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

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.


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