In which patients, not doctors, get a vacation from the hospital

September 13, 2018Leave a comment

Let’s talk about the idea of going on vacation from the hospital. Not for the doctors, but for the patients.

Every morning here in Whakatane we start our day with a group round. In the lounge room at the end of the hall are about twenty chairs surrounding a large table. Sometimes the table will have an unfinished puzzle sitting on it, worked on by patients and family members. At times the TV in the lounge (the only one for patients on the wards) will be turned onto the morning news show and we’ll switch it off. Just before 8 am, in file the rounding doctors for the day, the residents on duty, Nurse Managers, Social Workers, Physical and Occupational Therapists, Maori Health representatives, Respiratory Therapists, and Pharmacists. We go through the patients who are in the hospital with brief presentations so any of the support staff who need to see the patient are aware of them and their needs.

On the Friday of the first week I started working, we gathered for our usual morning rounds. About halfway through going through patients, we came to Mrs. Smith. “Mrs. Smith is going on leave this weekend,” reported her doctor that day.

“Leave?” I thought to myself. “I must have misheard.”

But, no, on he went and there was another patient who was also going on leave, which meant they were given enough pills from the hospital dispensary to take what they would need for the weekend and then were going to go home for a few days and come back on Monday for a reassessment. The physical and occupational therapist sometimes would go to the patient’s house with them to see where the deficiencies lay or at least reconvene on Monday for a discussion to see if they needed additional equipment or support.

Since then I’ve learned this is a commonplace occurrence. I had a patient who was ill with an infection and required IV antibiotics every eight hours. He was improving but still needed IV medication. On Friday, when I saw him, he asked, “Do you think I could go to church on Sunday? I usually play the organ for the choir.” I couldn’t think of a good reason why not, and off he went on Sunday between doses.

Other patients I’ve had have gone on leave as well while they wait for procedures that we can’t get easily as outpatients. A prime example is an echocardiogram, or heart ultrasound. An outpatient echocardiogram can take between one month to a year depending on how urgently it’s needed. Even at our facility we can only get them on Tuesdays and Fridays, and only four can be done on those days. If someone is generally well on say a Wednesday but really needs the test sooner than a month, we will keep them in the hospital but let them go on leave for times so they’re not stuck in their rooms.

I had another patient who was quite ill, also with an infection and was less stable, with worrisome kidney function and so weak he was unable to walk. However, his grandfather with whom he was very close had recently died, and the three-day funeral was starting the next day. Could he go on leave for the funeral activities?

This is utterly unheard of in the US, at least where I used to work. (If you’re a US based doc and this is a normal thing for you, please let me know, I’m curious.) The reasons are vast, starting with litigation. God forbid if something bad happened to someone while you’d let them leave the hospital, you would guarantee a lawsuit even if you’d gone over potential risks beforehand. People here also seem to have more family around who are able to help and stay with their loved ones – there almost always seems to be at least a few (and usually quite a lot) family members who live locally and help out regularly. We also have midlevel facilities in the States, which we don’t have here, called Skilled Nursing Facilities (SNF for short), for patients who don’t necessarily need hospital-level care but aren’t quite well enough to go home. Length of stay in the US is also typically pretty low because of that and because of financial pressures, so you’re in the hospital only as long as you can’t get the same level of care somewhere else, and then off you go. There is a stark dividing line between home and hospital – either you’re sick enough to stay in the hospital or you’re well enough to go home, and if you’re in between, then off to a SNF you go.

I get that mentality, and it took me a while to get used to the idea of leave, but I’ve grown to see it as an excellent idea. Sometimes, elderly people who seem highly dysfunctional in an unfamiliar hospital environment will do far better in their own space, where they’ve likely adapted their surroundings to work for them. A trial of a few days with family supervision seems far preferable than making a permanent decision of nursing home placement directly from the hospital setting.

It can be mentally healing as well. I had one patient who had not been doing well from a mental health standpoint. He’d been quite depressed in the hospital and just not getting much better. It looked like he was heading for permanent nursing home placement as he couldn’t get any stronger. His family said that if he could just go home for a few hours, sit on his couch, pet his dog, he’d be much improved. Despite my American doctor sensibilities, I acceded to their request. You know what? They were right. He came back with new enthusiasm and was able to be discharged home the next week.

For my patient who wanted to attend the funeral despite his own serious illness, it was clear that to miss the funeral would be something he would regret forever. Despite the risk, his family was able to arrange wheelchairs and transportation and he was able to attend at least for a few hours daily. Could something bad have happened? Sure, but we talked about the risks, he and the family accepted. Again, they made sure to time their visit around his medications so no doses were missed or late. It’s not a medically litigious society and people overall are far more comfortable with understanding that they’re taking a risk and living with it. I see some decisions like this as working with people to address other needs than just the physical, which overall impacts health.

I know this isn’t something I’ll be able to do at home, it’s just not accepted practice. But I have to wonder for people who are in the hospital for long periods of time whether a little break, a little return to normalcy and the outside world doesn’t provide a lot more benefits than I can give through an IV line.

-s

In which there are goats

August 2, 20186 Comments

On the last day I tried to surf several months ago, Mother Nature let it be known that I had no business in the ocean and tossed me about rather viciously. Since then I’ve had some pain in my lower back, not a huge deal but enough that I figured I should go see a physical therapist to sort out.

In one of our recent sessions, I was chatting with her about how, while I missed my husband and daughter, it did make packing up for home a lot easier in that I only had to do things one way, which was my way (the correct way, really.)

She replied, laughing “I know what you mean! My husband is gone to Australia for a week and in some ways it’s been easier. Except for having to move the goat shed over, which is usually his job. One of the baby goats we’d found had died and I guess it was too cold where it was. We had to hook up the shed to the truck….” She continued with the technical specifications of moving the goat shed, but I’d really stopped listening by then as all I could think of was the same repeating questions in my head which I then blurted out, “Wait, what do you mean ‘one of the baby goats we FOUND?’ Are there a lot of wild goats roaming around New Zealand?”

She paused for a moment and then said, “Well, yeah, I guess I can see how that could sound odd,” in a way that suggested that I was a complete moron for not understanding where one acquires baby goats in New Zealand as it’s common knowledge in these parts. As it turns out, she lives out in the countryside and her neighbor has a cattle farm. He also has goats which help to keep the weeds down, though these are largely feral at this point and he doesn’t bother with them much. Apparently, if a goatess has babies but the herd chooses to move along, she abandons the kids if they can’t keep up, sort of like what I do with my children on long hikes. It is these goats that Karen (for that is my PTs name) and her family find on neighboring property and take in. Last year, they started with three goats as well, and named them Katniss, Peeta and Gale. I would argue that these names did not bode well for the survival of the goats.

They weren’t really sure what to feed the goats at first, so started with diluted cow’s milk. This proved not to be the best food as Peeta began bleating in distress shortly thereafter. His cold body was found in the morning. Karen and her family dug a hole.

A visit to the goat shop led them to the correct formula to feed the goats, and Katniss and Gale thrived, delighting Karen’s kids. They were rather mischevious, however. The goats would often run into the street and cause cars to swerve out of the way. Given that this is a somewhat rural dirt road, this didn’t happen all that often but was a bit problematic.

Once, a goat, let’s say it was Gale, jumped in front of a car which skidded left and then stopped. The driver walked out to check on the goat. Gale appeared to be unharmed and then quickly skipped around the driver, went through his open car door, said hello to the wife and then leapt into the backseat of the car where he made himself at home. Karen had by this point come out of the house and began to apologize profusely to the driver who seemed rather amused by it all. “Rather a cute thing,” he said to Karen, looking back at the caprine intruder. “He seems to like us,” he continued, “do you mind if we keep him?” And thus did Gale find a new home, because only in New Zealand do you adopt a domesticated goat that nearly wrecked your car.

Katniss also got into trouble a few times for jumping into vehicles, namely the school bus. The goat clearly missed the memo that it was a lamb that was to follow its owner to school. The school bus driver, like most school bus drivers, was short of humor after years of driving screaming kids to and fro and was rather displeased by the sudden appearance of a goat in his ridership. It was time for Katniss to head on, so Karen did as one does and listed the goat on TradeMe for $30, which is the NZ equivalent of eBay. A call came soon after and a shabby man dressed in a priest’s frock trundled up the road in a puttering truck. He got out of the car and in now in plain sight, appeared clearly underfed. Karen recognized his poverty and couldn’t bring herself to charge the man for the goat, but her kids insisted on asking the man if the goat would be eaten. “Uh, no, I’m not going to eat it…she’ll just be my pet,” he said, while avoiding direct eye contact. Good enough, and off Katniss went with the impoverished priest, I’m sure to NOT be roasted over an open fire and eaten.

Onto this year, where once again, Karen and family found themselves in possession of three goats that were abandoned near their property line. These they took in and named Harry, Hermione and Finnick. Why not complete the trio, I wondered, but never asked. Harry and Hermione came to frozen ends, necessitating the moving of the shed which I mentioned earlier, and the purchasing of goat blankets which, yes, are a thing. Finnick is now doing quite well and rather cute, or so I’m led to believe. “What’s to become of Finnick?” I asked. “Will he also go to live unharmed with the priest from last year?”

“Nah, we’ve become rather attached to him. I think we’ll just keep him.”

Looks like the odds were in his favor after all.

Stock photo of baby goat for reference

-s

In Which we trek through Mordor to Mt. Doom

February 25, 2018February 25, 20183 Comments

Panoramic view of Ruapehu on the left, Ngaurahoe on the right

After months of anticipation and training, it was time for our Northern Circuit hiking trip! The Northern Circuit is a three-day hiking and hut trip through Tongariro National Park, which is in the center of the North Island. Its big star is Mt. Ngaurahoe, better known as Mt. Doom from the Lord of the Rings movies. You can’t climb Nguarahoe itself, but skirt all around its base and get some amazing views.

Starting out on the hike, full of energy

As we are not particularly skilled outdoorsy types, nor did we bring any of our camping gear with us (which, let’s be honest, we don’t own any backcountry stuff) we chose to go with a guided tour group, Walking Legends. They deal with the food and arranging accomodations and we had to carry our own clothes, water, and sleeping bags for the trip. 10 miles on day one, 5 miles day two, and another 10 on day 3, staying in rustic huts along the way.

Heading into the valley

Intrepid hiker unafraid of the looming clouds. Why he’s rocking a half style LL Cool J one pants leg rolled, I don’t know.

I obsessively checked the weather before the trip, and nervously saw that it was slated to rain the entire time. As much as I was looking forward to the hike, I didn’t really want to have three soggy, cold, squelchy days in the backcountry.

Looking back over the valley from Devils Staircase, all you see are old lava flow

Up Devils Staircase over rocky lava scree

Touching a cloud. Pants mode: Full LL Cool J now.

The day before the hike, the weather cleared at least for the first two days. It started off foggy but soon cleared to a stunning blue sky and long distance views. Nguarahoe remained shrouded in mist that day, however, and wasn’t revealed to us until the second day of our trip.

Rock scramble!

Super windy here! Check out the boy’s pack strap fluttering in the wind. Pants: back down. It’s cold here!

Almost at the top! By far the most challenging part of the hike. The kids had to kneel at times when big gusts of wind threatend to blow them off the ridge

View from the top, as the fog lifts over the Emerald and Blue lakes below

We made it!

Distance view from the top with Blue lake just peeking out in the distance.

Pondering by the sacred Blue Lake. To touch the waters is Tapu, as is to eat or drink by it.

Red Crater, from a volcanic eruption and still an active volcano

Wine and cheese happy hour was much enjoyed after the 16km hike

There are resident rangers at the huts along the way, who give a nightly chat about the surrounding area and safety information. They’re required to give information about what to do in case of a volcanic eruption, and in both instances the “safety talk” was basically a shrug and a recommendation to a) pull out your camera to record the event and then b) make sure you strike an intriguing pose so that when they dig your body out of the ash a la Pompeii, you will confuse the future archaeologists. Not exactly reassuring, but we escaped unscathed and eruption-free from the valley.

Mt. Ngaurahoe unveiled in the light of sunrise

The stars of Tongariro Park are the active volcanoes along the way, especially Mt. Ngaurahoe, best known as Mt. Doom from the Lord of the Rings movies. Fun fact about Mt. Doom – Peter Jackson approached the local Maori tribe about using the mountain in the movie, and they initially declined as the mountain is considered sacred, but eventually agreed as long as the top of the mountain was not shown on screen as that is the holiest part. Therefore all of the top of Mt. Doom that you see in the movies is CGI! None of the scenes with people were filmed on Nguarahoe either, only external shots, the people scenes were filmed on nearby Ruapehu, in what becomes the beginner ski area in winter.

The volcanic valley between the mountains is Mordor, and it’s easy to see why – a dark rocky lava strewn landscape, with occasional bursts of steam emanating from geothermal vents makes for an eerie trek.

Mordor awaits

The trek through Mordor. Fortunately, no orcs were spotted.

Ngaurahoe in the distance

Taking a break by a little stream on our way to the second hut

Out of Mordor, into the forest

Light filtering through the trees into the mossy greens

A chilly yet refreshing bath in a local stream

The dam had been knocked over by recent flooding so the kids spent some time building it back up again to create a bathing pool

The second hut was so beautiful!

Hand carved boat from pumice and woven sail from reeds around the campsite

I taught the kids how to play blackjack, and we used scrabble tiles to bet. Great parenting.

The last day of the hike, we awoke to a drizzly and windy morning. Our guide advised that 10 miles of hiking in winds and with wet river crossings and with children would prove to be a miserable day, and so we bailed out and took the three mile exit track to where a van picked us up. I’m disappointed we weren’t able to finish the last leg of the hike, but in hindsight it was the right move, as having six miserable hours of hiking in wet boots would have meant cranky and unhappy kids and where’s the fun in that?

A wet, drizzly last 5k hike to get off the track

Erosion at work from rains

Happy, wet, tired hikers. They rocked it.

Such a great trip overall, Walking Legends was incredible for making everything easy except the walking itself. Moreover, it was so peaceful to be unplugged and removed from the rest of the world, and something I think we should all have the ability to do more.

-s

In which we get to star in our own jungle adventure movie. And eat ice cream.

February 16, 2018Leave a comment

If you were to ever come to New Zealand around the summer months, you’ll see signs everywhere for “Real Fruit Ice Cream”. I beseech you not to drive by, but to pull over the MINUTE you see this sign.

There is your usual scoop ice cream here, tasty in the oversweetened way that all bucket scoop ice cream is, but the real fruit ice cream is a treat, especially if you can find it at a local berry farm that grows its own fruit on premises and then makes it into a delicious cone.

You get a choice of strawberry, blueberry, raspberry, boysenberry or mixed. Take your pick, they’re all tasty. A screwpull machine sits on the counter, and into this two scoops of vanilla ice cream are lobbed in, followed by a few scoops of your berry of choice. The handle is lowered and the motor is turned on, crushing the berries and the ice cream together into a swirl of fresh, tart, tastiness, and not one bit too sweet.

Into the white container go berries and icecream

the screw comes down and they are swirled together!

mmmmm

We’re eating up as much as we can while it’s still here, as it doesn’t stick around for —winter.

A close up of perfection

In other news, we went to Raglan a few weekends ago for a visit to the West coast of NZ. Another family who we’ve become friends with wanted to check out a reggae music festival there that touts itself as being family-friendly. Eric and I took a look at the music schedule, thought about muddy mosh pits, port-a-potties, and reggae music and decided to pass on the festival.

Pukeko Crossing!

Upon arrival to Raglan, Eric wanted to go the beach to look at the waves, and the kids only wanted to go to what they remembered as a magical playground from our short stop there last year. It was still fun, though sadly smaller than they remembered.

Eric’s dream was to surf the West Coast and catch a ride on a different sort of wave than the gentle surf we have in Ohope. We walked past the festival grounds, and saw swarms of twentysomething women all dressed in identical clothing – cutoff jean shorts, crop tops, Adidas sneakers, holding clear plastic cups with beer as they ambled past. The rare one had flip-flops on as the only sartorial variation I saw among festival goers. The twentysomething boys were dressed pretty generically similar as well – shorts, tees, same sneakers, same cup of beer. As we got to the beach, some of them were running around wildly and stripping off before diving into the water, knocking other people out of the way. We looked at our kids and told them they’d BETTER never act like that, though chances are they probably will.

I usually feel pretty young-at-heart, as if I could still be a twentysomething inside, but then there are moments when I’m around ACTUAL twentysomethings and I think to myself, nope, I’m every bit of forty and perfectly happy to be so. Our friends had a very short visit to the festival, drew the same conclusions, and spent the rest of the time at the beach.

The Air BnB we stayed at had kayaks available for our use, and we hauled them down to the bay to ride around. One of them had a missing back gasket, but we happened to have a roll of duck tape and MacGyvered it so we could still take out the kayak. It was the girl’s first time in a single kayak and she did great! We kayaked across the bay to the limestone rock formations. We had unknowingly set out at high tide, an excellent accident as we could paddle our way around and through the pancake rocks, feeling very much like intrepid explorers.

Rounding the corner around pancake rocks

We’ve signed up for a three day hut hiking trip over the Tongariro Northern Circuit. One of the highlights is Mt. Ngaurahoe (Nau-ra-ho-ee), otherwise known as Mt. Doom to Lord of the Rings fans! Our friend Chris has been trying in vain to convince our kids that orcs lie in wait for them on the trail and Nazgul might snatch them from overhead, but to no avail – they are too streetwise to fall for such tricks.

Each day has us hiking between 5-10 miles and sleeping in huts along the way. We are in no way capable of doing this on our own and have signed up with a company that feeds us, guides us, and carries the heavy stuff so we don’t have to.

Eek! Steep steps on a training hike!

We have been doing a lot of training hikes to get ourselves and the kids ready. We did a nice long one in Raglan that was about 3.5 hours and one of the most challenging hikes we’ve done. Most of it starts off going straight uphill, until you come to a rocky narrow ledge that has steep dropoffs on either side. bout halfway up, Eric got worried the kids wouldn’t make it down. I threw a small fit about wanting to complete the hike, given that no matter if we went further it’s not like the going down would be easier at that point. We were all happy that we didn’t for shortly after was a scramble up a muddy, rootbound hill which has chains helpfully bolted in for you to hold onto as you climb up or down, and now we all got to feel a bit like Lara Croft as she scampered through jungle scenes.

Chain rappeling through the jungle

Eric tried his legs at surfing on the West Coast, and alas the waves were just a bit too rough and knocked him around a bit. I went out boogie boarding with the kids and this was fantastic, as the shore break is long and you get a fun ride in! Once, though, I got out just a few feet farther than I should have and the ocean let me know it by smashing me down – the West Coast ocean does not mess around.

The view on the way up

On the way back to Ohope, we stopped in at the Hamilton Botanic Gardens which are free to the public. They have these wonderful walled in garden spaces that are set up like gardens from times past and future. Some of them, like the “American pop modern” garden isn’t what I would consider a typical botanical garden, but a backyard outdoor space, with a large pop art painting of Marilyn Monroe, a small paddling pool and a turquoise blob of concrete meant to be art – and that was the point, to make you reconsider what it meant to have something be a garden. Some of the more traditional ones are below, and we had a lovely few hours wandering around before heading home to our little beachside house.

English Medieval Garden

Maori Kumara (yam) field – Red building is a gorgeous carved storehouse to dry yams

Italian Renaissance Garden

Chinese Contemplative Garden, a rare moment of peace.

-s

In which I battle the Lord of the Flies, and lose.

February 2, 2018February 2, 20185 Comments

It’s summertime in New Zealand, and apparently this means that it is the beginning of war. War of the flies, that is. For some unknown reason, New Zealand does not believe in having screens on windows, which means that you must choose between getting baked alive in your house or dealing with swarms of flies in it.

We have tried swatting at them individually, both with towels and with rolled up newspapers. This has the effect of being immediately gratifying as well as giving the kids something to do over summer break. Eventually, though, the flies land on me and the kids would attack me with the towels and newspapers, making this method significantly less attractive.

Then came the boy who insisted that burning kawakawa leaves is an effective deterrent for the flies. Kawakawa is a plant that grows in New Zealand and has been used as a traditional medicinal by the Maori people for years. It can be used as a balm, a tonic and a tea for pain relief. We burned a few of the leaves on a plate, and the toxic smoke seemed to clear out the flies for a bit, but the leaves burned quickly and the relief short-lasting.

Then came a series of experiments where we tried to create homemade oil lamps from a kawakawa infusion to keep the flies at bay. Putting a wick of cotton in a shallow bowl to mimic the Indian oil lamps I grew up with seemed to be the most effective, but the boy underwent elaborate experiments with glass jars, drilling through the lids, creating a wick with cotton twine pretreated with wax, then lighting them on fire. None of them worked. The flies continued to descend.

I looked up more non-toxic ways to get rid of flies. I tried making a flytrap out of a glass of wine and a paper funnel. Other than wasting half a glass of perfectly decent pinot, this was a failure. We hung up flypaper and waited for them to fill up with flies, but they’re too smart for flypaper in this country, and the gross sticky strips remained largely untouched except for some unlucky moths. I made a homemade flyspray with dishsoap and water in a spray bottle, and we chased the flies around. Some we did get with this, but the larger effect was to enrage Eric when the kids sprayed the flies sitting on windows, as he had just finished cleaning them and they were now coated in a soapy film.

We tried keeping all the doors and windows open to let the flies roam in and out freely. They roam in but do not roam out.

Sitting on the couch one day I looked over to the arm where I heard a frantic buzzing and saw two flies mating not a foot away from me. For shame flies, for shame. I should have realized the futility at that point, but alas, my foolhardiness continued.

At the grocery store last week I came upon the household goods aisle and saw person after person walking away with a canister of aerosol fly spray. Enough of this non-toxic nonsense, I decided, and grabbed a can.

At home, I attacked the flies with the spray. “90% natural” advertises the can. “Citronella scent” it touts. Our house was soon filled with a cloud of unbreathably thick vaguely citrus scent. We ate dinner outside that night, in the cooling evening air. When we returned, the flies lined up and stared at us, with one especially large one in front. He raised a front leg and curled it in a “come and get me” maneuver.

We admitted defeat. I for one welcome our new fly overlords. And the first cold snap of winter that will hopefully kill them all.

-s

In which I return to America, and find that I still quite like it.

January 7, 2018January 7, 2018Leave a comment

New Zealand is in full on summer mode down here in the southern hemisphere. This means that we may have a few days of lovely, warm sunny summer weather and then a few days of pouring rain and cyclonic winds. There’s a skylight in our bedroom so the crashing rainfall at night keeps Eric and I up quite a bit, until the clouds dissipate and the sunshine returns again.

From a recent seaside hike…

With bright, long, warm days it was hard to get into the Christmas spirit down here. We were graciously lent a tree by a fellow doctor, complete with ornaments of a summer christmas such as a surfing santa and a kiwi in a convertible on his way to the beach. We hastily wrapped presents with yesterday’s newspaper, but it felt ridiculous to listen to songs about the weather being frightful or a white Christmas when it was 80 degrees outside. Last year, Barcelona for Christmas felt like a special travel event, and was festive in its own right. Here, we were in our house, doing our usual thing, only it was the middle of summer and it felt ill-fitting to celebrate Christmas the way we do at home.

Beach BBQ for Xmas?!

We tried with a TV Yule log…

I got to get a little bit of cold weather Christmastime though, on a short trip I took to the States. The government of New Zealand gives its docs a very reasonable amount of money for continuing education, and I used some of these funds to take a jaunt to New York in December for a conference and also to get some baby snuggle time with my newish nephew, Zian!

Zian!

Eric attempting to sway his nephew to Go Green!

Failed Selfie. I look I’m the witch from Hansel&Gretel and am excited about my tasty snack.

I was nervous about going back to the States. We’ve been away for almost six months. Would it feel strange to be back? Would it feel uncomfortable? We’re living in a rural town which doesn’t even have any traffic lights or a single Starbucks – would I have culture shock on being in Manhattan, a slightly larger city? And what would the environment be like overall? Watching the news from back home reads like a horror show from so far away. Most importantly, would I look the wrong way while crossing the street and get squashed by an errant truck?

While 24 hours of straight travel might seem rough, it felt like a luxury to be traveling on my own without having to manage kids and I upgraded on the long haul flights so had a pleasant journey indeed. I finally got to watch Logan on the way over, which is now one of my favorite movies of the year. (On the way back I rewatched Episode II of Star Wars, and I hated it only slightly less than I have on previous watchings. What a terrible film, shame on you, George Lucas. That moment when Shmi dies and her head flops over…gah.) Once I exited, I quickly opened my bag and pulled out the pouch of winter outerwear I’d prepared, pulling on a sweater, scarf, gloves, hat and coat in short order and waited for my car to pick me up.

I hadn’t worn this many layers in months

The cold weather felt cozy to me for the time I was there, and being with family and friends felt warming and like Christmastime was right again. More than that though, it felt really, really nice to be back in the States. You might argue that New York City isn’t exactly representative of the US at large, and you’d be right. However, it felt comfortable to be back home. It was nice to be somewhere where I understood what everyone was saying to me the first time around, and where I was understood as well. Where you can crack a joke and have a shared background that makes it funny. And in all honesty, it was nice to be back in a large city again. The crowds were annoying in a way, but never overwhelming. And the sheer variety of food and shops available to me was something we haven’t had out here at all, and something I was happy to have back.

In a nutshell, it felt good to be home, and it made me realize that New Zealand isn’t where we’d want to stay permanently. I love our casual lifestyle here, the fact that I’m done with my job by early afternoon most days, that the kids are learning all sorts of watersports, that Eric gets to be the surfer dude he always was in his heart, the friends we’ve made and the adventures we’ve had here. I’m nervous about losing all of that and going back to our higher stress life back home, but despite all of it, the U.S. is still where I feel like I belong and where we’ll come back to.

At least for now.

-s

In which we head to the tippy top of New Zealand

December 13, 20171 Comment

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.

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.

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

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.

Skipping along the beach

Lookinkg over the site of an old WWII garrison

Post paddle hot chocolate!

Little waterways among the islands

-S

In which I realize my dream of becoming a Quizmaster

November 10, 2017November 10, 20172 Comments

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.

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.

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.

do you know? we were clueless.

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.

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.

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.

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

November 6, 20176 Comments

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

September 9, 2017September 9, 20173 Comments

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.

Even the salt shakers

seagulls…

they are watching…

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.

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.

kids walking and even scootering home from school, shoeless

Having a barefoot day

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.

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!”

Hospital lobby

Entrance signage. No gang patches, and remove muddy shoes…and enter shoeless.

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.

How to get staff to do online education modules

This cardboard cutout encouraging hand hygiene scares the crap out of me when I walk by.

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

fretzes on the loose

a family of four out of America

Tag: New Zealand

In which patients, not doctors, get a vacation from the hospital

In which there are goats

In Which we trek through Mordor to Mt. Doom

In which we get to star in our own jungle adventure movie. And eat ice cream.

In which I battle the Lord of the Flies, and lose.

In which I return to America, and find that I still quite like it.

In which we head to the tippy top of New Zealand

In which I realize my dream of becoming a Quizmaster

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

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

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