One week in Dunedin….

It’s difficult to imagine it has only been one week since I arrived here.  What was so foreign a week ago, was less novel a few days later, is now almost a routine.  But then, if things ever get dull, I can go to the hospital.

“Nil by Mouth” is a sign posted by someone’s bedside or the door to their room.  It’s English, or course, and we can figure out this means to not give the patient anything by mouth, for fear they may aspirate (for example if they had a stroke).  In the US, we do something similar, but our signs usually read “NPO”.  Don’t try and pronounce this (if you tried, we might think you were having a stroke…..since it would sound like ‘nnnnnn poh’, and then we would have to admit you to the hospital….and starve you.).  In the US we are BIG into acronyms.  I mean BIG.  That’s one thing I noticed right away here….LTNA (little to no acronyms….do you see how clever that  was?)  Let’s take the same, fictitious, patient and have that patient admitted to a hospital in the US and then here in Dunedin, and see how differently the doctors describe him.  When the doctors use an acronym, I’ll put the real words in parenthesis for those of us who aren’t medically inclined.

In the US, “This is an 80 year old male admitted for ICH (IntraCranial Hemorrhage.  or a bleed in the brain).  He has a h/o (history of…meaning he has these diagnoses in the past), CHF (congestive heart failure, or a weak heart), CKD (Chronic Kidney Disease), BPH (Benign Prostatic Hypertrophy, or an enlarged prostate), DM (Diabetes Mellitus) and TIA (Transient Ischemic Attacks, or strokes that have resolved in one or two days).

In Dunedin, now, the same patient:  “This is an 80 years old man (note they said 80 years-not year- old, and they said man, not male.  Male, of course, is an adjective.  The subject described in the US encounter could have been an 80 years old gorilla, but we do often assume things, such as we are talking about human primates, and not the more hairy, banana loving kind).  He collapsed at whilst at work, and was found to have an acute intracranial hemorrhage.  His past medical history includes left ventricular heart failure, chronic kidney disease, prostatic hypertrophy and two prior TIAs.

They are not immune to acronyms here, they are simply used on the order of several fold less.  It should be, therefore, much easier to understand what everyone here is saying, but I’ve also noticed the accents get in the way.  Particularly so in the hospital, which is a melting pot of English speaking folks.  I thought, before I arrived here, I would just have to adjust to the New Zealand accent (and it’s true, I do need to adjust).  But, on my ward service are doctors from the England, Scotland, Asutrailia, Ireland, and New Zealand.  There have been time on ward rounds, when I notice subtle differences in accents, I begin to wonder where that person is from.  This, however, is not a recommended practice, because then someone will ask you a question on rounds, like, “Doctor Clarke, what do you think?”, and then I’m forced to start making stuff up, not waning to admit I was pondering the subtle differences between the English accents.  I thought it was just me who had difficulty with the accents, but today I went to Grand Rounds (a fancy way to say a lecture….but Grand Rounds sounds some much….well, Grander) and when the presenter asked if there were questions, a doctor in the front row (it’s always the doctors in the front row who ask the questions, I’ve observed) asked a particular long winded question (that usually means they are not interested in the the answer to the question, they just want everyone to hear how smart their question appears).  My New Zealand colleague, after hearing the question, turned to me and said (and I’m not making this up),  “What the hell did she just say?  I couldn’t understand a word she said.  She must be from Scotland.”

Another interesting difference here is the hospital fashion.  Not  the doctors so much, but the patients.  In the US, when you go the Emergency Department and/or get admitted to the hospital, the first thing they have you do is take off all your clothes, and they give you a gown, which “opens” in the back.  It’s usually just seconds after they check your insurance card until you’re in the gown.  Here in Dunedin, the patients in the hospital are most often wearing their own PJs, or robes, or even street clothes.  It’s really very interesting what people choose to wear.  I would show you, in pictures, but the higher ups frown on that sort of thing.

I’ll close today with another true story.  On Sunday I drove out along the peninsula to go fishing.   It was a quick trip, mostly to scout out potential fishing spots for when I have more time.  On the way back, there were many people biking (the Otago Peninsula is one of the most touted biking destinations in the world), walking, and jogging.  People here do seem to be into the outdoors…and fitness.  It was all ho-hum, until I passed this man……

I passed him in my car, slowing down to both not run him over and also to ensure I saw what I thought I saw.  Indeed, he was jogging with a goat.  I pulled along side the road just ahead, because I HAD TO get a picture of this.

I was stopped along side the road just ahead of him, and as he caught up to me he slowed down, and again, I couldn’t make this up if I tried, he said, “Hey, do you know whose goat this is?”

“No.” I answered, wondering why he thought I might know (since I was taking pictures).  That’s just the kind of place Dunedin is, where you can go jogging along the bayside on a beautiful Sunday afternoon, and a goat…not even your own goat…can decide to just come along for the jog.  I like it here….I like it a lot.

Coming up….shopping in Dunedin.

Cheers,