In which we get to the tippy top, and head back again

(This is the second blog of our trip to Northland, New Zealand. For part 1 check out this link: blog post part 1)

After Russell we had an epically long driving day – 3 1/2 hours up the East side of the long spit of land to Cape Reinga at the very tip of New Zealand, and then 3 hours back. We’d considered skipping it because, well, it is a bit out of the way but I’m so happy we didn’t.

Cape Reinga is majestical, to use a Kiwi word, and just stunning. All you can see for miles around you is blue water. At the Cape is also the point where two oceans meet, which you can see in the pictures with the variation in water colors.

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Where Oceans Collide

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The Famous Lighthouse

We spent a lot of time just sitting on one of the bluffs and admiring the view.

On the way back down the Cape, we stopped in for some sandboarding atop the famous Te Paki Dunes! Amazing to go from the ocean to the desert in just a few minutes. You rent “sandboards” in the parking lot, climb up, and go down on your belly. Pro tip: use your feet to brake, not your hands in front of you else sand flies up into your eyes, nose, teeth, shirt…everywhere. I mean everywhere.

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The other big draw up here on the Cape is 90 Mile Beach which I feel compelled to point out is closer to 66 miles. The big draw on 90 Mile Beach is to drive your car along the beach or pack into a large tourist bus that drives along the beach. Honestly, I don’t get this either. Why spoil a perfectly nice beach with fume spewing machinery?

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There’s a car. On a beach. Woo hoo.

After this came my favorite part of the trip – visiting the big Kauri groves. Kauri are large, ancient trees only second in age to the Sequoia. They grow in girth, not height, making for massive squat trees. They have declined considerably as they grow straight and as they grow the lower limbs fall off, making them into long logs perfect for lumber, and were used for years in the logging industry here. They are now seen as a taonga (treasure) and protected, but still under various threats.

Our first stop before going into the forests was a quirky little puzzle shop I’d read about in the delightful “New Zealand Frenzy” guidebook, which gives you all sorts of off the beaten path trips and tricks.

 

After this was a hike through a muddy but quiet little Kauri grove. One thing I love about hiking here is that if you’re not on one of the major tourist hikes, you may see no one else on your hike, just enjoy a peaceful stroll through the forest.

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Waterfall along the hike

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Kauri bark close up. It sheds this rough layer as it grows to become entirely smooth

 

Then came the tourist Kauri, or Tane Mahuta. Touristy or not, he is a sight to behold.

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The largest living Kauri tree known alive today, Tane Mahuta is estimated to be between 1500 and 2500 years old. I can’t even wrap my brain around that! Something that was just beginning life around the time of Ancient Greece and is still alive today.

A little ways down the road is another hike to a few other large Kauri. We took the road less traveled by and found ourselves on another solitary hike up to Yakas, a huggable Kauri.

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Trying to hug the massive, massive tree

 

We checked into a fun Top 10 Holiday Park for a glamping night. These places are great – they have clean facilities and a fun playground for the kids (and intrepid adults)!

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Wheee! The prettiest flying fox ride ever

That night, we went for a kiwi walk in the dark kauri forest, guided by a ranger with a red flashlight. While we saw eel, weta (large cockroachy insects) and gloworms in the forest, we did not spot any kiwi! Shy little critters.

Our last stop before heading home was a visit to the quirky Kauri Museum. It goes through the life of the Kauri forests, when logging industry and later Kauri Gum (amber) was big business.

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Showing the age and rings of an Ancient Kauri

 

After this, was a long ride home, back to our little house near the beach, until our next adventure in Aotearoa (Maori word for New Zealand).

-S

 

 

 

 

In which we head to the tippy top of New Zealand

A couple months ago, I took a week off of work for the kids’ Spring break and we headed up north on a road trip.

Driving in New Zealand is not really a fun experience. It’s often quite lovely, as you are threading your way by deep gorges covered in subtropical foliage, or along a rugged coastline, but it is almost entirely two lane roads that wend their way precariously along them. Much of the time, the maximum speed is 40 mph. So even though distances look short on a map, like 2 inches, it can take HOURS to get anywhere.

We drove to Auckland, excited to find a real sushi place, as we were going to the big city. In this, we were entirely disappointed. I have yet to find sushi here that even matches with the average roll you’d find at Whole Foods back home, sadly. It’s all futomaki and filled with traditional Japanese meats such as fried chicken. We were kindly hosted by our friend Chris’ parents there, and headed out early in the morning.

Our first stop was to the Waipu caves, tucked off road on a gravel path. New Zealand is well known for glowworm caves, where you walk in and after giving your eyes a minute to adjust, look as if you’re outside under the stars because of the thousands of tiny little glowing creatures covering the roof and walls of the caves.  It’s so beautiful, and we first saw this at the heavily trafficked tourist haven of Waitomo last year where you are sheperded in a line and sit in a tiny canoe on a track for five minutes to see the magic. These caves, however, are entirely free.  You pull up, walk across a grassy field of muck and down you go, open to explore to your heart’s content.

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The unassuming entrance to the caves

As we pulled up, a group of French tourists got out, completely bedecked in spelunking gear. Waterproof pants, jackets, headlamps, hiking boots with covers, they were PREPARED. As we are trying to be more culturally sensitive here, we decided to do it the Kiwi way – barefoot and using our phone flashlight to navigate. The kids and I scampered forth and may have left Eric behind, which he may have been a bit upset about given that he is not fond of caves in the first place.

Sadly, because I didn’t bring a camera and tripod to take long exposure pictures, you can’t see the glowworms the way we did, so you’ll just have to trust me on it. But it was incredibly cool to scramble around in the quiet underground with the Milky Way seemingly overhead, and feel the mud squelching between your toes.

After that it was onward to Tutukaka, where I had been hoping for a snorkelling trip to the Poor Knights Islands, alas, the weather did not allow for this. Instead we spent a few pleasant days kayaking around the harbor and hiking the beautiful walks to be found around before heading to Russell.

 

Further up north, our first stop was the Waitangi Treaty grounds. The Treaty of Waitangi (Te Tiriti o Waitangi in Maori) is a document signed in 1840 that theoretically establishes a governance of New Zealand by the British Commonwealth under the Crown, recognizes Maori land ownership and gives them the rights of British citizens. In practice, this is much more controversial. The English and Maori versions of the documents vary considerably in word and intent, and it cannot be argued that the two peoples have had a peaceful and equal existence since the signing of the Treaty. Today, the Treaty seems to be looked at still as a guiding document and one that is used to attempt to redress Colonial wrongs.

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Marae (meeting house) with traditional Maori powhiri (pronounced “pofiri” welcoming ceremony)

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Ceremonial Waka (war canoes)

 

One of the big tourist draws in the Bay of Islands on the Northland East Coast is to take a boat tour that takes you out to Hole in the Rock. This is a large Rock in the middle of the Bay with a hole in it. I…don’t see the interest and whoever is responsible for the marketing is a genius. We had still hoped to take a boat out to one of the smaller islands for a trek around, but it was still winter season and we hadn’t planned very well, so instead ended up taking a small boat to go around a bit to one of the largely uninhabited islands. The boat had stand up paddleboards, and we enjoyed a pleasant hour floating about the isolated bay.

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Little waterways among the islands

 

-S

In which I realize my dream of becoming a Quizmaster

Things have been going along fairly smoothly for us the last weeks. I’ve emerged from the immigrant doldrums into really appreciating our life here and how lucky we are.

The kids started their second semester of school and ironically are now involved in multiple afterschool activities in a way that typifies modern childhood in the U.S. We’ve generally really guarded against this at home, because with two working parents it gets too overwhelming to be shuttling kids to activities all week, homework takes up quite a bit of time, and I also value having dinner together as a family every night.  (Though I question that value on a regular basis when dinner seems to be an excuse for the kids to snipe at each other or for me to tell them for the millionth time that an entire quarter of a quesadilla isn’t an acceptable “bite.” Sigh.)  Here though, we have one slightly-employed parent, one full time working parent who’s largely home by 4pm every day, little to no homework, and a bunch of activities that are pretty special. So our schedule: Sunday mornings: Surf lifesaving (both). Monday afternoon swimming (both). Tuesday afternoon Drama (girl) Guitar (boy). Wednesday afternoon Violin (girl) then Surfing (both). The girl currently also has orchestra practice on Fridays. Phew. She wanted to pick up Rugby or Cricket as well, but those are scheduled on Wednesdays so it wasn’t possible.

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Coming out of the water at surf lifesaving

That said, it doesn’t feel terribly hectic because we still have a lot of free time around all those, and therein lies the major difference between life at home and life here. The stress level here is simply a lot lower. There’s no traffic to battle – in fact our town doesn’t even have a single traffic light! – and people everywhere are generally pleasant. I drive past the beach every day on my way home from work. Most days I can work out at the hospital gym and still make it home by four. When you want to meet up with friends, no one pulls out their phone to check their schedules to find a date in two months that works. You’ll say “hey, want to have drinks tonight?” and the answer is pretty much always “yes.” Our social life here is so much fuller than it is at home, and it’s really lovely.

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Impromptu drinks on a weekend afternoon, or my harem. (Joke people, I have women friends, they’re just not in the pic!)

We are scheduled in that Wednesday night is pub quiz night at the Ohope Chartered Club. Quiz is a different animal here than it is at home. For those of you who attend pub quiz in the states, the usual format is a quizmaster asking clues out, you write them down and turn them in. There’s audio rounds as well, where you have to identify movie quotes or songs. Because trivia is the domain of nerdlings at home, there are usually no more than 3 or 4 sports questions because they know their audience and want to be kind.

Here, there’s a quizmaster but the questions are shown on screens and there’s usually an accompanying graphic that may or may not be of any help to foreigners like ourselves. Example: “What was the name of the lost painting featured in ‘Allo! Allo!’?” Answer: “The Fallen Madonna of the Big Boobies.” Me: ????!

In addition, Kiwis find it incomprehensible that people would know nothing about sports so there are usually a LOT of questions about sports. You might think you’d have an advantage if you know sports trivia, and I regret to inform you that you’d be sadly mistaken. Because no matter how many baseball or football stats you know, they don’t care here. It’s all about Rugby and Cricket and Sailing and Netball. Now, there will often be a question that is ridiculously easy for an American like “What’s the smallest state in the USA” but Kiwis have no clue about, and we get to feel special.

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We are still in the British Commonwealth you know…

We’ve managed to cobble together a group of eclectic people to play trivia with every Wednesday, with people from the hospital and other friends. Among the group are people from India, Canada, Ireland, and of course we Americans. With this Voltron like supergroup, you’d think we couldn’t lose, and you’d be almost wrong – we generally get second or third most nights. The first place trophy as yet proves elusive, as we find ourselves beaten by a group of Kiwis every week.

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quiz night panorama, intently discussing a tricky question

As generally happens with quiz, the fun is partly from answering questions but more from making fun of people who get questions wrong. Last week there was a geography round about countries and they showed a picture of a ziggurat. For some  unknown reason (cough two glasses of wine cough) I went into Tourette’s mode and just kept chirping “It’s Chichen Itza! It’s Chichen Itza!” over and over. People would try to change the topic but I was undeterred, hell bent on pointing out that it was Chichen Itza until someone acknowledged how incredible it was that I knew that. Eric, however, couldn’t take it anymore and finally looked at me and flatly said, “You have GOT to stop saying Chichen Itza. We GET IT.” “But…but it’s…” “Chichen Itza!” chorused the other players.  We wrote down Mexico and moved on. No one else seemed to notice that when the answer round came through, it was actually Teotihuacan, and I didn’t advertise the fact. Now, when I get too excited about an answer, people just yell Chichen Itza at me and I shut up.

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CHICHEN ITZA, OF COURSE

As the title hints, I’ve also realized one of my lifelong dreams. Becoming a doctor? Meh. World travel? Whatever. But I’ve always wanted to be a QUIZMASTER and now I can say that I am! I’ve signed up to be a backup quizmaster, and had my first run at it this week! I think it went pretty well, with only minor technical difficulties. Some of my jokes didn’t go over as well as I’d hoped, as when I teased one person about thinking that a photo of Jennifer Lawrence was actually one of Viola Davis, because Viola Davis is black and Jennifer Lawrence is about as far away from that as you can get. My loving husband offered me a pity laugh, but from the Kiwis, crickets.

It’s my favorite night of the week, hands down.

-S

In which I feature someone else who knits, and it leads to a healing connection

A short story about medicine in a small town, or how small communities and their connectedness can be healing. As a side note, when I share any patient stories I will usually change significant details to avoid breaking confidentiality but maintain the essence of the problem. If I feel like a story needs more real details to share, I’ve asked permission of the patient to share first, as in this case.

In the hospital is currently a woman who I’ll call Mary who’s been in a healthcare facility for over three months. She initially came in with near total paralysis from Guillain Barre syndrome, an immune disorder that attacks your nerves, can leave you unable to walk, use your hands, and in rare cases, even breathe. Our hospital here functions as an acute care hospital as well as an inpatient rehab unit, so once the initial part of her hospitalization was over, she transitioned to acute rehab where she’s remained as she gets stronger, with her goal of walking freely again. During her time here, her husband had brought her a knitting loom, which she took to with aplomb and began churning out hats. She’s made hats for other patients, the children’s unit, and hospital staff. Once I walked in on another patient of mine wearing a sprightly red and black hat, and asked if Mary had made it, and of course she had. Over the course of the last week, she’d had a few features written up about her, one in the hospital newsletter, and then one in the local paper, focusing on her rehab and how her love of craft and knitting had helped her to heal.

Over the last week, however, she had been getting quite despondent with what she felt was the slowness of her progress, and wanting things to get back to her normal, which I think anyone in her situation would feel.  An elderly patient in the hospital in a different ward happened to read one of the newspaper articles and remembered that her husband had been afflicted with the same disease many years ago, and told him that he had to find Mary and go talk to her. And he did – coming into the ward, he asked for her room and walked in tentatively calling her name. She answered and he came in and sat at the side of her bed for over an hour, talking about his journey with Guillain Barre, how his recovery took six months, how he had even cried many times at his low moments wondering if he would fully recover, but how he eventually had.

I spoke with her the next day, and she felt entirely validated by the experience. Her tears and worry were not unusual, nor was she recovering too slowly. Someone else had struggled the same way she had, and had lived and thrived afterwards.

It was a healing conversation for Mary, and though it can’t take away all of the worries she has, was wonderful for her to have a connection with someone else. This is an aspect of rural small town medicine that I think is wonderful. The interconnectedness of the community and the openness of it make interactions like this possible, to the benefit of all.

-s

In which I learn the price of wool from one of my patients, and the kids footwear budget drops considerably

It is perhaps unsurprising that we would find ourselves in a bit of the doldrums over the last few weeks.

It’s pretty normal in the world of expat psychology, where at some point you start to miss all that you had at home, like your friends at home, or your kitchen, or having a goddamn garbage disposal. It’s part of the usual adjustment process, but it can leave you with questions about whether or not you did the right thing by moving halfway around the world. Eventually this is followed by another up, then downs, until you reach a homeostasis of expatriation, or just another middle ground.

Even New Zealand seemed to have it out for some of us. One day it was a “mufti day” which meant that the boy could wear whatever he wanted instead of his uniform. Deciding that he loved his uniform, he decided to accessorize only with his Stitch hat with the big flappy ears. He left the house to walk to the bus stop. Eric was drinking a cup of coffee on the balcony overlooking the street.  Suddenly, he noticed a commotion below him. The seagulls had left their usual post on top of the street lights to dive towards our son. The boy was being bombarded by a flock of seagulls who apparently thought that he, in his hat, was some kind of tasty large worm. The boy ran down the sidewalk, frantically waving his hands over his head to ward off the gulls, who squawked in frustration at being blocked from their breakfast. An older man walking along the beach stopped and stared at the scene, while we howled with laughter.

As if to troll us, our new place is decorated with all sorts of seagull paraphernalia that seems to have been put up with a permanent sticking charm. The boy doesn’t wear his hat indoors here, for fear of calling out the avian demons. They’d probably leave their paintings to attack in the middle of the night.

The girl has melted into school, and is having a ball. While she hasn’t made a lot of friends yet, she bounces out of bed every morning so excited about going to class. She loves her teacher, and one thing we’ve seen is that creativity is far more valued here than it is at home. Her homework, or “home learning” as it’s called here, is entirely open. Every two weeks she gets a sheet of paper with a variety of options for home learning – you can choose artistic options, math options, writing – so that every kid can find something to interest them at home, but without the rote tasks that homework seems to be back home.

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Homework for two weeks! You are expected to pick as many as you want to do and share at the end.

The boy is likewise enjoying school, and has a first playdate set up for this weekend. He was initially feeling a bit down about it, as NZ kids are quite sporty, and he’s…not. But he’s found his own little group of nerdlings as he does, playing chess in the school library at lunch and just this week has started introducing Dungeons and Dragons to his crew. His highlight of the last week was when he “accidentally” locked his shoes in the house when he left for the bus (we’d all already left for other destinations) and “had” to go to school barefoot. Upon arrival at school he was given the option of wearing a pair of the extra shoes they have at the office, but he declined.

As for me, the hospital work keeps on. Despite my years of experience back home, learning new medications and new systems leads me to feel like a new resident much of the time, which brings back all the traumatic PTSD I have related to that time and leaves me feeling unconfident.

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These signs are all over the hospital. What sort of zombie apocalype are they expecting?!

So many times I’ll casually ask for something that Americans would see as completely normal, only to have it thrown back at me. I had a patient who had fallen and had a nasty scrape where he’d lost a fair amount of skin. Unthinkingly, I said, “let’s put some polysporin on it and cover it with a nonadhesive bandage.” The resident I was working with looked shocked. Absolutely SHOCKED. “We…shouldn’t do that. It’ll lead to antibiotic resistance.” I paused, knitting my brows, and replied, “so…you can’t just get an antibacterial ointment over the counter here? What do people put on cuts?” “We just tell them to put hydrogen peroxide on,” he replied. He then proceeded to look up antibiotic ointments that were available in the hospital, and after a search of five minutes finally came up with one that they had that used a different mechanism of action less likely to result in resistance.  WHEW. I was kind of left feeling like, “Who’s the attending here?” and wanting to say indignantly “I AM! I’m the attending!”

Sometimes people think I’m a blinking idiot because it seems I can’t grasp a basic idea they’re talking about, when it’s just that I can’t understand their accent. They then go into details of whatever they were describing like I’m a moron, at which point I’m too embarrassed to correct them and say that it was their accent I couldn’t understand since of course, I’m the one with the accent. I had a patient who was telling me that he had “hot tack” a few years ago. Thinking that this was some Kiwi traditional therapy or something, I asked what “hot tack” was, only to get a quizzical look from my resident as she described “Hot tack? Well, it’s when the heart doesn’t get enough blood and then doesn’t work as well, and they get chest pain?” Oh.  A heart attack.  Great, now both patient and my resident think that I don’t know what a heart attack is. There goes any credibility I might have had.

That said, I continue to be amazed by the relative reasonableness of patients regarding their medical conditions. I’ve had far more conversations with ill people about their potential for death, and all of the elderly people I’ve talked with have expressed to me that they don’t want any aggressive measures to be taken and that they understand that this could lead to their death.  These are different than conversations like this I have at home, where usually the question is asked to someone who is not in extremis, and even then limits to “what can be done” is not typically discussed. People will talk about not wanting to be resuscitated, or be put onto a breathing machine, but smaller discussions don’t often take place, and there is a different attitude towards end of life.

I do feel like I can be more relaxed overall with the patients here, chatting with them and able to bring more humor into our interactions. I’ll leave you with a story from last week.

I performed a procedure to remove excess fluid from someone’s belly, and it takes a while to get the fluid out slowly as we don’t have the handy vacuum sealed flasks here that whoosh it out in a matter of minutes.  Over the 30 minutes I sat in the room, I chatted with the patient, a Maori person, and his daughter in the room. They live out in farming country, and I asked what type. “Cows, ship, pigs. All sohts of animuls.”

“Do you raise the sheep for meat or for their wool?”

“Wull. You can do it foh both…but listen to this. Theh was a farmah who hed his whole flock stolen! And thin two wiks latah, the entiah flock was returned to him, but they’d all bin sheahed! I said to myself, ‘theyah’s a man who knows the price of wul!’”

“Wait,” I said, “They brought the sheep back and no one noticed?”

“Oh yeah!” the daughter said, “And that’s when I said you know thet wasn’t no Mowri pehson stealin’ the ship because we would have kept those ship and fed them to our families!”

 

-s

In which a bit of Iceland comes to New Zealand, or…I knit another sweater

Remember back in June, when my real excitement in Iceland was picking up some Plotulopi yarn? It’s found it’s way into a sweater!

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Look like you’re in love, the photographer said…I ended up simpering

It took me a while to find a good pattern. A lot of the traditional Icelandic sweater patterns look, well…old, and not particularly pretty or stylish. The other finalist was the pattern below, but I felt like it wasn’t as modern looking, and I loved the geometric shapes of this one and the details on the bottom and the sleeves.

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Grettir from Brooklyn Tweed, the rejected pattern

 

The yarn is untwisted roving, which means that it breaks apart very easily. Try to imagine using fluffy bolts of cotton candy to sew together a leather jerkin, and you’ll have a decent idea of what it’s like to knit with. As with many things involving knitting, I try to find a metaphor in this, and for this project it was learning exactly how much tension and pressure to hold the yarn with. Too little, and the yarn would loop and sag unattractively in the stitch. Too much and it would simply tear apart. A happy medium existed, though it took a while to find it. Extrapolate that to a life lesson as you will.

 

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Neckline close up

 

The other difficulty was that I the pattern I’d chosen called for this yarn to be held singly, though it’s usually knit double. I swatched both and greatly preferred the double thickness, creating as it did a lofty and cozy fabric. With a sigh, I pulled out a calculator as using a bigger yarn meant that I’d have to do math to figure out the new sizing. I figured out that if I just followed the instructions for the smallest size, it should work out okay.

It almost was, until the very end. While I’d been able to change the horizontal measurements of the sweater with fewer stitches and I could simply knit fewer rows to make the length correct, this didn’t translate with the neck of the pattern where you can’t just cut out rows. The first iteration of this did not work well, and I looked like I’d made a sweater for a thick-necked giraffe.

 

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The pic I sent to my phone a friend, thick necked giraffey sweater

After a telephonic and picture consultation with a knitting friend back home, I ripped back to the middle of the yellow diamonds, switched to a smaller needle and began decreases in the black areas between to hide them and maintain the pattern. It worked pretty well! I wish I could tell you that this sweater was 100% perfect to me, and it almost is. Trying to account for vertical gauge and burned by the extra fabric Eric’s sweater had in the shoulders with all the short rows, I knit fewer of them and I wish I hadn’t. I would have preferred the sweater come up a bit higher in the back, and I wish I’d knit the sleeves just a touch longer but overall I’m pretty happy with it! I especially love the shaping in the waist, which is key in such a big bulky sweater to avoid making one look like the Michelin Man.

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Next up, to finally finish all the socks for the kids I’ve promised them and have completely ignored. Of course, now that they run around barefoot like all the other Kiwi kids, I wonder if I should even bother.

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Sweater in action along West End, Ohope Beach

pattern: Telja by Jennifer Steingass

-s

In which I start my job as a doc in New Zealand

I knew I’d have a lot to learn working as a doctor in a new country, but I didn’t think it would start before I entered the hospital.

I walked up to the hospital on my first day of work, held my badge up to the double doors and expectantly waited for them to open for me. They did not. I flashed my badge a few times, looking like a proper idiot, wondering if the doors weren’t working. I then realized that I had to manually open the doors here and walked on in. I had two days of a gentle orientation before beginning to see patients, where I got a tour of the hospital, filled out important paperwork and was introduced to nearly everyone and welcomed warmly.

On Wednesday, it was time to start the real doctoring.

Things run a lot differently here than I’ve been used to. Some of that is simply because I’m working in a small rural hospital instead of the large urban center I was at. Some of it is because I’m working with the New Zealand medical system, and some is because I’m taking care of New Zealanders and not Americans, who seem to approach their healthcare quite differently.

I came into morning report, a gathering of the doctors on for the day, the head nurse, physical and occupational therapists, pharmacists and other members of the care team. We listen to the new patients admitted overnight and then run through our list of patients to see what is needed from members of the care team. I picked up my list of five new patients to start seeing that day and met up with my house officer. The training system in New Zealand is beyond my capacity to understand – from what I can tell, the educational level of the H.O.’s is about that of a 3rd or 4th year medical student, but they function much as interns. It’s also not necessarily linear in a way that’s incomprehensible to me. My house officer, upon later conversation, casually mentioned that he was going to quit to go travel for 6 months and planned on returning. I’d like to find a residency in the States that would let that happen!

I went to see one of my first patients, a man who needed a procedure done to drain fluid out of his body. He was on a blood thinner, though, making it more dangerous. I approached this the way I do with my American patients, carefully explaining to him and his family the risks and benefits of the procedure, the possibility of increased bleeding, what we would do to prevent this from happening, and how we couldn’t do much if bleeding happened. I asked at the end if he would like to think about it and we could return later, which would be pretty typical at home. “Nah, I guess we’ll just go for it.” I blinked a few times, as it seemed a bit too easy. “You’re…sure you don’t have any other questions?” “Nah, if it’ll help me feel better let’s just do it.” We set up the procedure for the next day, and it went swimmingly.

I saw another patient who was in for a heart issue for which ultimate diagnosis would require an echocardiogram, or an ultrasound of the heart. The only problem was that it was Wednesday, and echoes are only done on Tuesdays and Fridays, and even then only four on a single day. If you’re the fifth patient, too bad, you’re going to have to wait. If you need a more urgent echo, you’ll have to be driven an hour away to Tauranga to a larger hospital. This is utterly unheard of in urban centers, where I would roll my eyes at an echo taking more than a few hours to obtain. Feeling sheepish, I went into discuss this with the patient, expecting anger and incredulity at the inefficiency of the system. “Oh, no problem,” was the reply, “If we can’t get it on Friday my daughters can just drive me up to Tauranga to get one.”  I was forced to use actual clinical skills to diagnose and treat her without the technological test, which ultimately did get done on Friday.

Another thing we don’t have available that I’m used to : consultants. There’s a surgical team and an orthopedic team, but other than that, there are no medical subspecialties here at all. If someone really needs to be seen by a cardiologist (heart) or a nephrologist (kidney) we ship them to Tauranga hospital for evaluation. Once the patient has been seen and recommendations given, they’ll be shipped back for us to continue the remainder of their hospital stay.

At home, I’m used to doing all the primary work of doctoring myself by which I mean writing notes, ordering medications and tests, following up, and taking calls from nurses if something goes wrong. Here, my house officer does all of that for me. I look up pertinent information before seeing the patient, and then we see the patient together, and then I just tell him what needs to be done and written and…it gets done. It leaves me feeling a little unmoored to be honest, and without me sitting down and looking through all the details of the chart as I write, I keep feeling like I’m missing something. Somewhere along the way I’m supposed to be teaching them something, but I’m okay with letting that slide for a couple weeks while I figure out the system myself.

Being in a nationalized health care system means that there are stricter limitations on what medications you can use in the hospital, especially antibiotics. A patient who comes in with pneumonia in the U.S. would reflexively be prescribed ceftriaxone and azithromycin or levofloxacin for treatment. There are infection nurses who look over more unusual antibiotic choices to regulate those, but no one would stop you from prescribing ceftriaxone. I had to call an Infectious Disease doctor to order it as part of a combination treatment for a patient of mine who came in with pneumonia and got worse with outpatient Augmentin pill therapy. The doctor paused for a second before she said, “I don’t think that’s necessary yet, let’s try IV Augmentin first.” I was denied. (The patient did, though, get better with the IV Augmentin, I must admit.)

There are at least a few patients daily who hear my accent and take the time to tell me what an unhinged lunatic Trump is. One guy, hardly able to breathe with a lung problem, still took time to squeak out that he thought Trump would be the last president of the United States as we know it. It’s a common feeling here, where the U.S. is currently regarded as something of a laughingstock.

All in all I’m enjoying the new gig, though I feel I’ve got a lot of learning to do before I get a handle on how things really work.

-s