Archive for March, 2011

Left-sided trauma, skin infections, paperwork for income, and a surgical emergency at the end of the day

March 30, 2011

I will not belittle or curse

Nor whine when it comes to my purse

     I won’t cry or scream

     I work on a team

And I can delegate to the nurse.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh, New Zealand and working in Wellsford, Matakana, and Snell’s Beach.

Today I attended twenty-seven patients.

Four asked me to fill out paperwork so that they would get an income from the government.  One denied any medical problem so clearly that I suspected some agency had recruited a patient to try to trap me into bad practice, and I refused.  For the others I advised lab investigation, retraining, and lifestyle modification.

Nine patients had superficial skin infections.  I heard the term “school sores” applied to a painless blister that rises, then drains pus, and starts to spread.  I prescribed a lot of mupuricin (Bactroban).  Three patients had fungal skin infections, and I prescribed clotrimazole, available back home over-the-counter as Lotrimin.

The vast majority of the trauma I saw happened to the patients’ left side, and included fracture, sprain, bruise, cut, and contusion.

I learned that cigarettes go for $12 per pack of 30, and that those smokers who protest they can’t afford medical care don’t like me getting out the calculator any more than the smokers at home do.

I calmed three children by playing with my yoyo.

Freezing off warts, a simple operation that requires about fifteen minutes of training, pays obscenely well at home because our system rewards procedures more than cognitive-based actions.  Today I had the delight of sending a patient with warts to the practice nurse, who was happy to apply liquid nitrogen.

I sent two patients to the Ear Clinic for wax removal.  I’ve written other posts about the satisfaction that comes from getting out a really nasty hunk of cerumen, but I never detailed the occasional frustration and back pain that goes along with it.  The frequency of ear wax impaction justifies dedicating a nurse three days a week.

I checked patients’ blood pressures today.  For twenty-three years I could say, “Vital signs?  That’s the nurse’s job,” but I’m in a different framework here.  The nurses have a lot more responsibility and power.  They do a good job and free me up for other things, and I don’t mind if I pay the price of collecting all the vital signs I want.

At five, as I settled down to complete my documentation for the day, a nurse asked me if I’d see a patient.  The doctor on call had stepped out.  Not a problem, I said, and saw an opportunity to demonstrate good team work. 

I can’t write any of the specifics of the case because I didn’t get the patient’s permission. But I can say that the nurse did a good workup and that I had the satisfaction of going one layer deeper to uncover a true surgical emergency.

I had seen a couple similar cases a year ago, and even in my own clinic and zone of comfort, my emotions ran high.

Currently, I have limited access to the Internet. 

Barefoot in the doctor’s office

March 30, 2011

The patients I meet and I greet,

They walk right in off the street

     It doesn’t confuse

     The shoes they don’t use

They come in with the bare feet.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m working on the North Island of New Zealand. 

Bethany and I are staying in a beautiful beach house in Leigh, overlooking Matheson’s Bay on New Zealand’s east coast, not far from the west coast in this narrow part of the North Island.

This morning we drove to the clinic in Snell’s Beach, a village of about a thousand, half an hour’s drive from Leigh.  The road winds between vineyards, pastures, and fields.

In this practice, a doctor works out of one exam room with three times the area of the examination rooms I’m used to.  The physician calls the patient from the waiting room, and obtains and records the vital signs (temperature, pulse, blood pressure, respiratory rate).    

Registered Nurses (RNs) carry a good deal more responsibility here than they do in the States.  They manage diabetes, high cholesterol, and high blood pressure, unless the patient specifies a preference for a doctor.  They do a lot of triage by phone and in person, attending patients who would require a physician’s attention back home.

The Wellsford clinic has a half-dozen doctors working at any one time, and sports an ambulance entrance and two ER bays. 

The Snell’s Bay clinic has one physician full-time and sometimes has a locum tenens (substitute) like me to help fill in. 

I’m still getting the hang of how things work, and I asked questions of the nurse as often as of the other doc. 

The New Zealand Medical Counsel emphasizes confidentiality, and I will not be writing any identifying data about my patients. I probably won’t even ask. 

I can still record my thoughts and feelings. 

With only ten patients on my morning schedule, I saw something I’d never seen before, a syndrome well investigated years prior and extremely rare; I had a good handle on the basic nature of the problem because I’ve seen a lot of endocrinology patients in the past.

Many of my patients, smokers, ex-smokers, and non-smokers, suffered from respiratory problems.  A lot of them had superficial skin infections, and I prescribed a topical antibiotic.  I turned down a couple of requests for oral antibiotics.  I filled out a form for the government.

I attended a couple of Maori families, who seem just as friendly and outgoing as New Zealanders in general. 

I told several patients how erudite and sophisticated the Kiwi accent sounds to me, and they got a good chuckle.  They ask if I’m from Canada or the United Kingdom, some express surprise to learn I’m not from New Zealand.

I haven’t seen a “NO SHIRT, NO SHOES, NO SERVICE” sign here.  Many people go barefoot into businesses, bakeries, cafés, and doctors’ offices, and no one seems to think twice about it. 

I am treated with respect, not formality; I don’t mind being addressed by my first name.

Currently I have only limited access to the net and can only post every couple of days.

One cutting of hay a year: back at work and talking with farmers.

March 28, 2011

 

And it’s not that I like to shirk

I’ve fought my way out of the murk

    It’s such a relief

    Here’s my belief:

I’m someone who just loves to work.

 Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh, New Zealand.  My net access has been limited.

Sunday I received confirmation of professional liability coverage while I processed emails in the staff room at the Wellsford clinic. 

Electronic communication started piling up when we arrived in Leigh.  With limited connectivity, I took to deleting chuckle-worthy downloads.  But when  I came to the post detailing my insurance, I grinned and read it out loud to Bethany.

I felt relieved; it meant I could start to work.

Four hours into a marathon net session, we went to lunch.  On our way out, a nurse stopped me for a brief clinical decision interpreting a test.  I confirmed significant abnormality.  She thanked me for the help; I thanked her for the opportunity to make my first clinical decision since I left Barrow four weeks ago.

In the late afternoon we drove back to Leigh, stopping at nearby Omaha Beach.  At the beach house we ate supper al fresco, and afterwards lay on the deck looking up at the stars.

Today I had my first real day of work in New Zealand.  I cared for Maori, Pakeha (non-Maori New Zealanders who have ancestors buried here), and several flavors of Europeans. 

I got to talk to a couple of dairy farmers, and I learned a lot.  Most dairy cattle graze on pasture and do not receive grain supplementation.  The grass descends, apparently, from plants native to New Zealand.  Those who cut hay can expect one cutting per year, two in an exceptional year.  Some milk their cattle twice daily, some once.  They don’t inject cows with hormones to boost production.  Frisian cows put so much into the milk they don’t live very long; a lot of farmers prefer Jerseys.  Modern land measurement uses the hectare, corresponding to about 2.5 acres. 

They call corn maize, and figure yields in metric tons (1000 kilograms) per hectare.  I haven’t compared Iowa yields to New Zealand yields.  Fertilizers here include lime, phosphate, potash, and urea but no anhydrous ammonia.  They call it topdressing.

We pass a lot of sheep when we drive, fewer cattle, and a very few horses; I haven’t seen or smelled pigs though some of the farmers talked about them.

I want to sit down and talk to the farmers, quiz them about what farming in New Zealand means, find out what makes the market tick.

My command of the computer system finished the day considerably stronger than when I started.  By the end of the second session I had gotten a lot better at the paperwork. 

For the last patient of the day I got to experience the transfer process.  The word registrar here refers to a physician advanced in training far enough to do a lot but not be a fellow; I talked to the surgical registrar in Whangatei. 

An easy handover; the doc at the other end didn’t ask me for lab or x-ray and didn’t try to dodge the work.

Terrible traffic and courteous drivers, narrow lanes with gorgeous vistas, impossible situations with competent bureaucrats. Caution: contains 1100 words.

March 26, 2011

I started orientation

On the verge of final frustration

    Without enough slumber

    I awaited my number

And at last I got registration

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh, New Zealand, hoping to start work next week. 

I slept poorly last night because of anticipation of my weekly Care Initiatives Hospice meeting, my orientation to the new clinic, my interview with the Medical Council of New Zealand, my appointment with Immigration, and the need to move at the end of the day.

We have no net access in the beautiful town where we’re staying; running out of megabytes and the noise of passing trucks marred my Skype session and jangled my nerves as I sat outside the only wireless hot-spot available, a half-hour away from our apartment.

At orientation, in Wellsford, I filled out more paperwork, came up short on the professional liability issue, the work visa, and the medical registration number.

I have been struggling with those three issues since I arrived.  Before I can have a license, the Medical Council of New Zealand wants to see me, with my original medical school diploma and my passport in the same place at the same time.  Most days dawn with the expectation that Today Will Be The Day and end with hope for tomorrow.  Four days ago frustration replaced anticipation. 

My license hung up a week ago on the fact that the hard copy Certificate of Good Standing from one of my State Medical Boards hadn’t arrived. (When I made my overseas call to investigate, the person who sent it out muttered he always had problems with overseas mail.) 

The process involves a three-way Catch-22: to have a job, one needs a license and a visa; to have a visa, one needs a job, which also requires a license; to have a license, one needs a job.  Because 40% of the doctors in New Zealand come from other countries, physicians rate enough flexibility to render the task possible.

The manager of the twelve doctor operation, Sara, glows with professionalism; calls flew back and forth, and by 11:15 I had my invitation to meet with the Medical Council in Auckland.  I could visit Immigration first as long as I had the invitation in hand.  We headed out at 11:30.

The drive took an hour and a half, through spectacular vistas. 

Auckland , New Zealand’s biggest city and four times larger than the capitol, Wellington, boasts 1.4 million people.  As with any other city that size, the traffic problem drives many to insanity.  The hyper vigilance engendered by accommodating to driving on the left didn’t help me, though the courtesy of the other drivers did.

Our GPS guided us to the proper spot but couldn’t find us a parking place.

Twenty traffic-crawling minutes later, Bethany guided me into a parking spot in a facility designed for very small cars being driven by really good parkers.

Downtown Auckland appears to be vigorous, energetic, young, and Asian, with a few Maori and Pakeha thrown in.  Sushi, tandoori, curry, and kebab restaurants crowd against banks, electronics shops, and fashion stores. 

Immigration rules from the fourth floor of a high-rise office building.  I heard languages from Korea, China, Japan, India, Germany, America, and Australia.  Dress ranged from business suit to blue jeans, footwear from flip-flops to oxfords to hiking boots.

After a fifteen minute wait in line I approached the counter with my green plastic folder full of paperwork.  Three people handled the stack, assured me that all was not in order, I would need to leave my passport, and they would send me my visa in a couple of days.

I called my agency in a panic from the counter.  “This is anything but a walk in the park with a couple of rubber stamps that you promised,” I said.  “I can’t leave my passport, I need it when I meet with the Medical Council.  They tell me you need to call Carl.”

I was told to sit down and calm down and wait.

We waited.  In the early afternoon, I knew from long experience, sleep deprivation hits after the morning hormonal surge has left.  Worst case scenarios ran through my mind, and I started to figure.

There is much to be said both for never giving up and for knowing when to quit throwing good money after bad; such is the basis of game theory.

“If I’m not working in a week,” I told Bethany, “we’re going home.”

“You sure you want to give them that long?” She asked.

“I’m figuring time investment as a percentage of time spent working,” I said.

We waited another hour.  I called my agency.  “Nothing is happening.  I’m getting upset,” I said.  Just before I said I’m giving this up as a bad bit of work and I’m going home and the heck with you, a grizzled office veteran called me.

Smiling, courteous, and professional, I relaxed in his presence.  He explained the hang-up and the work-around, and called me back to desk 6.

Two more people handled my packet, and ten minutes later, with the hologram-decorated visa pasted into my passport, we left.

Polite drivers let me edge into the crush of Auckland’s rush hour.

I faced reminders of home: lanes as narrow as the Pennsylvania Turnpike and Jersey barriers.

We arrived ninety minutes early in suburbia marked by young trees.

I power napped and brought out my computer while Bethany slept beside me.  At 5:15 I met with a Justice of the Peace who looked over my papers, handed me a 250 page tome “Medical Practice in New Zealand,” and assured me that five working days was optimistic for a license number.

Waiting for traffic to abate, we ate in a food court and I bought work shirts.  We drove out of the city, back out into the verdant countryside as darkness closed around us and a drizzle fell.

By the time we got back to Leigh the clouds had opened and rain fell in sheets.  Traveling light brings the advantage of quick packing, and before nine we had unloaded and unpacked into an incredibly gorgeous beach house with a view.

Eighteen hours later I had my license number.

This post was written on Thursday, not posted till now because of internet access problems.

What is and is not poetry, what is and what is not insurance

March 24, 2011

When I view the longs and the shorts

The government law about torts

     Could give me assurance

     Not exactly insurance

But it kept me out of the courts.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh, New Zealand, hoping I’ll start work up next week.  I have had very limited net access for the last three days.

Another day has come and gone and the Medical Council of New Zealand has not emailed the letter inviting me to Auckland.  I have to appear before them or their representative with my passport and my original medical degree.

I’ve been carrying that precious piece of paper for the last two weeks.  All in all, I would really rather have left it at home in its frame, or locked away in a safety deposit box.  Yet that synecdoche representing twenty thousand hours of work and study has ridden in suitcase and backpack since we left Sioux City.  I’m looking forward to finding a secure way of getting it home.

We drove into Warkworth, thirty minutes distance, to the closest internet café.  While going through email, I had a moment of panic when answering a query about professional liability insurance.  During my five years with the Indian Health Service I didn’t have malpractice insurance; I had the protective shield of the Federal Tort Claims Act.  (Under the doctrine of sovereign immunity, “the king can do no wrong,” a government can only be sued by the people if it gives consent.  Thus doctors employed by the feds, and therefore agents of the government, carry a certain immunity from medical malpractice suits.  As it turns out, its coverage isn’t very good, which, strangely, prevents a lot of court actions.)  The email requested a letter from the Federal Tort Claims Act.  Of course no such entity exists, nor do I know whom to ask about documentation proving I hadn’t been sued during my years of government employ.  On the other hand, the sort of doc who goes into the Indian Health Service has a sense of adventure, and I’m certain I can benefit from the experience of others.

After Bethany and I finished our email we walked around the business district, and I went looking for a saxophone to rent.  Businesses close, businesses move, and in our peregrinations we stumbled into a thrift store run by Hospice.  I bought four figs and a book.

The paperback’s cover had been faded by exposure to sunlight, but I made out “Fifteen Contemporary New Zealand…” on the cover.  With a publication date of 1980 and a price of $2 NZ, I figured I couldn’t go wrong.

The missing word from the cover turned out to be “Poets.”

I have little patience for the contemporary poetry that lacks structure, cohesiveness, and comprehensibility.  It’s like trying to contact a law.  I find more evocative imagery in conversations with florid schizophrenics. 

 I write poetry, but the limericks that start my posts, while they may have rhyme and meter, lack imagery and thus do not qualify as poems.

Sleeping soundly the first night in Leigh, New Zealand

March 24, 2011

In seeking the best times of sleep

When it’s restful and dreamy and deep,

     This wisdom, please mark

     You must have it dark

And uninterrupted by beep.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Leigh,  New Zealand, hoping I’ll start work up next week.  I’ve not been able to access the net for the last three days.

A hovel, properly speaking, is any dwelling where the entrance leads below ground, and includes all those places with the wonderful euphemism “garden level apartment.”

During my premed days when I didn’t live in my mom’s basement I couldn’t afford anything other than basement apartments, and they worked well for me; they were dark and quiet during the day.

Such a domicile stood me in good stead during the first half of residency, especially during those rotations when I worked all night and slept all day.

When I went walkabout last May I traveled from Sioux City to Barrow, Alaska, and I learned how critical darkness is to sleep.

I originally attributed my grogginess there to jet lag, but as the weeks went by and layers of foil and cardboard went up on the inside of my windows, I came to realize how darkness relates to sleep/wake cycles, and how important it is to rest.  Despite everything I did, the unremitting sunlight robbed me of deep, restful sleep.

Barrow sits on flat land with no trees and only one tall building (three stories, not all that tall).  The well-lighted streets give the long (sixty-three day) Arctic night the visual impact of a very large Wal-Mart parking lot.  The hospital maintains halogen security lights, which shine into most apartment windows.  Within twenty-four hours of our arrival we purchased duct tape and heavy-duty foil.  Which helped a lot, but the apartment didn’t need night lights.  Bethany and I found unremitting night much easier to handle than unremitting daylight.

We stayed nine nights at a fine hotel in Wellington, but city lights impinged on the darkness and thus on our sleep.

Last night, we arrived late in a driving rain in Leigh (pronounced Lee), New Zealand, a tiny community on the east coast of the North Island.  After the terrifying experience of driving on the left side of narrow, winding roads in a downpour, we switched off the lights and the welcome darkness enveloped us.

This morning, we awoke to an astonishing view of the ocean.  Despite the stress of getting here, we slept soundly. 

Twenty years from now people will reminisce about the great real estate prices in Leigh before the tourists and commuters drove the values up.  Right now the town doesn’t suffer from an excess of street lights, traffic, or night-life.

And I can, in good conscience, shut off my cell phone, because I have to go down the block to get service.

The terror of driving on the left

March 21, 2011

  I thought we’d never arrive

I feared we’d never survive   

    I am not yet deft,

    When it comes to the left

The side on which Kiwis drive.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, today I left Wellington, New Zealand in preparation for a job in Wellsford, in the north part of the North Island

Arriving from Wellington at the car rental in Auckland just as rush hour traffic started to abate, we picked up a Toyota Corolla.

I like Toyota products; I just don’t like them with right hand drive.  I don’t particularly like driving, though I’ve done a ton of it in the last year, and I really don’t like driving on the left. 

My first clue that perhaps I’d gnawed off more than I could swallow came when I started to enter the vehicle from what would be the driver’s side in the US.  Bethany had her hand on the other side door latch.  When I pointed out our error we laughed because we had no other response.

For the last ten days I’ve been imagining driving on the left.  To get myself to sleep I reversed the chirality (handedness) of my old commute. 

Bethany recalled her three-month bicycle tour of England, Wales, and Ireland.  She remembered how every day she’d start going the wrong way until her companions reminded her. 

Our two-day stay in the Bahamas sprang to mind; while a pedestrian there I consistently looked the wrong way when trying to cross streets.

Back when we still did martial arts, one of the forms ran in a palindrome, with the first half a mirror image of the second half, and though the moves themselves were simple, mastery came harder than any for any other form.

The fact that I talked to others who have mastered the task of driving on the left gave me a misplaced confidence.

Backing out of the parking stall showed me that, when driving from the right, I had no sense of where the left side of the car was. 

Driving in traffic, which I had practiced mentally, terrified me more because every time I tried to signal a turn I turned on the windshield wipers.

As the sun went down and the twilight deepened we made our way north in a light drizzle, through spectacular country, as green as if no other color existed.  My fear behind the wheel detracted from my appreciation of the scenery.  Bethany kept her hands firmly clasped in front of her mouth so she wouldn’t scream.

Driving on the left for the first time brought a dizziness, but not in the physical sense.  More like the brain squirm the first time I went underwater and inhaled through scuba gear.  Without the blind confidence characteristic of testosterone poisoning, I gripped the wheel like a fourteen-year old with a learner’s permit, and, just like when I was learning to drive, I tended to drift towards the side of the lane I couldn’t see well.

The divided highway turned into a two-lane road, and we followed our GPS unit’s instructions towards Wellsford.  We arrived at dark and got fish-and-chips at a Chinese restaurant.  It had been frightening, I thought, but it could have been worse.

Things indeed got worse from Wellsford to Leigh (pronounced Lee), the last forty-five minutes of our prolonged learning experience.  The light drizzle turned to heavy rain, the road turned rough and noisy, darkness closed in, and the caution signs looked like Lyme disease germs.

We arrived in a downpour, sheets of rain testing our personal commitment to withstand erosion.  I carried our luggage up with the aid of a cap-mounted flashlight I’d bought in Barrow, Alaska, less than a month ago, on a day when the high missed the freezing point by fifty degrees Fahrenheit (twenty-seven degrees Celsius).

Wellington, New Zealand, in a nuclear-free nutshell

March 19, 2011

New Zealand said, “Yanks, put up your dukes

It’s all of us, not just the kooks,

     We’ll show you no fear,

     Don’t park your boat here,

Unless you promise no nukes.    

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Wellington, New Zealand, getting things squared away to start work next week.

New Zealand’s nuclear-free stance caused a diplomatic re-alignment in the 1980’s.  Prior to the US insistence on not disclosing presence or absence of nuclear weapons on board ships, New Zealand counted America as her major ally, and even sent troops to Viet Nam.  Since then, the Kiwis have looked to Australia and other Pacific countries.  Australia dominates the import and export markets though the US comes in third and second, respectively. 

The country’s most exported products come from dairy farms; petroleum and its by-products comprise the chief imports.

Gasoline here goes for $1.5NZ per liter, the equivalent of $6US per gallon.  As I’ve only been in Wellington city center, I don’t have a sense of how much people walk or cycle for their transportation outside urban areas, but here in the New Zealand capitol pedestrians rule. 

Currently $1NZ is worth about $.75US, and goods are priced and packaged metrically.  Fruit comes by the kilogram (2.2 pounds); cheese, olives, chocolates and other delicacies by the hundred grams (3.3 ounces).

Food costs a lot more here than it does in Iowa, and serving sizes in restaurants run smaller.   Not surprisingly, the population in Wellington seems a lot leaner than in Sioux City.  In terms of build, they look more like they descended from rugby players than from football players, and I can’t help but wondering if national sports preference doesn’t constitute a sort of selective breeding program.

Whereas in Sioux City, our most expensive dining has been sushi, we’ve found it the least expensive in Wellington, and we’ve been able to eat well on the equivalent of $5US per person for carry-out (in the local parlance, takeaway).  A breakfast of coffee, two eggs, toast and hash browns goes for $10US.

High quality smoked salmon (the equivalent of American lox) finds its way onto most breakfast menus as a side-order.

GST (goods and services tax) comes built into the price, and most service people don’t expect a tip.

The cyclists we’ve seen, excluding the obvious tourists on rentals riding up and down the waterfront, include commuters in business attire and racers with helmets and close-fitting clothing.

Within the last century, the city reclaimed land from the bay and built out onto what had been harbor, much like San Francisco.  And, much like San Francisco, a major fault line runs through the area and produces several thousand earthquakes a year.

Wellington resembles San Francisco as well in the steepness of the surrounding country.  Beautiful homes cling to cliffs, with stunning views of the harbor.  Four-hundred and fifty private cable car systems provide access.  One public cable car system transports people from the city center to Victoria University and elite homes in the heights above.

Wellington’s weather, windy most of the time, year round between 12C and 22C (52F and 72F).  They never have snow or frost, but rain, wind, and fog come and go; in between the air is gloriously clear.

Pakeha and Maori: amicable race relations in the wake of a royal apology

March 17, 2011

The Queen said, I apologize

For the wrongs that no-one denies

     The Maori, once warriors

    Now very good lawyers

Worked past innuendo and lies.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, right now I’m in Wellington, New Zealand, getting things squared away to start work next week.

Eight hundred years ago, as the Mongol invasion reached its peak and England still held sway over large parts of France, before the ravages of the Black Death or the Wars of Religion in Europe, human beings arrived in New Zealand from Hawaii.

They found two very large islands inhabited by birds.  The only land mammals at the time were three species of bats.  The dogs, rats, and chickens they brought with them survived and went feral.

The largest birds that ever lived, the moa, supplied easy protein.  The population of people exploded, and within two hundred years, extinguished every species of moa.  Their gardens producing well, and the sea providing fish and seals, the population continued to grow and reached carrying capacity.  The inhabitants organized into tribes (iwi) and a warrior tradition followed.

Less than five hundred years after humans discovered New Zealand, Europeans sighted the islands, and made contact in the early 1700s.  The called the inhabitants Maori; their language maintained mutual intelligibility from one end of New Zealand to the other.

At that time, the Maori had a sense of identity within their iwi but no conception of a Maori identity.  With good initial relations, a number of iwi signed a treaty in 1840 with the Queen of England.  In 1860, after blatantly fraudulent land purchases, violence broke out in a series of Maori Wars. 

The Maori fought the English to a standstill, but land theft continued, European diseases killed tens of thousands, and the Maori population collapsed.  Experts predicted the end of the Maori.

With the rise of urbanism, Maori drifted into the cities, and became part of the problems that afflict all people there, but they continued to adapt.  They served in both World Wars, the children went to schools and university and became, among other things, doctors and lawyers.  Eventually, they started seeking legal redress for treaty violations. 

Their legitimacy and goals were aided by the fact that there had been one treaty with the sovereign rather than with a government.  Queen Elizabeth II, in the 1970’s, publicly apologized to the Maori and signed into law a decree to start a reconciliation process. 

Race relations in modern New Zealand seem amicable.  A person is Maori, not by quantum of heredity or skin color, but by self-identification.  All other New Zealanders, whether European, Asian, American, or African are regarded as Pakeha (a Maori word which has come to mean non-Maori), if they have ancestors buried here.  One cannot tell a Maori by skin coloration or physiognomy; some self-identified Pakeha look very Maori, and some very European-looking people speak Maori well and can list their Native and non-Native genealogy.  Part of Maori culture is pride in one’s ancestors, wherever they came from.

The country has three official languages, Maori, English, and New Zealand Sign Language of the Deaf.  The Maori Network on TV has slick, professional programming in Maori with English subtitles or in English with Maori subtitles.

Maori and Pakeha speak English with the same accent.

These are my impressions so far, from conversations with many Pakeha and a few Maori.

You won’t believe who I ran into in New Zealand

March 17, 2011

OB, I thought, was a blast

But now I’m a thing of the past

     Because I am male

     And I knew when to bail.

I was sure  the thing couldn’t last.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to avoid burnout, while my non-compete clause ticks away I’m having adventures, visiting family and friends, and working in out-of-the-way places.  Just back from a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m in Wellington, New Zealand taking care of details before I start work.

Yesterday on the way out of Te Papa, the New Zealand museum in Wellington, two American tourists approached us and asked us if we’d enjoyed the museum. 

We had. 

They asked, How much is it?

Free, we said, and fell to chatting as American tourists do in other countries.

They came from California; they had been two weeks in Australia and would spend another two weeks sight-seeing in New Zealand.  

The subject of languages came up, and the female of the couple, a tall blonde, said a few things in Spanish, mentioning that she learned the language at LA Women’s Hospital where she’d worked as a nurse.

“No me digas,(you don’t say),” I said.  I worked there the month of July 1981, doing an externship during residency.  I delivered a lot of babies that month and I quit counting at fifty.

The nurse, it turned out, had been working in the same place at the same time, and had certainly worked with me.

Memories came flooding back.  My schedule in theory went twenty-four hours on, twenty-four hours off, and an eight-hour clinic.  The reality came out differently; after the twenty-four hours on I had to do postpartum rounds which sometimes stretched into late afternoon.

When I finished my long day, I would dress in shorts and t-shirt and go out into the barrio.  I would look for my favorite video game, Battle Zone, and play a few times.  When I had spent all the quarters I was going to, I would look for the dodgiest restaurant I could find.

At a time when, per hour, I earned less than minimum wage, I could spend two dollars and get enough really great food that I would need another eighteen hours to digest it.

Bethany, pregnant with our first child at the time, hung around the apartment till she figured out how terrible the schedule really was, and went off to visit friends in South California.

I don’t blame her.

I learned a lot about obstetrics that month.  I used that knowledge and enjoyed delivering babies for the next thirty years.  As time went on, my resilience faded to the long hours, vigilance, and sleep deprivation.  I gave it up last May.

Here in New Zealand, the midwife movement has pushed the doctor away from intrapartum OB for the majority of births, and an increasing number of deliveries happen at home.

Some of the docts fought the trend, as they’d built practices and careers on that segment of medicine. 

Decades ago I recognized that only an accident of history would have let men into attending births of babies.  I am grateful to have been part of that experience, and each delivery I did left me euphoric and awestruck.

But I don’t miss it.