Archive for May, 2011

I was just finishing my souffle when the police came to pick me up.

May 31, 2011

Too late for the one on the rug

To meet or to greet or to hug

     It wasn’t a hunch

     I hurried my lunch

And nobody pulled out the plug.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  Right now I’m living in Amberley, and working the last four days of a four-week assignment in Waikari, less than an hour from quake-stricken Christchurch, in New Zealand’s South Island. 

I was just finishing my lunch souffle when the police came to pick me up.

I stepped out the staff door and got in the car.

I had had a full morning. Complicated clinical problems intertwined with the ravages of tobacco and alcohol. Inescapable realities stalked the clinical landscape: gravity, mortality, Newton’s laws of motion, and the fact that two objects cannot occupy the same space at the same time.

I took care of as many people by phone and message as I did face-to-face; lab results rolled in one after another, some demanding treatment, others demanding neglect.

As I was getting ready for lunch, the police called.

Bethany had dropped me at the Hurunui Health Center, aka the Waikari Clinic, early in the morning, taking the car into Rangiora to do some grocery shopping.

Thus without transport, I told the police I didn’t mind, I’d be happy to help, but they would have to send someone to pick me up. 

I didn’t exactly bolt my food, but I didn’t savor it, and I didn’t have time to heat it up.  I had no idea how long the task would take, and I didn’t know if I’d be able to eat once I got back.

The policewoman had just started to walk away from the blue and white cruiser when I stepped out of the door into the clear, cool sunshine under the brilliant blue sky.  We made small talk during the 6 kilometer drive.  South Island police don’t need to carry guns; tasers do well.  The methamphetamine (here called P) epidemic has started in a small way; it has made its usual criminal inroads in South Auckland.

We agreed that neither of us would be nearly as busy without drugs and alcohol.

The pavement ended and we continued down a gravel road to a narrow driveway.  By the house the space opened up; like most Kiwi yards it deserves the local term “garden,” well-tended and groomed, neat, free of junk.

I found the house cold, the drama and irony on the carpet.

The body lay on the floor, arms outstretched; the inevitable had evidently arrived as a surprise.  I noted rigor mortis (the stiffening muscles that come after death) and dependent livido (the red color where blood, no longer circulating, has pooled).  Still I knelt with the stethoscope in my hand and listened for the heartbeat that would never come.  I felt for the absent carotid pulse.  I tried to open the eyes to check for pupillary reflex, but the muscles controlling the lids had stiffened as well. 

I filled out the form the other policeman had waiting for me, confirming the person’s life had ended. 

A bumper sticker, I BRAKE FOR HALLUCINATIONS, graced the side of the refrigerator.

I looked around at the layers of uniqueness that had been the person’s life. 

I did my best to drink in the scene, but I didn’t have time to linger.

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While I’m away, tornados and floods hit close to home

May 30, 2011

Out here I still have to worry

About my friends on the River Missouri

     In the spring flowers bud

     But the rivers run flood

And they might have to leave in a hurry.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  Right now I’m living in Amberley, and working the last half of a four-week assignment in Waikari, less than an hour from quake-stricken Christchurch, in New Zealand’s South Island. 

When I left Sioux City a year ago (to the day) and flew to Barrow on the shore of the Arctic Ocean, I lost my concerns about the Practice Formerly Known As Mine.  I took a vacation from my worries. 

People on the North Slope might know about world events, but hold more interest in the whale harvest, Nalukaataaq, and the Fourth of July Parade.  Barrow ceased being the middle of nowhere and became, in my mind, the center of the universe.

I have never been able to control world events, and during my travels I started to take more interest in the happenings on the ground around me. 

The big September temblor in Christchurch made headlines last year at a time when I didn’t have New Zealand firmly on my radar, and I noted it only in passing.  I heard about the big quake in February, when I returned to Barrow, and took a ribbing from the hospital staff about my goals.  At the time, I didn’t know Christchurch’s status as the largest city on the South Island, nor did I appreciate the difference between the two islands.

American news interests me less now that I’m in New Zealand, and I’ve taken a growing interest in Kiwi doings, following, for example, the schism in the Maori Party that formed the Mana Party and the ongoing problem with the Christchurch rebuild.

I still take an eight-hour break from worrying every night (except call) because my cell phone doesn’t work reliably. 

Not that I’ve ever been able to solve world problems but when I measure my distance from hotspots in thousands of miles, I give them less energy.

Some American news can’t be ignored; the Joplin tornado story rated front page status here.  That twister struck literally too close to home.  I shake my head and I think about the Midwest.  Tornado season hasn’t come close to peaking yet.   This summer could set some terrible records.

Today I heard about rising waters on the Missouri River, threatening an upscale town close to my house.  I have good friends living there who, under orders from the governor, have moved out their personal belongings and sandbagged their homes, staying alert for an evacuation order. 

Via the Internet we have offered our Midwest home to those who need it.   There’s a big difference between problems you can do something about and problems you can’t.

Planning too much versus not planning: the optimum dances.

May 29, 2011

In the past I’ve done what I can

For the future, just making a scan

     I took a chance on a blunder

     To re-ignite wonder

Sometimes I still make a plan.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  Right now I’m living in Amberley, and working the last half of a four-week assignment in Waikari, less than an hour from quake-stricken Christchurch, in New Zealand’s South Island. 

Bethany and I taught and participated in a diet/exercise program, Ultimate Bodyshaping Challenge (UBC) for five years.  One of its guiding principles, “when you fail to plan you plan to fail,” rings true in a lot of human endeavors.

The opposite slogan, “just do it,” carries the message of spontaneity and adventure.

I have learned that both approaches carry validity.  I don’t know if I want to strike a balance or resonate between the two principles.

For years I did an inhuman amount of work, going top speed at peak efficiency sixteen hours a day.  I reached that level of productivity by knowing each step of the day before I got out of bed.  Such a system gets a lot done but lacks resilience and strains the psyche.

I faced a tradeoff: efficiency vs flexibility.  And while life is full of tradeoffs, I had gotten a particular mental set of what life felt like.

In the last year I’ve learned that slowing down 20% did away with half the stress (check my posts from a year ago in Barrow).  I also found out that I fail to plan a day and still enjoy it.

Bethany and I, with another physician/teacher couple, Cheryl and Larry, took an excursion via train from Christchurch to Greymouth, on the west coast of the South Island.  We arrived with few plans and no expectations.  The hotel we’d booked turned out to be 3 kilometers (1.8 miles) from the railway station.  We took a taxi out, dropped our bags, and walked into town on the beach.

I’d never been close to the Tasman Sea before.  I hadn’t read anything on the net, I had no expectations.  I watched the violent surf crashing a dozen meters from where I stood at the low tide line.  Rounded rocks, grey smooth granite and white and pink marble, dotted the light grey sand.

If we plan everything we do, and if everything goes according to plan, the world loses its surprise, and, with it, its wonder.  Encountering new things involves risk, but fear and risk don’t keep us stuck in a rut as much the mental set that tells us what life should be.

Yet without a plan I wouldn’t have gotten to the beach.

Where do we find the optimum between planning and spontaneity?  If we can’t define an end point, does an optimum exist? 

Or does the optimum shift and dance away, depending on our phase of life?

A rubber band on the wrist to help you forget: self-administered aversion therapy

May 26, 2011

If toxic thoughts you want canned
What you need is a plain rubber band
It never has missed
When placed on the wrist
Of a person’s non-dominant hand.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the brink of burnout, while my one-year non-compete clause ticked off I’m having adventures and working in out-of-the-way places.   Currently in New Zealand’s South Island, I’m living in Amberley and working in Waikari, less than an hour from quake-devastated Christchurch.

I live my life according to principles and usually I don’t have to prioritize them. Yesterday I did.

“Do what’s right for the patient” governs my professional life. “You can either be happy or you can be right” generally leads me to choose being happy in my personal life.

I had to choose doing the right thing for the patient, and, in the process choosing to be right.

I made the right clinical decision, the patient disagreed, and a confrontation followed.

I probably puzzled the next patient by being so happy to see him, but contrast remains the essence of meaning.

Though I enjoyed every patient after the first one, the gnawing, intrusive thoughts from negative interaction haunted me the rest of the day. I didn’t take my own advice.

We get time in a series of moments. When you get out of bed in the morning you can be certain that you’ll face good moments and bad moments, and most moments will be neutral. If you let the bad moments contaminate the neutral moments, you give them too much power. If you let the bad moments into the good moments, you’re giving up joy. And if you let hypothetical bad moments in at all, you’re missing the point.

I had some bad moments towards the beginning of the day. It had been so long since I let negative thoughts resonate I’d forgotten the rubber band trick.

Put a rubber band on your non-dominant wrist.  When you experience a thought that brings useless worry, pull the rubber band back twelve inches and let it go.

The psychiatric profession calls this technique “self-administered aversion”.  It works for any intrusive mind activity, including a name, phrase, or song that annoyingly gets stuck in your head.  It can do away with any habit if the patient is motivated enough to do it.

It doesn’t work if a person doesn’t want to change, and it will not modify a person’s basic personality characteristics. 

It serves as an aid to not remembering.

I slipped a rubber band on my wrist this morning when I left for work.  By now, I forgot why.

A day at the hot springs and a send-off in the evening

May 25, 2011

Buying food is a regular chore,

So we set off on a drive to the store

     We’re living like kings,

     We went to the hot springs

And we ate a few chocolates more.

Synopsis: I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the brink of burnout while my one-year non-compete clause expired, I’m working in out-of-the-way places and having adventures.  Currently I’m living in Amberley and working in Waikari, less than an hour from earthquake-devastated Christchurch, on New Zealand’s North Island.

I get Tuesdays off from the clinic in Waikari.

Rangiora, half-way to earthquake-stricken Christchurch, has the nearest large supermarket.  The drive lasts thirty minutes, five minutes longer than the drive from our home in Sioux City to the closest Sam’s Club, but here we drive on two-lane country roads, through small towns, past paddocks of sheep and horses.

After dropping the groceries, we headed back to Hamner Springs, stopping at a small chocolate manufactory in Culverden.  

Few people take the waters in the middle of the week during the off-season, and we found the tourist town wonderfully quiet.  I soaked in the hot mineral spring water pool while Bethany swam laps, and we lunched on very fresh blue cod at an Indian restaurant afterwards.

At six we walked from our apartment to the Amberley Medical Centre for a going away party.

One of the other doctors, originally from Dagestan, will be moving to Australia to be close to grandchildren. 

Dagestan, Russia’s most ethnically diverse area, includes the speakers of Tsez, the world’s most complicated language.  Children take ten years to learn to speak it properly (for comparison, English takes six, Navajo nine).  We asked a few questions about the region, and found out about the ethnic strife and rampant corruption.  Why, we asked, if they want to secede, would Russia want to keep  a fractious problem republic?  Oil and gas, came the reply, and we nodded then shook our heads.

Twelve people sat in the staff room and snacked on meat pies, quiche, sandwiches, and fruit.  Two bottles of white wine disappeared quickly; the two bottles of red went much slowly. 

I’ve attended a dozen doctor send-off gatherings; I was the center of three.  Each one evokes the term bitter-sweet. 

They include elements of celebration and grief coloring the universal human phenomenon of separation anxiety.

During this last year I worked at an installation which sees so much doctor turnover that welcoming and farewell get-togethers disappeared.  Other places where I worked threw them for students who only stayed a month.

At my sendoff from the Canoncito Band of Navajo the tribe gave me my exquisite silver and turquoise belt buckle, which since became one of the few material objects that found a place in my heart and daily life.

I couldn’t help but think of the celebration the Clinic Formerly Known as Mine put on for me when I left a year ago.  We lunched on steak and sushi, and the last going-away present, a soprano saxophone, helped make my summer the best ever.

Bethany and I walked back through perfect temperatures in the quiet New Zealand night.  We passed homes redolent of wood heating, and one stinking of burning coal.

Sights and signs you’re not likely to see in Sioux City

May 24, 2011

 

Sometimes in the road there’s a sign

It warns of what’s down the line.

     But if you see the sheep,

     Your horn you don’t beep.

And the deer have a very good dine.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  Honoring a one year non-compete clasue, I’m on sabbatical, having adventures and working in out-of-the-way places.  Right now I’m winding up an assignment in Waikari, while I live in Amberley, in New Zealand’s North Island.

Hundreds of sheep in the street, on my way to work. Streets of Amberley, New Zealand

 New Zealanders call a group of sheep a mob, not a herd.  The law plainly states that sheep on a roadway have the right-of-way.  While sheep are a fact of life here without which the economy would collapse, having to wait for a mob of sheep on the way to work came as a complete surprise.   I took this picture from inside the car, inside the city limits.  The border collies kept the sheep together, the drover stayed in the SUV, which, you’ll note, is driving on the wrong side of the road, for New Zealand.

Fur seal in the wild, reading the DO NOT DISTURB SEALS sign. Kaikoura, New Zealand

We took a drive last Sunday off to Kaikoura.  The city built a car park and tourist site at the tip of a peninsula.  As the fur seal population slowly recovered, the pinnepeds  established a colony, evidently proving that if you build it, they will come.  You don’t see fur seals hanging around the pedestrian paths in Sioux City, and, if you did, you’d never see them reading the Do Not Disturb The Seals sign.

When the sign in New Zealand says ! FORD, it doesn't refer to a brand of automobile.

Some people complain about the roads in Iowa.  Really, compared to New Zealand, the county and the state build and maintain roadways well.  According to current standards, putting a state road across a watercourse requires either a bridge or a culvert; here in New Zealand they just put up a caution sign.  I’ll grant you, they put up a really good photogenic caution sign.  On the other hand, if the caution sign in Iowa would read !FORD most people would think more about recalls than about flowing water.

Sign on feed store in Amberley, New Zealand. Really, they feed their deer on purpose.

New Zealand exports a lot of protein; for the most part raised on a sustainable growth of grass.  Feed stores in Sioux City provide for horses, calves, poultry, pigs, cats, dogs, birds, and fish.  You might be able to buy llama feed, which you could use on guanaco; and I know of a few ostrich farmers, so you could probably buy ostrich feed.   But I can’t think of anyone back home who WANTS to feed deer; those pesky Bambis just come into the yard and help themselves.  To everything including jalapenos, and they’re shameless about it; they even come into the front yard.

Rationing medical care: in the absence of an infinite budget, it only makes sense.

May 23, 2011

Out here where they’re grazing the sheep,

They know MRIs don’t come cheap

      The skin takes a beating

   Though winter is fleeting

And the snow never gets very deep.

    

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  Right now I’m living in Amberley, and working the last half of a four-week assignment in Waikari, less than an hour from quake-stricken Christchurch, in New Zealand’s South Island. 

This part of New Zealand lies as far south of the Equator as Sioux City lies north, but has a much gentler climate.

The trees shed more leaves every day, most have bare branches.  I found frost on the windshield one morning last week.

Still patients come in wearing shorts, albeit with three or four layers up top.  With the first day of winter only twenty-eight days away, and a dusting of snow most mornings on the Southern Alp peaks, I wear my jacket in the car. 

We haven’t seen central heating in New Zealand.  Our apartment has two space heaters and good sunshine during the day; we haven’t needed more so far, and I wear my jacket inside.  My medical consultation room has a switch marked HEAT, I turn it on and the room warms up but I can’t tell where the heat comes from.

I see lots of firewood piles; smoke rose from chimneys in Waikari on my way home.

Of course my clinic load reflects the change in climate.  Cold air dries when heated, and in turn dries out skin and medical problems follow.

Thus dermatology constitutes a disproportionate part of my case mix.  I saw patients today with scabies, eczema, ringworm, psoriasis, viral rashes, and impetigo; all received straightforward treatment. 

One pediatric patient came in with fatigue, poor appetite and fever.  The physical exam gave no diagnostic clues.  My dialogue with the parent (who gave permission to use this much information) boiled to two choices: do nothing and see what happens, or draw blood work and get x-rays.

In fact, in the US, I would order CAT scans of the chest and abdomen, because fear of lawyers drives the system.  The parent laughed at the idea.  In New Zealand, generalists like me can order CAT scans and MRIs only if the patient wants to pay for those studies out-of-pocket. 

I don’t find the idea insulting, in fact I rather like it.  In Iowa I relied far too much on CYA documentation and not enough on common sense. 

In Alaska, the nearest CAT scan machine resided at a distance of eight hundred air miles, and the over-worked specialists I talked to did their best to keep my patients away.

Here, the referral hospital in Christchurch maintains a website with excellent clinical information for the front line doctor, so that calls to registrars (the equivalent of US residents) go smoothly and efficiently.

The twenty-one District Health Boards effectively ration medical care when they decide what services are subsidized.  After all, with a finite budget, they have to set priorities. 

Demented octogenarians with sputtering neurologic symptoms, for example, don’t get a full neurologic workup.  Not only wouldn’t the government pay for it, but the families wouldn’t stand for it. 

When I made my weekly rounds at the Waikari Country Hospital, five of my seven patients (not the oldest one) struggle with dementia to one degree or another, but further neurologic work-up remains out of the question.  And no one expects it.

Retrospective: distilled aphorisms from last summer’s posts

May 22, 2011

It’s been now a year and a day

Since I left near the end of last May

     I’ve bettered my writing

     I’ve weathered weird lighting

And I’m not doing this for the pay.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the verge of burnout, I’m having adventures and working in out-of-the-way places.  Right now I’m living in Amberley, and working the last half of a four-week assignment in Waikari, less than an hour from quake-stricken Christchurch, in New Zealand’s South Island. 

My non-compete clause expired yesterday; I went over my posts from that time, and found the following pieces of truth:

One cannot go to discover new adventures without leaving home; mobility must be weighed against cost.

Life is full of tradeoffs.

Anyone who asks for medical care in the hallway deserves what they get.

Little is certain in life, especially when it comes to the future.

If “call” means twelve hours, the term carries fewer negative connotations than when it means seventy-two hours.

Two doctors who talk to each other will consistently give better medical care than one doctor, no matter how brilliant, who doesn’t converse professionally.

Cheese and crackers at leisure taste better than steak bolted.

Contrast is the essence of meaning.

Where there is cultural contact there will be gene flow.  It’s in the nature of young men and women.

Separation anxiety is a universal human emotion.

A toddler, given an object, will find a way to insert that object into an orifice.   

A cut needing stitches raises suspicions of a family under stress.

 People who don’t sleep well get sick.

You can’t know what you can’t know.

Stress and alcohol make things worse which makes drinking under stress a bad idea.

A thin young drunk runs faster than an aging, overweight, well equipped cop in Kevlar, but doesn’t get far because the cop can run in a straight line.

If you’ve seen more than three doctors for the same problem, the chances that I’m going to make you better tonight are not good.

No one can count anything after two drinks, especially not the number of drinks.

Every day I see patients I will see at least one thing I’ve never seen before.

Most lifelong scars are acquired under or near the influence of alcohol, before the age of 10 or between puberty and 25.

Things that seem like a good idea at the time turn out to be a really bad idea when alcohol is included.

High emotions make for high learning.

Every doctor faces information overload; prioritize or be swamped. 

The wonderful parts about day-to-day life lose their wonder when they come every day; but when we go and come back we can relish and savor the ordinary.

The line between work and friends got blurrier and blurrier as the years went on.

Economists have shown that people get happier in proportion to their money only until they’re slightly over the poverty line, then they get more unhappy with every extra dollar.  So don’t buy a lottery ticket, you might win.

More happens in a day of sitting around camp on an island than I care to write or than my audience would care to read.

All work and no play make Jack a dead boy.

Interpersonal respect, hours, money and benefits much be considered as a whole package.

If all the doctors had a sudden attack of sanity and stopped working life-shortening overtime hours, there wouldn’t be enough doctors.

Dead-end and bitterness define each other, and sap the joy from life.

You’ll enjoy the trip a lot more if you’re not in a hurry.

Forty years changes you more than it changes the road.

Chronic pain cannot be controlled in the absence of good, restorative sleep.

A year to the day, and the world didn’t end.

May 21, 2011

The moment is now and right here

It’s something precious and dear

     I journeyed because

     Of a non-compete clause

Now, to the day, it’s a year. 

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical while my non-compete clause expires and I dance back from the brink of burnout, I’m having adventures and working in out-of-the-way places. Right now I’m living in Amberley and working in Waikari, less than an hour from quake stricken Christchurch in New Zealand’s North Island.

Contrary to predictions, the world didn’t end today.  The earth’s destruction was supposed to start with earthquakes in New Zealand.

Christchurch suffered a large earthquake in September 2010.  The following February, a less powerful, closer temblor ripped the heart out of the city.

Geologists say that buildings near a fault line should anchor on bedrock, but Christchurch’s founders built on swampland, and the city rose on saturated soil.  If you shake dirt enough it acts less like a solid and more like a liquid, in proportion to its water content, and Cantabrians still talk about the stink of liquefaction.

Over tea at the clinic the nurses casually mention shattered heirloom china and crystal; they smile when they recount seeing cupboard doors open after the first quake and nothing broke

Yesterday two of my patients announced plans to return to Christchurch, asking for medication enough till they re-establish with a new doctor.

Nobody mentions the half-dozen GPs who died when the TV building collapsed around them; most have forgotten.

***

Three hundred and sixty-five days ago I walked out of The Clinic Formerly Known as Mine.  I worked there twenty-three years.

The decision to leave did not come lightly.  You don’t work for a couple of decades in one place without putting down roots. 

I was dancing on the edge of burnout.  I didn’t realize how close I’d come till I went back and read my posts from the spring of 2010.  But Bethany knew, and she supported me completely throughout this odyssey.

When I signed on with my old outfit my contract specified that I couldn’t work as a family practitioner within 30 miles of Sioux City’s city limits for one year.  That paragraph, enforceable when I signed it, would not hold up in twenty-first century Iowa court.

Still, I am a man of my word.  And if the desire to slow down provided my motivation for my career change, it made no sense to move straight across town and have my patients follow me.

I picked the best time in history to go walkabout.  The world has never been safer nor more prosperous; information, transportation, goods, and food have never had such quality and accessibility.

None of my original plans worked out, and I have learned that I have more fun with my second choice than my first, and to enjoy the moment that I have.

Today we walked around Amberley in perfect weather, with gloriously clear blue skies and bright sun.  Our dessert out reminded us of our wedding cake.  We have reveled in our second honeymoon.  We didn’t plan it that way.

A drunk with a cut

May 19, 2011

The laceration was open then shut.

Quiet? It was anything but.

     To sew up a drunk

    Took a two-hour chunk

But it was really quite a large cut.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical to dance back from the brink of burnout, while my one-year non-compete clause ticks off, I’m having adventures and working in out-of-the-way experiences.  Right now I’m living in Amberley and working in Waikari, within an hour of Christchurch in New Zealand’s South Island.

I had call last night, taking the four bags of resuscitation equipment in the clinic car.

At bedtime, I checked the two beepers and the three cell phones. Then I told myself, lying, that I wasn’t on call. I slept marvelously for two hours.

The beeper went off about 12:30AM.

The first problem I faced was not knowing which beeper went off, the second was trying to figure the beeper out. Eventually, I got the info from the parasitic collection of semiconductors and realized that I didn’t know what to do with the terse codes and abbreviations, followed by an address in a municipality I didn’t recognize.

I hate waking doctors in the middle of the night, especially when they’re not on call, but I had to phone my back-up.
He received the call graciously, and told me whom to ring.

By this time Bethany was wide awake.

With the full moon light streaming in the bedroom window, I explained to the dispatcher that I didn’t understand the system. She asked for my phone number. I realized I didn’t know it.  I heard her clicking keys in the background, and then she agreed to call me back

Ten minutes later I talked to the ambulance crew.

The problem involved a drunk and a laceration, and a ten minute ambulance ride.

Back home, I’ve figured out a system to slip out of the house with minimal family disturbance when I get called out in the middle of the night; here I still stumble around with the lights on.

The ambulance beat me to the clinic.

Having the key to the clinic and the code to the alarm system doesn’t mean I know where to find the key pad or light switches or how to actually disarm the system. I triggered the alarm, a deafening experience.  My ears are still ringing.

The St John ambulance crew, marvels of professionalism, kept the intoxicated patient calm.  I eventually found everything I needed.  I anesthetized and scrubbed the 7 cm (3 inch) gash and stitched it back together. 

After the laceration, the EMT’s worked with the patient to figure out disposition (not an easy task) while I wrote a note to the receptionists about billing and filling out the ACC45 form. 

I enjoyed driving through the sleeping town in the full moonlight, alone with my thoughts.

I got back to the flat two hours after I left, to find Bethany sleeping soundly.

I did my best in the moonlight not to need to turn on the light.  I dropped one of the beepers in the dark, discovering that I couldn’t really handle five pieces of electronics without pockets. 

I arranged them on the bedside table.  I could lie to myself again about my on-call status only because I trusted the multiple layer redundancy of my communications equipment.

I slept deep till the alarm went off.