Sometimes I know more than the consultant.

I walked up to the hospital grounds

To make my weekly grand rounds

     But I’m a better neurologist

     Than the on-call nephrologist

Though I know my clinical bounds.

Synopsis:  I’m a family practitioner from Sioux City, Iowa.  On sabbatical avoid burnout, while my one-year non-compete clause ticks away I’m having adventures and working in out-of-the-way places.  Right now I’m on assignment in Waikari, in New Zealand’s South Island, an hour outside of Christchurch.

I started my clinic day with rounds at the Waikari Country Hospital.

Of the seven patients, one came for terminal care, three for respite, and one for long-term post-op recovery.   The other two, in the United States, would reside in nursing homes.

Every person who needs long-term care because of age-related problems could tell incredible stories; generally I just start the ball rolling.

One of the patients remembered watching the Germans enter his border village at the beginning of the war and leave at the end.

New Zealand registered nurses, empowered to make therapeutic decisions in diabetes and hypertension, among others, are not allowed to transcribe.  Thus weekly hospital duties include writing name and dose of each medication, time of dosing, route of administration, maximum dose per twenty-four hours, indication, my signature, my printed last name, the date, and my initials; I have to do it for every patient.  I didn’t complain about the busy work and reveled in the joy of being the lowest man on the totem pole.

I also had to draw blood on one patient. 

I learned a long time ago that if doctors had to carry out all their orders, they would give fewer orders.  In the month I worked as an intern at Denver Children’s Hospital I developed strategies to avoid IV’s.

I walked back to the clinic, the Southern Alps and their new snow caps in the distance, the sheep in paddocks in town grazing on the greenery, the cool wind in my face.

Before my morning patients, the two docs at the clinic met with the Plunket nurses.

Founded in 1907, and financed by the government, Plunket Clinics provide early childhood counseling and care throughout the country.  Nurses here do the well child checks; while they do a good job I would miss seeing the grand spectacle of watching babies becoming children becoming adolescents becoming adults becoming parents.

I took care of a lot of farmers and farm families today.  I talked to a sheep stockman and learned how standard selective breeding developed sheep that gain weight faster and on less grass.  I discussed my slowing down and semi-retirement and he talked about being able to work smarter for less money with a great global market for his product.

I saw two patients with three rugby injuries today, and had to refer one into town.  I called the medical center, asked for the neurology registrar and got the nephrology registrar.  “Sorry,” I said, “I’ll ring back.”

“No, don’t,” she replied.  “After hours we share calls and it’s after hours by…um…five minutes.” 

As a front line doc I have to know when I don’t know and know who knows more than me.  When I figured out that I had more neurology than the physician I was talking to, I politely backed out of the conversation and called the Emergency Department.