, Greg’s body has weathered this storm.

  ‘Good work, Ivan,’ Leonie says.

  ‘Good work, yourself,’ he replies.

  We are having a lunchtime meeting at a cafe away from the health centre. It is a rare event because we have been able to align the windows in our schedules. Leonie is showing off her brand-new, cosy, wool-lined ankle boots, and Adele is suitably admiring.

  The phone rings and Leonie is called by the cafe owner to take an emergency call, alerting her to a small plane crash in the swamp nearby. Then a man in the airline’s uniform walks into the cafe with a small forehead gash. It is the co-pilot, and he tells us that after takeoff the plane veered off into the raupō swamp just 400 metres from where we are standing. We swing into action.

  The health centre is positioned beside the Claris Airfield and we have practised for such scenarios. This time it is for real. We quickly assign roles. Leonie will rush to the scene and triage—identify the most seriously injured—and Adele will assess and care for the copilot, return to the health centre to alert everyone there, assemble the vehicles as stand-by ambulances and return to assist with transporting the survivors—everyone on board, the co-pilot assures us.

  ‘We lost power and the pilot put the plane down as gently as he could. We landed level but we hit pretty hard. Some of the passengers are badly injured.’

  He gives as many details as he is able as they drive. He directs Adele to a point in the road that he thinks is closest to the crash site. Leonie straps on her backpack containing emergency gear and sallies forth into the raupō as Adele drives off back down the road towards the health centre.

  Leonie strikes trouble immediately. The raupō is a lot taller than her: she feels like Minnie Mouse in the lush, green fastness of the swamp, and cannot orientate herself. She feels a rising panic when there is the sound of a labouring two-stroke motor out on the road. She hurries back to the roadside, and is grateful to see one of the taller locals puttering along on a diminutive motor scooter.

  ‘Leonie!’ he says. ‘What are you doing in there? Do you need a hand?’

  ‘I sure do!’ she replies. ‘There is a plane down in there, but I can’t see where I’m going. Would you take this for me?’ She gives him the heaviest emergency backpack. ‘Lead the way!’

  He obligingly stomps off into the swamp and Leonie follows as closely as she can, the brackish, far-from-fragrant water up to her thighs in places. The rushes close behind him quickly, so that she is claustrophobically walled in by the raupō. But she can hear his progress, and she follows the sound.

  The crunching and the crashing stops after they have ploughed about 100 metres into the swamp.

  ‘Over here!’ he calls.

  Leonie follows his voice and emerges from a wall of raupō into a clearing gouged by the plane. The plane itself is intact and resting on its belly, steam rising from the engines in the swamp. With a bit of help from her trailblazer, Leonie scrambles on to a wing and from here can assess the passengers in the fuselage. Some appear mildly shocked but otherwise OK, but it is clear two of them are seriously injured.

  Leonie hears the sounds of other people making their way through the raupō, and she is relieved they will have help to extricate the injured. The emergency services have swung into action, and soon there is barely any room on the wing. The GP arrives with more emergency gear. The local roading contractors have assembled parties to stretcher out the two injured, and they are carefully secured in the scoop stretchers and slung down to waiting hands.

  Leonie and the general practitioner follow a patient each out to the road where four-wheel-drive vehicles are waiting to convey them to the health centre. It is far easier walking out than it was walking in: the various sets of feet that have trodden down the raupō have created a veritable highway, and Leonie can walk on the flattened rushes without sinking into the mire.

  Once the two serious cases are on their way, Leonie returns to assist with escorting the remaining passengers to the health centre for a fuller assessment. She finally stands in the nurse’s station, dripping and decidedly not smelling her best. She ruefully tugs off her new boots—they come off with a squelch. She is glad she had them—they likely protected her from shredding her feet on sharp sticks and stones in the swamp—but they have paid the ultimate price.

  She drops them in the wastepaper basket with a clang.

  ‘So much for my lovely new boots!’ she says. ‘I think I will invest in steel caps next time.’

  Everyone laughs, perhaps a little louder than necessary; the adrenaline has to be worked through one way or another.

  Leonie is baking with Amiria and Jordan. They are laughing and enjoying one another’s company and Leonie is marvelling—as every parent marvels from time to time—at how big and capable they are getting. Then the phone goes. It is a neighbour of Jill’s.

  ‘She’s collapsed,’ he says.

  ‘Is she conscious? Breathing?’

  ‘Yes, she’s breathing, but she’s unconscious.’

  Leonie puts down the phone, and she is in nurse mode. Mother mode has to wait. The children are used to this, and they carry on measuring and stirring as Leonie races to put on her sturdy walking shoes and shrugs into the straps of her backpack.

  ‘Listen to see if the cake is talking when the buzzer goes,’ she tells Ivan, who has put down his book and rolled up his sleeves ready to help with the baking. ‘That recipe usually needs a few minutes longer, so be prepared to leave it in for another five minutes,’ she calls as she races out of the room.

  But even as she speaks her mind is already in professional mode, already running through scenarios and marking off items she may need on a mental checklist. She phones the new locum general practitioner and arranges to meet her en route. They will need her large four-wheel-drive to tackle the track to Allom Bay: her husband will drive—he is very skilled. With all organised, she climbs into her vehicle and sets off for the rendezvous.

  After meeting up, they drive for twenty minutes along a track that gets steeper then narrower as it drops down into Blind Bay towards the west coast. At the road’s end, they can see the water through the trees and then drive down on to a sandy beach. Another of Jill’s neighbours is waiting there with a quad bike, which Leonie and the GP load up with their gear. The neighbour sets off with the GP perched uncomfortably behind him, and Leonie jogs along behind, struggling to keep up. It is fifteen minutes up then down through the bush to Allom Bay, around the point from the road-end. When she is getting close, she hears the approach of the prearranged Auckland Rescue Helicopter. When she breaks out into the open, on to the grassy flat adjacent to the foreshore where the small cottage that Jill rents out to guests is situated, she can see the big, red machine hovering, scoping a suitable place to land on the foreshore.r />
  On closer inspection, in front of her she can see the cottage and Jill sprawled on the ground near the door, her children—her daughter is eight now, and her son six—huddled beside her. But there are two people she doesn’t recognise—off-islanders—standing uncertainly in the background, too.

  This moment will replay and replay with Leonie. She feels the full depth and significance of the scene. When she approaches, against all the principles of emergency care, she begins by hugging the children. Intuition overrules training. The neighbour briefs the assembled GP, paramedic and Leonie.

  ‘This couple are renting the lodge. Jill was showing them over and she had a sudden, violent headache and lost consciousness.’

  The helicopter paramedic and his crew are there, and with methodical, practised movements, the paramedic is already preparing to establish an airway as he listens. Leonie is able to contribute details of Jill’s family and personal medical history where needed, along with descriptions of the resources available on the island, the names and phone numbers of people who may be of assistance. The GP—who is very experienced—offers her medical opinion, too. It is the kind of impromptu team that assembles at all emergencies, where complementary skillsets mesh and clinical responsibility is shared. We agree that we suspect that Jill has suffered a sub-arachnoid haemorrhage.

  A basic airway is established, and the paramedic attaches equipment to monitor Jill’s respiration and circulation. It is clear Jill is in serious trouble. Leonie hands over the items of equipment—the endotracheal tube, the Cobbs connector, the Ambu bag and angiocaths—and writes down details as information is relayed to her.

  Ten minutes have passed since the attempt to resuscitate Jill began.

  ‘I told Mum she should come and see you about her headaches,’ her daughter says quietly. ‘I was worried about them.’

  It turns out that Jill had been suffering from intense headaches in the weeks before this collapse. Typically stoical and fit and healthy, she had dismissed these. Leonie can just hear her laying aside the suggestion that a sore head was serious enough to bother her about.

  The conviction is growing among the team that the tentative diagnosis of SAH—sub-arachnoid haemorrhage, or bleed into the arachnoid space, a void beneath one of the delicate membranes covering the brain—is correct. This is usually due to an aneurysm, an abnormality of a blood vessel, and occasionally the catastrophic rupture of an aneurysm is preceded by ‘sentinel’ headaches, pain caused by lesser bleeds that can serve as warnings if treated as such.

  Twenty minutes have passed. The paramedic is satisfied that Jill is sufficiently stable to load aboard the helicopter and evacuate to the Intensive Care Unit at Auckland Hospital. Leonie stands with the two children as the stretcher is wheeled across the grass to the helicopter, the aircraft and the shining chrome and stainless steel of the stretcher glittering in the sun.

  The engine note of the helicopter rises and changes as the pilot alters pitch, and with a clattering roar it lifts into the air and swings out towards the bush-clad headland. Soon the sound has faded to a thrum, and the habitual silence of Allom Bay, overlaid with birdsong and cicadas, is restored. There is an emptiness with it, an awful, forlorn sense of aftermath.

  The doctor and a neighbour roar off up the track on the quad bike. Leonie sits on the grass with the children as the stranded off-island couple—a pair of middle-aged holidaymakers who would never have believed that their island idyll would start like this—stand bewildered. They have hardly moved all this time.

  ‘Will Mum be OK, Leonie?’ Jill’s daughter asks.

  ‘We think she is very sick,’ she quietly replies. ‘They will do everything they can at the hospital. They will want to do special tests to see why your mum’s head was hurting so much.’

  The children look stricken, but they could see for themselves how desperate their mother’s situation was. They are fighting with their tears: like most Barrier children, they have inherited their mother’s stoicism.

  ‘I heard you have got some new baby chickens,’ Leonie says. ‘Do you want to show me?’

  Together they wander up the hill, behind the stone house to where the chickens are housed. Away from the others, the children are free to express their fears and, importantly for Leonie too, to cry. They have more questions: Leonie tries to answer frankly. Trying to pretend the situation is otherwise than it is will not help anyone. Leonie also knows that Jill would want her children to be comforted and to be reassured that their dad would be with them as soon as he could arrange it. Leonie the nurse tells them about the medical emergency that their mother has suffered. Leonie, their mother’s friend, is there for them, to comfort them. Their father, Jill’s partner, is a stonemason by trade, and he is off-island working. Until he can get back, the best and only thing Leonie can do for Jill is to be there for her children in what will be a terrible and confusing time for them.

  When they return back down to the guest cottage, after sitting around rather dazed, eventually Jill’s other neighbour realises that it is probably best that she scoops the children up and takes them back to her house to await their dad’s instructions. The holidaymakers can’t decide whether they should stay or return to the mainland. They eventually decide to stay.

  During the actual emergency, Leonie kept her own feelings in check. It is not until she gets home and begins to tell Ivan what has happened that she is swamped by grief for her friend and for her friend’s children. She weeps again and again over the next 24 hours, especially when news reaches the island that imaging has confirmed an inaccessible SAH that continues to bleed. Jill’s life support is turned off 24 hours later, and in a few quiet minutes a wonderful woman, daughter, mother, partner and friend slips from the lives of those who love her like a boat quietly leaving harbour.

  Chapter 13

  TE PŌ, TE AO

  Anyone who grows to be middle-aged learns about the circularities of life, of the cycle by which life renews itself independently of those who are alive. We all see the stars revolve above us, the moon and the sun chase each other across the skies. On an island, you are acutely aware of the tides, and of the seasons—winter brings storms, and it is a time for staying close to home and venturing out only as needed. The raucous call of kākā and the boisterous melody of tūī brawling over territory herald the approach of spring. Summer on Aotea is cicadas and the blaze of pōhutukawa bloom, the annual influx of holidaymakers, long, hot days when the glare of the sand on the east coast can just about blind you. Vegetable gardens are in full production—if you can keep them watered—and the shortcomings of your power and hot water generation arrangements aren’t so critical, because of the long twilights and the heat. In autumn, we get our lives back, with the madness of peak season easing. The days are still warm but the nights are cool. As a consolation, the boughs of fruit trees hang low. And then, usually with that first decent storm, we are back into winter.

  As a nurse in a rural community, especially on an island, your sense of the cycle is heightened. People are born, they thrive and they die, and you are often standing among the family of those who are birthing, who are celebrating some milestone in life, who are dying or being laid to rest. You are part of it, and you are apart. Sometimes, you might almost imagine you are immune—but of course, you are not.

  Back in the days when New Zealanders got about their country in watercraft, drowning was known as ‘the New Zealand death’. But with the construction of roads, and the perfection of air travel, for most of us, drowning has become a hazard associated with recreation or freak natural disaster. It is not quite so on Aotea, where people still rely heavily on boats to get to and from their homes and places of work—if their boat is not actually their home, or their place of work. Some of the old families lost people to drowning, or have stories of near misses as they went about their activities on the water. Some of the bays around Great Barrier Island’s coast are named for ships that were wrecked there—Cecilia Sudden Bay, Rosalie Bay, Schooner Bay—and t
here are two celebrity shipwrecks (the SS Wiltshire in 1922 and the SS Wairarapa in 1894, with the loss of over 120 lives, one of the worst civilian maritime disasters in New Zealand history) that lie mouldering on the seabed. There are five graveyards around the northern part of Aotea where lie many of the Wairarapa’s dead. One of the larger ones at Katherine Bay commemorates not only the disaster but also the heroism of the tangata whenua, who saved many lives and cared for the shocked survivors in the aftermath.

  During one of Ivan’s wanderings along Kaitoke Beach, he found a plastic container with a note scribbled on the back of a cheque book inside. The message, addressed to the writer’s children, stated the name of a yacht and promised them that the skipper—the writer—was not afraid to die. Ivan handed the item over to the island’s policeman, and he passed it on to his superiors on the mainland. The Police enlisted the Department of Scientific and Industrial Research (DSIR) to conduct tests, and meanwhile conducted enquiries of their own. The DSIR concluded that the item did indeed seem to have been in the water for some considerable time around the same time that the Police established that a yacht of the name mentioned in the message was indeed missing in the Pacific. The yacht was never found.

  At last, thinks Adele, as she hears the distinctive note of the MV Manui’s engines. A short time later, her navigation lights heave in view as she cruises down the harbour, outward bound for Coromandel.

  Adele checks her watch. It is ten o’clock.

  Darkness was already falling as Shannon went off grumbling to help Bruno, his business partner, load the mussels from the barge to the Manui. The Manui was late coming to collect the day’s mussel harvest from Shannon’s and Bruno’s barge, because it had engine trouble. Normally it would have been and gone by three in the afternoon.

  Adele gets on with her evening, but by eleven, she is starting to get grumpy herself. Shannon and Bruno are doubtless having a beer and a yarn out on the barge. But as still more time goes by, worry starts seeping past the anger. It reaches the point where she gets in the car and drives to the vantages from which the barge can be seen in the distance. There are no lights on.