Should America ever get its act together (it’s not looking good) it might be possible someday to travel to the amazing country of New Zealand. And should you ever have the opportunity to travel here, being the altruistic guy I am, I’d like to prepare you for your arrival. Yes, they speak English here…but it’s a different kind of English than ‘American English’ (which to some, is admittedly an oxymoron). I wouldn’t want any of you to experience the embarrassment I’ve experienced, learning this new language.

You can see from the photo above, that what Americans call flip flops, or sandals, or maybe thongs are here called “Jandals”. Should you, in a lapse of judgement as you’re heading out to the beach say, “Just a minute…I need to put my thongs on”, you will emerge from your room to an audience expecting to see you in a G-string. You could wear a thong to the beach, but if you do, expect to be very cold, and also expect a lot of attention directed your way. Instead of a G-string, grab your TOGS!

You’re all set to go the beach now…you’ve got your togs, your jandals..check and check! You jump in the car and head down the road, and bump!…what was that, you ask. “Oh,” a knowing local informs you, “you just ran over a jutterbar”. No, it’s not the Kiwi equivalent of a Nutterbar (that wouldn’t make such a big bump in the road)…it was a speed bump. I did ask why it’s called a jutterbar… apparently it’s because it makes your car shake when you go over them. Fair enough. On the way to the beach, you notice almost every car on the road…even the occasional Porsche or BMW sedan…all have hitches on the back. You mention this to your local friends…”Why do all cars here have hitches?” and are met with blank stares all around. “You know, on the back of the car, to tow things”, you clarify. “Oh, tow bars! We all have them..you know, in case we want to tow anything. You HAVE to have one.” End of discussion.

Every car needs a tow bar?! You can’t ever tell if they are taking the piss out of you. Which means, if I might be so bold as to translate, maybe they are trying to tease or kid you. I first encountered this saying in the hospital. One of the patients said something in a teasing way to me (I couldn’t tell), and I looked at my registrar for translation help (I do this about 43 times a day)..and she said, “He’s just taking the piss out of you.” I replied, firmly, “I’m the doctor, I think I should be removing the urine from him.”

“No, No..it’s just a saying..he’s kidding.” She quickly explained.

“Yes, I know…” I lied.

The Kiwis are sooooo polite. How polite, you might ask? Well, when they say no, they do in the most polite way possible. For example, you might during hospital rounds excitedly exclaim, “I think another 4 years of Trump would be great!”. And it would be met with a, “Yeah….nah.” You see, even when these uber polite Kiwis disagree with you, they first agree with you….then, they say what they really think. Like the other day, I was having a yarn with my colleague…(have a yarn = talking about stuff)…and she was telling me about her son, who had gone on a hoon (a hoon = a crazy drive) out in the whop whops (whop whoops = out in the boonies or out in the sticks). I said, “you know, that’s just what kids do.” And she said, “Don’t be an egg.” (don’t be an egg = don’t be dumb..or dense) “Even though he’s fit as a buck rat,” (fit as a buck rat = strong) “things could still go grotty on a drive like that, and even if he’s OK, the car would be munted.” (grotty = bad, in a bad way) (munted = wrecked or destroyed).

I might digress here just a bit and stray from the subject of Kiwi language to the very interesting topic of….KIWI INGENUITY.

New Zealand is, of course, an island (or two, or three..). When something breaks, or you need something in a hurry, it might takes weeks to get it shipped here, so the culture here has adapted…and people just figure out way to make things work.

Practicing medicine in the hospital I encounter a lot of urgent clinical dilemmas, and a portable ultrasound can answer many clinical questions in a very short time. Does the patient have a large pericardial effusion?(fluid around the heart) Are they dry…or do they need fluid? Can I safely tap this pleural effusion? (removed fluid from around the lung) Almost daily, one of these situations arises, and that’s why when I came to New Zealand, I packed my trusty little portable ultrasound machine (it even hooks into my iPhone to produce images!)

Occasionally, though, there are patients with infection control issues…maybe they have C. difficile (a bad kind of diarrhea…not that there is a good kind…but this is especially bad) or maybe they are colonized with Staph. In those circumstances, it’s important to have the ultrasound probe covered with a clean plastic covering so the device doesn’t get contaminated. Unfortunately, I didn’t bring any of these covers to New Zealand. I was having a yarn with one of my colleagues about this issue (having a yarn, see above for translation) and she said, “Oh, we just use condoms…come on down to my office, I have heaps of them!” (heaps of them = many, many condoms). So, the other day I sauntered down to her office….

Her office staff assured me they work great with their ultrasound machine….

They showed me their machine…and I quickly appreciated their probe was much larger than mine. Probably sensing my apprehension, one of the staff, eyeing my ultrasound probe, quickly chimed in, “Oh, don’t worry, the condoms will even fit your probe.”

Sheepishly, I quickly took several of the condoms, thanking the staff for sharing them, and went back to my office.

So that’s an introduction to Kiwi life. And I’m not trying to take the piss out of you.

Kia Ora,

Dave

It is Spring in New Zealand, and whilst thankfully there is no Covid in the air, there is change. The cadence of nature is all around you. Springtime ushers in brilliant green grasses and budding tree leaves. These vibrant greens burst into full color (or, colour) display when the sun shines, as it did during the hike up to Diamond Lake, just outside Wanaka. Spring also means lambing season. The Roy’s Peak track (which I hiked about 3 weeks ago) is now closed for about a month (since you have to traverse several paddocks in the lower sections of the track, which are now full of sheep and their lambs). I think we are hardwired to look at babies of all species and think they are cute; baby lambs are definitely cute… the way they bounce along following their mother, and the way their tails happily wag when they go in for some mother’s milk.

That New Zealand abounds with beauty was not new to me. But the majesty, the sheer power, of the beauty I saw this last weekend left me awestruck.

On my first day of the journey I meandered up the East Coast of the South Island to Omaru, a small seaside town a little over 100 km North of Dunedin. From there, I turned inland and followed the Waitaki Valley towards my destination of Twizel. The Waitaki Valley is magnificent. Verdant green and surrounded by snow capped mountains, the Waitaki River (and its many dams) flows through the valley on its way to the sea.

Twizel is a small town in the MacKenzie basin, a dry high altitude grassland plain surrounded by rugged mountains.

Twizel was to be my base for two nights; I would only sleep there, as my days would be spent exploring the river system of the basin in search of trout. I should clarify that…I would be fishing and my guide, Ian Cole (whom I knew from my last trip to Nz 7 years ago) would be searching for trout. More on that in a minute.

We set out early in the morning and headed about an hour Northeast of Twizel to the Opuha River. It was, on the surface, an unassuming river and I was somewhat skeptical it would hold that many fish. Fortunately, trout don’t live on the surface.

It was cold that first day. Like, 2C cold. But I had packed layers, wore waders…and most importantly I was fishing…so I wasn’t cold. The plan was Ian would walk ahead of me, looking for trout in the river, and when he would find one he would point it out to me, and I would cast my fly and see if I could fool the trout into thinking it was food. Great plan. Here’s how it actually went…Ian would walk up to a place that we agreed looked ‘fishy’ (meaning, it looked like a trout might like to hang out there and wait for food to be brought downstream to his/her waiting mouth). Almost invariable Ian would then point, and say…”there…there’s one right there.” And I would say, “Where?”. He would take my fly rod, extend it and point right at the fish (the tip of the rod couldn’t have been more than 5 feet from the fish) and say, “Right there.” And I would say, “I don’t see. But I’ll cast there anyway.”

We did this for two days…I think I saw maybe 5 of the 50 fish he pointed out to me. Fortunately, the trout didn’t seem to care that I was casting using my hands and Ian’s eyes…it was an unbelievable two days of fishing with fish just as beautiful and the landscape they inhabit. This is the second year in a row I have been able to fish on my birthday; I may have found a cadence of my own.

To decompress for all that stressful fishing (haha), I drove about 90 minutes South to Wanaka to wind up my little birthday celebration.

It didn’t matter if it was raining (which it does.. A LOT..in the Spring) or if the sun was shinning. Around every bend of the track was a new vista more spectacular than the last…or some secret little lush fern grotto appearing out of no where.

This is a magical land. And, I’ll just say it: I’m hooked.

Stay tuned for next week…learn to talk like a Kiwi and some fun times in the hospital.

Kia Ora,

Dave

Original words are exceedingly rare. So, I will borrow one to describe my ‘backyard’….Magical.

Since my trip to Wanaka two weeks ago, I’ve worked a weekend day in each of the last two weekends. That makes trips out of town a little more challenging, and backyard exploring is all the more intriguing. I am fortunate to live in a place where exploring your backyard can be just incredible (that’s two words I’ve borrowed). All of these photos were taken within just 24 hours (with one exception…which will be obvious), just to give you an idea of how much and how fast things change.

Last Tuesday, it snowed in Dunedin. Snow flurries whisked down from above sporadically throughout the day, at times leaving the hills surrounding the city blanketed in white. Then, for periods of minutes to maybe an hour, the sun would come out, and the snow would melt. Only, just minutes later, a large dark cloud would move in and another blanket of snow would dust the hills. It was a mystical and truly marvelous day (that’s fours words…I’ll stop counting). You have to love the first week of Spring. The cold front only last two days, so by the end of the week it began to warm up (awesome, I thought, as I only had to work a half day Saturday and was off all of Sunday). The warmer weather brought huge billowing clouds, which produced the sunset in the first picture of this post. Saturday was indeed warm…I was able to do TWO loads of laundry (I don’t have a dryer..and depend on Mother Nature to dry my clothes). I was in heaven.

I was off Sunday, but wouldn’t you know, another cold front was forecasted. Undeterred (which is necessary here if you want to do anything outside) I went out a walk to the Pyramids. The Pyramids are two pyramid-like hills (made up of geometric basalt volcanic columns) which overload the Okia Reserve (a wetland) and Victory Beach (named after a steamship, unsurprisingly named “Victory”, which crashed on the beach). Victory Beach is the longest beach on the Otago Peninsula!

As you can see, it was a cloudy day, and much of the city got a lot of rain…I managed to stay dry and the clouds just provided an amazing backdrop to this marvelous scenery. I’m always in awe of the how green the sea looks when grey storm clouds lurk overhead.

The storm on Sunday passed through quickly, and today it was glorious…20C and warm winds (you immediately can tell where the winds come from…when I go outside, I don’t have to think hard when feeling a rush of air that some hours ago was above the Antarctic). A little warm day excursion in my backyard was in order, to celebrate to warm Spring air…and no better, or more fitting place, than…Doctor’s Point.

I had been to Doctor’s Point years ago (7, to be exact), and it was pretty…but I had previously gone there at high tide. A rookie mistake, I was told, and this time went at low tide. Wow, what a difference…at low tide you can walk though a large cave in the rocks, which then leads to even more beaches.

The water looked so inviting! I just HAD to get out there and test it….Yep…still 9C..no full on swimming until summer (and maybe a wetsuit).

The views were just breathtaking…and the vastness of the area isn’t well captured in any photograph, so these are just small glimpses of the grandeur which awaits the visitors to this special place (if…you go at LOW tide).

So that is a little glimpse of my backyard. There are ‘heaps’ more things in my backyard (that is a very Kiwi word for ‘lots’), which I plan to explore (and share!, so stay tuned for Backyards 2) every chance I get.

Kia Ora,

Dave

In 1972 Lou Reed released his second album (you know, the vinyl kind) which included the song, “Walk on the Wild Side”. It would be his biggest hit, and interestingly the album was co-produced by David Bowie. Also on the album was the song, “Perfect Day”, and so my weekend in Wanaka encompassed two songs on this album…a perfect day, and a walk on the wild side.

Wanaka is a small town…though it has grown since I last visited here 6 years ago from 7500 people to about 9000. Still, given the grandeur of the setting, it’s amazing there are not more people that live here. (The uber rich have bought up quite a bit of the land around the lake…I won’t give up names, but you can google it). If you have been to Lake Tahoe (in California/Nevada), coming to Wanaka would be like visiting Tahoe in about 1950. Imagine that. One of the most famous sites here is the Wanaka Tree (seen above), a willow growing just offshore with its trunk partially submerged in the lake. Sadly, some vandals cut down some of the low hanging branches earlier this year (yes, it even happens here), so the picture I took on Saturday may not look exactly like some the pictures from Instagram. Wanaka is situated at the base of Lake Wanaka (there is one river draining the lake, the Clutha River, whose outlet is near the town). It is the 4th largest lake in New Zealand, 42 km at its longest length and some parts of the lake are 1000 feet deep. It is surrounded by mountains (and, as you might have guessed, was formed from a glacial melt), and these mountains provide much of the fun activities the area provides. It is currently the tail end of ski season, but there were still many skiers and snowboarders in town at the end of the day. But I was there to hike…and specifically to hike Roy’s Peak.

About 3/4 of the way up this 8km trek to the peak is a lookout that is one of the most famous vistas in New Zealand. How famous, you ask? Well, search Instagram for Roy’s Peak, and you’ll get a taste. On my way up, I passed a young woman hiking the trail, and I kid you not, in a red knit dress and black leggings. I thought to myself, ‘that seems arduous…and a bit odd’. On my way down from the peak, I came upon this woman…who has stopped at the famous look out to ensure her photograph of the Roy’s Peak climb was astonishing. I have never felt so underdressed…it was like going to the opera, in Levi’s.

If you wonder why there is no selfie of me…how could I compete with that???

It is a 4000 feet climb to the top of Roy’s peak; a slow steady and unrelenting climb up. Slow and steady, because every time you look out at the views, you have to stop and take a picture. I must have taken 50 on the way up (and another 50 on the way down). It’s almost impossible to describe the beauty seen on this hike…and in particular on this last weekend of winter, to hike the trail on a cloudless day with temperatures requiring only a single layer of clothes. Talk about a ‘perfect day’!

As I neared the summit, the snow went from patchy to confluent..but it was never really much of an issue this being so late in winter.

I thought the downhill would be easier than going up…and in many ways it was. But it was 8km of steep downhill, and I vaguely remember someone told me to never do a big hike in new boots (OK, I may have been the one saying that to someone else)..but out of necessity I broke that rule on Sunday. The price was a blister or two…but I was happy to pay it, given rewards I had just reaped.

Since I “had” to drive through Central Otago to get back to Dunedin, I thought why not nurse my sore feet with a wine tasting (someone to put my feet up, so to speak)? Central Otago, unlike the West Coast of the South Island (or Dunedin, for that matter) is a desert. Dry, tussock dotted hills surround a valley that warms in the summer sunshine. The perfect place to grow grapes…and make amazing wine.

So my weekend in Wanaka ended Sunday evening. My legs were a little sore, my feet talked to me just a bit through the evening, but my spirit was high. Lou Reed would have been proud..I had taken a walk on the wild side, on a perfect day. For the record, I did not pluck my eyebrows or shave my legs. (You’ll get it…listen to the song).

Kia Ora,

Dave

Last week, as I drove along the Southern Coastal Highway (a two lane road) towards a favorite local fishing spot, I began to feel…well….comfortable. I noticed I’m no longer freaked out by seeing the steering wheel on right hand side of the car. I rarely have to remind myself to stay on the left hand side of the road (rarely…but not never). And, as I drove along this beautiful stretch of road, with the deep blue Pacific Ocean on my left and the rolling verdant hills dotted with sheep on my right I thought to myself…yep…I live here. I see this stunning beauty almost every day.

Almost every morning the sunrise is spectacular, and almost every evening there is a breathtaking sunset right outside my window. By now, you will recognize the view from my deck (above)…truly this is what I see as I eat dinner each night. I’ve now been here over 2 months…enough time to not be overwhelmed by these amazing spectacles of light almost every morning and evening, and despite their frequency, I remain truly awed when they are there. I hope the awe never ceases.

This last weekend I drove North to Moeraki Village.. a quaint little fishing town, and home to the world famous Moraki Boulders (more below). In New Zealand, lobster are called crayfish. I happened upon a local open air eatery called ‘The Fishwife’, and found myself faced with a paua/crayfish dilemma. Paua is the local word for abalone. I opted for a lunch of paua (fritters) and chips (French Fries). I believe I’ve already gone over the coffee menu..but as refresher…a long black is a regular cup of coffee..a flat white is coffee and warmed milk…and just last week I learned what a piccolo was…espresso and a very small amount of milk, served in a very small cup.

As I was finishing my lunch, the one of the cooks at the Fishwife began passing out very sturdy squirt guns. One to a table. ‘This will get interesting’, I thought to myself…sizing up the other patrons of the restaurant. I spied several little kids I thought I could easily take down. The cook, noticing my zeal and the tight grip around the barrel of the gun, said, “They are for the seagulls.” “Oh, I know.” I lied.

I realize I have not posted for the blog in over 3 weeks…which feels somewhat humiliating and I am embarrassed at the length of the lapse. In my defense, I have been working a lot, which is the double edged sword of lots of time spent at the hospital and not a computer producing a piece for the blog, and also more time at the hospital means less time exploring. So, with that Mia Culpa out of the way…onward to more exploring.

As you might imagine..there are two stories of these magnificent geological structures..one story from the indigenous Maori, and a slightly less colorful one with longer and more difficult to pronounce words… from a geologist. Regardless, there are few sights like this in the world…and less than an hour from my house I can walk on this beach and hop onto these ancient stones and watch the waves swirl around me. It’s like I live here.

This is, after all, an island country. We are surrounded by water, and it’s no surprise that so much of the history, culture, and art of New Zealand incorporates the theme of of the ocean. In the news this week, it was a highlight when a large number of humpback whales were spotted off the coast of Kaikoura ( a town just North of Christchurch..usually known for its large population of sperm whales, but humpback whales, like the one above, are much less common). There is something magical about the ocean…and despite the fact I see the ocean every single day, it never fails to capture my imagination. Even now…late at night (I’m on call…from home, thankfully)…I gaze out at the reflection of the city lights shimmering in the harbor waters..and I think to myself…I live here. I am so lucky.

Until next time,

Kia Ora,

Dave

Neil and Tim Flynn, of Crowded House, wrote a song with this title in 1992 (I was very young at the time..) about the weather in Melbourne..which, apparently, can change very rapidly. This may be a Southern Hemisphere thing…since in Dunedin we experience the same thing. A lot.

For example, just this week we went from a relatively warm winter day (see the picture above)…to just hours later (back at my house) experiencing temperatures dipping into the 40s (F) and this….

Weather in Dunedin is often a topic of conversation, and the weather here is also renown around New Zealand. If, for example, I was talking with someone from Auckland (the capital is in the Northern part of the Northern Island of New Zealand), they might (ok…many of them do) say, “The weather is crap down there in Dunedin…why do you want to live there?”

This is not the reason I live in Dunedin. Full disclosure…I have never eaten at Sal’s. It is highly likely they serve an amazing pizza slice. I will satisfy both my curiosity and my appetite at some point and eat there…but it’s still on the ‘to do’ list.

I have been working quite a bit lately (this was my third week of working 6 days a week), and that makes it challenging to have much of a life outside the hospital. Inside the hospital, the experience remains much as I have described before, and in particular, it’s been impossible to not walk away from the hospital at the end of the day, astonished at just how nice all the patients are. For example, this week I saw a patient who likely had Total Global Amnesia (or, TGA as we call it, since ‘we’ like to use letters more than whole words). This is a very uncommon condition in which you suddenly lose the ability to form short term memories. Yes, that could come in handy (“Honey, yes, I forgot today was our anniversary…but I had a sudden attack of TGA!!!”), but mostly it’s a very scary event. I took care of a patient a few years ago…he was an attorney who left his office at the end of the day (I’ll try to refrain from saying it was 3pm) and then his wife called the office several hours later when he did not arrive at home. She was told he left the office hours ago. He was found by the Highway Patrol, 200 miles away, driving in circles in a parking lot. He had no idea how it got there.

The patient I cared for this week was athletic and highly functional; I explained the theories (since no one really knows) about how this happens. We could do an MRI, which might show some characteristic abnormalities…but our MRI scanner isn’t currently operational (the word we use instead of ‘broken’) ..I said.

Above is an example of what we might have seen…if the MRI scanner was working.

There is no treatment for this condition, however, and thus there is no necessity to rush to do an MR scan if the diagnosis seems certain.

But imagine you’re the patient…How difficult it must be to hear all the things we don’t know about this condition. We discussed what my tentative diagnosis was….though the patient had already Googled the condition and knew a lot about it. This sort of scenario happens a lot in California, but not as much here…despite the excellent WiFi connection in the hospital. So, I continued with our bedside discussion, “Here is what our theories are about how this happen (emphasize the word, “theories”)”. “There is no certain way to diagnose this problem” (Especially since our MR scanner isn’t working). “There is no treatment for this problem.” “Although most people don’t have a recurrence, it can happen again.”

The response of the patient was classic Kiwi. “Fair enough.”

And in the practical way that most Kiwis deal with life, the questions asked at the bedside were very pragmatic…’what do you recommend I do to avoid this coming back?’ ‘When can I exercise again?’ ‘What would you do if this was you?’ Poignantly, there was never a demand for certainty.

There is no certainty in the weather here…you just take what you get. Maybe that’s why I see people jogging, riding their bike, and kayaking in the Harbor..no matter what the weather. And maybe that ability to just roll with the punches transcends to all aspects of life…

So I will continue to try and adapt. To get out of my bike even in the rain and 30mph winds. To go fish, even if the weather is a little tenuous. Who knows, I might get rewarded.

Kia Ora

Dave

There is art everywhere in Dunedin. Just across the street from my favorite wine store (Wine Freedom… in case there was ever any doubt…owned and run by long time friend Paul) is this thought provoking image. It’s these nooks and crannies that you begin to see once you start to settle into a place…once you begin to get your feet on the ground.

There are more of these, and I am sure I will be showing them to you over the next few weeks. But first…

I have started to settle into my newly rented house (tonight is my 7th night in this house…so it’s all still quite fresh). Having living in Dunedin previously, I had an idea of what I wanted in a domicile…several bedrooms, North facing (for sun), and fantastic views of the city and harbor…oh, and I only want to spend $1500 a month.

Fortune smiled upon me a couple of weeks ago when this home came up for rent. I recognized the potential, and quickly snapped it up. It came pretty much unfurnished (one bed and one table and several chairs), and I spent a week getting the kitchen stocked before moving in 6 days ago. After 5 weeks of living out of a suitcase, and meals consisting of just ‘heating things up’ I was finally ready to make myself a proper meal. Last Saturday I visited the Otago Farmer’s Market last, and that night and the following made my first two ‘real’ meals.

It wasn’t Thomas Keller…but what a difference home cooked food is when you’ve been eating pre-prepared food for 5 weeks! I’ll be restocking the frig tomorrow, after another visit to the Farmer’s Market…

I love the house…and the views!…but one can only appreciate those Otago Harbor views for just so long before lusting to explore this magnificent land. Last Saturday I ventured about an hour outside of Dunedin to fish (read..fishing, not catching)..and despite my admonition to not take my little rental Toyota Corolla on any more muddy roads, I found myself zigging and zagging along a wet dirt road to a small community called “Toko Mouth”. It was an in-coming tide (my plan all along) and the tidal estuary looked “very fishy” (a term used by fisherman when it looks like you should catch a lot of fish…but unexpectedly don’t get a bite). No fish, but you can’t argue with the view!

Not getting any bites here, I thought I might try the mouth of the Clutha River (New Zealand’s fastest flowing river…and a very big river at that!), and so I drove about 30 minutes along the South Coastal highway.. as the sun was reaching lower in the sky, I just happened to stumble into this majestic view.

It was late in the day, and this particular stretch of the river did not look very “fishy”…it was silted and murky from recent rains, so I opted to just enjoy the view rather than say I fished and didn’t get a bite.

This was also the week I had to return my rental car….which meant I had to find a car to buy. My biggest priority…a proper 4 wheel drive vehicle. Last thing I want is to be stuck on some road a hundred km from the nearest home or person. It’s like every Monday at work…Where’s Dave? Someone call out the search party! Where did he say he was going fishing??!! So, in addition to fishing for trout, last weekend I went fishing for cars (or trucks). It is a very interesting experience shopping for cars in another country (let alone another hemisphere). I looked at Subarus… (if you’re from the USA, they pronounce them different here…they say, “Sue-Bar-U” with heavy emphasis on the ‘Bar’. I also looked at the Nissan trucks (not ‘Knee-Sawn’…but rather…’Niss-Awn’). In the end, I found a very reliable Mitsubishi Pajero (pronounced Pa-Jer-O…no one here is accustomed to how Spanish words are pronounced).

Over the next week, I plan to test the limits of the true ‘4 Wheeler’, as they say. If you don’t hear from me for awhile…you’ll know why.

This is likely a crime…to have already been in New Zealand many weeks and not have posted any pictures of sheep. So, in the hopes of avoiding (more) jail time, I will leave you with a little taste of last week’s explore….

Kia Ora,

Dave

If you’re a physician, the CT scan above ought to get your attention….but more on that later.

A lot of people (well, doctors mostly, but they, too, are people…mostly) want to know what’s it like to practice medicine in a different country. So this week I thought I’d share a typical day of my work at the hospital.

I should first mention, we don’t have any COVID cases in the hospital. Actually, not even any COVID cases in Dunedin. And to be fully truthful, for two straight days none in the whole country. That’s just a little different than what I would be experiencing in California. Just a little…

I’ll walk you through a typical ‘on call’ day…which means I’ll be accepting patients for admission to the hospital beginning at 8am and ending the following day at 8am. I arrive at the hospital a little after 7am. My office is on the 7th floor, but given that the ground floor is street level (what in the USA would be the first floor), I have 8 flights of stairs to ascend. It’s a good way to start the day.

It’s a good thing the cardiology department is also on the 7th floor, as I’m sure one day I will experience some chest pain during the ascent.

Did I mention there were no COVID cases in NZ?

When I arrive to my office, I’ll review the events of the last 24 hours, and then proceed to our 8am handoff meeting, where all the patients admitted over the last 24 hours are reviewed and assigned to the relevant teams. I then round (or go see patients) with my team…which consists of a registrar (kind of like a senior resident in the US, though my registrar has many years of training under his belt), a house officer (who is in her third year of postgraduate training), and a medical student.

During the day, we will see the patients who need hospital admission to the internal medicine service. The variety on conditions we see is legion, and you never know when the operator calls to connect you to someone what you might encounter on the other line. Like, in the case of last Tuesday, when the operator connected me to a physician from a rural hospital about 150 km outside of Dunedin. A patient had come to the hospital with visual disturbances and new mild right sided weakness. The CT scan there looked similar to the one above (which I pulled from the internet to preserve patient confidentiality). I asked some pertinent clinical details, and since we have a neurosurgeon on staff here, agreed to have the patient transported here for further evaluation and possible intervention. The transport would be a helicopter, which is a common mode of transport to this hospital (I think helicopters transport patients here at least 4-5 times a day…we have a helicopter pad at the hospital I worked at in California…it is not used nearly as often…like 4-5 times a year).

It wasn’t a long a wait for the patient to arrive in Dunedin…maybe 2 hours since the phone call…and in that period the condition of the patient had worsened. We arranged another CT scan of the brain, which confirmed our clinical suspicion of further bleeding and worsening edema of the brain. We talked with the neurosurgeon, who felt there was already significant damage to the brain, and the surgeon was of the opinion that even with an operation there would still be significant functional impairment. To translate that, at best, the patient would be completely paralyzed on the right side. We then discussed this with his family (by phone, as they would be driving here and wouldn’t be here for an hour or two), and they informed us that if we felt the outcome was unlikely to be significantly better with surgery, since the patient had previously been very clear that any significant physical impairment would not be acceptable, to not proceed with any surgery.

My registrar diligently cared for the patient that night…and we all met together the next morning with the patient (who was not responsive…read- not awake-) and the patient’s whole family…the spouse, sons, daughters, and grandchildren.

I should reiterate, again, we don’t have any COVID patients in the hospital, in case you had forgotten.

Back to my patient now…

The patient’s condition had worsened mildly overnight; we had tried some medical therapies to decrease swelling in the brain, with only modest effect. We had lengthy discussions with his family throughout the day and the family was very clear the patient would not have wanted any life prolongation measures in this particular circumstances, and would just want to made comfortable. So that is what we did, and very quickly after that, the patient passed away.

I met with my team at the end of the day, because it was not clear to me they truly appreciated all that had happened that day. We gathered around, and reviewed the clinical events; a patient with long-standing high blood pressure presented with an acute intra-cerebral hemorrhage (bleeding in the brain), which was too severe and in a location which was not amenable to surgical therapy. He died of this acute event. That information we all understood, but what was so unique for me was that I have never experienced the kind of discussion with a family about an acute, devastating event that occurred that day. In fact, the words to my team were, ‘in the 34 years I’ve been practicing medicine, I have never had a family discussion like that…..ever’.

What made this discussion different for me (and keep in mind my registrar has been here in New Zealand for 4 years and he didn’t bat an eye during the discussion) was how sincerely nice every single member of the patient’s family was during this devastating event. I remember explaining to the family what had likely happened to cause the bleeding. They acknowledged the patient had high blood pressure, that these things (like bleeding) can happen, and that we all are going to pass away sometime. Those were the families’ words. They appreciated (and they said that several times) that we seriously considered trying to do surgery (the acute helicopter transport to Dunedin and a thorough review with the neurosurgeon) and they accepted the outcome with surgery would have likely been not what the patient had wanted. In these conversations, my accent (clearly not New Zealand) came up…they thought I was from Canada. We all laughed as I tried to distance myself from the fact I was from the land of the President who shall not be named. We talked about water polo, since one of the patient’s granddaughters had a water polo sweatshirt on…we talked about the life the patient had with his spouse of about 40 years. We cried at the sadness of a life’s end, and we were also thankful for the lack of prolonged suffering and disability. There were hugs all around, several times during the day. This was a brief illness, and a brief encounter in the scheme of things for me… less than 48 hours…but it was an encounter I will never, ever forget. And this was just my first full week working in the hospital, and I suspect there will be more encounters like this.

Oh yeah…there are no COVID cases in NZ.

There are struggles working here in New Zealand, just as there are struggles working in any hospital, anywhere. But if you wonder what’s different here…what’s truly different here…it’s the people.

Be well, remember that life is short. If there is someone in your life you love, tell them today.

Kia Ora,

Dave

It was an unusual sensation, my firsts breaths of fresh air without wearing a mask. Once I cleared the last health check in Auckland (after 2 negative COVID swabs, the first on my third day of quarantine, and the second on the 12th day), I was then ‘processed’ by immigration (making sure my passport and visa were in order), checked out of the hotel (no bill to me, though there are rumors of travels being charged in the future), and then I summoned an Uber to take me to the Auckland airport. Domestic terminal, please, I said with relief.

The flight from Auckland to Dunedin was just under two hours (it’s about 1000km, or if you prefer, about 660 miles by air), and it was a stunning and bright sunny day as the plane descended into the verdant valley and landed at the Dunedin Airport. The airport is about 20 minutes outside of the South Island’s second most populous city, though it’s interesting to note Dunedin is one of the largest (geographic size) cities in the world, with a territorial size of 1280 square miles (3314 sq km).

As in the UK, you drive on the left hand side of the road here. Fortunately, the car I rented had a reminder….

One week in, and I’ve had no egregious driving errors… We don’t count the number of times I’ve turned on the windshield wipers, meaning to signal. Keep your fingers crossed (and perhaps stay off the Dunedin roads for another week or so…).

It’s the middle of Winter here, but it hasn’t stopped the sun from shinning. The clear days bring brisk temperatures, usually hovering around 3-4C at night and 8-10C during the day. The wind, nearly always present, makes it feel colder. It’s great walking weather, though, so on Saturday I walked around the town..visiting some old haunts like the Train Station, the First Church..and the Farmer’s Market of Otago. So fun! When I left the Northern Hemisphere, I was enjoying the bounty of California summer fruits…so I’ve had to reset my taste buds for the fruit available here…which are local apples (I counted at least 10 different varieties) and pears (another half dozen varieties).

I have a relatively common name…but here…it seems I’m everywhere!

I’ve spent a couple of days touring the Otago peninsula, which is just a magnificent, wild, and scenic location (and just a short drive from the hospital).

So that’s a little taste of the scenery here…as I look at these photos some of them almost seem tropical. But, the winds are almost always howling (today at Allan’s Beach the wind was a constant 25 mph) and the temperature may have reached into double digits (C) only the late afternoon. It’s all about layers (though, I did wear shorts….you can take the boy out of California, but…).

Next week, hopefully a little more about the the job, people and culture. If I can keep my camera off, that is.

Kia Ora,

Dave