Posts Tagged ‘Wellsford’

Getting good at saying goodbye, another great last day

May 7, 2011

I said “no” to some pills,

Said “yes” to other refills

     I didn’t cry

     But saying good-bye

Is growing as one of my skills

   Synopsis: I’m a family practitioner from Sioux City, Iowa.  Taking a sabbatical to bounce back from the brink of burnt-out, while my one-year non-compete clause ticks away I’m having adventures and working in out-of-the-way places.  I’ve just finished seven weeks in Wellsford, north of Auckland, on the North Island of New Zealand 

My last day in the Wellsford/Matakana area came wet and rainy.  I breakfasted on clean-out-the-fridge and leftovers. With my improved NZ driving skills the morning commute only took me 34 minutes.

Drama and irony ruled the day. 

I took care of two patients with dog bites, and while I examined them and filled out the ACC45 form, I listened to stories of unexpected violence and betrayal.

I fielded two requests for inappropriate medications.  One explanation: abusing one drug doesn’t warrant a prescription for another easily abused drug.  Another involved a pharmaceutical known to aggravate migraines in a patient with worsening migraines; when I denied the request I realized that the situation’s complexity ran deep.  Saying “no” cost more time than the rest of the visit put together.

A patient with a low-grade skin malignancy incompletely removed on shave biopsy refused to come in for complete excision, wanting to wait to see what happens.

I saw three cases of impetigo

At lunch the rain had stopped and I ran into another doc at the Tangiers Cafe.  We had a great time discussing cases and demographics.  The world can’t sustain current human growth without fossil fuels, we agreed, peak population will hit about 2050, after that the religious extremists will populate the world.  The doom and gloom didn’t keep us from enjoying our Mississippi Mud chocolate cake afterwards, nor did it dampen my appreciation of the dramatic sky on the walk back, clear blue and sunny to our left; dark, and threatening to our right, with a gentle warm drizzle.

A patient requested chronic pain relievers, to my surprise specifying Panadol (= American Tylenol) and a non-steroidal anti-inflammatory drug (NSAID).  Of course I said yes, glad I politely asked, “What would you like?” not, “Let’s get this straight, I don’t prescribe narcotics for back pain.”

Throughout the day, nurses and other staff came in to give me good-bye hugs.

On two occasions I said, “I don’t think you have a medical problem that warrants an income from the government, but, hey, it’s my last day and you can come back next week and ask someone else.”

A patient told me that the current relationship involved an alcoholic, bipolar, drug-abusing, sex-addicted partner but didn’t involve love.  I advised saying, “Don’t come back till you’re on medication and in AA for six months.”

When the pharmacy called I realized I mixed up names of the last two scheduled patients.  A flurry of paperwork always accompanies the last hours of a clinical tenure, and while I struggled to set the two prescriptions right and get the last few items signed, a nurse poked her head in. 

Sometimes Americans begin a request with  “Would you mind…”; Kiwis use “Would you be happy to…” I strode over to the curtained cubicle where I could feel a patient’s fracture.  Appropriate management had already started.  The requested medication constituted a lower potential for abuse; I walked the prescription over to the nurses’ area.

I left the clinic in the rain, saying goodbye to seven weeks of a rollicking good time.

I had a great last day, making six great last days in the last year, but I don’t want to be an expert at it.

I drove back to Matakana in the pouring rain and the deepening twilight.  Bethany and I ate Greek salad, garlic bread, and dessert at the Rusty Pelican.  Our packing process efficiency improves with each move; Bethany does most of it.  A torrential downpour over night produced a noisy overflow from the water storage tank, and 3 of the 5 hours we devoted to sleep went well. 

Unexpected time lost to a sticky garage door ate into planned get-lost minutes, but we dropped the rental car at the airport and arrived at the train depot ahead of schedule.

We enjoyed the twelve-hour train ride.  We napped and snacked and talked and joked.  We agreed that taking the train showed us more scenery than the plane and gave us more relaxation than driving.  A storm hit at sunset, with winds so violent the train rocked.

We arrived in the dark in Wellington.

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Chocolate, tornado, lemonade, ear wax, and a supervisory visit

May 3, 2011

Don’t even try to refute,

For this there is no dispute

     Could I get any closer?

     I tell you, No Sir!

Happiness is a shorter commute

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, I’m working on the North Island of New Zealand.

I started the day at leisure with a seven-step commute to my office.  I sat down promptly at 8:00 AM and started to review lab work.

In the quiet of the morning, early, before the first patient arrived, I found an alarming erythrocyte sedimentation rate (ESR) with the highest C-reactive protein (CRP) I’ve ever seen; both markers of inflammation throughout the body, I prescribed prednisone.  I don’t prescribe that medication often, and always in the context of getting a specialist’s opinion.

I can’t talk about patients and their medical problems without permission, but I can talk about myself and about medicine.  Yet diseases don’t come to me, people come to me; none of them perfect, each with flaws, quirks, a terrific back story and a family.  Every person who seeks my advice has a unique smell, voice, accent, style of dress and body language.

If a person presents with an ear wax problem, and I take the wax out with a simple instrument called an ear curette, I’ll tell them how to keep the wax problem at bay.  I make sure they’ve never had a hole in their ear drum and I instruct them to start with body temperature water and put in enough white vinegar that it smells like vinegar but not so much it feels cooler.  Then, I say, use a bulb suction syringe to rinse the ears out about once a week.

I saw another person today with appendicitis, making three since I arrived.  At least, I hope I saw the first case of appendicitis I’ve ever seen in a person who had enjoyed their lunch.  I worry that my patient has something worse.

I saw a person with a single distended vein where I’ve never seen one before.

I made referrals the general surgeon, ophthalmologist, urologist, neurologist, and orthopedist.

At mid-morning, I took a tea break.  While the fifteen minute hiatus comes built into my schedule, most mornings I use it to catch up.  Today I walked back through the apartment, picked a lemon from the tree, came back in, made hot lemonade and sipped it while I talked with Bethany, nibbling on some exquisite dark chocolate macadamia nut bark.

When noon came round we lunched while we watched the shocking, driving rain outside.  The first thunder we’ve heard since we arrived made us stop and listen.

The rain continued for the afternoon drive to Wellsford.

In accordance with the Medical Council of New Zealand rules, any doctor new to the system requires supervision their first year.  In this case my supervisor is the clinical director, and we met in the early afternoon.

I enjoyed the interview. 

A reasonable clinical pace.  I told people on asthma medication to quit smoking.   I gave others with high cholesterol levels instructions about diet and exercise.

Driving back to Matakana in the rain, we learned that the same storm that gave our afternoon’s deluge spawned a tornado, so rare in New Zealand that rating came only with difficulty.

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.

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.

First night call since December and I had to take it in-house

April 10, 2011

 

The question came up for debate:

To work or not to work late.

       A mistake in the roster

       A dilemma did foster  

In the morning I walked out at eight.

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’ve just finished my first night call since December.

At the end of my clinic day in Snell’s Beach I drove back to Wellsford.  Despite cognitive dissonance about who had call for the evening with my name on the roster and another doc on the computer template, I couldn’t face another forty-minute drive and made it look like I took the night’s assignment graciously. 

The anticipated chickenpox outbreak had arrived, the pharmacy (in Kiwi, the “chemist’s”) had closed, but I rooted through the after-hours drug dispensary and found a surprise supply of acyclovir.

Nitrous oxide and my yoyo tricks convinced a recalcitrant child to hold still to have a cast applied. 

As always, most of the evening’s pathology came from tobacco, alcohol and the immutable law that two objects cannot occupy the same space at the same time.

But I got the chance to quiz the people on life in New Zealand.

Agriculture supports the nation.  Farming divides into dairy and “dry stock” (sheep, cattle and deer).  An average dairy operation runs 300 head.  With one cutting of hay per year most farmers don’t know what grasses nourish their herds.  Deer produce almost as much revenue from antler velvet as they do from meat.  Wapiti (North American for elk) cross readily with English red deer and cannot jump a two meter (six-foot seven-inch) fence.

At eight, the end of the scheduled patients, I got a tour of the clinic’s emergency room, crash cart, defibrillator, lights, locks, dispensary, and alarm system.  The other doc, who had stayed to do documentation, left.  The nurse stayed longer than she had to.

I didn’t ask permission to give clinical information, but from 8:45 till 10:15 I took care of a Maori patient accompanied by family.  I got the gratification of hands-on patient care I usually delegate to the nurse.  I called an expert at a hospital an hour away, who gave me courage to use drugs in doses I’m not used to.  I found more medication in the dispensary, avoiding ambulance and hospitalization. 

I learned that the Maori language has changed in the memory of most Maori.  Some on the Maori channel speak classical Maori, a language richer in nuance than modern Maori, which is losing dialect variation.  The urge to absorb one’s enemies’ life-force and mana (a complex Maori word meaning strength, honor, and social standing) drove Maori head-hunting and cannibalism.  Traditional Maori tattooing was done with a chisel, not a needle, and went deep; any expression of pain would diminish one’s mana.

I finished with a new word in Maori, aye, meaning yes.

By the time I locked the door and turned out the lights I felt rumpled.  I stepped out downstairs into perfect temperature and smelled the early autumn and gazed at the stars. 

Fatigue didn’t slow the bouncing waves of the day’s human tragicomedy, and I didn’t have Bethany’s comfort and listening ear.  In a new bed, alone with my vigilance, shallow sleep danced with the day’s memories.

When the eastern sky lightened I dressed and snacked and read Thursday’s newspaper.  At 8:00 I gave handover (Kiwi for check-out) to the doctor coming on call, and at 8:05 I trundled out of Wellsford and onto the road back to Leigh, winding through hills greener than poetry, listening to the morning news breaking up in the valley’s radio shadows.

Chickenpox, shingles, and widows. Drama=irony, surgery=theatre

April 9, 2011

For lunch I had me a pie

I went back to work bye and bye

          I am no cheater

          If surgery’s theatre

I won’t make the audience cry.

 

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.

I arrived early at the clinic in Snell’s Beach and started work in the quiet of the morning.  With the doors of the clinic open to the sunny, cool air, I reviewed lab and x-ray results; four of fourteen needed follow-up.

When patients started, I refilled a lot of prescriptions, many of them for asthma.  A lot of kiwis have asthma, mostly unrelated to smoking.  The commonest combination, salbumetol and flixitide, would be called albuterol and fluticasone in the States.

In New Zealand, surgery refers to seeing outpatients.  What we would call surgery at home gets the word theatre here.  Thus whereas in the States “Have you done much theatre?” might mean anything from “What live acting credits do you have?” to “Are you gay?” the Kiwis mean “Have you done many operations?”

At lunch I stepped outside into perfect weather, with cool, breezy air and bright clear sunshine, and went to the bakery for an unhurried steak and curry meat pie.

Back at the clinic I’d started tidying up my documentation when the nurse said, “I know you’re still on your lunch break, but…” 

In fact, I’m not used to an hour lunch break; at home I got into the habit of bolting my meals.  Of course when I got the opportunity to do what the locals would call theatre to help a patient cope with the consequences of steel’s excess kinetic energy contacting flesh I said yes.

When I finished I found myself twenty minutes behind schedule.

I’d almost caught up by 4:00 when a patient asked for a letter for court.  I couldn’t contact the requesting lawyer.  I made it clear that both parties had to be comfortable with the letter, and I would only write truth but not conjecture.  I wrote, we edited, and in the end, the piece of paper left with the patient but the process took twenty-five minutes.

By 5:15 I’d seen 24 patients and written refill prescriptions for another.  One third of my patients, both male and female, mentioned their status as widows.  Half had been widowed more than once, all wanted to tell their stories, and the drama and irony of the human condition flowed raw and unrestrained.  I listened with sympathy.  At one point I mentioned the high rate of spousal death.  “Oh, yes,” the patient said, “Snell’s Beach is full of us.”

Four of the day’s patients had superficial skin infections.  One had shingles, and I remarked that if it didn’t presage a chickenpox outbreak it would constitute a unique experience in my career.

I drove the rough, narrow, winding road with dense traffic and courteous drivers to the clinic in Wellsford.  I checked in with the nurses, and a flurry of confusion followed.  With my name on the roster (as they call the schedule), and another doctor’s name on the computer template, I had the option of taking off and going home.

The thought of another forty minutes on the roads pushed my decision to take the night on call, thereby earning me a dinner break and collegial gratitude.

I walked down the street, gobbled mediocre steam-table Chinese food, and walked back in the gathering gloom.

The anticipated chicken pox outbreak had arrived, the pharmacy (in Kiwi, the “chemist’s”) had closed, but I rooted through the after-hours drug dispensary and found, to my surprise, a good supply of aciclovir.

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Day off vs. being a team player, an easy choice.

April 5, 2011

I awakened feeling so great

From the hour I’d spent sleeping late

     The best of the best

     Is getting good rest

And I said yes to working at eight.

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.

Today was my day off, and the first work day after daylight savings time ended. 

Bethany and I slept in, awakened feeling rested as the sun rose, and talked about what we would do for the day.  Breakfast to start, then we’d go to Pakiri Beach, and actually take a swim.  After that, we said, we’d go to Sheep World, where the trained dogs show how great they are at making sheep do the right thing. 

I sautéed onion, Portobello mushrooms, green peppers and locally smoked fish in olive oil, opened four eggs, waited till the right time, then broke the yolks and stirred things up while the cheese batard toasted. 

We ate outside and marveled at dramatic clouds in blue skies over rippling seas.  We commented on the lack of surfers.

We had finished our leisurely breakfast, just starting to clean up when my phone rang.

The cell phone that the agency obtained for me has not worked reliably.  It makes a chirping noise when I leave or enter the service area.  It chirps a lot, understandable while driving New Zealand back roads, not understandable when it just sits on the table.  When it rang, I asked Bethany what the noise was.

“It’s your phone,” she said.

The office manager asked if I would mind working the Matakana clinic that morning, as one of the other doctors had taken ill. 

I keep trying to be the best team player on the field, and I saw a golden chance to further my goal.  “I’d be happy to,” I said.

She asked if I would be happy to work the afternoon clinic at Wellsford as well.

I told her I’d wanted to talk to Bethany about it, and asked for forty-five minutes to get to Matakana.

During the flurry of clean up, I realized that the other doc had probably been scheduled for the Wellsford clinic in the afternoon.  When I called, the manager confirmed that to be the case, and I told her I’d be delighted to help out.

I realize that in the process of slowing down I should choose leisure over work consistently.  On the other hand I faced a thirty-two hour week before I agreed to take the two sessions. 

And I couldn’t forget all the times my colleagues had filled in for me when I came down with strep or faced a death in my family.

 I had the best part of the day off: an unhurried awakening and breakfast.

It didn’t hurt that I sleep better knowing I can’t do anything about my phone’s unreliability.

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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.

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).