What’s Different about Dunedin

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I’ve been here eight weeks.  Long enough to wake up some mornings and wish I didn’t have to put on a tie.  Long enough to, within a single day, both feel as if I belong here and then long for home.  Long enough for my colleagues to think I’m pretty funny….for an American.  Long enough to see, no matter whether you stand and look West or East to the Pacific Ocean, we are all more similar than different.  But even with all its similarities it is a different experience being a doctor here.

I cannot, of course, give any details which would identify the patients or families I’ve cared for, but despite shading those demographics I think I can provide some perspective on life here as a doctor.  Some of these things are probably only of interest to others in the medical profession, and some are human stories which I hope would have a broader audience.

There are difficulties in the transition from practicing medicine in the United States to New Zealand.  The first thing I noticed was the way in laboratory tests are reported.   While some tests are reported in the same units as they are in US, most are not.  It takes some getting used to, especially since I’ve been in the US medical system since the mid 1980s.  So many things are second nature, and now I have to convert them to another system of measurement.  It would be like going to grocery store, with everything measured in units with which you have no familiarity.  Imagine you’re looking buying some salmon and you look at the price: $250 a macrobyte.  How much do your order?  You’ll either come home with enough salmon to feed the whole block or barely enough for your bagel.  The first time I looked at one my patient’s blood sugar (it was 7) I almost fainted.  A blood sugar of 7, in the US, and you’d be dead or well on your way there.  Here, it’s maybe just a little high.  I understand the calculation from the units used here to the US system, but it’s not something you could easier do in you head.  So, there is a lot of me asking, “What’s the normal values?”, but I do that less now than 8 weeks ago.

The drugs all have different names, but that’s a little easier adjustment, because at least I’ve heard of most the generic names of the medicines.  Still, I am surprised daily by at least one drug related difference.  Like yesterday, when a patient complained of itching, and I suggested we give the patient some Benadryl.  “We don’t have that here” was the reply.  Really?  There were other antihistamines available (we gave the patient Claritin), but that was a tough one for me to understand.  What, it’s too expensive?  About half of the drugs I prescribed for patients in the US are the same here, but for the rest, the drug I usually prescribe isn’t available here, and I have to choose another drug from the same class of drugs (which isn’t all that difficult).  Overall, the drug shift has been a minor one and I’m mostly used to it.  Of course, no Tylenol here…that one still gets me when I slip up and suggest Tylenol, and then remember and correct myself, “Paracetamol, I mean.”

It has also been a challenge to adjust to the pace of medicine.  Back in the US, in the overwhelming majority of instances, when I order a test (ultrasound, CT scan or MRI) the test will be done that day.  Here is maybe a day or two (for a CT or ultrasound), and maybe longer (for an MRI).  There is simply not enough equipment and trained workers to fully staff the machines 24 hours a day, and so things do run more slowly.  That means people tend to stay in the hospital longer (two or three times as long of a stay here compared to the US for the same problem).  If I wasn’t used to working in a machine of efficiency (and the hospital I worked in back home was very, very efficient), the delays would just seem normal, and I probably wouldn’t notice them.  I know the patients don’t expect things to be done super quickly (that’s a relief), and since they are no so bothered, it makes it easier to just go with the flow.

But the most notable change, for me, has been the patients themselves.  For one, I care for older people here than I did in the US.  And, I didn’t think that was possible, because back in the US most of my patients were old.  It’s just that here they are older.  Many, many of my patients are in their late 80’s to early 90’s.  I’ve already cared for two patients older than 100 years.  And so many of them live alone (or at least they did before they got into the hospital).   I would say easily 1/3 of the patients we admit to the hospital live alone at the time they are admitted.  And they are tough.

I was seeing a patient of mine in a four bed ward when I noticed some commotion in the bed across from me.  It wasn’t my patient, but I was right there and went to help.  The patient, who was seated in a chair, and was supposed to be going home that day, but had suddenly become unresponsive.  I was the first doctor there, and though the patient was breathing and had a pulse, there was no one home.  The nurses and I picked up the patient from the chair and put them back into their bed, all the while assessing various medical issues (blood sugars, blood pressures, oxygenation).  In about 2-3 minutes, the patient gradually awakened (we had started some oxygen and IV fluids).  I was standing by their side, and I’m not making this up, this is what they said when I explained to them what had happened.  “Oh my goodness, I passed out!  Well, you’re such a nice doctor to help me.  I’m old; I’m sure it’s nothing you can fix.  I’ll be alright, don’t worry.  See how much better I am already!”  How did she know there isn’t much I can really fix?

I’ve cared for three patients who have passed away in the last month.   Two were in their 90’s with quite a number of medical problems.  One of the patient’s had a granddaughter who was a surgeon and a grandson who was a GP (office internal medicine physician).   I was prepared for some intense questioning of my medical judgement from the family, but instead received support and consolation.   The other older patient had rapidly debilitating illness, and we placed them on hospice and arranged for them to go home (which is what they wanted) to pass away in their own home.  Since another of their family members was hospitalized, I was able to talk with the family about the recent death, and they simply could not have been nicer or more complimentary about the care we had provided. And, really, we had just done our jobs: nothing out of the ordinary.

Recently, I met with the children of a patient in their 90’s who had previously lived along but as their dementia was progressing, it was becoming apparent this would not be feasible in the future.  It is such a life changing event, to lose one’s independence; something we may not think about that much, but I can assure you dealing with this is a very emotionally charged situation.  I have been in many family conferences over the years where the stress of the situation produces a lot of anger, much of the time directed at the bearers of bad news.  So, I was naturally worried about the family meeting with the 3 children of this patient (I was outnumbered, and that’s always bad).  But they were lovely.  Concerned for their parent, yes; wanting to do what’s best for them, yes; but never hostile, angry or upset.  They were practical, thoughtful and had perspective about their parent’s life.

I have tried to capsulize exactly what makes the people here different.   I don’t have the answer (yet).  Maybe it’s that so many of the people here look at their life in perspective, rather than being so in the minute.  I’ve had many patients remind me how old they were, proud they have achieved this station in life, and they tell me they have had a great life.  They have accepted this phase, however long it lasts, is one of the last phases of their life.  And when they talk about their life, they talk about it in perspective of their whole life.  Three times this week I’ve cared to patients who have been married over 60 years (two married 62 years and one 63 years).  In each case, it was a source of pride, that they had helped build something very important (a lasting marriage with children, grandchildren and great-grandchildren), but is was also a very clear statement that most of their is behind them.  It is very, very interesting and it is very different than what is the norm where I work in California where people commonly fight back death regardless of their position in life.  I’m not judging; I have never been 80 or 90 years old and don’t know what I’ll be like as an older man (please no comments about my current age).    I am just so intrigued by palpable differences in cultures.   I have so, so much to learn.

A very dear friend recently sent me a birthday gift with the inscription “Ancora Imparo”.  Yes, that’s it.  Forever.

Cheers

Published by dave clarke

I am different things to different people. Husband, father, doctor, teacher, friend, or if you're a fish, a fly fisherman. But really, I'm just a guy trying to learn about life, and if I'm lucky, maybe teach a little bit along the way. If I were a golfer (I'm not) I would be on the back nine of my life, or if I were a book, there would be more pages turned than not. Any yet, I'm far from finished creating chapters of my life. The goal of Next Chapters is inspiration, and I'm hopeful the traffic goes in both directions.

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