From cradle to grave

Location : Norwich

When I first left school after my A levels, I took up a job as a nursing auxiliary, as they were called then, a healthcare assistant now, at the local community hospital where I was living at Felixstowe, the Felixstowe General. I worked as a health nursing auxiliary there and got lots of experience for a good six months, which involved learning all the basics around nursing and caring. But I do remember that there was a small operating theatre there. I think they used to do varicose veins and hernias and things, so all good experience. But I do remember blotting my copy book because I fainted in theatre for the first time of going in and I thought perhaps theatre work might not be for me in the future. But I certainly learnt a lot with lovely mumsy-type nurses that had done many years working there. And I remember very happy times.

I think it must have been the year that Princess Anne got married because I remember watching a Royal wedding with some of the patients on a lovely sunny afternoon. But we had our sad times as well and I remember seeing my first patient who was dead, laying the person out and being privileged to be able to do that for somebody. But all these [things], and how to make a bed properly – I remember getting the envelope corners right. So when I did go to London to do my general nurse training, it was state registered nursing then, SRN, I really felt I’d got a bit of experience tucked under my belt and felt – not that I knew everything – but I did feel I had a slight advantage over those that were completely new to it.

Nikki as a young nurse

Nikki as a young nurse

SRN training and staff nurse at UCH

I trained at University College Hospital, London, a big teaching hospital and it was lovely getting a place there. I always wanted to go to London ‘cos I felt it was the best place to go to train. Having lived in Felixstowe most of my life the lights of London seemed to certainly attract me too. But I remember applying to several of the London hospitals to train but University College Hospital – UCH as we call it – had a very poignant reason for me going. My mother had been ill as a child and had been in UCH with a condition called osteomyelitis, which is an infection of the bones of her legs. She was very ill and they saved her life there so I felt very drawn to the hospital because of that. Because without UCH I wouldn’t be here. So that was my real attraction. But also they were so friendly and I just was so excited about going there and I had very very happy years there.

We went in to PTS – preliminary training service – for about six weeks, where we learnt the basics. And then I did a modular training. My first module, for example, was general medicine so we had a week learning the theory about general medicine, then we spent six weeks on the ward getting our experience. Of course now students are supernumerary but we were actually the workers on the ward. There was quite a hierarchy; we were first students and everybody could tell who we were by the colour of our belt and I think it was a white belt in the first year, so you were the low of the low (laughs). But a very happy time gaining lots of experience and lots of really good memories. Memories of working at Christmas you know, and thinking do I really want to work Christmas and not be with Mum and Dad and my twin sister and my brother. But actually I did work Christmas and I think people used to want to work Christmas because we used to decorate the wards up in a theme and have such a good time that you felt you missed out if you weren’t there. So often I did. If I worked Christmas Day you often had Boxing Day off; my dear Dad used to come up to the edge of London and I used to come on the underground out to the suburbs and he used to pick me up from there and bring me home for a second Christmas Day at home (laughs). So I remember that. I remember my parents being very proud of me, getting in to UCH. It was a very happy time; I learnt a lot as I said.

We did this modular training so we were a bit experimental in our set. There were about 35 nurses that used to come in for training every two months so vast numbers of nurses in training at any one time so very soon became not the new girl anymore or new boy cos our set we had a chap. We had a man who in fact I remember being a day late because he came, he was on his honeymoon and I just thought, we all thought that was quite funny that perhaps his wife thought better get him married before coming to join 34 young women in his set (both laugh). But he was a lovely Irishman, he was great fun. And as said, I finished my training. We did a modular scheme and I was fast-tracked because I did my A levels at school; about eight of us from the set were fast tracked so we took our finals after eighteen months of training which seems horrific now but seven out of eight of us I think passed and so after that our main point was to gain experience. But of course having got our qualification, the hospital could use us as trained staff rather than as a third year student, so there was an advantage to them as well. But very happy getting my SRN and my hospital badge, which I still wear with pride today. I really loved it.

But after I did some experience as a staff nurse I worked on male orthopaedics. That was fun ‑ most of them on the ward were young men who had come off motorbikes or whatever so it was quite light hearted as they weren’t ill. Had to keep them in their place because they tried to be naughty at times (both laugh). But it was all, as I said, good fun. And I worked on a female surgical ward with a Sister Major and her name perhaps described the type of person she was – she was an unmarried lady with very strict routine to the ward but gosh, it taught me such a lot. I still, I was in touch with her since then, and I hold her very much in my heart because although as a student nurse you were terrified of her, I do understand why she was like that. Discipline on the ward I think is really important and perhaps we could do with a few more Sister Majors today in our NHS now. She did have very high expectations of her staff but we felt comfortable working with her. And of course I was in London in the early seventies and the IRA bombs were going off then and I remember the hospital being evacuated many times but Sister Major would sit with the patients that were too ill to be moved; she would not leave their bedside and I admire her for that. I know she did get an MBE for her work because her dedication to her whole nursing was just unbelievable and I feel very proud that I worked under her. She actually asked me to come back on her ward and work as a staff nurse and then lo and behold, she actually nominated me for one of the medals that they awarded at the hospital. There were gold, silver and bronze medals awarded every year to the outstanding students and I got the bronze. The Bonham-Carter bronze award which I’ve still kept and so you know, although she seemed a very feisty sister I learnt a lot and respected the work that she does and hopefully carry it on. I’m not quite as feisty as she was but I did – I do – have very high standards.

nikki sawkins_0001

Midwifery at the Norfolk and Norwich Hospital

After I did my general training and stayed as a staff nurse for probably a year. During my nurse training I met my first husband and so I wanted to come back to the East Anglian area and I applied to do midwifery at the Norfolk and Norwich Hospital. That’s of course the old Norfolk and Norwich, the tall building that’s not there and in fact we recently had a reunion of our set, quite a few of us got together and we went and had a photograph taken just where the old building used to be. So again, we did our midwifery training, delivered lots of babies in you know, practicing to be a good midwife and when I qualified I worked on the antenatal clinic. I used to do some of the parent craft classes and used to teach mums and dads all about parent crafting, having not been a parent myself and I now realise that some of the advice that one gives when one hasn’t had a baby is perhaps different to the advice one would give now (both laugh). It was a very interesting time, but again very enjoyable. As I said, I’d met my first husband and our son was born, so I did what I call my part three midwifery which was having a baby of your own and that was an experience in itself! But as I said, on reflection, it’s an interesting one because I do feel when I went to midwifery after having my son I felt I was perhaps a better midwife than what I was before because of the experience of it all.

District nursing and midwifery in Suffolk

I then gave up nursing and midwifery for quite a while to give some time to my little boy who was quite an active little boy. And I remember my GP suggesting perhaps I went back to just doing a bit of nursing just to have a break (both laugh). It was very intensive time with David. I did actually go back to doing a couple of nights a week as a staff nurse at Ipswich site. We’d moved back to Felixstowe by this time so I used to do a couple of nights a week on the wards at Ipswich Hospital, Anglesea Road Wing, which again sadly is not anymore. So but that fitted in very well with family life. On the morning I got home after doing a night shift, my mother would look after David to allow me to have a few hours sleep, either in preparation for going on to night duty or in recovery afterwards. But again, very happy times. And then my husband had a move with his work and I noticed that there was an advert in the local paper for a district nursing sister, midwife, doing district nursing and midwifery and I remember saying to my husband, “Oh that’s my dream job.” And he said, “Go for it, go for it”. By this time David was two and a half so I thought, okay I will and shock of all shocks I actually got it, was offered it there after I had been for my interview. And I thought oh gosh, what next? We were still living in Felixstowe at the time and we hadn’t moved to Halesworth where the new post was so I commuted for the first few months until we moved house. And I remember delivering my first baby on a commute from Felixstowe.

There were two district nurse midwives, Elizabeth Lovett who’d been a midwife there for many years and I’m still in touch with Elizabeth now. And she and I worked just two of us, so if one of us was off duty the other one was on duty and if we had any babies due that meant you were on call twenty-four seven, which is quite a challenge when you’ve got a little one and a husband that was working shift work too. So we had to have very elaborate plans in case anybody went into labour, but we managed to do that. As I said I got the job when David was two and a half. You did an extra year’s training in district nursing in those days so it’s a year on top of the general training. I attended the Norwich City College and got my district nursing certificate which involved attending the college and having experience.

I was actually placed for my practical experience, with a very experienced district nurse at Kessingland and did my main placement there, which again was a real learning curve. Because district nursing is a very different ball game to hospital nursing. You know you are a guest in somebody’s home for a start so that was a very different perspective on care and they’re not a name or a number in a bed. You’re a guest in their house. And both in Norfolk and Suffolk they always say that perhaps it takes you a while to be accepted in the community but perhaps as a district midwife and as a district nurse I had a slight advantage so I felt very much part of the community quite quickly.

For the first twelve years of my twenty-eight years I think I did in total in the district at Halesworth, a small rural practice thirty miles from a district general hospital. We did have some quite hairy moments, particularly with midwifery when babies don’t always do what they should do when they’re coming into the world. I remember looking after a girl who had an undiagnosed breach that two doctors that saw her and two midwives that saw her still hadn’t realised that this baby was not a deeply engaged head. It was certainly a baby’s bottom that was coming forward and that caused us quite a lot of worry. We did take her in to the Norfolk and Norwich and the baby was safely delivered, but it did cause us a little bit of worry at the time. In those days of midwifery, labour could be five … could be three days certainly but sometimes perhaps when they went in to early labour, you’re probably in touch with somebody over a period of about five days. So you know, we used to get tired. Of course our district nursing work, in those days it was before the Community Care Act, and we used to do things like washing and dressing people who’d had strokes and getting them up in the morning. And giving insulin and things like that. And of course you know, people died at home too so we cared for them to die at home. So really from cradle to grave and that’s termed my little history of my working life “from cradle to grave” for that very reason. So sometimes I’d deliver a baby in the morning or in the evening or the night, and perhaps attend someone who was dying at home in the afternoon. It seemed really strange that sometimes you’d get a birth and a death in the same road and often it was of the same sex. It was almost as if life was trying to put things in balance. And sometimes when families are very distressed of losing a loved one, sometimes to hear the news that a baby had been born and I’d been present at the delivery, was a bit of comfort to people and to take their minds off the situation they were in.

The snow baby

So we had some very happy and some very sad moments. But I loved my district nursing, I loved my midwifery.

We had some amazing deliveries and some …, no running water in some of the houses. I remember being called out one February to a girl in fact who was going to have her baby in hospital so I hadn’t actually visited her at home and I got this call in the middle of the night from the local GP. I wasn’t on call but the first thing I knew was a police Land Rover was outside my house with its blue light flashing. I thought my goodness me, whatever’s going on? And then the phone rang and it was the local GP saying that there was a girl who was in labour eight miles from our home here in Halesworth and that she couldn’t get out and we needed to go out to her. That was more problem than I can remember – there were six-foot snowdrifts out there. One of the snowploughs that had was trying to clear the road had got stuck. There was an American snowplough from the American base had been called in, that one had got stuck as well. So it was very treacherous driving. We got the instructions on where the house was from this girl’s mother and we set off in the Land Rover. We went as far as the Land Rover could go and by our description of where the house was by the mother, we thought we could set off on foot to the house. Little did we know that in fact she had given us the wrong directions (both laugh). So we arrived at this house, this little house with still some way to go and really a complete worry about how we were going to get there. But because it was a farm house, in the shed, there was what they call a Unimog, which is one of these agricultural beasts that have six foot wheels and help with moving machinery and heavy hay and stuff. So the offer was by the farmer, to put the GP and myself, plus all the baggage because there wasn’t only my delivery bag but the GP I went out with was belts and braces (laughs) – he had everything. He had forceps, he had everything. So the poor police officer that was accompanying us on this journey was overwhelmed by the amount of equipment he was having to carry. So he did manage to get it all in the Unimog and we set off across country. You couldn’t see where the roads where. You couldn’t see where the ditches were. You couldn’t see where the pond was. So thank goodness the local farmer knew exactly where we were but it was quite treacherous and quite risky but we were just keen to get there and this chap seemed to know what we were doing.

So we did get to this house. Got to this house with beautiful stabling for the horses but inside I remember there was green mould on the walls and in the hallway the water was actually frozen over. So it was not an ideal place for this girl to give birth to her baby. We were even thinking that perhaps that the stable looked more interesting and perhaps safer (both laugh) and cleaner maybe, than the house! Anyway, we got there and she was in labour but we had a little bit of time to sort things out. We tried to scramble a helicopter from Ellough at Beccles but that was grounded because of the weather conditions, which of course was still snowing when we actually got there and they were going to send a helicopter from Wiltshire. But again because of the weather conditions it was considered too risky. But we felt we couldn’t keep her there, we couldn’t keep her at the house because the conditions were so poor and we felt we had a bit of time. So we put Mum and baby-to-be and myself and the GP. Again the poor police officer was coming behind us in the tracks of the Unimog carrying some of the equipment. But I remember sitting very tightly on this GP’s lap. I was under thirty and remember thinking this is interesting (both laugh). To be very tucked in close to your GP you were working with, I do think that our relationship did change (Mary laughs). He was quite an aloof man so this was quite fun. And we still meet each other and laugh about it even now. But we did manage to get the girl out to the crossroads bit and they’d managed to get an ambulance up to there.

It did make the Anglia news, her rescue and we did escort her in to the hospital. It had actually taken us nearly five hours to get her house. And I remember thinking blow the uniform, I’m going to put my ski outfit on so I tucked all my uniform into my salopettes and wore my ski suit. And in those days we had these amazing coats that were made of Scottish wool in the Outer Hebrides, which smelt dreadful when they were wet but my word they did keep me warm. I remember my GP friend, who again was wearing a very lightweight winter coat and no hat and he looked frozen but I was very snug in my outfit. And it was a good job we were in these salopettes because we were, when we had to go from the police Land Rover to the house we were falling in the ditches up to our armpits in snow. So I felt very snug and very smug in my outfit.

So we got her back in to the hospital, the local hospital, the community hospital with a small maternity unit there. Mums used to be able to go in there to have their babies and then either go home after a few hours or come back there to have a bit of luxury living really before going back home to face the world and have that lying in period as we used to call it which was considered as luxury now. Sadly the maternity unit closed in 1988 soon after my daughter was born. So you know Patrick Stead Hospital maternity was a very special place. And Mum and baby arrived, the baby arrived, the baby was quite what we call flat, it did need a bit of encouragement, but this world was better than where she’d been, and we were holding our breath a bit when she was born but she was born safely. And I see her today. In fact I was invited, she had quite a quiet wedding but she did invite me to her wedding and she’s known as my snow baby and of course (showing my age and the years that have gone by) she’s given birth to a baby too and she’s told the story to her daughter. So it’s quite a lovely story.

It might have been so different. But that’s what midwifery was like and you know in the first days of being a midwife we did have our own instruments – we had a midwifery bag. We used to boil up the instruments on the stove when we used to get back. But very soon after I came into post we actually had special packs, delivery packs that we left at the house because often, this was an unusual situation, often people had been booked to have home deliveries and we knew that they were safe. The one that I mentioned before that was the undiagnosed breach, was actually a girl. It was her first baby but she was wanting to have a home delivery against advice but we still needed to support her. We had the active birth group that were in residence locally so they were encouraging even first mothers to have their babies at home which as I said, is good if everything goes well but if things start to go not well, it’s a long way, thirty miles is a long way to the nearest maternity unit.

And as I said, Elizabeth and I were the only two district nurse-midwives in the whole of the East of England in 1981 because we were so rural it was considered that because you were attached to a surgery in those days – the midwife was attached and the district nurse was attached – but twelve years after I started there in ’81 it was decided that the job would be split and the midwifery service went into the acute midwifery service at the James Paget and the district nursing became just a district nursing team. But it was about the same time as the maternity unit was closing at Patrick Stead and so the midwives at the local maternity unit were going to be losing their jobs unless they wanted to go on the district.

Having been up many nights and having by this time remarried and having two more children of my own, the very thought of not being on call at night was an attraction. So I went down the route of being a district nursing sister and I left my midwifery life behind. Sometimes with a bit of sadness. I have had pangs of thinking I would like to do it again but I think certainly I, it’s not a prospect that I think of but I do have very happy memories of that and some of the women I delivered are my best friends still to this day. I think it shows the relationship that can build with your midwife and one of the last babies I delivered – and this is all about local midwifery – I had Thomas my other son (well, I planned to have him at home but things didn’t work and got rushed in to the Norfolk and Norwich and he was safely delivered). Tom, my husband had given up teaching and was having a go at being a house husband so I’d gone back to work full time and it was my first day back in March and I remember getting a call about four o’clock in the afternoon from somebody to say she was in labour, and I thought gosh, another baby on its way. And it turned out to be one of our GPs who actually wasn’t working in our GP surgery at the time but then came to join us later. So my predicament was that I was called out to deliver this baby, which I did about six o’clock-ish. I know the mother was expecting people for dinner and of course trying to get hold of people in those days was always a challenge – so she was expecting guests to come for dinner and my poor husband had a baby that needed breast feeding at home, some nearly eighteen – well across country it was about eighteen miles so. I suggested that my husband brought the baby to me because I couldn’t leave the new Mum on her own. So in true community midwifery style that would be terribly frowned on now, but I think in those days perhaps things were different, Tom was brought out to me so I could breastfeed him. I remember the scene of my breastfeeding my little boy who was only about three / four months and the new Mum feeding her baby, William, in the same room together.

The nice story from that is that we met each other some years later down the line, nine years later, when the two boys were just about to go in to the middle school and we had a surgery barbecue. By this time William’s Mum had joined our practice as a GP and they got on really well and they said, “Oh I hope we’re in the same class” and they were in the same class and the story of them meeting on the day of William’s birth was told to them many times over the years. And they are still to this day like brothers, not just friends because they have very much a bond that was very special to them. And I remember William coming with Tom to see my Mother once and hearing William say to my Mother, “You do realise Nikki’s very special to me, she’s very special to me, she delivered me and she’s very special.” And for a nine year old to reflect that back was quite something that I hold very dear. So yes it was, it was a nice time.

And as I said [there are] many, many stories of midwifery and district nursing – and district nursing has now changed quite considerably. It was interesting when I did my general training there were nurses then doing degrees but they were trained into management and I wanted a very much a hands-on role with nursing. But I do remember doing study as well as working full time as well as being a mother, and actually thought perhaps it might have been a good idea to have done a degree at that time. So I think the opportunity that people have now of doing a degree when they are supernumerary and perhaps at a different time in their life is certainly perhaps a good thing. Things have changed dramatically, but I do feel that the NHS is moving on and we need to move with the times.

With my district nursing I did some extra training again to become a trainer of district nurses, so I used to train district nurses. They used to spend a year with me in practice and I used to be their mentor so I would teach them the skills of becoming a district nurse in addition to their general training. But of course now training for midwifery for example, you can go as a straight entrant in to midwifery you don’t have to be a trained nurse first and then go into midwifery as we did. So people can be a direct entry midwife. But I do feel that perhaps the nursing, even in elements of my midwifery work and life experience perhaps, made me the midwife I am or was at the time.

The development of the Primary Care Trusts

So I stayed on district happily for many years but teaching district nurses. With the development of the primary care trusts, I did some work around strategic development of services, particularly around cancer services and palliative care, end of life care when people were dying services, and I was appointed as the cancer lead for the local Waveney PCT which interested in trying to develop services better to look at and listen to what patients were saying and develop services accordingly – which lit my fire at that time. And I was the cancer lead as I said for Waveney PCT and with the Norfolk and Suffolk and some of the Waveney, North Suffolk and Norfolk cancer leads from each of the areas of Norfolk and Waveney, we used to meet together in Norwich and have meetings to take our little bit of Norfolk or North Suffolk to the table to try and work out how we could develop services better. And that gave me certainly a real drive to do this work. I did that for, I think it was about eight years and I did some project work with the cancer network looking into specialist palliative care and did that as a project manager with another girl for eighteen months.

The Gold Standards Framework and the National End of Life Care Programme

Then after that I thought, what next? and somebody I’d been working with, with the East of England strategic health authority, sent me an email with, “this job’s got your name on it” and it was for a nurse lead role, national nurse lead role for palliative care, end of life care with the Gold Standards Framework team based in the Midlands but working across the country. I would never have thought about it, but I thought well, if this person feels I can perhaps I ought to just have a go at applying for it. So I did and I got it. And of course then it was: this was based in the Midlands, this was based in Birmingham and I thought, just of the mechanics of doing two days a week in the Midlands and three days a week as a district nursing sister. A prospect that was quite a daunting one to start with but my husband who, as I said, had given up teaching and was a superb house husband was encouraging me to do it. He did everything at home (laughs). We did things together when I was there but he used to do the ironing, he used to sort the children out for school and I did a motherly role at times but he was the main person who ran the home so encouraged me to do it and I did take up the post.

My role was with the National End of Life Care Programme, on again developing services across the country, trying to improve the quality of care of services and one of things with the Gold Standards Framework team, which was a project led by a GP to ensure that all things were in place when people were coming to the end of their lives so that if things happened there wasn’t this mad crisis and this panic at the end. We’d spoken to the people and found out what they would like, where they would like to be, for example, and things like that. So we could make plans, we could do advanced care planning with them. We could plan with them, to some extent about talking about their wishes and wants as they approach the end of their lives. And it was built on that, this team work and trying to develop better hospice care, better care in acute hospitals where many people die so that it was a better experience for patients and certainly a better experience for their families. So all progressive work to ensuring more than, you know, it being a luck thing “She was lucky, she had a good doctor”, or whatever. That this was what was expected, that people could expect a better, more controlled, pain controlled, more symptom controlled, planned … It wasn’t about euthanasia or anything like that. It was just that if we could control symptoms, if we could talk to relatives better, there would be a better experience for a very dire situation for people.

So with my national nurse lead role I was asked to be part of some of the developments around the National End of Life Care Strategy. It was strange because you know, I was working with people who were very knowledgeable in the field and had written widely, they’d spent their life dedicated to this work and I used to sometimes almost want to pinch myself to think who was I, a district nurse, a little me a district nurse from the middle of Suffolk and they were listening to what I was saying about what it was like to live in the middle of the country thirty miles from a hospital with a very limited family networks and things, and what from a carer perspective, from that perspective what it was like and what people were saying to me. Because I was still grounded, I was through all my development strategic work I’ve always kept a one day of clinical work and even when I became almost full time with the national team because the Gold Standards Framework had grown out of all proportion, it’s part of the End of Life Care Strategy, so we were developing work in, not just in GP practices but we were developing work in the care homes. I developed a training programme for care homes across the country which is now an accredited recognition of good quality care that carries on today. And you know, it was always going to the next level and the work that Professor Kerry Thomas led on this work and I was her lead nurse, was just amazing what has been achieved in the years over this development. And it does make a difference to people’s lives, which of course is always the thing. But even when I was working four days a week I was still one day in practice with patients working with their families, running palliative care day centre at Beccles. So I feel that part of whatever you do, you need to never forget the grounding level of actually the work that’s so important at the bedside.

Volunteering in community care and counselling

And in 2010 the pressure of all this work, with the travelling – I was doing three thousand miles a month in my car and the way that I was working was almost too much for me and I was paying in my health. So I decided to step down from that, take some time out to rethink and I took early retirement from the NHS so I could fulfil some of the other work that I wanted to do. And I do still continue to work with a charity I set up when I was a district nurse – the Halesworth Community Nursing Care Fund, which helped in the decision that people made in around where they wanted to die. Because in the rural area that we lived in there were very limited number of beds at the local hospital. The main district general hospital was thirty miles away and a lot of people wanted to die at home but didn’t have the family network to be able to do this. Colleagues and I actually set up this charity to support people so they could live and die at home. And it has gone from strength to strength and we’re now in the process of actually building an information support centre following a legacy that was left us that will benefit the people not just of Halesworth but of South Norfolk, Harleston and Beccles and Bungay and also Leiston and Saxmundham and beyond. A fifteen mile radius of Halesworth offering support and information to families and the people who we need to cater for. So I’m very involved with that work as a volunteer trustee and also work around supporting family care for people with dementia.

So although I have officially retired from the NHS, I (laughs) still use some of my nursing background to fulfil some of the local work and also I’m a Cruse Bereavement volunteer so again using some of my experience in that. And caring for Freddie my grandson, two days a week. So I really do have a very … I’m very mindful of the NHS work I’ve done and I still our local hospital Patrick Stead hospital is hanging on with beds, local beds there and I still try to do one or two days a week, shifts a week to maintain the beds there. And the lovely thing is I’m re-meeting the people I cared for in the community and it’s like a reunion. So just happy times in being part of the community which of course the majority of my working life has been. I’m still very much part of that living community and hope to be part of that for many years to come.

Nikki Sawkins (b. 1955) interviewed in Halesworth for WISEArchive on 18th June 2015.

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