On the road again….

In my job contract there is mention of my duties at the Balclutha Hospital….yada, yada, yada….who reads that stuff?  Today, I got the Balclutha experience.  As it turns out, if you read the fine print (which was oddly the same font size as the rest of the contract) about every other week, I am to spend the day at the Balclutha Hospital, which is in the town of….wait for it….Balclutha.  Balclutha, or as the locals refer to it, Clutha, is a town of about 4-5000 persons about 75 kilometers South of Dunedin, about half way to Invercargill (which is basically the Southernmost town on the South Island of New Zealand).  It has a small hospital which is not staffed with a full time consultant in medicine, and the DHB (District Health Board) has arranged for one of the internal medicine consultants to visit the hospital once a week to help out with some of the more difficult patients (patients for whom the GP, or General Practioners, would like some assistance).  Today one of doctors and I went there (my first trip, so I was chaperoned).  The usual procedure is for the doctor who is heading down there the next day (we leave early in the morning, like at 8am) to check out a car from the motor pool the day before (they don’t expect you to use your own car, or, for instance to walk there).  So, this morning I was picked up at about 8am in the motor pool car.  Last night there was a big storm throughout most of Nz, with much snow falling on most of the country.  There was a only a little bit of snow on the hills above Dunedin (maybe 1000 feet above sea level).

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I snapped these pictures as we sped along the road to Clutha.  As you can see, it was a beautiful, clear, sunny day today.  We drove along the ocean for about 1/3 of the drive.  It’s not uncommon to drive for ten or fifteen miles along the ocean and see absolutely no one on the beach.  I’m not used to that yet (will I ever be?).  There are just not that many people here.  Anyway, we stopped just before Clutha to get gas (on the hospital, of course), and I noticed the gas station (a BP station) was remarkably similar to ones back home.  Refrigerators full of Gatorade, Red Bull, snacks….and a magazine rack.  While my colleague was signing for the gas, I took the opportunity to thumb through some the latest journals displayed.

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For those of you who have let your subscriptions lapse, this is THE September issue of New Zealand Logger…and let me tell you, it was a page turner.

We arrived safely in Clutha a few minutes later (me still breathless from reading the latest Logger articles).  Parked in front of the hospital was this….

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It’s the coolest thing.  It’s a HUGE trailer in which they perform outpatient surgeries, and it’s hauled around the country to places that typically don’t have the facilities for such things (things like laproscopic cholecystectomies, tonsillectomies, etc).  It comes to Clutha about six times a year.  Very cool.

The Balclutha hospital is small, about 10-15 beds.  There is no Emergency Department, per se (no ED doctors, either), and I didn’t see any telemetry.  Any who is unstable is transferred by ambulance (helicopter or truck, depending on the need) to Dunedin.  Today we saw four or five patients in the hospital in the morning, and then saw several patients in the clinic in the afternoon.  Everyone there was SOOO nice.  They had made us little sandwiches and a muffin, and put them on our desk for lunch.  So sweet.   Again, I was struck by the multicultural (well, multi-Anglo-cultural) nature of the area.  One of the doctors and one of nurses was from Scotland, another doctor was from Ireland, one doctor had studied at Cal (Berkeley).

As we drove back to Dunedin, I was inspired by the lush green rolling hills, spotted with white sheep.  It’s lambing season (see how easy that rolls from my keyboard now?) and many of the ewes had one or two wee little lambs following them closely.  It was very serene.  I don’t think it will every get old.  And I thought, too, about how the people here reflect the landscape so well.  The landscapes are so solid, and the people just the same.  So matter-of-fact, so grounded, so humble.  Being a doctor, I’m used to the fact I often bring people bad news…you have this, or your tests show that….(just once I’d like to say something happy, like, “It’s a new baby boy!”, but then that would presume I’d delivered the baby, a practice for which I’m not very prepared).  The diseases here are no different than the ones back home (strokes, cancers, heart disease), but I see I can learn a lot about life from the people here, who seem to have a broad(er) perspective on life, and take things in stride.

It is late Thursday night; this weekend I’m going to travel outside my bubble.  Stay tuned (I may even pick up the October issue of New Zealand Logger!).

cheers,

What a difference a day makes…and resisting temptation.

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Most of the patients we care for on the medical team are on the eighth floor (it’s a nine story building) of the hospital.  This is a view from the stroke ward window on the eighth floor.  Not too shabby.  In the US, we would say it’s the 9th floor, because we call the ground floor a ‘first’ floor, and we call the floor just above that the second floor.  Here, as in much of the world the ground for is, well, the ground floor (it’s marked ‘G’ on the elevator), and the floor above that is the first floor.  It’s not that bad, once you get the hang of it….

Today it snowed.  It was particularly cool this morning when I walked to work, and it started to drizzle half way through my five minute walk.  I noticed that most people here don’t bother with umbrellas for a drizzle, like what we experienced this morning.  I didn’t bring my umbrella not because of any newfound New Zealand toughness, but rather because I hadn’t bothered to look at the window before I left.  But I’ve been impressed that the local folks are in general not impressed by mildly inclement weather.  Perhaps only one out of ten people I saw this morning had an umbrella out, and I can’t believe those without the umbrella were all as thick as I, not having looked at the window before they left.  In any case, about midway through our morning rounds we looked outside the window (I suppose I shouldn’t say I was daydreaming looking at the window during rounds, but then I was running the rounds, so it’s probably OK), we noticed it was snowing.  I’m happy to report I wasn’t the one who first noticed the snow (it makes me feel better, at least, since it was the medical students who noticed the snow first.  On the other hand, it makes me wonder if they were paying any attention to what was being said in rounds).  And, I find it reassuring that when we all stopped rounds (the poor patient, whose acute heart failure was upstaged by the weather) to admire the snow, everyone was quite excited.  To me, if snow is that novel for the regulars, then I’m not as worried about having to slog through a foot of snow for days on end in the dead of winter.  The snow didn’t stick to the ground, and by the time I left the hospital the skies were partly cloudy (as seen in the photo above).  But is was a good deal colder today (high temperature only in the 40s) than yesterday (high temperature maybe in high 50s).

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This bells sit on the nurses station.  I was sorely tempted to ring it because it says ‘For nurses use only’, and I’m just that kind of guy who would want to ring it and see what happened.  But I’m new here, and judgement interfered with my impulse.  Perhaps tomorrow, though.

Here’s another thing I noticed today; none of the doctors here wear a white coat.  Back at home, I don’t wear a white coat either, but overall I’m in the minority there.  Here, I just fit right in (though I do wear a tie, which very few of the doctors wear, so maybe I don’t fit in as well as I’d like to believe).

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There are A LOT of posters on the walls of the hospital.  I thought it would be fun to share a few of them.

Didn’t get to the shopping today (as promised).  I wimped out because it was too cold.  But I will, I promise.

cheers,

One week in Dunedin….

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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.

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“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……

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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.

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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,

Father’s Day

It’s Sunday evening in Dunedin, and the first day of September.  The sun would be setting, but it’s obscured by the late afternoon clouds which often meander into the harbor this time of day.  The air is still outside my window and there are still many birds chirping before night arrives.   It is the end of a beautiful sunny day.  It’s also Father’s Day (here).   2013 is the first year of my life without my own father, who passed away this April.  It’s fitting I’m in New Zealand, for without my dad (he wasn’t a formal guy, and preferred ‘dad’ to ‘father’) I would not have embarked on this journey.  So, this post is for you, dad.

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When I was ten years old, my family moved to Cartagena, Colombia.  My dad signed up for two year stint with Project Hope, a nonprofit organization dedicated to improving medical care in developing countries (he was a pediatrician).  None of us had ever taken Spanish, and culturally, I would say it was quite a shock.  More so for my parents, I would assume (being a parent myself now) since we had no hot water and once, when my mom ordered a turkey so we could celebrate Thanksgiving Day, it was handed to her on a leash…and it was walking.  But speaking for myself, I was happy as long as I could swim and fish….which I could every day since we lived right on the ocean.  Those two years were some of the best times in my life, and for our whole family, too.  We did things, saw things, ate things that would never have come our way had we not ventured out of the bubble.  All my life, I have wanted that kind of experience for my own family….because you can’t get it any other way.  You can’t read a book, see the movie, play a virtual game of living abroad.  You just have to go.

Five years ago my dad got sick, and if the odds were correct, he would have only lived six months.  But that was not his plan.  He fought hard, willing to endure just about any treatment, as long as the quality of his life in between treatments was good (and he could play golf).  Fortunately, he was a tough guy, and he always bounced back…..usually bouncing back to the golf course.  It is noteworthy my dad played his best golf after he was diagnosed with cancer, and just a few months before he passed away, he was still taking golf lessons.  Now, that’s an optimist.  In the midst of all this, I was wondering when, and if, I should attempt to take my family abroad for a year.  There just never seemed the right time, with one or the other treatment being started or stopped.  Finally, last October, I was talking to my dad about my potential plans to travel, but sharing my concerns about being away from him when he needed me.  Of course, his reply was ‘”you should just go, don’t worry, I’ll be fine.”  Then in the first part of this year I got an offer that looked good (where I am now), and at about that same time, my dad’s cancer really started to grow.  He stopped all treatment at that point; it was not helping him and was just making him more ill.  Things looked bad and I knew these were his last weeks.  I had had almost five years to prepare for this, but there is no way of really preparing to say goodbye to your biggest fan.

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I thought about our time together, and the wonderful memories we have.  He loved golf (I never picked that up), wine (maybe I picked that up a little), and he loved to fish (I picked that up, and then some). What could I tell him, in his final weeks, that I had not already said?  So, late one night, I sat up and wrote him a letter (email), and he then replied back to me.  Here are those two letters:

April 7, 2013.

Dear Dad,

I was thinking if you were feeling OK, we might try and go to the NCAA basketball game tomorrow; just let me know and I’ll get tickets.

Dad, I’m so sorry you have not been feeling well lately and that your cancer is growing.  I am heartbroken to see you in such pain and struggling with things which recently were so easy for you.  I sat down today and cried…cried just because even the thought of life on this Earth without you was so painful.  You mean that much to me.  I am not at peace with all this, though in all honesty, I would not feel different in ten years.  There is never enough time with the ones you love.  I would always want more.

I hope you know you are loved…by me, Deb and my boys.

I hope you know my life would have never been so good without you.  Your faith in me, your trust in me, allowed me to become who I am.

I hope you know the principles you taught me will live on through me and through my children.

I hope you know I tried my best to make you better, and cure what ailed you, and I am very sorry I could not make it all go away.

I love you, Dad.

AND HERE IS HIS REPLY;

Dear Dave,

Thank you for your thoughts.  I also cry, more often now as it appears my winter is approaching.  I don’t cry about missing Tahiti or the Amalfi Coast, but rather about missing watching you and your wonderful family grow together.  I so wanted to see your boys into adulthood, and I wanted to be around should a crisis appear.

I have so greatly admired you and the person you have become…at work, as a father and a husband.  I am sure that because of you I have received some extra time here, and while I will always want more time, I understand it’s not in my, or your, hands.  I feel very fortunate my time here has been so rewarding, and very fortunate to have had a family so different than my own growing up- those years I seldom talk about.  I do now spend a lot of time reliving all the wonderful times we had.  If there were ever any bad times, I have forgotten them, and mostly what I do now is remember my times with you and your family and smile.

Love, Dad

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So, for all you fathers out there, Happy Father’s Day, and that includes you, Dad.

Cheers,

dave

I haven’t even left the city yet……

Okay, I meant to post something funny today.  Maybe an anecdote about my IT training yesterday, invasive body screens….there was much material from which to choose.  Today, after all, was Saturday, my day of leisure (which has been, let’s be honest, pretty much every day so far, since I don’t officially start work until Monday).  I was going to have all day to construct my humorous tale.  My jet lag is wearing off, and I slept passed 5am today.  I watched the sun rise, and looked out my window, and caught the sun just hitting the Otogo Boys School up the hill.  I promise this is my last picture of the Boys School because, well, if I take many more it would just seem creepy (imagine the security detail watching me with my telephotos lens taking pictures around the boys school). So here it is, at sun rise.

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So, after breakfast I studied for an hour (three boards, T minus two years), and then went to the Farmer’s Market.  Here’s the thing about Dunedin’s Farmer’s Market.  The food there is all great- fresh from the farmer, a tremendous selection, friendly people- it’s all that AND it’s cheaper than the supermarket.  I’m used to the farmer’s markets back home when you shell out $20 dollar bills like they are Monopoly money and get two apples.  It was a great find, and I’ll surely be back next Saturday.  I could only spend a short amount of time at the Market, because one of the doctor’s with whom I’ll be working invited me to his house for brunch today.  He and his wife live just outside of the main town, about a twenty minute drive out on the Otago peninsula.  It may be only twenty minutes, but it was a world away.  They have about 40 acres of lands and as many sheep, two donkeys and four goats.  Their dining room has glass on three sides, and we sat over 1,000 feet above sea level and the room afforded breath taking views of the surrounding hills (green, and dotted with white sheep) and Pacific Ocean.  It was similar in many ways to the coastline of Big Sur.  Just spectacular.  And the brunch (lobster, Quiche Lorraine and Paella and fresh pastries with local honey) was more than I could have asked for.   I came back to the apartment to meet up with a chap who kept a car I bought from one of the doctors who left two weeks ago.  He took me up to his home after we dropped off my rental car, and then I became the official owner of a silver Subaru Legacy.  Sweet.  To celebrate my new wheels, I went back up the Otago peninsula to Sandfly Beach.  The drive there was treacherous, not so much because the road is narrow and winding (it is) or because I’m still acclimating to driving on the left (I am), but more so because at every turn is a beautiful vista, and you’re want to look at it, instead of watching the road, as you should be.  Here is what I mean….

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So tell me, could you keep your eyes of the road while driving past these views?

I arrived at Sandfly beach unscathed.  It’s called Sandfly Beach because the wind blows the sand around a lot, and not because of any pesky little insects.  I’m sure if there is a Sandfly Beach in Austrailia, it’s named that because the sand flies there burrow into your skin (it’s a Bill Bryson reference…you have to have read ‘In a Sunburned Country).  The parking lot for Sandfly Beach sits about 700 feet higher than the ocean, and it’s all sand on the way down (it was fun) and the way back up (not as much fun).  But the thing about Sandfly Beach is there are BOTH penguins and seals that rest on the beach in the late afternoon.  That’s what I was told, anyway, but how many times have you heard stuff like that and gone there only to be spend hours watching the waves come in (and no animals)?

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Wait, could that be?  There were easily a dozen seals up on the beach.  Big ones, smaller ones.  Lighter ones and darker  ones.

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I walked to the end of the mile long beach, because I was told (and read the sign on the walk down to the beach) the penguins come on to the beach in later afternoon after feeding all day out at sea, and then at each end of the beach they make a several hundred yard trek up the cliffs to sleep for the night and care for their young.  And, sure enough…

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It was fascinating watching them walk up the cliffs, waddling when the path was even, and then hopping to get over rocks.  These are very rare penguins, the yellow-eyed, or hoiho penguins (there are three species of penguins which reside in New Zealand).

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This is Sandfly Beach, as the sun is beginning to set behind us.  It’s about a mile long, and the penguins above were photographed at the very far end of the beach (which is still in sunshine).  It was a beautiful clear day, with tempartures in the mid teens (50s), and winds about 20mph.  Down on the beach, watching the sets of waves crash, was quite a sight.

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On the hike back up, through meadows and pastures, you can’t help but enjoy the other creatures more commonly seen.

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And one last look into the pasture as the sun sets.

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Then I tuck my Subaru in for the night, and watch rugby (called football here) because there is NOTHING ELSE on.

Cheers,

No funny stories today, just beauty.

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A Dunedin sunrise…..one of the few advantages of jet lag.

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The Otago Boys High School.  It almost makes me want to go back to high school.

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The Otago peninsula on a cool crisp later winter day.

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A pastoral setting with the falling sun.  You can’t see the sheep, but you know they are there.

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What did I say about the sheep?

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One of the many, many small bays in the Otago Harbor.

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The beginning of the Otago Bay, on a Friday afternoon.  So, so crowded.

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Very cool shells on the beach; no two alike.  You could sift through these for hours.

Today was a beautiful late winter day.  In the city, no jacket required, just shirt sleeves.  Brilliant.  Took a drive out to the beach, as you guessed, where a jacket would be recommended (windy).   I promise some funny stories this weekend……but hope the pictures can suffice until then.

Cheers

Comparisons (Part Two). And, you want me to swab my what?

A very interesting day.  It started with 8am rounds at the hospital.  I was observing only, as I can’t officially work until the Medical Council gives me the final OK (expected next week).  These were called hand-off rounds, where the doctors who had worked overnight discussed the cases they had seen, and then one of the surgical house officers presented a little lecture about atrial fibrillation (an irregular heart rhythm).  A bit about terminology and medical education in New Zealand (which I’m still learning, so bear with me).  Medical school in New Zealand is a six year endeavor.  However, unlike the United States, where you attend medical school for four years after you graduate from college (University), in New Zealand you enter medical school directly after high school.  The first four to five years are not so clinical, and the in the fifth, and especially the sixth year, you are on the medical wards preparing to become a house officer (the US equivalent of an intern, or first year resident).  Here, though, you do two years as a house officer (often called a surgical house officer, even though your training can be in medicine) and then you become a registrar (the US equivalent of a senior resident).  Today’s hand-off rounds went fine, and it all seemed pretty relaxed.  Then I was taken on a tour of the nine story hospital which included a tour of the staff cafeteria (we don’t have one of those where I worked in California).  It was pretty swanky, compared to our cafeteria back home.  Then I went to administration to fill our more forms (I’m nearing one hundred forms so far), and then we were off to the lab, I was told, for my MRSA swab.  MRSA stands for Methicillin Resistant Staphylococcus Aureus; a nasty bacteria.  In the US, we don’t routinely screen doctors to see if they carry this bacteria because there isn’t much you can do if you have it, and it’s not clear if you have the bacteria on your skin (and assuming you follow the recommended hand washing, which we all do) that it’s transmitted to patients.  Anyway, there we were at the lab and they handed me TWO swabs.  I knew they would want to swab my nose, but I asked what the second swab was for.  “Oh, that’s for your perineum.”  I was told, matter-of-factly.  Interesting.  (Your perineum, well, mine anyway, is that place ‘down there’ where your legs meet your nether regions).  They handed me the swabs, and pointed me to a public toilet.  Off I went, swabbing away.  I should have the test results back next week.  Wish me luck.  I do not want to know what is in store for me if I test positive.  Tomorrow, I’m told, I am meeting with the IT department, which I really hope means Information Technology, and not some other area on my body to swab.

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Now, about some comparisons.  There are two grocery stores within a block area from my apartment.  I like to eat healthy food, so it didn’t take me long after I arrived to begin to shop for my own food to cook (a standard, middle of the road, restaurant meal is about $20 dollars, with the Nz dollar about 0.8 to the US dollar).  The first thing I noticed was there were no blueberries.  In fact, there were no raspberries and no strawberries.  There were kiwi fruits.  If you know me, you’ll wonder how I’ll survive without eating blueberries every day.  Believe me, I starting to wonder too.  Even as I write this, my hands are shaking from blueberry withdrawal.  Fortunately, they have excellent grape juice here (aged in oak, if you know what I mean), which helps with withdrawal symptoms.  Once I recovered (about an hour, and two epinephrine injections) from the fact there were no fresh blueberries to be had, then I had a look around the rest of the grocery store.  It was, in many respects, very similar to what we have back in the US.  Except, the prices.  Look at the picture above, and yes, that’s right, a small little box of tomatoes is 7 to 8 dollars.  There were not special tomatoes, like we see at Whole Foods- “organically grown and hand picked on Tuesday, by James Wilson, of Wilson farms, at 10:29am”- these were regular tomatoes.  And it was like that for all the vegetables. The kiwi fruit was a good buy, though.  And it did take a while to get used to food being sold by the kilogram.  I saw some fresh king salmon today for $47 dollars a kilo.  At first I was taken aback; but then doing the math it’s not that much different than Whole Foods back home (if you don’t shop at Whole Foods, here is a simple calculation- think what you spend for any grocery item, double it, and you have the Whole Foods price.  It’s that easy!).  Apples, too, were not too expensive; about $4 dollars a kilo.  I bought several, and they were excellent.  Well, I must rest up for my IT encounter tomorrow, so for now,

Cheers.

 

Comparisons….It’s only natural. (Part One)

You can’t help yourself; it’s irresistible.  You travel to someone new and compare your new surroundings to wherever is home.  A narwhal may be almost mystical to us, but ho-hum if you’re used to seeing them everyday, and that same person who finds the narwhal common place may be amazed by a parakeet.  So it is with Dunedin.

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Dunedin has charm.  It is a city, to be sure, with its own industry and industries.  Out my window I’m afforded a wonderful view of the Cadbury chocolate factory, a one city block wide complex where I assume they make A LOT of chocolate.  I did see sign offering tours, so perhaps the next rainy day I will indulge myself, hoping for free chocolates at the end of the tour.  But Dunedin has a townish feel, a charm missing in many other cities.  On my first evening in Dunedin, beleaguered by jet lag, I wandered the city in search of food.  I had asked the twenty-ish year old man who delivered my rental car for dining (well, perhaps I mentioned drinking too) recommendations, and he strongly encouraged me to venture to one of the establishments at the Octagon.  Heaps of fun there, he said.  So, I meandered up that way and found a suitable looking place (what I mean by suitable is this:  I saw waitresses pouring beer there, and there were other people outside eating).  It was a glorious late winter evening, with temperatures about 16-17 C (that’s about 61-63 F).  I sat down outside at one of the several tables on the cobblestone sidewalk, the awning overhead also supplied with radiant heaters (so the 16 C felt more like 25 C) and waited for my tall glass of Pale Ale.  The Octagon is a social place.  There were many high school aged kids there, dressed in their school uniforms, doing what high schoolers do well (hang out).  George Street travels directly through the middle of the Octagon, and despite this road being a main thoroughfare for Dunedin, there was no traffic per se.  Cars, yes, but there was never traffic.  One of the doctors with whom I will work picked me up at the airport earlier that day with her husband, and they told me, on the drive back into town, that Dunedin had no traffic.  I suspected they meant little traffic, because I couldn’t imagine a city without any traffic.  But indeed, as I sat there now sipping my tall glass of Pale Ale, I saw no traffic.  Charming.  And then church bells began to chime, and I looked across the Octagon at the one hundred year old massive church spire, complete with an illuminated clock, and I thought nothing exudes charm like church bells.  Perhaps listening to church bells while sipping beer, but I’m sure it was mostly the church bells.  And these were the kind of church bells that got your attention, the kind which you not only hear, but you feel.  We don’t get this at home, I thought to myself (talking to yourself in a new city is discouraged).  And I sat there, eating my seared venison salad and sipping beer, and I watched the evening unfold into night.  I pondered ordering a second beer, but thought better of it (the jet lag alone was probably two beers’ worth of disorientation).  I watched uniformed school kids being just kids.  I watched the pace with which people walked home from work or towards the restaurants in the Octagon, and marveled that most of them did not appear to be in a rush- there was none of that urgency which seems to saturate our lives at home.   And you see, there it was, the comparison.  Most of our schools don’t require children to wear uniforms, most of the time we all seem to be in a rush, and there are no churches nearby with soaring spires and illuminated clocks whose bells ring in the hour.  It’s all so charming.

Tomorrow I’ll comment on another old world tradition, grocery shopping.

Cheers, Mate.

Transitions

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The Octagon, in central Dunedin.  A small (eight-sided, if your imagination is vivid, or if you’ve sampled many brews) central park surrounded by warm and inviting eating and drinking (not in that order) establishments.

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The train station in Dunedin, which I’m told is one of (if not the) most photographed buildings in the country.  Because I was told this I took many, many pictures of the building today.

Transitions

A little more than twenty-hours ago, I boarded Air New Zealand flight 7, nonstop from San Francisco to Auckland.  If all went according to plan, I was to depart from San Francisco at 10pm Sunday night, and arrive in Auckland at 5:55am Tuesday morning.  Then I would clear customs, and rush to catch the 7:20am flight to Dunedin.   Here’s the play-by-play.

It was a sad day packing on Sunday.  I don’t travel (OK, well, I drive to the hospital) in my normal job, so for me to leave the family was novel….and sad.  We did rehearse how to Skype (I was in the living room, Debra was in the kitchen), and ensured that once I arrived in Nz we would still be able to ‘communicate’.  There were tears in all four pairs of eyes at the airport Sunday night. I am blessed to have such a caring and understanding family.  I had a plan for the 12 hour flight:  I bought an air pillow to go around my neck to help me sleep (check), my plane took off on time (check), I watched a couple of movies (check) and took an Ambien to get some sleep (check).  Sixty minutes after taking the Ambien, I was still awake (uncheck).  I was getting anxious…what happens if I can’t sleep at all?  I was restless, tossing from side to side in the dark cabin.  Everyone around me appeared to have no trouble sleeping.   Then the valve cover for my air pillow came off in my tossing, and the pillow quickly deflated.  Now, I’m worried- will I be able to sleep without my trusty air pillow?  I can’t find the valve cover anywhere.  I’m crawling on the floor around the seats,  using my iPhone to illuminate the ground, trying to find the valve cover for my air pillow, and trying not to disturb my sleeping neighbors.  After twenty minutes of searching, I give up.  I find the most comfortable position possible (sans air pillow), and low and behold, I fall asleep.  Five hours later, I am woken up by the announcement that breakfast is served.  An hour later, we are on our final approach to Auckland, and I remember I need to fill out the customs declaration.  Most the the questions are standard fare- are you carrying an Uzi submachine gun, or similar weapon?  That sort of thing, but then I’m thrown off by the following question:  “Are you bringing any sports  equipment, including shoes?”  I did pack my squash racquet and tennis shoes….and my fishing rod.  Now, I’m in trouble.  I don’t want to lie (they have X ray scanners, and an X ray image of a fishing rod looks very similar to…. a fishing rod).  I am keenly aware (look at that, I’m already picking up the word, “keenly”) any delay through customs and I won’t be able to make my flight to Dunedin (which is scheduled to leave Auckland only 90 minutes after I land).  When I had my passport and customs declaration to the Customs Official, he asks, “I see you’ve declared some sports equipment, what did you bring?”  I say (loudly), “Oh, a squash racquet.”  And then quietly “and a fishing rod”.  He’s a young man, with good hearing.  He then asks, “Would that be a freshwater rod, or a salt water rod?”  Clearly, if I guess wrong, he’ll point me over to the body search screening area.  “Saltwater.”  I say confidently, hoping that it’s freshwater bugs he wants to keep out of New Zealand.  “Excellent.”  (pronounced Eggs-salad-ent).  “Go on ahead”.   Gotta know your flora and fauna, I say.  I leave the customs areas and enquire how far to the domestic terminal to catch my flight to Dunedin.  “Oh,” the helpful woman at the desk answers, “it’s just ten (pronounced ‘TEEN’) minute walk to your right, follow the green line on the ‘SEE-ment’ “.  New Zealanders walk fast.  It took me twelve minutes.   I had no difficulty making the Dunedin flight, but was quite worried as I boarding the plane with TWO carry-on items the flight attendants would tackle me.  There were no less than fifteen announcements (in the six minutes I was waiting to board the flight) that we were allowed only one carry-on item of 7.5kg or less.  I was carrying my camera backpack (estimated weight, 32 kg), and my leather duffel bag (another 20kg); I used all my strength to make carrying them appear effortless.  It worked.  A short 90 minute flight and I’d be at my final destination, Dunedin.  Luck of the draw, though, I sat next to a very nice couple, who were in dire need of convincing me that:  (1) I needed to move to New Zealand…..right now and buy the 40 acres of land next to their house. (2) If you lived anywhere else, the radiation from the Japanese nuclear power plant melt-down was going to poison you. (3) The US government was trying to keep secrets about the health benefits of marijuana from US,  even to the point of removing academic papers touting this little known fact from the NIH databank.  (Truthfully, there were eighteen more points).  It was a long 90 minutes.

I did arrive here in Dunedin on a beautiful, crisp, clear morning.  There were people in shorts.  I knew I would fit right in.  Ninety seconds after leaving the airport I saw my first sheep, and then my second, my third….you get the point. I got settled into my apartment, walked around the city, hired a car for the week (it has a sign, hanging from the rearview mirror, reminding me to drive on the right….yeah, like I’ll need reminding), opened a bank account, walked around the whole city, and then had a lovely outside dinner (seared venision salad with local pale ale) at one of the restaurants on the Octagon.   Cheers.

Anticipation

Anticipation

T minus two weeks.
Is anything ever what you expect it to be?
Perhaps because I’ve lived in other countries (England, Mexico, Colombia, Grenada) I’ve learned to be more open to new experiences and not have set expectations about an experience. But then, maybe it’s just me.
As I make my final preparations for moving to New Zealand for a year, I can’t help but to wonder what the year will hold. I’m told Dunedin, the city in which I’ll live, has had a mild winter. Living in the San Francisco Bay Area, I have gone through mild winters without ever putting on a coat. A mild winter in Fairbanks, Alaska, might require sturdier attire, and a mild winter in Dunedin, is….well, we’re back to that anticipation concept.
I have driven on the left side of the road before, but it’s been awhile. This week I purchased a car (a ten year old Subaru) sight unseen (from a doctor who is leaving Dunedin about the same time as I arrive), and I wonder what it will be like to drive for a whole year on the left side of the road, and to adjust back to the right side in year.
And finally, what will it be like to practice medicine in New Zealand? I’m told by those who have worked there (or are working there) the pace is slower, and there isn’t as much fear of litigation. Maybe I’ve gotten used to things here in the States, and will be very aware of the differences when I get to Nz. But I’ve always centered my practice of medicine around the people I care for, and it’s difficult to imagine the people will be that much different. We’ll see…..