Maree McDonald has experienced the full gamut of emotions - laughter, tears, satisfaction and frustration - during her distinguished 47-year nursing career.
Ms McDonald retired yesterday as charge nurse manager of the dialysis unit at Dunedin Hospital after a working life at the front line of the evolution of treatment for kidney disease.
It has been much more than a job. It has consumed her life and her services to the development of dialysis treatment have been recognised nationally and internationally.
She acknowledged the position had been mentally draining as she shared the highs and lows of the patients, budget constraints and staffing levels.
But in the end it was about people and their families as they adjusted their lives to cope with a debilitating disease.
''One of my happiest memories is of a 2-year-old toddler who had a transplant about 20 years ago,'' she said.
''He was a very sick, listless child. He came back from his transplant with a tube down his nose and he ran into the unit with a big grin on his face. You realised the difference that a kidney could make.
''We become very attached to the patients and it is very difficult when things go wrong for them. It can be very sad, especially when they are long-term patients.
''Before there were retrieval transplant teams, we used to have to go to theatre when the surgeon removed the kidney from deceased donors and we would have to perfuse the kidney, clear it of blood, pack it in ice and ensure it was sent off to whatever hospital it was destined for.
''That was sad because you saw the consequences of young people who had fallen from a horse or been involved in a fatal car accident.''
Ms McDonald, who worked in renal units for 34 years, said dialysis treatment now was far advanced from when it came to New Zealand in 1969.
''When I started nursing in 1966, I remember two young men died of renal failure because there was no dialysis. If kidneys failed and did not work again, people died.''
Ms McDonald, who undertook a postgraduate course in renal nursing at the Royal Free Hospital in London and began working in dialysis at Dunedin Hospital in 1975, said it was much more time-consuming for patients and staff back then.
''We had to build the dialysers and, because they weren't as efficient, patients had to dialyse overnight for 10 hours. It was much less sophisticated. Some patients ran out of veins for access for dialysis and they died.
''The consequences of the side-effects of drugs with transplants in the early days were sometimes horrific. The skin would peel off their bodies because of the drugs.
''The criteria for dialysing in the early days was very strict. No-one over the age of 45 or under 18 would be considered for treatment. Now, as in all areas of health, people have expectations they will be treated. Until 1989, in Dunedin, we didn't dialyse anyone over 60 but now, with peritoneal dialysis [patients dialyse through a tube in their stomach], the criteria widened.''
Nursing, too, has changed over the years.
''When you trained in the 1960s, you didn't complain about your duties or your hours. It's changed over the years, that's for sure.''
Until 2003, the Dunedin dialysis unit was staffed by only three nurses caring for patients from Bluff to the Waitaki and Central Otago.
''We worked long hours. There were no tracers or cellphones. We had to sit around waiting for the phone to go when we were on call. If one of us was on holiday, the other two would work seven days a week for weeks at a time.
''They wouldn't give us more nurses so we had to cope. If we hadn't, patients would have died.''
There are now seven specially trained dialysis nurses and even they battle to cope with the 102 patients in Otago and Southland.
''We and the patients need support if we are to maintain our home dialysis philosophy. The frustration has been in the budget constraints and in a lack of understanding and insight of management about how complex our renal patients are and how much input is needed. I think maybe that is finally becoming clear to management.
''But like most charge nurses, I feel I should have more resources and I should have a much larger facility.''
Dialysis is different from other branches of nursing as the association with patients can last for 30 years and longer. Patients can dialyse, have a transplant which eventually fails and have to dialyse again. Some have had three transplants.
''The special thing about renal nursing is that when patients present, often acutely unwell, the association can go on for many years. We stay in contact with patients and their families,'' Ms McDonald said.
Most patients were fearful and apprehensive when they began dialysis.
''They are scared and they don't think they'll do it. Just about everyone says they hate needles. But they've got to do it and it becomes part of their survival mechanism.
''We have had some patients who have just about passed out in the chair but, in the end, they are needling themselves and they don't want anyone else to do it. They become independent and that's a real highlight.''
Ms McDonald acknowledged there were occasionally non-compliant patients.
''It's frustrating because you want everyone to do well and they don't. I guess it reflects on how society has changed. When I started, virtually everyone did what they were asked because they realised they were lucky to be able to dialyse.''
Ms McDonald said the happiest memories were of successful transplants, especially for patients who had struggled on dialysis for a long period.
''And it's also satisfying to get a patient home on dialysis and empowering them to be fully independent. It's important to preserve the home dialysis philosophy. We've managed to maintain that and now the world is turning back to it.''
Ms McDonald said dialysis was very much a family affair.
''One of the highlights of my job has been my relationship not just with the patients but with their families. They're amazing; the strength, love and care that they have for each other is inspirational. People who have the support of their families do much better than those who don't.''
Ms McDonald said it was important patients were able to have holidays and she was instrumental (she was the founding chairwoman of the Otago Kidney Society) in the conversion of a building at Cromwell Hospital into a holiday home in 1976.
''Our consultant at the time didn't want patients to go on dialysis in other hospitals because of the risk of infection so the Kidney Society, with the help of the Ravensbourne and Cromwell Lions, converted the former nurses' house into a unit for the use of patients.''
Cromwell Hospital closed and the holiday unit is now at Dunstan Hospital in Clyde.
There is a slogan that dialysis is a life sentence, not a death sentence, but Ms McDonald does not entirely subscribe to it.
''I always think of a life sentence as something awful. For some patients, it may seem like a life sentence because dialysis might not be appropriate for them. But if people adjust well to dialysis, it should give them a decent quality of life.''
Ms McDonald has two children - daughter Bree, who works for Dunedin Tourism and is married to Mat Reynen, and son Greg, who is an associate professor in vascular research at the hospital and Otago University. He and his wife, Rachel, have three children.
Ms McDonald had her own personal sadness three years ago when her partner of three years, Dunedin businessman Bruce Davie - himself a dialysis patient - died after a lengthy illness.
He had a transplant which lasted for 12 years before he had to go back on dialysis and he finally succumbed to heart surgery and cancer. Ms McDonald nursed him at home in his final days.
''I knew where it would end and Bruce did, too. It was a trying time but he had a peaceful death. When I started nursing, everyone's life had to be saved. Now we talk about planning for death and talking it through with the patient and that's been a big advance.''
Ms McDonald's hobbies away from work are reading, the movies, travel, walking, food and wine.
She tried badminton but, in her first game, she ruptured her Achilles tendon.
''I realised that rupturing your Achilles has to be worse than a broken bone!''
She is planning a trip to Europe and/or Vietnam later this year before she contemplates retirement.
''I'll sit back for a while and then I'll look at voluntary work. I'm scared because what do you do when nursing has been your life?''
Last year, Ms McDonald received a special award from the New Zealand branch of the Renal Society of Australasia for her outstanding contribution to renal services.
The citation read, in part: ''Maree inspires those who work with her by the passion with which she practises and her commitment to improving the lives of her patients. Her sense of humour, readiness to share knowledge and practical grasp of what works continues to motivate her colleagues and peers.''
