A biannual publication of the

School of Nursing and Health Care Practices,

Southern Cross University,

in association with the

Australian College of Holistic Nurses Inc.

email: ajohn@scu.edu.au

…and the nurses offered to stay on for free

Sandi Grieve

Sandi Grieve is the Director of Nursing at Walwa Bush Hospital,
and in this edited transcript from ABC Radio National’s Life Matters,
she kindly shares her perceptions of nursing within this inspirational hospital.

Walwa hospital recently faced closure, and the nurses offered to stay on for free to provide palliative care for one of the patients so she wouldn't have to be moved
(Julie McCrossin, 2002).

 

When I first began working in a tiny country hospital, I felt it was a step backward. There was no amazing technology, only one full time doctor, and only one nurse on duty each shift. I cringed at how it was possible to adequately care for people under such primitive conditions. 12 years later, I have had the privilege of nursing many community members as they recovered from illness, or as they died, I can passionately say, the care offered in our tiny hospital is exemplary. I now know what is possible, that what we were taught as students is not idealistic, that given the correct environment and circumstance, absolute patient care, with an emphasis on what is important to the patient, not just what will save lives, is entirely possible.

Why is the care we are able to give so different from the larger hospitals? I believe it occurs almost by an accident. We know the people we nurse, we are their neighbours and friends, when they come to our hospital, they are people, not conditions. Even in circumstances where we are unfamiliar with a patient, the mind set that dictates the caring is already established. We immediately relate to any patient in an entirely holistic manner as it has become second nature. As a result, patients are cared for with all the love and compassion of family members, combined with extremely good nursing skill. In 12 years of my experience in this hospital, we have never allowed a patient to develop a pressure area, we have never grown our own resistant infections, and the patients that come to us to die, do so with dignity, and no pain Their every need is tended to immediately, their families are nurtured, we have no structured visiting hours, allowing unrestricted access by all family members (including dogs!) The families know who the nurses are and who the domestic staff are. They know a request to kitchen staff will not be met with disdain; our domestics regularly help with feeding debilitated patients in the absence of nursing staff.

The patients and their families know who the doctor is. They know who to address their questions to, know they will get the answers they need. They are not intimidated by rules and regulations they see in bigger hospitals. Things that most people would never dream to ask in big hospitals, are often suggested by our nurses. It is not unusual for us to wheel beds outside, under the stars, so a dying patient can once more look at, or take last breaths under the night sky. Our nurses will join families in hymn singing or prayer at the bedside, or make masses of toasted sandwiches for relatives who would rather not leave. We sit with the dying, hold their hands and cry with them. Their mouths are cleaned, their backs are rubbed, they are repositioned in the bed, their skin is sponged and moisturised as a matter of routine. Our patients and their families suffer little of the normal stress associated with being hospitalised, and I have come to believe this is one of the reasons our patients do well, or die well. Even without the fancy technology, the extra nursing staff, the numerous doctors, our dying patients do so with peace and dignity. When I worked in the city, I was a firm believer in euthanasia; I can no longer see the point.

Most of our nurses have worked here for many years. Our nurses create and review our policies. We do not suffer under the authoritarian relationships that can occur between physicians and nurses in larger hospitals. Nurses have developed strong relationships with the doctor, and this enables truly horizontal dialogue, honest questioning of orders, and equal involvement in care and planning as a matter of course.. Equally important, our doctor knows and cares deeply about our patients. We know that a call to him at any time will be given immediate consideration, and will not create a conflict of priorities.

I have been forced to defend, and justify our hospital's practice on many levels. We have been in financial difficulty and at risk of closure. We have been continually judged on the state of our aging facilities, our skeleton work force, and our "old fashioned practice". But ask our patients what matters to them when they are unwell, and they will always choose the love and care they receive from our nursing staff above the shiny facilities offered in larger hospitals. There is good, professional nursing care available in our cities, but it is in our small bush hospitals that exceptional, loving, old fashioned, truly holistic nursing care is the norm. I believe there are lessons to be learnt from the way we practice, but without assistance, this tiny pocket of extraordinary nursing practice in small regional areas like Walwa will disappear.

Reference
McCrossin J 2002 Life Matters ABC Radio National: 27th June, 2002

Sandi Grieve
Director of Nursing at Walwa Bush Hospital
walwahos@bigpond.com.au

Back from the bush

... Being a bush nurse means working in the heat, showering at least twice a day, trying to keep the dust out of your house and the wire-eating ants out of your computer. It means obtaining a history and assessing a client in the waiting area of the clinic because there are no individual consulting rooms. It means assessing, diagnosing and prescribing drugs. Life without a doctor means learning how to listen to a chest, examine an ear and palpate an abdomen — most of which is learnt on the job.

It is doing the best you can when someone arrests on you and you don't have a monitor or a defibrillator and you struggle with the antiquated ECG machine to get a Lead 2 reading but the suction caps keep popping off the chest because you can't stop the CPR.

It is about understanding that your clientele live without a watch, twenty people to a house and have no access to a phone and no refrigerator. It's acknowledging that although they speak up to four languages, their literacy and numeracy skills are poor. Traditional Aboriginal people have different priorities in health care that do not include managing their diabetes so they can live to be 70, or understanding why you are forcing a foul-tasting medicine down the throat of a screaming infant for a condition called anemia that they cannot see.

Doctors visit once a week and hold clinics. These days are more mad than usual but the visiting medicos respect the bush nurses and acknowledge that because they live there they usually know the true story. We are the primary caregivers and the doctors are grateful for it. They are available on the phone any time of the day and will usually listen when the the bush nurse reports near normal observations but has a 'bad feeling' about the patient. So the plane is sent and the nurse is usually right ...

The healer: A true story

Dedicated to my friend Barbara, in memory of her son

Dr Joan O'Connor RN, BHlthSciN(Hons), PhD, MRCNA

I took the corner much too fast and felt the car pull out of control. I tried to hold it on the road, but I had no chance: I gave up the fight and held on as it ran off the road and headfirst down the embankment. There was the most appalling noise as the underside of the car tore at the bush and scraped on the trees, then silence as the car stopped. I sat very still and took some deep breaths: I didn’t seem to be hurt and the car seemed to be stationary. My brain was still foggy with the wine I had drunk with dinner and the argument with my husband that followed the wine.

Poor William, I had said some terrible things to him, all the misery that had gathered in me during the past six months came pouring out and washed over him. Some part of my mind recognised, even at the time, that the reason I was angry with him was that he had grieved and I had not, could not, would not.

I opened the door and the headlights showed me that the car was held fast by a huge outcrop of lantana. Looking down I saw the way back to the road was covered with the same bush. I was going to be very scratched on my way back uphill. Tiredly I decided that that was what had to be done and I clambered out and up, feeling the branches pull and tear at me through the thin cotton of my slacks. By the time I reached the road my hands and arms were bleeding. I had left the headlights on, and thought ‘Who cares’.

So, here I stood by the side of an unlit road, with no help in sight and no ability to find any help. I had no idea where I was and no money with me to summon help. I stood blankly, waiting for what I know not, but I waited mindlessly just the same.

After what could have been an hour or five minutes (I had lost all sense of time) a car came toward me and pulled over. In the beam of the headlights, as the driver walked toward me, I saw a man somewhere in his late twenties, dressed in jeans and T shirt. He put his hand on my arm and asked if I was okay. I stood there in the night with this stranger, in a situation which would normally terrify me, and something burst within me. Some great dam of sorrow overcame me; every emotion I had held rigidly in check for the past six months overwhelmed me. I felt it rise from within finally seeking expression. ‘No’ I answered, "I am not OK, my little boy died" and I began to cry. Cry is not the word for it, sob, moan, lament, these are words which may cover the noise that came from me. I could hear the great, almost mad cries come from the deep places in my soul. I had finally let go. My rescuer looked at me, then at the car, but it was beyond me to get words out. I realise now that he thought my son had died in the car when it ran down the embankment, rather than six months ago in his own little bed as his illness took the last of him from me. He left me howling on the road side and plunged down to the car, then came back to say there was no one there. ‘That’s right’ I said, ‘I am alone’. He seemed to understand, just how I am not sure, then taking me by the arm he led me to his car and very gently placed me in the passenger seat, as I helplessly continued to sob. Six months of grief holds a great many tears. He left me and went down to my car, I saw the lights go out and heard the car door slam as he locked it. When he came back he placed my handbag and keys in my hands. I had enough wit left to grope in the bag for some tissues as he started his car. To the sound of my sobs, we went into the night, where we were going I neither knew nor cared, I just kept crying.

After a time we turned into a rutted driveway, and drove down to a small hut set in the bush. He came around to my door and helped me out of the car and inside his home. I sat on a chair in the corner of a clean but sparse little room still weeping. I was aware of movement and it registered in my distraught mind that my host was changing the sheets on a bed in the corner of the room. The next thing I noted was a cup of tea being placed in my unresisting hands, the tea was hot and sweet and tasted wonderful. As I sipped and wept he gently began to bathe my hands and arms and feet with a warm menthol smelling liquid. With utmost care he led me to the bed, took off my shoes and helped me to lie down. He sat on the floor and held my hand as my sobs shook the bed, myself, and the man holding my hand.

I let the memories of Oliver flood over me. For the first time in so long I saw his sweet face, heard his laughter and his quick feet on the path as he chased a ball. I remembered the odd lassitude that came over him so suddenly the day he turned three. I put it down to too much birthday party, but the next day he was no better. William said I worried too much about him, it was just some childhood thing, it would pass. But somehow both of us knew it wasn’t. Both of us felt an odd foreboding. When they diagnosed leukemia I don’t think I was surprised. Devastated, grief stricken, shattered, but not surprised. He was three; we kept him alive for another four months.

Eventually that night I slept.

Daylight streamed in the little room through a stained glass window set high in what I could now see to be a mud brick wall. As I began to sit up the door opened and my rescuer came in carrying milk and bread. He told me he had been down to the nearby village where he had enlisted the help of the local garage owner in rescuing my car from its misfortune. The car was being checked out and would be ready tomorrow. We ate bread and jam and drank tea together in an easy silence. My head felt woolly and my eyes burned from their ordeal of last night. When we finished he said he would take me to the bus stop near his house, and asked if I had any money. I knew when I left my home last night I had wanted to die and one did not need money in one’s purse to do that. He gave $5 to cover the bus fare home, and drove me back down the driveway to the roadside where a shaky old bus jerked along the road and waited while I got on. I turned to wave to him and realised I had not said thank you and I did not know his name.

As the bus bumped its way along the country road I became aware that this was a beautiful morning. The sun shone and a light breeze stirred the trees around me. We creaked past the village school as the children banged through he gate. A boy turned to look at the bus, his face full of happiness for the day about to begin, he reminded me of Oliver. I waited for the familiar jag of pain and was surprised when it did not come. I had begun to heal.

Three years later I was enjoying the last of my breakfast coffee and planning my day when the phone rang. It was my mother. ‘Felicity, you must go and see Marjorie Corcoran, today’. My mother does not waste time on the phone with niceties like good morning, how are you, are you busy, are you free today. She likes the direct method of communication, especially on the phone; I think she feels the phone company charges by the second, even on local calls. I considered what I had to do that day and why I needed to see this friend of my mother’s whom I had always regarded as a somewhat remote person, with scant regard for the feelings of others, especially her children. My mother’s voice cut through these thoughts, ‘You will go and see her today, her son has been killed.’ My mother seemed to believe I was an expert at dealing with crisis in other people’s lives, my fragility in these situations was not something she believed in. Anyway, it was pointless to arguing, she had hung up. I went to see Marjorie with my heart somewhere in the region of my left knee.

I found her at home, sitting in her well appointed lounge room, her face hard and tearless. I explained my mission and told her of my mother’s concern. She began to speak about her son, telling me of his wasted life, of his alternate lifestyle, how he had left a promising career in law to ‘go bush’ and live ‘like a savage’. How he had died in a car accident, how his life was wasted and how he had never done a thing to help another human being, ever. Her lips drew tight as she made this last statement. Struck by her coldness I began to look around the room, trying to find something to say to make it easier for this woman. ‘Is that your son’s photo on the table?’ I asked. I had not met Marjorie’s son, she was my mother’s friend not mine.

As I reached for the frame, she answered ‘Yes, his name was Damien’. My hand closed on the picture and my heart stood still, here was the man who three years ago took me into his life for a short while and waited with great gentility with me while I grieved. ‘Marjorie’ I said, ‘I have a story to tell you’, and I did.

I looked at her face as I told her about the son she never really knew and saw her face soften and crumble, and then watched the tears as they began to flow. Marjorie could now bury her son with dignity; Damien had begun healing his mother.