Friday night and the end of my fourth week of work here. Just thought I'd jot down a few scenes from the clinic I'd like to remember from the last week or so.
- Two old men chatting in the waiting room together about being in the same hospital when they served in the war. "If Hitler had that Matron on his side, he'd a won the bloomin' war!" one told me as I called him back.
- Patients often returning to the waiting room to finish a conversation with another waiting friend after I'd seen them.
- 92 year old woman telling me about how she lives alone, "I only have the nurse come 3 days a week to check me" and proudly showing me the alarm buzzer on her wrist. "When I fell and broke my hip last year, they came in 15 minutes". Also telling me, "I never expected to live this long, I'm long past due my expiry date!". [expiry date= the date food goes bad on New Zealand labels]
- Two tough old sheep shearers giving me the business as they both lay in the dressing area, one with a deep leg wound that was just getting over a nasty infection (behind the curtain) , the other in front of me with a new cut on his hand.
==My (dumb) question "How dirty was that shearing comb?"
==Patient, "Why doc, it just come out of the sterilizer, don't you know!". Laughing from behind me.
=="Well, we better put you on some antibiotics to prevent infection".
==Patient, "Why doc, it was a clean cut, I'd a sewed it myself if I had me own thread. And I don't like to take pills."
==Me, "Well, I'll give you some anyway". Nurse behind patient shaking head that he won't take them anyway.
==Patient, "Doc, I got some at home from last month, I'll take those". More laughter from behind the curtain.
==Me, "Well, I'd sure hate to see you lose your finger from an infection".
==Patient, holding up hands to show me missing index fingers on each side, "Heck doc, I'd still have 7 good ones left anyway!" Gaffawing from behind other curtain.
- Smiling curly haired two year old with huge eyelashes, hopping up the exam table and pulling his ear back voluntarily for me to look into.
I don't have pictures of these episodes, except in my head. However, I've posted pictures from our last two weeks on a separate page, if you're interested.
We might be off or Queenstown tomorrow. Or not. We'll see. I have my "I" hat on!
An academic Family Doc and his family's adventures on a 6 month working "sabbatical" in New Zealand.
Wednesday, February 11, 2004
Waitangi Day was last Friday, and a long 3 day weekend here. Thursday afternoon, the hot water went out in our house. The electrician came and thought he fixed things, but by the next morning things were ice cold again. Waitangi day is mostly celebrated (or protested) on the North Island. There were no commemorations in Southland that I could find in the newspapers, beyond sales advertisments. There was a lot of discussion on the telly and in the papers comparing the ambivalence Kiwi's have for their national day with the exuberant, blow out celebrations "across the ditch" for Australia Day. This year the big news has been the leader of the National Party here, Don Brash, giving a speech calling for an end to "special treatment" of Maori in government policies, and quite a bit of political debate following that, leading up to a session of name calling on the floor of Parliament at the opening Monday. It's all a bit hard to follow as a non-native, although one of Mr. Brash's arguments, about admitting supposedly "less qualified" Maori applicants preferentially over "pakeha" (European) applicants is reminiscent of the famous Bakke case in the U.S. I have to keep reminding myself that it's a different nation and situation, and that "mapping" my poor understanding of race relations and affirmative action debates from my own country onto events in New Zealand is only going to get me into real trouble. So I mostly just listen and watch the events and try to keep up. The most interesting article was in Sunday's paper. An analysis of healthcare for Maori shows that although they are 15% of the population and consume about 16% of health resouces, overall their health is much poorer than other groups and on average they have 10 years less life expectancy. The article concluded that although porportional resouces are devoted to Maori healthcare, the delivery is not doing the job. More worrisime is the fact that even when NOT in a lower or deprived socioeconomic state, Maori patients still have poorer health and shorter lifespans. What this means for social policy here I haven't a clue, but it is sure interesting, and something for a healthcare worker to ponder on Waitangi day.
We spent the day mostly hanging around Winton. I was tired from the week which had been very busy. I messed around on the computer, and Vicki and I took a nice walk to through the Winton Reserve, a local park at the North end of town which is a nice bush walk, and has beautiful trees and shrubs. We stopped in the grocery store, made dinner and just hung out, as it was a bit rainy off an on. My computer work was for planning Saturday's trip, which was South to the Catlins. This area, the southernmost coast of the South Island is largely forest park, and very sparsely populated. The main attractions are along the seacoast. We consulted our tide tables, and discovered low tide was at 10:10 AM; so we all got up about 0630, had a quick brekkie, and headed off for our first stop, a fossilized forest from 60 million years ago. This was at Curio Bay. The drive there took about 1.5 hours, through beautiful countryside with hills, sheep and bush, finally to 20 km of gravel road. You come over the hill and there is the Southern Ocean, with breakers. All the trees in the area are "one sided" with almost no branches on the Western sides, due to prevailing and howling winds. We parked and walked out onto the beach to look at the fossilized tree stumps and logs. These were covered in mudflows at the time of the dinosaurs, but you can still see the tree rings and the stumps with roots in place in the rock. It really puts the age of the earth in perspective, to stand over these and remember that when they were alive, there were no birds, nor modern mammals. Our next stop, timed for the tide nadir, was Cathedral caves. These sea caves have been hollowed out of the rock by the surf, and they are reached by a hike down a steep hill that takes about 30 minutes, followed by a brisk windy 15 minute walk over the sand. When we got to the bottom of the hill, an old woman was coming up on crutches- amazingly tough, these people! The caves were wonderful, but even more special, were the baby blue penguin chicks up in the furthest recesses of the cave. We could just barely see their white bellies, but we could hear them calling and crying for their mums. We continued down the coast after hiking back up off the beach, and did a short hike to two nice waterfalls, then returned to a high bluff overlooking the sea in time for the sun to break through during our lunchtime. People were stopping and hiking down the bluff to go fishing or paiua harvesting- brave work in very cold, rough seas! We took another walk on a sandy beach for awhile, watching weekend surfers and children scamper out of the cold waves, then headed back to Curio Bay to watch for yellow-eyed penguins. These fellows live in the bush next to the beach all year, and they "come in from the surf at tea-time" in the afternoon. By this time, although intermittantly sunny, the wind was gusting up to 80 km per hour. We climbed up to the "hide" above the beach and stood against the gale for an hour before seeing our first penguin. Eventually, we saw three at the edge of the bush, before calling it a day and heading out. Thoroughly chilled, we stopped at a nice little tea house in Niagara (location of the Catlins famous Niagara Falls, where lamprey eels swarm during mating season). We had hot tea and supper and then headed home to our hot-waterless house. However, once a fire was going in the woodstove, we improvised and heated water on the stove and teakettle, enough for each of us to have a hot bath, before flopping into bed.
Sunday, of course, was a day of rest and recovery. It was raining again, but I marched down and got a Sunday paper and took a short walk around town. It was nice to relax and get ready for this week. I will try to post some pictures of our trip later on this week.
We spent the day mostly hanging around Winton. I was tired from the week which had been very busy. I messed around on the computer, and Vicki and I took a nice walk to through the Winton Reserve, a local park at the North end of town which is a nice bush walk, and has beautiful trees and shrubs. We stopped in the grocery store, made dinner and just hung out, as it was a bit rainy off an on. My computer work was for planning Saturday's trip, which was South to the Catlins. This area, the southernmost coast of the South Island is largely forest park, and very sparsely populated. The main attractions are along the seacoast. We consulted our tide tables, and discovered low tide was at 10:10 AM; so we all got up about 0630, had a quick brekkie, and headed off for our first stop, a fossilized forest from 60 million years ago. This was at Curio Bay. The drive there took about 1.5 hours, through beautiful countryside with hills, sheep and bush, finally to 20 km of gravel road. You come over the hill and there is the Southern Ocean, with breakers. All the trees in the area are "one sided" with almost no branches on the Western sides, due to prevailing and howling winds. We parked and walked out onto the beach to look at the fossilized tree stumps and logs. These were covered in mudflows at the time of the dinosaurs, but you can still see the tree rings and the stumps with roots in place in the rock. It really puts the age of the earth in perspective, to stand over these and remember that when they were alive, there were no birds, nor modern mammals. Our next stop, timed for the tide nadir, was Cathedral caves. These sea caves have been hollowed out of the rock by the surf, and they are reached by a hike down a steep hill that takes about 30 minutes, followed by a brisk windy 15 minute walk over the sand. When we got to the bottom of the hill, an old woman was coming up on crutches- amazingly tough, these people! The caves were wonderful, but even more special, were the baby blue penguin chicks up in the furthest recesses of the cave. We could just barely see their white bellies, but we could hear them calling and crying for their mums. We continued down the coast after hiking back up off the beach, and did a short hike to two nice waterfalls, then returned to a high bluff overlooking the sea in time for the sun to break through during our lunchtime. People were stopping and hiking down the bluff to go fishing or paiua harvesting- brave work in very cold, rough seas! We took another walk on a sandy beach for awhile, watching weekend surfers and children scamper out of the cold waves, then headed back to Curio Bay to watch for yellow-eyed penguins. These fellows live in the bush next to the beach all year, and they "come in from the surf at tea-time" in the afternoon. By this time, although intermittantly sunny, the wind was gusting up to 80 km per hour. We climbed up to the "hide" above the beach and stood against the gale for an hour before seeing our first penguin. Eventually, we saw three at the edge of the bush, before calling it a day and heading out. Thoroughly chilled, we stopped at a nice little tea house in Niagara (location of the Catlins famous Niagara Falls, where lamprey eels swarm during mating season). We had hot tea and supper and then headed home to our hot-waterless house. However, once a fire was going in the woodstove, we improvised and heated water on the stove and teakettle, enough for each of us to have a hot bath, before flopping into bed.
Sunday, of course, was a day of rest and recovery. It was raining again, but I marched down and got a Sunday paper and took a short walk around town. It was nice to relax and get ready for this week. I will try to post some pictures of our trip later on this week.
Sunday, February 08, 2004
A lot has happened since the last blog and I'm just now recovering I think. Its Sunday night here of a long holiday weekend. Last weekend we spent Saturday shopping and looking around Invercargill. Vicki was on a mission to find Crisco shortening, so we checked every store, to no avail. Everyone here has never heard of using vegetable shortening to make pie crusts, etc. They all use lard or butter, which, considering the farming community here, makes a lot of sense. We did our "big shopping" for the next few weeks in a large grocery store there. This is always fun but a bit tiring. For example, the cuts of beef in the case all have different names than we are used to, so it takes some thought. We have decided that the bisquits (cookies) are so delicious and varied, that we are going to start at one end of the aisle and try one of each kind during out time here. There is NO WAY we will be able to reach the end of the aisle without putting on 30 kg! {We did get a real chuckle out of an article in the papers recently about "boozy bickies"!} I also took Vicki shopping for her birthday, and found a beautiful paiua (abalone shell) ring. Liz did most of the shopping, getting things she needed for school, which started in ernest this last week for her. We had lunch in the Japanese restaurant, and came home and just took it easy the rest of the evening. Sunday was a bit of a rainy day, but in the afternoon Vicki and I went out to Forest Hill Reserve, a hilltop covered with native forest about 6 km south of Winton. We walked up into the drippy, wet forest. Out in the fields the wind was howling and the drizzly rain driving sideways, but as soon as you enter the dense "bush" here, the wind stops. The forest is so thick that hardly any rain falls on your head- it mostly drips down the vines and trunks of the trees. The birds were singing loudly. The bellbird is VERY loud and has a beautiful song , but you can never see them, even when you know they are right over your head. At one point Vicki went ahead and I was messing around trying to take a picture of a spiderweb, when over my head about a half-dozen tui came into a large rata tree. They were eating from the flowers and were quite vocal. This is a lovely forest that is rarely visited. There is a track across the top of the hill to another pick up point, and we promised ourselves we would do that some day and have Liz pick us up at the other end.
Monday I was the only doctor in the clinic, so it was well that I'd had a nice outing the day before. I saw 28 folks, only 1 or 2 of them were rechecks, and supervised a half-dozen wound checks. It was a busy day, but the staff did an awesome job of triaging patients, so most the problems were acute. That made things go a lot faster. Tuesday through Friday we other "relieving" doctors helping. These are two women who help out in rural clinics on a contract basis, episodically, as a form of practice. I was very glad to have Liz and Penny helping me after Monday. Many of the patients we see are older and have multiple medical problems and medications. Since they are all new to me, it is a real challenge to get up to speed on their cases and fulfill their needs. I've quickly realized that a lot of return visits are in order, just to have enough contact to get things done bit by bit. Fortunately, the patients expect this and don't seem to mind. Each day here has its own special challenge: an asymptomatic middle aged woman with BP of 230/130, two kids with a rash I thought was bug bites, followed two days later by a playmate with the same rash; a farmer with a black and blue (fractured!) ankle he's walked on for a week, etc. Wednesday I did 3 excisions of suspicious lesions, as well as "liquid nitrogen clinic" at the end of the day. LN Clinic is a walk in session where the nurse and I line up about 8-15 patients who have come in with warts, papillomata, seborrhic keratoses, and actinic keratoses that need to be frozen off. I have to admit the excisions were great fun for me- as a teacher, my residents are always pushing for as many procedures as they can get, so I seldom get to do many of these by myself. There is a simple joy in removing a suspicious lesion, and closing the wound nicely, and having the patient thank you for helping them resolve that worry. The most exciting time of the week was a stat call over lunch hour one day to go next door to the birthing center. A woman had just been delivered by the midwife, and had a huge postpartum hemorrhage. They needed a lot of hands, so I helped by starting the IV. Got it on the 2nd try- I was pretty pleased (and relieved!), since its been about 6-7 years since I last started one. The midwives had already been giving her the appropriate drugs, with good result, so we poured in a lot of fluids and got her stabilized for the ride to Invercargill.
Wednesday night, I attended at the "Urgent Doctor Center" in Invercargill. There is no night or after hours call here; and our patients with problems are directed either to go to the hospital 30 km down the road, or to the Urgent Doctor. This is a small office building downtown which during the day and evening also doubles as a surgeon's private office, and a private ultrasound facility. It is not an ER. It has a crash cart, but no EKG, and minimal oxygen, etc. It is really designed for after hours visits. This time I took the 7-10 pm shift and saw about 8-9 patients. The patients usually call in and are given a time to come. One lady needed a shot of narcotic for her migraine- so the nurse calls 2 buildings down the block to the Police station, and tells them she (the nurse) will be over to pick up the shot- because that's where it's stored. It was a nice, quiet functional facility and I was greatly relieved to see it wasn't a "mini-ER" type of setting. Later this year I will get to do the long 5pm-7am shift, which is the phone calls and home visits part of the shift. That doctor was busy, so I never got to meet him Wednesday.
After this long week in the office I was ready for a nice weekend, but I'll blog about that tomorrow. Liz has started regular school sessions, and I'm trying to talk her into doing a "guest blog". Vicki has mostly kept busy taking care of the two of us, writing notes, catching up on the bills from our vacation at the beginning of this journey, etc. Somewhere in this week she turned 50, we had a small birthday party and Liz and I made her a cake. (Well, Liz mostly made it and I cleaned up the dishes.) The hot water went out in our house on Thursday, and the fix didn't work, and its Waitangi Weekend here; but that's a story for another day....
Monday I was the only doctor in the clinic, so it was well that I'd had a nice outing the day before. I saw 28 folks, only 1 or 2 of them were rechecks, and supervised a half-dozen wound checks. It was a busy day, but the staff did an awesome job of triaging patients, so most the problems were acute. That made things go a lot faster. Tuesday through Friday we other "relieving" doctors helping. These are two women who help out in rural clinics on a contract basis, episodically, as a form of practice. I was very glad to have Liz and Penny helping me after Monday. Many of the patients we see are older and have multiple medical problems and medications. Since they are all new to me, it is a real challenge to get up to speed on their cases and fulfill their needs. I've quickly realized that a lot of return visits are in order, just to have enough contact to get things done bit by bit. Fortunately, the patients expect this and don't seem to mind. Each day here has its own special challenge: an asymptomatic middle aged woman with BP of 230/130, two kids with a rash I thought was bug bites, followed two days later by a playmate with the same rash; a farmer with a black and blue (fractured!) ankle he's walked on for a week, etc. Wednesday I did 3 excisions of suspicious lesions, as well as "liquid nitrogen clinic" at the end of the day. LN Clinic is a walk in session where the nurse and I line up about 8-15 patients who have come in with warts, papillomata, seborrhic keratoses, and actinic keratoses that need to be frozen off. I have to admit the excisions were great fun for me- as a teacher, my residents are always pushing for as many procedures as they can get, so I seldom get to do many of these by myself. There is a simple joy in removing a suspicious lesion, and closing the wound nicely, and having the patient thank you for helping them resolve that worry. The most exciting time of the week was a stat call over lunch hour one day to go next door to the birthing center. A woman had just been delivered by the midwife, and had a huge postpartum hemorrhage. They needed a lot of hands, so I helped by starting the IV. Got it on the 2nd try- I was pretty pleased (and relieved!), since its been about 6-7 years since I last started one. The midwives had already been giving her the appropriate drugs, with good result, so we poured in a lot of fluids and got her stabilized for the ride to Invercargill.
Wednesday night, I attended at the "Urgent Doctor Center" in Invercargill. There is no night or after hours call here; and our patients with problems are directed either to go to the hospital 30 km down the road, or to the Urgent Doctor. This is a small office building downtown which during the day and evening also doubles as a surgeon's private office, and a private ultrasound facility. It is not an ER. It has a crash cart, but no EKG, and minimal oxygen, etc. It is really designed for after hours visits. This time I took the 7-10 pm shift and saw about 8-9 patients. The patients usually call in and are given a time to come. One lady needed a shot of narcotic for her migraine- so the nurse calls 2 buildings down the block to the Police station, and tells them she (the nurse) will be over to pick up the shot- because that's where it's stored. It was a nice, quiet functional facility and I was greatly relieved to see it wasn't a "mini-ER" type of setting. Later this year I will get to do the long 5pm-7am shift, which is the phone calls and home visits part of the shift. That doctor was busy, so I never got to meet him Wednesday.
After this long week in the office I was ready for a nice weekend, but I'll blog about that tomorrow. Liz has started regular school sessions, and I'm trying to talk her into doing a "guest blog". Vicki has mostly kept busy taking care of the two of us, writing notes, catching up on the bills from our vacation at the beginning of this journey, etc. Somewhere in this week she turned 50, we had a small birthday party and Liz and I made her a cake. (Well, Liz mostly made it and I cleaned up the dishes.) The hot water went out in our house on Thursday, and the fix didn't work, and its Waitangi Weekend here; but that's a story for another day....
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