Archive for April, 2011

In praise of Beds R Us, Warkworth, Rodney District, New Zealand

April 30, 2011

The pain of an uncomfortable bed

Is a thing that fills me with dread

     Trying to make do

     Is like an ill-fitting shoe.

Get something better instead.

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.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to the clinic where I work in Matakana, north of Auckland.

When we arrived at the doctor’s residence in Matakana, a simple flat attached to the clinic, we became aware of the mattress’s deficiencies.  Still, looking ahead to a couple of weeks, we figured we could live with it or make do with improvisations.

First we bought a sheet of plywood at the lumber yard (here called a timber yard) next door, and had it cut to 140×200 cm.  We carried it on our heads, but when we arrived we became aware of a strong chemical stink. Not a problem, we thought, if we just leave the board outside till the smell evaporates. 

We moved the mattress off the box spring and tried sleeping on the box spring, which constituted a slow torture.  Neither of us could stay asleep more than six hours.  Three nights later we moved the mattress out to the living room (here called the lounge); the speed of the torture increased.

No matter what we did, every spring poked at me through inadequate padding.  My trochanteric bursitis, quiescent since I stopped marathoning in the early ‘80’s, reawakened. 

At about the same time we realized the hopelessness of trying to continue with the mattress, we decided to extend our stay in Matakana.  By then we hadn’t slept well in a couple of weeks, and my back, bad to start with, had me walking like a pretzel in the morning.

I emailed the office manager, saying that Bethany and I had decided to buy a new mattress.  As we couldn’t take it with us in our carry-on, we planned to leave it, and would the practice pay for half?

Bethany handled the matter with a quick trip to Beds R Us in Warkworth, Coast to Coast Medical Care refused to let us pay anything, and when I made the seven step commute home from the clinic that afternoon, the goods had been ordered and finances arranged.

When we went to bed Thursday evening, ecstatic waves of relief washed over us.

While one night on a bad mattress can be shaken off like a pebble can be shaken out of a shoe, after two weeks an uncomfortable bed becomes a parasite on the daylight hours, draining energy and sapping resilience.

I’ve written a lot about the importance of good sleep in this blog.  Bethany and I tried to remember a worse mattress, and we couldn’t.  But we still appreciate the quality of the new mattress every time we lay down.  In the long run, everything else an accomodation has to offer becomes irrelevant in the presence of an uncomfortable bed, but a person doesn’t realize that without experiencing a bad one.

Contrast is the essence of meaning.

Every CV should be verified.

April 28, 2011

 It would seem when you get to this stage

And you’re way past the minimum wage

     It can’t be a must

     To just take things on trust

When we’re all in the digital age

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.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to a clinic in Matakana, north of Auckland.

When the Maori arrived in New Zealand about a thousand years ago, they found two islands with no land mammals aside from three species of bats; birds dominated the ecology.  The Maori brought dogs and the Pacific rat, and the ecologic destruction began. 

After work last evening Bethany called me into the back yard to see an animal and asked me for identification.

Hedgehogs cause enough damage in their native environments that they have no legal protection.  Some misguided soul thought enough of the idea of importation that New Zealand now has hedgehogs, which wreak terrible havoc with birds and local plants.

This particular specimen appeared unsteady on his feet.  I had to get close to produce a decent image with my wide-angle lens.  Bethany warned me not to get too close; she remembered the day I came across a raccoon with the blind staggers (I had to shoot the animal on the assumption it had rabies).

Hedgehog in Matakana, at a distance of twenty centimeters

But it didn’t look like it could move very fast, and I got a good photograph. 

We took a walk for a half hour in the cool, clear, clean air, then we drove the harrowing narrow road back to Leigh for a dinner gathering.

We arrived early and I volunteered to cut vegetables.  I’m good at sharpening knives, and on this trip I learned how to use the back of a ceramic plate as a hone.  I sharpened four knives to razor edges, and Bethany gave me the signal that I’d done enough.

I sat next to a geologist.

New Zealand’s volcanic activity includes hot mineral springs that actively deposit gold, in stark contrast to most of earth’s gold, whose deposition dates back two billion years.  Both of us agreed that the most likely source of life on earth were the extreme environments of undersea volcanic vents.  I learned that most DNA sequencing is done using a thermophilic bacterium isolated from a hot spring with temperatures suitable for making hard-boiled eggs. 

New Zealand built a prison in a bog where the heavy metals borne from the earth’s interior include mercury.  The liquid metal can be found in places near the site, and the peat has enough to qualify as mercury ore.  The committee that placed the prison ignored the recommendation of the geologists.

The Southern Alps, the main range of mountains on the South Island, lie on a fault where the earth moves an inch or two a year.

Eventually, the conversation touched on groups, leadership, and credibility.  I talked about my experiences getting my medical credentials in New Zealand.

In short order the conversation at the table buzzed about the scientific head of the New Zealand Defense Technology Agency, who got his position on the basis of a fraudulent CV and held it for five years.

No one checked his bona fides.

I said I hoped the information I put on my forms hadn’t been taken on faith, that in the digital age it could have all be verified or generated via the internet, so why the heck would I have to fill out the form in the first place?

I guess because I’m a doctor, and not a top government scientist.

Slowing down: fifty-four, not seventy-two

April 26, 2011

Here’s a fact that I’ve found

This one I’m sure will astound

     It’s just fifty-four

     Hours, no more

But really, I am slowing down

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.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to a clinic in Matakana, north of Auckland.

ANZAC day commemorates the Australia-New Zealand Army Corps losses, first in WWI and then in later wars. It’s not my holiday because I’m not a Kiwi, and I volunteered to work the clinic today. This year the coincidence with the Easter weekend gave the country a four consecutive days off.  I tacked my fourteen hours today onto the fourteen I did on Good Friday and the twenty-four I worked the day after.  I worked at a reasonable pace, and got at least one break a day; today I took a morning and afternoon tea break and went out for both lunch and supper.

Yesterday evening I stopped being able to stay awake at 8:00 PM and went to bed; I slept soundly till 4:30.  Breakfast followed shower.  Without the anticipated traffic I arrived twenty-five minutes early.

Holiday business continued; as of 6:00PM I’ve seen twenty patients and done (or not done) phone prescriptions for 4 more.

‘Two patients have studies pending which I hope prove me wrong.

I looked at one patient whose dermatologic problem has failed to clear for nine years, and instantly disagreed with the previous diagnosis, in part because of inadequate response to medication.  I prescribed a skin creme, handed over my card, and requested a post or email if a cure resulted.

I treated six patients non-pharmacologically. 

I lost track of the number I told to quit smoking and drinking.

I made four patients better before they left; I cured one.

I did no defensive medicine.

When I went out to eat I walked down Wellsford’s main street in the rain, glad of my duck-hunting jacket and my cap.  I heard a couple speaking Spanish outside a cafe; I threw six words into their conversation and made them smile.  I wanted to stop and chat, to find out where they were from, and the forces that had acted on them to be here in this place at this time, but I walked on so I wouldn’t breathe their cigarette smoke.

They had left  by the time I returned; the nurse departed at eight and I spent the next two hours on-line researching my next placement.  When I turned out the lights and set the alarm at ten, I had worked fifty-two hours, twenty less than I usually work on Easter weekend. 

Pouring rain lengthened the drive home by twenty percent.  With light traffic, I fought the urge to break the speed limit along the straightaways.  I arrived in Matakana, the town was dark and quiet, and, like me, tired from the long weekend.

Tourists, Maori, and Pakeha; asthma, accidents and impetigo; drama and irony; just another Easter on call

April 23, 2011

Normal means little goes wrong

My Saturday session went long

     Not much of a purist,

     I took care of the tourists

They came off the road by the throng.

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.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to a clinic in Matakana, north of Auckland.

To the delight of my colleagues I work Easters, usually signing up for seventy-two continuous hours.  This year, though, I had to ask four times, and ended up with fifty-four hours.  I kept reassuring the office manager that I was happy to do so.

Wellsford sits on State Highway 1 an hour north of Auckland.  The divided highway gives up halfway to the rough-paved two-lane.  On Friday morning the outbound holiday traffic backed up four kilometers before Wellsford.  I inched along for twenty minutes, arriving on time when I had given myself fifteen extra minutes for delays.

The holiday hypomania permeated the clinic as we prepared for the tsunami of the ill, injured and worried.  Our 8:30 opening patient called from the traffic jam, begging our forgiveness, pledging to arrive as soon as possible but probably fifteen minutes late.

ACC, or Accident Compensation Corporation, accounted for most of the traffic on Friday.  Decades ago the New Zealanders recognized that accidents happen and established a governmental agency to pay for medical treatment for those injuries, in the process doing away with the basis of most tort claims.

Five of Saturday’s thirty-eight patients needed a blue ACC 45 form completed.

Four were Maori, thirty-two were Pakeha or other resident New Zealanders, two came from other countries.  Fourteen were children, twenty-four adults.  I dealt with five by phone or fax and the others face-to-face.

Thirteen had problems involving the skin, including three viral rashes, one case of jaundice with severe itch, two significant traumas, and seven superficial skin infections.

Four had asthma.

Twenty three lived outside the Rodney District; on vacation (which the Kiwis call holiday), most came from Auckland.

One drove an hour to get here.

A fall with a dramatic, bloody consequence led me to a flurry of calls to helpful registrars (the equivalent of US senior residents) until I got the proper surgeon, who instantly agreed to the consultation and gave a couple of helpful hints.

I used the term bicycle, grain sack, grinder, fish hook, and drill when I filled in the Mechanism of Injury section of the ACC 45.  I had to search the computer to figure out how to code lacerations, sprains, fractures, contusions, and puncture wounds.

The real human lessons of trauma have no slot on a form; no government agency collects statistics for patient learned and won’t get injured again, patient still has no insight and will reinjure, adolescent patient acquires life-long damage just because he/she hasn’t figured out how to deal with growing limbs, patient drinks too much, machine injures inventor who intends to redesign, or safety equipment hanging within arm’s reach.

Asthma accounted for another seven patients, worried well for one.

On five occasions I politely but firmly set a limit of one patient per appointment.

With the doors closed and locked, the last patient of the day called; I did not get permission to mention clinical details, nor, given the situation, did I ask.  I can say that every neurotransmitter has a receptor in the intestinal tract.  We all know that high emotions bring abdominal problems, that ambivalence makes our guts roil.  I wanted to say yes to the patient’s request for a home visit, just to view the drama and irony first hand, but travel time to the venue would have put me past my fifteen-minute radius.

An extremely short commute and a frightening first patient.

April 21, 2011

Sometimes I need to talk fast

When the ambulance is tuned up and gassed

     It’s like a commercial,

    But not controversial,

It resembles a blast from the past.

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.  On assignment on the North Island of New Zealand, I’m living in an apartment attached to a clinic in Matakana, north of Auckland.

I got up early for my weekly meeting with Care Initiatives Hospice; with a seven-hour time difference, my 6:00 AM corresponds to Iowa’s 1:00 PM.  The meeting went well; we got through the material for two dozen patients efficiently, and when things ended I stayed online, tidying up email and doing some literature research. 

I stepped through the clinic door at 7:00, before arrival of staff or patients, to shower.  We breakfasted with time to savor our food, and at 8:00 sharp I walked ten steps from my breakfast table to my desk and booted up my work computer.  The first patient showed up at 8:30.

Within one minute I suspected a problem requiring prompt treatment in order to avoid death, walked the patient across the hall to the treatment area, requested a diagnostic test and an IV, and said, “Call the ambulance.”

Four minutes later I had proof of diagnosis.

I called the medical registrar (the equivalent of a US senior resident on the internal medicine service) at the North Shore Hospital, an hour away in Auckland, and a minute later she had accepted the transfer. 

In the late ‘60’s I dedicated three years to college radio, and in the process learned a great deal about human communication, lessons which have served me well.  Presenting a patient to a consultant by phone resembles a sixty-second radio commercial; I can communicate everything in a minute if I’m organized.  By now I have had a great deal of practice.

My colleague at the end of the line came across as crisp, professional, knowledgeable and friendly, and agreed with my diagnosis and plan, much like every transfer I’ve arranged here. 

By contrast, I remember during my Indian Health Service days when I had a patient with Reye’s syndrome.  I had the diagnosis in the first thirty seconds, forty-five minutes later I had the lab tests to prove it, but it took me two hours to work my way up the hierarchy ladder to the overworked chief resident.  I repeated the clinical story, the history, physical, and lab results for the fourth time.  At 2:30 in the morning, the remote hospital quiet but for a life-and-death drama, with no other connection than the telephone, I could hear the break in the overworked doctor’s voice, along with it something shattering in his soul, when he realized he couldn’t dodge the admission. 

I think the difference between the two scenarios boils down sleep deprivation; pediatrics residents in the early ’80’s worked 110 hour weeks when things went well, and the medical registrar I talked to sounded rested and motivated.

Twenty minutes after I called the patient back to my exam room the EMTs wheeled him out the front door, oxygen and IV going.

A move, a short commute, and two puzzling patients.

April 20, 2011

Sometimes it’s up to my care

For an unusual case here or there

     With symptoms so weird

     I’m left scratching my beard

For the patient has something rare.

 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.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand. 

Bethany and I moved into the doctor’s quarters attached to the Matakana clinic.  Much like a parsonage, it features a kitchen, lounge (=living room in the U.S.), dining area, utility room and closet.  The yard has four citrus trees, which fruit will not ripen during my tenure, and a tree with ripe fiejoas. 

I won’t miss the drive from Leigh with the narrow, noisy, winding road where speeds of 40 kilometers per hour (24 MPH) amount to overdriving the visibility and traction and risking a spectacular flight into the sea.

My commute consists of stepping through a door into the clinic area. 

Few people do the math when it comes to their travel to and from work; perhaps Jack makes $12.50 per hour, but if he works an 8 hour day and has a one hour drive each way, he effectively makes 20% less than Jill who lives next door to the shop and does the same work.

Today I had the pleasure of working all day and never being more than fifteen steps away from my bedroom.

I cared for people aged six to eighty-five; most of the business, as always, stemmed from tobacco and alcohol.  Superficial skin infections, here called “school sores”, continue to be a major source of business. 

Several people came from the UK, a few came from Pacific countries.  I talked to one, not a patient, who had grown up in Matakana, and remembered the clinic building when it was home to a family with two deaf parents.

I took care of more than one puzzling patient; both presented with fatigue.  Both concern me, one more than the other. 

Sometimes a patient has a rare problem, or a common problem that presents uncommonly, or limited communications skills, but in any case presents an intellectual challenge.  My chance of making the patient better is inversely proportional to the number of years the patient has had the problem and the number of doctors the patient has seen.  Sometimes I nod sagely, reassure the patient that, for example, Mayo Clinic has done a fine job of making sure there’s nothing really serious.  From time to time, I finish convinced of a major disease ravaging the patient and equally convinced of my ignorance. 

I anticipated a difficult member of the “worried well,” and asked the nurse to sit in on the visit.  In less than three minutes I felt myself to be in the good company of a range of doctors who had missed a significant diagnosis.  I found several abnormalities on physical exam, but nothing straightforward. 

Galileo said he had seen so far because he’d stood on the shoulders of giants.  I told my challenging patients that if I found a rare diagnosis, it was because the other docs looked in the reasonable places first and I knew where not to look.

Valuable lessons learned from an unreliable cell phone

April 17, 2011

Whether tool or weapon or crutch

For patients and family and such

     It’s not that I’d shirk,

     But if my phone doesn’t work

I don’t worry about being in touch.

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.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand. 

In residency, a mentor who rightfully commanded a great deal of respect talked about the responsibility of being on call.  One evening early in his career he’d had a glass of wine with dinner, and when duty brought him into the hospital for an after-hours call, the patient smelled alcohol on his breath and commented on it.  Subsequently, that doctor would never drink in town.

One evening, during those days, I came back to my apartment exhausted after a hard night of call followed by a long day of work, and fell into an iron-clad sleep.  Two hours later a patient’s relative phoned.  I tried to talk intelligently but it took me a good five minutes and a review of everyone on my census before I had fully awakened.  I tell the story sometimes because it gets laughs, but I can still remember the active struggle for consciousness, the feeling of mental molasses behind my eyes.

Eight months later, while on OB call, after I had given myself whole-heartedly to sleep in the residents’ call room, the phone rang at 2:30AM.  I kept falling asleep trying to get out of bed, tie my shoes, and get out the door.

A few more embarrassing incidents like those taught me how to not fall completely asleep.  I think most doctors have similar experiences during their training; for one reason or another, most of us cannot sleep well when we have call.

I knew a doctor who slept as well on call as off; he said he just told himself he wasn’t on call right before he went to sleep.

Another physician of my acquaintance avoided accessibility.  To the consternation of his partners, he refused to get a cell phone.  His beeper’s notorious unreliability came from failure to charge and failure to carry.  In the last year, I’ve come to understand that his cheerful good humor and the depth of his emotional resilience stemmed from his ability to get restorative sleep on call and off, and his capacity to relax and recharge when not working.  I don’t think he’s capable of burn-out. 

Three companies provide cell phone service in New Zealand.  My agency issued me a cell phone when I arrived; and, whether from hardware, software, or service issues, it didn’t reliably receive calls.  Frustrated at first, I learned how to not worry if I went out without it.  I have since become accustomed to not having a piece of my mind devoted to vigilance.  Though the agency replaced that phone with one from a different company, I sleep as if no one’s life depends on me awakening promptly.  If I’m on call, I’m on call, and I stay at the clinic.  When I’m not on call, we walk away from home and I don’t bring my phone.  We stroll down to the beach and I don’t run up out of the water to check my beeper. 

Yes, I work 40 or 50 hours a week.  I still feel like I’m on vacation.

Four couples on the beach, and a supper better than planned

April 16, 2011

I said, as I squeezed my wife’s hand

And we stood ‘twixt the water and sand

     “What better setting

     Than a beach for a wedding

Things turn out better than planned.”

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.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand.

In the later parts of yesterday’s leisurely afternoon off, Bethany and I walked down to a beach about a kilometer away.  Cars whizzed by us on the steep winding road down, the only possible destination the car park at the bottom.

Under cloudy skies, we realized on our arrival at the Matheson Bay Beach that we’d found a wedding in progress, about a hundred and fifty meters away, at the other end of the strand.

We spied a couple floating on a raft, another swimming, and we shed our t-shirts and outer wear undeterred by the festivities.

I waded into the salt water, then dove in and swam ten strokes out.  I trod water and encouraged Bethany, who immersed more gradually.

She didn’t mean to show off, but she is a strong swimmer. 

The couple on the raft, younger than us, and the other couple in the water, older than us by a decade, finished swimming and left the water.  The day waned and we came out of the surf as the music from the wedding drifted across the sand, barely audible over the waves.  I thought about the maturation of relationships and how a beach can set the scene for romance, even by the Arctic Ocean.

This morning the power went out.  Most of the houses in Leigh rely for water from tanks filled with rain, and, without electricity we had no pump.  We drove through a light drizzle to the Matakana grower’s market; we bought locally made macadamia nut butter.  By the time we came back, the rain had changed to a downpour and power had been restored.

We had failed to buy groceries or plan for supper tonight; we didn’t make reservations at the Leigh Sawmill Café, and we didn’t want to drive back to the trendy, expensive Matakana eateries.  Nor did we want to have fish and chips again.

Which left the Portside café as the walking-distance option. 

While the sun set we strode past glorious trophy homes with For Sale signs hard by sheep pastures and weather-beaten houses in over-grown lots.

A crowd of Australian fishing tourists drinking beer filled the two rooms.  As we seated ourselves, Bethany pointed out a snail on my seat cushion, and we started to wait.

While I enjoy the New Zealand’s custom of not tipping, I have to admit that service suffers.  After a bit, Bethany got up and brought back a menu, while the Aussies continued to wander in and the noise level went from loud to painful.

Nothing on the menu looked appealing.

On the way home we discussed dinner possibilities.

“We’ve got bread and cheese,” I said.

“I could make grilled cheese sandwiches,” she said.  We walked on.  “With onions.”

I said, “Mm, we have lots of onions.  I could fry some with the last of the mushrooms.”

“And we have those olives.”

Supper came out as a smashing success.  I took my time sautéing the mushrooms, caramelizing the onions. 

We agreed that supper at home turned out far tastier and more relaxed than anything we could have bought.

Lying to myself: something I don’t have much experience with and I haven’t practiced much.

April 14, 2011

 

At the clinic for my overnight stay

On a bed with a mattress I lay

    I’ll tell you why

    To myself I did lie

And woke rested at the breaking of day.

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.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand.

I took call last night and stayed in Wellsford. 

The clinic proper has two emergency bays, three cubicles next to the nurses’ station, a procedure room, an x-ray room, a good-sized phlebotomy room, a waiting room, six doctor’s offices, a birthing center, and a small administrative area,.

The downstairs staff room, 20’x20’ has a microwave, fridge, sink, lockers, and dishwasher; it adjoins a smaller call room with a bed and a non-working TV.

The clinic day went well.  I took care of patients aged 6 weeks to 85 years.  I saw a lot of asthma, impetigo, high blood pressure, high cholesterol, diabetes, accidental trauma, and the ravages of alcohol and tobacco.

After not seeing a new case for more than a decade, two patients came in with thoracic outlet syndrome.  The bundle of nerves that go to the arm (the brachial plexus) have to pass over the first rib and under the collar-bone on the way out of the chest.  If that gap narrows, pinching the structures, the person feels numbness and pain down the arm; intensity of symptoms depend on the position of the body and extremity.

Many people have come to me over the years certain that the infection in their nose needed antibiotics, only to have me tell them that they had a cold.  A patient, who gave me permission to include more information than I have, came in certain he had a cold, only to have me tell him he had an infection in the nose.

I turned down a request for a “sickness benefit” (income from the government while a person is ill); after we discussed the situation, the patient agreed with me.

I’m getting more efficient at filling out the paperwork for the truck drivers’ physicals. 

I finished with the last patient by 8:15, the nursing staff went home and I turned off the lights. 

Once I asked a doctor who took a horrendous amount of night call how he slept well if he knew his beeper might go off.  He said he just told himself he wasn’t on call.  I’ve asked around, few doctors manage the vigilance problem that well.   But for the first time last night, I believed me when I told myself I wasn’t on call, and when I turned out the light, I slept soundly.

In the quiet of the empty building I sat and read a two-day-old paper.  An article on page two of the New Zealand Herald used the Maori words korowai, karakia, marae, whangai’ed,  and hapu without translation.  I understood all of them.

The sun is up now, I can hear the people in the clinic tramping around upstairs and I’m ready for a day off.

Seizing the day: a dip in the Pacific after a terrifying drive on a day off

April 13, 2011

 
I have no driving devotion

On arrival I gave into the notion

     If the drive gave me fright

     Before the coming of night

I’d go for a dip in the ocean.

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.  After a six-week assignment in Barrow, Alaska, the northernmost point in the United States, I’m working on the North Island of New Zealand.

Matakana, in the Rodney district of New Zealand’s North Island, bustles on the weekends with out-of- town folks who buy at the growers’ market and the crafts fair. 

Local products include fiejoas, avocados, pears, peppers, lemons, cheese, soap, olive oil, bread, baked goods, kiwi fruit, jams, chutneys, nut butters, chestnuts, fritters, free range organic eggs, and smoked salmon. 

Two narrow highway lanes carry traffic along the east edge of town by the river.  Matakana Valley Road leads west from the rotary through town.  A cinema shares a roof with a wine store, restaurant, yoga studio, hair salon, and bar, and one can enjoy a fine vintage in a good glass while watching a movie.  Four cafes, two restaurants, a coffee bar, two grocery stores, a surf shop, a pottery, a butchery, a bakery, and an auto mechanic line the road before the medical clinic.  Town lasts 800 meters, then the asphalt stretches out in the distance to green hills, lush with grass, dotted with sheep and cattle. 

On a weekday like today, cars, semis, and farm vehicles amble up and down the pavement, and Matakana life looks like rural Iowa.

We arrived early and parked on the street outside the medical facility.  The front part has the waiting room and a consultation room each for the practice nurse and the doctor.  The doctor’s quarters attach to the clinic area, with a communicating door; the doc currently living there, also a locum but nearing end of assignment, had a day off.

Bethany walked me to the door, gave me a kiss, and went about her business.

I attended fourteen patients in the morning, and refilled prescriptions for two more.  I saw patients for diabetes, hypertension, high cholesterol, superficial skin infection, and viral rash.  I advised several to check the website checkyourdrinking.net to avoid being judgmental (something I tend towards) about alcohol overuse.  I filled out forms for three patients injured by accident.

In the last week I’ve helped four groups of patients deal with the drama and irony of sexually transmitted diseases.  No matter how enlightened our society seems, STDs bring a tremendous emotional impact.

At half past twelve, Bethany came to collect me for my afternoon off.  I powered down the computer, and we went down the street to a café for lunch.  Then we walked down to the rotary so I could photograph the world’s most aesthetic public restrooms.

The world’s most aesthetic public restrooms, viewed from the rotary

At our next stop, Warkworth, we picked up a Vodem so that I can connect to the Internet, and we went grocery shopping.

Food prices here shock me; eggs cost $3.00 a dozen, whole chickens fetch $4.00 a pound.  But with locally grown produce coming in at harvest, onions came down to a dollar a pound, and avocadoes to$.60 each.

We dropped the groceries at the house in Leigh, and set out for Pakiri (PAH kee ree)Beach.

Six of the next eleven kilometers of narrow, steep one-lane gravel roads, in one place waiting to slide off into an abyss, constituted the most terrifying driving experience of my life, made worse by the idea that I had to go back the same way. 

At the beach, Bethany noted the falling temperatures and the descending sun and declined my urgings to swim.  I, on the other hand, having paid for my arrival with fear and unsure that I’d survive the return trip, would not be deterred by signs warning of life-threatening rips.  I strode across the sand exposed by the low tide, waded into the surf, dunked enough to swim a stroke, and came out.

During the summer I’d gone salt water swimming in the Arctic Ocean, which has no tides and no breakers; the air and water temperatures stood at 42F (5C).   Balmy by comparison, my dip in the Pacific proved again that contrast is the essence of meaning.