Zed Med in N. Zed

As winter grabs ahold of Southland, the mood has changed here. We've had lots of rainy cool days, with "frisky" winds as they say on the TV. When we have had a sunny day, we've been sure to try to walk outside. On Vicki's last weekend here, we walked in Forest Hill reserve, and the next day drove out to Lora Gorge road and walked up the stream to the end of the road high in the Hokonui Hills. The pastures are still brilliant green, but there are less sheep about and days are short, and often windy.
I worked Urgent Care on Tuesday night 8 days ago, and coming home at 10 pm, pulled off the road at Forest Hill to look at the stars. The valley floor was foggy, but taking the side road up the hill to the Forest Hill cemetery (very small rural location, maybe 30 graves) I drove up out of the fog and into clear air. I parked and turned off the lights and got out. The moon was setting over the mountains of Fiordland in the west, and I could barely see the Takitimu peaks in the reflected light. But overhead, the winter stars were brilliant. It is so rare to find a truly dark place anymore, but on Forest Hill there were only 2 or 3 farm lights visible in the distance. I had wanted to look for Comets NEAT and LINEAR, but was unable to spot them without my star map or binoculars. No matter, the Milky Way was luminous, and something I had never seen before, the dark gas in our galaxy could be clearly seen to blot out the stars. This was only because in a truly dark sky, the gas clouds are blacker than the "sky between stars". In other words, once your eyes adjust, you can tell the difference between sky that has minute stars in it that you can't resolve into points, and patches of sky where the dust clouds in the Milky Way blot out everything. It was so amazing I dragged Vicki back the next night, and even though conditions weren't as good (moon still up) it was still fabulous. We were able to see both comets, but you had to know where to look, and even with binoculars they were still just fuzzy snowballs in the night.
One of the traditions here is that each locum in the practice gives an in-service to the staff at the monthly educational lunch. Last week, it was my turn, so we talked about "hypertension". I chose this topic because my patient log (see previous blog) showed this was 18% of visits to the office, and that "only" 25% of patients were at goal pressures (which is actually pretty good compared to many other countries stats). And also because there is good community awareness of cholesterol and PSA facts, but it seemed, much less awareness of the dangers of high blood pressure. My focus was to talk about the current guidelines, and I made clear that I wasn't telling the practice what I thought they should do. Our visiting cardiologist, Dr. Patrick Kay had kindly sent me the recent Australasian guideline for Hypertension, from the Australasian Heart Foundation, so that is what we reviewed. (It was also a bit more up to date even than JNC7, as it is newer.) New Zealand has also produced a downloadable cardiac risk calculator that is used worldwide so we also talked about that. That same week, I wrote a small article on hypertension for the Winton Record, the local paper. Because the practice is now part of a PHO here in New Zealand, the Winton Medical Centre will need to do a quality improvement project in this next year, and I am hopeful that they will decide to address hypertension in our patients.
Vicki walked around town every day last week, and up on Forest Hill several days. She spent most of last week getting packed, cleaning the house, and taking care of details, before her flight back home last Saturday. As we backed out of the driveway, she said, "Goodbye, 33 Queen Street!" She has loved our time here in this little house. She made it back to Cedar Rapids ok, after a 30 hour trip, several delays, and the usual Customs and baggage hassles. Elizabeth is still here with me, looking forward to attending the Central Southland College Ball tomorrow night. Liz has been doing most of the cookings and I clean up and we get by ok.
I am really glad plans changed, and I am not here the last 3 weeks by myself. My patients are being really lovely and expressing their sadness that I am not staying permanently. We have many geriatric patients here, and the older men frequently say goodbye like this: "Doctor, I want to thank you for taking care of me and I hope you come back here some day for good. I won't see you again, I know, but it's been really nice knowing you." With the unspoken implication that they know they are not going to live long enough to see me return.
Now I really think this highlights one of the wonderful things about rural practice that is often forgotten. In medical school, we are "rotated" through different wards and practices. One of the effects of this style of training is that it reinforces the practice of keeping distance between doctor and patient. We are encouraged to be "objective". In fact, the Professor who interviewed me in Christchurch for my NZ license gave me, as parting advice, the admonition, "Don't get too close". I have only been here five short months, and many of these patients I've only seen 3-4 times. And even though people know I am a temporary doctor, they have invested something in making friends with me. It would be tempting to think that its something I am doing, but I don't think that is true, having practiced other places. I think it is the nature of the people here in Southland. They just connect to each other. They are a true rural community. And it is a darn shame that rural towns like Winton are becoming "endangered" worldwide, and its sad that so many of these little towns, in both New Zealand and the U.S. can't find a doctor. Because it is these friendships that make practice enjoyable and worthwhile.