Every clinic experiences some afternoons when it feels like the circus is in town, but last week it really was! Vicki and Liz were startled to hear two men speaking fluent Spanish in the grocery store on Tuesday, but it all became clear once we saw the big top of the Weber Brothers Circus set up on the green grass of the second-best rugby field in town. (You didn't think they'd use the BEST rugby field, did you?). It was a real tent, with red spires topped by the circus name in lights. Vicki and I walked down to see the show one evening. Elizabeth took a pass as she has never recovered from catching coulrophobia as a child. We came in a bit late, due to a mixup reading the paper for the start time. The tent was pitch black and full of children eating "fairy wool" (cotton candy) and playing with small strobe and lighted toys. There were maybe 400 people sitting in bleachers watching the single ring in the center. I was impressed at the advanced lighting and special effects- there was smoke and mist, huge larger-than-life puppets, and great sound effects well coordinated with the funnier acts. My favorite was the fellow on the trampoline. His acrobatics were nothing special, but his Chaplinesque moves and mugging to the crowd made the children (and us) howl with laughter. There were minimal animal acts; a trained dog jumping through hoops, and a goat and llama on a teeter-totter were about it. But the acrobatics and the aerialists were quite good. The final act, a pair of men from Colombia on a giant rotating metal device that looked like an eggbeater from hell had them scrambling around rotating cylinders about 25 meters in the air. It was an act I'd never seen before and quite enjoyable. But the best part was listening to the children laugh and exclaim, and letting ourselves remember the wonder of the circus through their eyes.
Speaking of childhood, this last weekend we were visited by Don and Betty Ritter, now of Southern California. Betty was Leah and Elizabeth's first Suzuki violin teacher when they began at age 3. She and her husband were visiting New Zealand and we had invited them to include Winton on the itinerary. It was great to see old friends again, and we enjoyed sharing what we have learned about New Zealand with them, including bragging about "our town" and the other great finds we've made here. Sunday we drove over to Riverton, on the south coast. There was a Sunday market at one of the local schools, complete with arts and crafts booths, and even a whole mutton roasting on a spit. For NZ$2 you can get a "mutton foldover" which is a large piece of white bread, slathered with butter. You carry it over to the rotating, wonderfully aromatic roasting sheep, and the cook carves off a large piece of meat and slaps it on the bread. You then apply Waddie's ketchup if you desire, and fold it over and chow down. I had one and gave Vicki a bite; whereupon she sent me back for one for her and another for me. "Tell him 'no fat' on mine though" she said. I passed this on to the cook who smiled and said "Well, YOU want some fat, don'tcha mate? All the flavor's in the fat!" as he carved off a chunk of fatty mutton and slapped it on my bread. As I fought to keep the grease from running down my chin, I had to agree that he was right. After lunch, we went walking on the beach, and up in the hills over the town. There is a wonderful walk that takes you to the top of the bluff, where we saw the bay and Riverton, and turning around, looked out over the Southern Ocean with Stewart Island rising out of the mist in the distance. Then down through lush temperate rain forest, full of tree ferns, to break out in sheep paddock and walk down to the beach among huge rocks sticking up out of the hill. Finally a walk back up "sandfly alley", through the bush again, and back to the car park for a great 2 hour excursion in the sea breezes.
Work in the clinic continues to be very agreeable the last few weeks. It is hard to believe this is now the middle of my 8th week. I have been here long enough that I have seem many people multiple times. I have even sent one gent back to the hospital twice now. The practice tends to a lot of geriatrics, with high prevalences of hypertension, heart disease and peripheral vascular disease, especially venous insufficiency. I think the latter must be related to long years of agricultural work standing on your feet- I remember seeing a lot of it when I was a country doctor in Quincy, WA. It sure seems like we don't see that much (at least in the non-obese patients) in my Iowa patients. I am impressed however, by the number of patients who "quit smoking 20 years ago". Very few of the older patients still smoke, and I haven't seen nearly as much smoking-related COPD as I do in the states. Obviously the public health folks here did a good job in the 60's and 70's. However, there is still a problem with new smoking among some young people. However, I realized today that I have not seen ONE ad for a tobacco product since I got here- not on any sporting events, sponsorships, billboards, magazines, etc. NOT ONE AD. We've only seen some very GRAPHIC anti-smoking ads- graphic as in an autopsy showing a human atherosclerotic artery being dissected on television. It made a big impression on Liz. I concluded that banning tobacco advertising is having some significant effects here, and a web search tonite finds actual data showing a halving of tobacco use. Way to go New Zealand!
We continue to delight in the foreign language the New Zealanders speak. I was reflecting to Vicki about some of the differences in medical terminology. When worried that something is ominous, such as a funny looking mole, or a sudden case of bloody diarrhea, patients and staff often refer to it as being "sinister". I have adopted this word in my vocabulary, replacing my phrase, "Oh, I don't think that {mole, etc} is something to worry about", with "That {mole, etc} does not look sinister to me". Besides being a more definite phrasing, the new phrase does not carry any emotional connotation that the patient is (or I am) "worrying" about something. "Sinister" also implies that an abnormal mole might be "evil" as well as dangerous or harmful. It feels more like the focus is on the possible behavior of the mole, and not on my opinion of it!
In a similar vein, diagnostic exams of blood, xrays, etc are termed "investigations" instead of "tests". I've thought a lot about this one. A "test" is something you pass or fail. You are graded on tests. You might get an A or an F. And a test implies that the result will be binary: its either good or bad. Compare that to an "investigation". This term reminds me of a detective story. A "private eye on your xray" or a "sherlock of cytology". There is nothing to pass or fail- we are looking for clues to the illness. We are investigating the body, looking for bad guys. And sometimes its unclear: is the mole good, is it bad, or maybe its in between or unclear. That can happen on detective shows you know. The nice blonde is really bad at heart. The whore has a heart of gold. Things are unclear, but if we are good detectives, we will eventually figure it out with timely and carefully chosen investigations.
An academic Family Doc and his family's adventures on a 6 month working "sabbatical" in New Zealand.
