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Andrea Zwart, who has been a hospice community nurse for 15 years, says she was not offended when an old friend once referred to her as “the death fairy”. She has supported many patients through the final stages of life and says what gets her through is her faith, a sense of humour, a strong home life and many games of tennis. She has seen hospice develop from its early days, when nurses worked in “the dungeon” with only 10 patients on the books, to a fully equipped facility caring for more than 80 people at any one time. Andrea was recently appointed leader of hospice’s palliative care team.
From the first moment I first nursed hospice patients, it touched my soul; that feeling comes from a place of care and compassion not only for the patient, but also for their family. The struggle with serious illness is not just the patient’s alone, but ripples out into the community, touching family, friends and all those who work in the support services.
I wanted to be a nurse from the age of seven, as my mother had before me. However, her father forbade her to enter a profession where she would be “cleaning bedpans for old men”. By contrast, my parents were fully supportive of my choice of career. I trained at Lower Hutt Hospital and worked in general nursing until my husband Michael and I started our family of five children. Between pregnancies I worked part-time and was given a bureau job at hospice Te Omanga in Lower Hutt, which proved to be a life-changing experience for me. Eventually I took a permanent night nurse job there and never wanted to do any other kind of nursing since.
Michael and I moved to the Hibiscus Coast in 1991 so he could start a building business. To save money, we moved into the Orewa Motor Camp and lived there for 16 months with our five children, before buying a house in Red Beach. We made lifelong friends at the Motor Camp and had a great time, living in two caravans with a makeshift fence around them. I got a job as a nurse at Hibiscus Hospice in 1994. At first I only worked two days a week, but as patient numbers increased, so did my hours. At the same time I completed my post-graduate certificate in palliative care. Back then we hospice nurses worked from a donated home in Pohutukawa Avenue, Red Beach, known as The James Centre. The nurses’ digs were called ‘the dungeon’ because they were dark, damp and cold. As the service grew, we let the counsellors and family support people have ‘the dungeon’ and hospice purchased the house next door for us. The nurses moved into a converted garage so it was extremely close quarters for the three of us, with no room for a patient to lie down during an examination. There was no insulation, so we cooked in summer and froze in winter; nevertheless we had a lot of laughs in ‘the shed’, which had million dollar views over Orewa Estuary. The new hospice facility is like a castle and has made our jobs a lot easier.
Our out patient service is vital because most people want to be cared for in their own home, and to die there. Not everyone who comes on the hospice programme has a terminal diagnosis of cancer. Some have a medical condition and come to us at the end stage of life, suffering, for example, from renal or heart failure. Although I moved into a more administrative role last November, when I was made leader of the community palliative care team, I still do hands-on nursing work, with a weekly clinic assessing patients. I mentor the nurses and assist with their on-going education. The work is demanding, but I never feel drained, because I maintain a healthy balance. I am always so busy at home. When my working day finishes I become a wife and mother and let that absorb me entirely, leaving my work at the door. Having this completely different focus has prevented me ever having burnout. My children are grown up now – the youngest is 19 and lives at home. None of them want to do my job because they see how hard I work and how little nurses get paid.
My real passion is tennis, and when I considered taking the full time job at hospice I was concerned at the amount of tennis I’d be missing! However, I figured after hospice had given me so much in the way of training and experience, that it was time for me to give something back, so tennis has gone on the back burner, apart from mixed doubles once a week. Michael and I take a daily walk in Arkles Bay, where we built our home. The sea to me is a spiritual place. I do a lot of self-reflection there and it does my soul good.
I have a Christian belief, but of course I don’t expect patients to share that. Hospice nursing has made me much more tolerant and makes the smallest of life’s gifts seem wonderful. I had a patient about 12 years ago who said she had a nightmare and told me it was that she’d won Lotto. That wasn’t a good dream for her, because all the money in the world couldn’t make her better. While it touches you, working with patients, and I become close to the families, I do not walk their journey with them. My role is always to support, advise and assist. We also have lots of fun – I have a strange sense of humour that also helps me through. Our whole team maintains a lighthearted approach, while at the same time being passionate about our work.
Palliative care has improved markedly over the years I’ve been involved and the key to that is education of the nurses, educating families and having a holistic approach to care. The hospice approach is to look at the spiritual, psychosocial, intellectual and sexual aspects of each person not just their physical needs. Having a chaplin and other support services makes this possible. In my experience, everyone handles dying in the same way as they have approached life. If someone has lived a very independent life, that’s the way they die. I see a huge connection between birthing and dying – in some ways hospice nursing is comparable to midwifery, just easing the end of life rather than the start. It is possible to have “a wonderful death” – some people even celebrate their wake while they are alive, with champagne, balloons and relatives and friends. This is most often older patients, whereas of course it’s a different story if someone young is facing death. Some of the most fascinating stories from family are about people who are dying and have conversations with those who are already dead. I firmly believe there is a spirit world out there and am a witness to that with the patients I care for. You don’t have to have a religious belief to see a spirit world. It is recognised by all the hospice nurses, who have a wide mixture of beliefs, and it can be a big comfort to families.
