Draft of prior blog posting found...

Samoa was the first Polynesian nation to gain its independence and did so on the year of my birth.  I would like to claim that this piece of information was what induced me to choose it as the location for my vacation- celebration for the end of my year in Auckland, but my reasons were much more mundane; plane schedules and cost.  Fiji has the reputation of being quite touristy, while Samoa and Tonga less effected by the tourist trade. Samoa lies about 1700 miles away from New Zealand, a mere trifle in the greater scheme of world travel.  I wanted to visit Polynesia while I was still in the southern hemisphere.  Samoa lies about 15 degrees south of the equator, as such, it could provide me with the week of summer I sought before returning to the northern hemisphere and autumn.  What I did not know, when I made my reservation online, was that it was also just on the other side of the international dateline.  I left Sunday, made reservations for Sunday, but I arrived on Saturday.

Fortunately, there are many Samoans at Middlemore Hospital where I worked.  A nurse and friend, Margaret, asked me when I was leaving as she would be home and able to pick me up from the airport.   "See you at the airport on Saturday," she said.  "Sunday," I corrected. "If you leave Auckland on Sunday, you arrive in Samoa on Saturday.  No worries," she proclaimed when I told her of my mistake. "We will take care of you." 

Disembarking from the plane in Samoa, the humid warm air greets you just outside the airplane door.  The walk across the tarmac to the small terminal is short.  A band plays for the arriving passengers as the passengers await their luggage. Margaret was there, as promised, waving happily with her daughter and sister in tow.  After a tour of the family house, some mango fresh off the tree and a drink, we drove to Apia to Hotel Elisa and the start of my Samoan week.

What will be the image, the aroma, the feel of Samoa that will linger when I recall the past week? It will not be the single bed at the Hotel Elisa on the seedier side of town.  The charcoal of a roadside BBQ.  The beach fales, with the front porch overlooking my private sand castle. Waves hushing me to sleep. The bulbul in the thatch of the roof, the cockroach running under the mat.  Perhaps the churchbells at 6:30 beconning that we have silence and consider our blessings.  The dogs that all seem to come from one rangy mutt.  Friendly ones, ones that cower and shy away from any human touch.  Know that they have not seen kindness. Seeing at once ribs showing plainly and teats, swollen and swaying.  I will remember the pigs and piglets at the side of the road, running squeeling from my footfalls.  The horses, tethered in the pasture and my heartache to know they were grown for food as well.  This beautiful land of languid beaches, tropical fruits.  The sensuality of a banana tree bearing fruit with the red flower at the tip of the stalk that yields  the  layered hands of sweet fruit.  This land, both lush and poor, loving and harsh.  Signs reading: Say no to rape and indecent acts.  The child swatted on the ferry.  The boxing ring, ugly stalls where men pitted against each other.  Money from foreign soils build ridiculously weathly establishments where fresh water fills pools while the village water supply down the road gets shut off after one hour.  Tourism comes in all flavors: Some folks come and stay in resorts, sipping Margueritas. Others prefer the budget fales with food served family style. Others hotels, or home stays.  The lives of the tourists in sharp contast to the way of life here.   Tourists clammer on bus/vans for a real Samoan experience.   One such tour landing unannounced  by my fale.  Six people crawled out, oogling my fale.  I, their unlikely and completely UN SAMOAN host.  Funny, that..  Cheerful, Engaging, yet unaware they came, swam.  I sighted whales in the distance.  My binoculars borrowed and trained  on empty vistas of sea and sky.

Perhaps I will remember the turtles  I saw snorkeling.  How my breathing and heart rate slows when watching the life of the coral reef.  Or  floating in the sea, another piece of debris on the surface.  The ferry, with people sleeping on the stairwell, plastic bags soaring into the sea. 

The banyan tree with a sleeping platform and the canopy walkway made seemingly from ladders lashed end to end with wood planking in between.  The chip sealed roads with no signs, just an arrow hinting at the possibility of a turn.

The jarring dichotomy of children watching a music video with grinding women, snorting men, lights flashing issueing from a grainy TV screen in a remote village of perhaps 50 people with the beauty of a starlit night and waves crashing on the shore.

Perhaps I will remember the people.  Women with beautiful smiles.  Folks walking along the side of the road for hours.  Boys with baskets on either end of a pole, hefting more than their weight.  Rugby games watched in Fale foles with cardboard hats, “Go Manu”

Breakfasts of paypaya, mango, banana

Dinners with fried veggies, onions.

Vailima beer, shanties

Discussing Fijian cultural politics with the French anthropologist.

Or  with the German cultural attaché.

Samoan men, who seemed universally bent on discovering my age, marital status, invevitably followed by  an invitation, to church, to date, to return to stay with their families… a ticket to somewhere else. 

I will remember  that the waste water just goes into the ground  A Culture so reliant on land, yet still mostly unaware of the environmental movement.  One protected rainforest. Several marine conservation areas adjacent to sewer dumped in the ground water.

Flowers. Frangiapane. Women with coffee colored skin, white teeth, long silky hair adorned with hibiscus, frangiapane, tropical treats. 

Lilting music as people sing and work, Sa, the evening choruses from church.

Heady, humid air.

The relief of a cool rain, or a dip in the ocean.

Breeze, warm.

Barking dogs at night

The crow of the rooster at any hour of the day or night.

The scarlet colored bird with black wings and down turned bill escaping my camera every time.

The dinner bell

Efita trying to teach me Samoan.

Faa afeeta. (thank you) Samoa, for my week of repose

Faa (bye).

I leave you with tears, and yet I don’t know why.

Traveling alone, I met friends.  Saw better ways of being.  Witnessed my close mindedness. 

Opened my heart to desire for

Further travel

And strangely, for home, for routine, for family and community.

Vineman 2012...Nothing to do with Auckland!!!

My Vineman experience began by investigating new “local” triathlons.  I was interested in doing another Ironman (as I aged up this year into the 50’s and had planned this since my last IM).  Vineman is the oldest independent full triathlon.  It was purported to be a friendly, well run triathlon and it completely lived up to its reputation.  It is also beautiful, cheaper and more available than the Ironman branded triathlons.  What did I have to lose?  It sounded like the tri for me.  I signed up before my job started and started training. 

Training when one is not working is easy.  Juggling a 50-60 hour work week, sleep, single living, and training for IM is not so easy.  After struggling with trying to figure out a good training scheme and honestly, not having enough time to even plan my training, I settled on trying out a trainer.  Mimi Winsberg is a local psychiatrist and IM triathlete/mother in her 40’s who has celiac dz (gluten intolerance and thus GI issues).  She was a great inspiration, source of advice and support.  I would recommend her to anyone seeking an online/phone coach. It was fun to follow her races and know that she “got it.”  

Finally, the day before the race arrived.  I mentally planned everything, down to where I would store the car key, what socks went in which bag, back up goggles.  I thought I had it down and would go for a quick ride the afternoon prior.  Of course, nothing goes according to plan.  I was late leaving SF and had to park for a while so I locked my bike to the bike rack, planning that I would ride later that day and unlock it…

By the time I left SF with my sister( who has recently undergone mastectomy for breast cancer) and my niece, 9 year old Alma, the traffic leaving the city was intense.  The 1.5 hour drive took more like 3. I arrived at registration for the penultimate race debrief, set up my run transition and left at nearly eight.  No time for a bike, much less cooking dinner. I had a delightful pasta dish in Healdsburg and got to the rental cottage at 9.  I had invited another mother and child pair for Friday night to both help Margaret and help entertain Alma while I was gone.  They arrived at 9:30.  It was closing in on 11 when I finally drifted off to sleep to the sound of the Olympic ceremonies in the next room.

I woke up at 4, packed and drove to the race start 45 minutes away.  I got there a good hour before the race start, despite the traffic.  I was ready!  Except when I realized my bike was still locked to the bike rack and the key was at the cottage… I called Margaret (who is not allowed to drive yet) who woke Carol, the other adult.  She agreed to deliver the key.  20 minutes later they called again to make sure they had the right key before leaving.  I knew then I would miss the start.  I checked with transition: I could bring my bike in until the transition closed.  I set up what I could of my bike transition and got my body marked before running back to the parking lot (1/2 mile down the road from the start).  The key arrived after the start.

I am so lucky to have been able to race at all.  I am lucky I invited folks to support my sister.  They wound up supporting me as well.  I am lucky that I got my bike to transition before it closed.  I got to the start… my goggles had fallen out in my racing back and forth.  They gave me an extra pair.  I asked if I could race… “Just get in and go” they said.  So I got in the water, started my Garmin, waited a few more seconds for the last fellow to round the buoy and off I went.  I had the advantage of not having a mass start, the disadvantage of having no one to draft and having to swim by the clots of the slowest swimmers.  Only a few people passed me. The water was warm. It was about 3-5 ft (I am guessing) deep and lovely.  After the first loop, my goggles were so foggy, and the fog on the river was dense enough it was hard to see.  The second loop seemed to whiz by and soon I was arriving at the finish. I stood up, pushed the lap button on my swim time (1:06?) really?  I had just finished my fastest 2.4 mile swim.  I knew my time would not be reflected on the official results.

My bike transition area was a little bit of a mess, having racked my bike and tossed things down so I could make it to the start before they could say I was too late. My transition was slow. I could not find my gloves. I shoved the excess of my gear into the transition bag. Oh no. GI issues hit… (stress is a trigger for me).  A trip to the porta potty before running out of transition.

The bike ride is a beautiful, no, stunning, course. Rolling hills, wine country, untraveled roads.  After only about 8 miles, I found a biker down.  I stopped.  He had what I think was a corneal abrasion and needed medics. Fortunately the race officials on the motorbikes called for them. Apparently, he had given the medics an \ ophthalmic anesthetic before the race!  I got back on my bike and continued racing.  I am really proud of my bike as I think I raced better than I ever have on my bike as well.  Gi issues meant I needed to stop once more at mile 18 and wait in line.

The course covers many miles of rough surfaced roads.  This means flats for many.  I stopped for one woman who forgot to pack her CO2 cartridge, and later another who had flatted both front and rear with no tubes, asking for 650C tubes. I stopped again.  Each stop was only a few minutes, and I caught back up to many of the folks I had previously passed.  I kept thinking that I should “Pay It Forward.” Many folks had let me race today: the key deliverer, the transition fellow, the goggle loaner, the race officials. I hoped I could keep other folks racing too. I kept the effort and attitude of race throughout despite the official clock.  I had one more pp line wait on the ride at around mile 70, but my GI issues seemed much better.

The run is three loops on quiet farm roads.  Lovely.  I was lucky it was only in the upper 80’s and not in the 90’s or worse.  My run started at 3:30. The first loop went well.  The second loop was going well and I had only a bit of foot pain, and not as terrible as my 25k trail runner earlier that year.  My GI issues had resulted in 2 stops, but long waits. I kept running and racing. On my way back, I heard that someone was confused and dehydrated. I stopped to help.  He was young (30’s?) the smell of fresh vomit permeating him.  Volunteers near, medics called, sublingual potato chip and coke sips… and I was off and running again after only a few minutes.  Somehow the combination of heat and the memory of the odor made me feel sympathetically queasy. (I routinely take care of folks who vomit, so I think it is odd that it effected me).  I thought I would soon toss my own cookies if I kept running. I walked. Drank coke, then thought : GI issues = potassium loss and downed some bananas.  Run. Walk, Run and eventually I was back running. This time for good… Just putting one foot in front of the other, and making it to the next aid station. Last loop went well.  As soon as the sun went down and the ice down my shirt and in my sunscreen sleeves and shorts was no longer required, I felt like a million bucks, picked up the pace and finished.

The spectators on the course were tremendous. Many telling folks they would be there for them until the close of the race at 11pm.  The folks I had invited to help Margaret met me and drove me back to the car and I had dinner waiting for me on my return.  The little girls had made their folks “swear” to wake them when I returned so they could hug me.  It was a lovely ending to a delightful race.

I finished, that was my goal.  Eighth in my age group. I own that place.  If you cut ½ an hour off my time for my delayed start, I would have been 7^th.  Either way, top ten… icing on the cake.

The best part of the weekend? Learning that my sister had only 5mm focus of infiltrating ductal carcinoma. … Associated with 95% 5 year survival. My race? Peanuts compared to hers.

Represent.

last day of work

Apia, Samoa

Through tumultuous weather, clouds and rain to the clear skies above, I left my year in Auckland today.  My apartment, emptied of bikes, crockery and books, awaits my return, where for 3 more nights I will spend the last days of my sojourn, a tourist once again.  I will return as a visitor on a foreign passport to collect mementos of time passed, attempting to capture events, friendships, places.  I hold these memories close to my heart, but they are like grains of sand in the hourglass, defying containment.   The trinkets in my suitcase a poor attempt to share this year with friends and family.

My last day at work was anti-climactic, lost in rugby world cup opening day traffic madness, patient care, the usual routine of a busy general surgical practice.  Oh, there were the patients who gifted books, socks, and greenstone.  Good-bye tears shed.  Phone calls with those who I had difficulty expressing the depth of my thanks for allowing me to come to NZ, for taking a risk on an unknown approach to a workforce problem, and for sharing knowledge, support and compassion. A quiet meal for lunch with nurses and house officers (interns and residents) celebrated our year.  The day prior marked by a gift from the department, with thanks. 

Red vented Bulbul

Friday, September 9^th, the opening day of the Rugby World Cup, is the event that marked the day, not the last day of two Physician Assistants.  Businesses closed early, transport promised to be hectic.  The usually empty train platform was packed.  When the already full train came, I stepped aboard, squeezing in as one more person fit between me and the door.  We got to talking, the young trainee intern with a penchant for all things Spanish: salsa dancing, Spanish language. The London-based physiotherapy couple who will visit the US in 2 months, the Samoan who boarded the train for the festivities.  All of us, pressed against one another, hot and sweating, as the train waited on the tracks.  I understood how desperation for escape in crowds can lead to mayhem.  Even as some opened the emergency exit, allowing fresh air to rush in, our car was calm.  My last day, spent meeting new faces, new friends.  New Zealand, the small country where folks claim only 2 degrees of separation, rather than 6.  Auckland, for the first time in my experience, resembled the bustling of a bigger city.  Crowds arriving for the Haka, traditional Maori warrior-welcome,(which I missed due to work and train delays), fireworks and festivities.  The game took place outside the CBD, though every bar boasted opening game viewing, even those in small back streets.

What has this year meant? Perspective of course must be considered; personally, professionally;  perspective from the general surgery department, to Middlemore, the health workforce and international health.  Conjecture will replace any true knowledge of what this has meant.  The spinning of this tale is not yet done, though my physical presence in Auckland soon will be.  It will be interesting to see who it is I stay in contact with, for that is determined in part by my willingness to reach out, by others willingness to stay in touch, and by happenstance.

Frangipane outside my hotel room.

This year, I have been vulnerable to loneliness, yet assuaged by travel and sport, by visitors and family.  I see now that the vulnerability, or the fear of it, has both protected me and isolated me.  With confidence comes further risk taking.  I see that this year has bred more confidence which I hope in turn will yield more personal connections, more travel, even as I do now- a solo woman flying to the south pacific.

Park across from Hotel Elisa

Professionally, though my hands have been tied by policy, I have learned a different way of medicine.  Folks often remark that Middlemore has third world medical problems in a first world health system. Like many large centers in the US, the work outpaces the work force. Long hours and burnout are common.  Yet, the hours are still less here than mandated resident hours in the US.  The nature of the medical work intrinsically lends itself to burn out.  The need to provide adequate cover 24 hours a day, 365 days a year.  Hospitals can’t close up shop at 5pm and wait for the earth to rotate to morning once more.  The emotional impact of caring for people produces burnout like no other. Yet there are so many gifts.

I don’t know how my year will be perceived by others institutionally, nationally or internationally.  I do think we have demonstrated to MMH and NZ that mid-level care is not middle of the road, but rather excels expectations, providing continuity that teaching hospitals world-wide are sorely lacking.  Filling gaps, sharing the work, knowledge and skill, our team of providers yields better care than any one of us could have done alone.  The past year has been a collaboration of consultants, registrars, house officers, nurses,  politicians and policy makers. Where the PA profession goes from here in NZ is largely out of my hands.  I feel I have worked hard in a local, immediate fashion.  I am reminded of the bumper sticker, “Think globally, act locally.”  Yes, I have thought globally, my actions have been limited to local colorectal team at Middlemore.  Perhaps the effects will have larger ripples through NZ. Australasia, and other countries where medicine has difficulty reaching its people.  I will continue to “watch this space.”

Hotel Elisa: Apia, Samoa

While medicine is a bottomless pit, in many ways (there is always more one person  can request), the US medical system gives so much, yet misses so many.  I have learned, too, the value of universal coverage, rationing and rationalization of care. I return a better practitioner for my experiences in NZ.

View from my room El Manumea hotel

 Sea and sky have met for the past few hours of flying.  Now, white sand beaches outline the eastern shores, aquamarine water  suggesting coral reefs fuse into deeper blue offshore.  Samoa, land of my exploration, contemplation and relaxation,  I see you.

The private, rock-walled, roofless bathroom at my hotel...

Full circle

Photos while running: Rangitoto from Beach near Takapuna, North Shore. Auckland

It has been a full year since I arrived on that windy, rainy day in Auckland.    I arrived ten days before the start of work, to get my bearings.  Now, two weeks remain in my work contract. I will miss Aotearoa, the land of the long white cloud.  Mostly, I will miss the people I have come to know.  No, they are not family, nor have I built a community, a home, although, with time, I have no doubt I would.  Through work, I have come to know nurses, cleaners, orderlies, administrative assistants, barristas, cafe workers, consultants, house officers, registrars, patients and others.  Outside of work,  through travels and casual conversation,  I have come to know train conductors, fellow  travelers, locals and foreign transplants. ~ a myriad of people in a true multicultural community. People  have shown me such kindness.  Folks have loaned me books, an ear, brought me food, invited me to dine, introduced Caleb to Auckland and other young adults, helped me learn about medicine, held my hand through long days and difficult moments.   It truly has been a privilege to work with and get to know the many faces of Auckland,  as well as met those from Wellington, Greymouth, Christchurch and smaller kiwi towns.  Some friends have moved on ~ to the US, Australia, England, Germany, Israel, Japan, China, India and further afield.  Others I will leave behind.  I will hold them in my heart.  To all of you, friends: If your travels happen to take you to San Francisco, or wherever I find my home, I hope you will come stay a while. The door will always be open...

Contemplative tidal pool. More photos while running...

This land, where I have run, walked, soul searched, swam, explored, will forever be in my memory.  In the past few weeks, I have been working on revisiting places I love and seeking out those sights I have intended to see but somehow postponed. I visited the old art museum before its scheduled closure.  A new museum is set to open on Sept 3 which I hope to visit next weekend.  The nation is putting its best foot forward as the world focuses on NZ with the Rugby World Cup which opens Sept 9th. I ran to the new waterfront art and cafe walk, and later went on a date to an art show there.  Last weekend, I went back to Muriwei, my favorite  beach spot.  The long black-sanded beach makes for a lovely run; watching surfers, seabirds, dog walkers, and horseback riders provides pensive entertainment.  Observing the gannets court and cavort in the wind following the run was like a fine appertif to be savored.  I could have stayed for hours, but my feet were numb and cold.

Sunday run photos...

This is winter??? photos while running

Today, I ran along the shore from Takapuna beach toward Devonport, the eastern "North Shore" of Auckland. Running the coast, over rocks and along the bluffs was stunning.  The sun was warm, reminiscent of summer. It is hard to believe that by the calendar, we were still in winter.  (yet last week we had the first snow in 80 years in Auckland!!).  Unfortunately, I bonked... and had to lay down in a cemetary to recover before running the rest of the way to my car.  Dinner and Jasmine tea at a Thai Restaurant in Devonport revived me.   I consider  the land my feet have covered in NZ: from Russell, in the Bay of Islands north of Auckland, to the waters of Milford Sound, the tracks in Marlborough sound, and the streets of Wellington, Christchurch and Dunedin; the Coramandel, Rotorua, D'Urville Island, Taupo, Mt. Manganui,  and Taranaki.  Alternatively, I have considered  the varied  topography of NZ from glow worm caves, to surfing waves, volcanoes, glaciers, muddied tracks, dry hard pack, sheep trails, farm, bush, parks,  and city streets.  It has been a lovely adventure.  I am not sure yet what it all has meant and how I have changed as a result.  Time and distance may provide that perspective. Now, I am busy attending to work, job hunting, and moving with little time for contemplation.  That time will come.

Just past Takapuna. Run photos.

Many have asked what is next for me~

The month ahead will bring me a year's worth of seasons: winter now, next week heralds the first of spring (which in NZ is the first of September).  In two weeks, I will venture to Samoa (which will feel like summer).  I will leave NZ on Sept 21, the first day of autumn.

Devonport Picnickers: music, food, friends, dogs... Photos while running

At this point, I have two job prospects: One is teaching at Pacific University in Hillsboro, OR (near Portland), the other working in GI Oncology at Stanford University Hospital.  I will live with my sister, Margaret, in SF until I find my next home.   I do seek community and a home base from which to continue to travel, exploring the world, my own backyard, and myself.

Hauraki Harbour, Coromandel Penninsula in the distance. Photos while running

I will likely write few more blog entries, namely one from Samoa, and one upon my return to the US, before putting my blog to rest.

Auckland, as seen from Devonport. Photos while running

Thank you all, dear friends, family and readers, for allowing me to share my journey; my thoughts, travels, and pictures.  Thank you for taking time to participate in my life.  I hope I can lend an ear, provide support, pick up mail, show my love to you as well as you have  through your support in this past year.

but wait there is moa

9 weeks.

Is it possible that I have a mere nine weeks remaining in my one year contract to work in NZ?  A year.  It seems contrite to say that it has flown past, as at times, it truly has crawled.  In reminiscing, I understand better the depths of my naivte upon arrival.  Can it have been any other way?  I recall trying to train my ear to understand the kiwi accent, at once enjoying the lilt of the Maoori and failing to follow conversations for lost phonics and phrases. Culture. History. Medical culture. Language, expectations. Living in Auckland has brought new meaning to each of these phrases.  Experience that cannot be contained in one word, or picture. A song, a fragrance, a greeting: Kia ora. The depth of which I don't even begin to understand, but at least I have a better idea now.
What has it meant? Has my presence had an impact on medicine here? My intent, to lead by example, has it been enough? Health workforce issues are and will be a huge problem in the years to come.  Insufficient health care providers to give the care that is needed.  Even that sentence is loaded with preconceived notions.  Who is the health care provider? What is the care that is needed?  Need. One word that encompasses such different parameters in different cultures.
I cared for a woman on the plane who likely had appendicitis. Her "need" was to get to her home country to have her medical care where she could afford to pay for it.  The fellow from Lebanon, a non-resident of New Zealand, wanting to return to Lebanon for medical treatment, because he would not require an interpreter to understand what transpired from one day to the next in his hospital stay.  Expectations. Emergency room and emergent admissions are covered in NZ, though it may take some time to get the tests required. Gratitude commonly expressed by patients for the simplest of kindnesses.
I strongly feel that PAs offer a unique solution to the workforce shortage.  Two years of intense medical school classes, with clinical rotations has led to a qualified, quantifiable work force with a good fund of knowledge that is consistent and reproducible (and requires recertification).  We are trained with doctors to problem solve in a similar fashion. We are a group that works in collaboration with doctors in a model that best exemplifies medical teamwork to provide outstanding care.  It is well known among PA circles that when evaluated by independent evaluators, PAs provide better quality care than MDs. Why? Not because PAs are smarter, more caring, or better, but we represent a team. Two (or more) heads, and hearts, for that matter, are better than one. It is not about how good the provider is, but how good the care is that is provided. 
What have Stethanie and I changed? No, we still do not have the right to prescribe medicine, order xrays, but these hurdles can be overcome with time.  We have not started a school, or a licensing board.  We do not assist in surgery, or do many procedures on our own. We have gone back to basics of medicine: clinical assessment, discussions with the patient, and formulating plans with good scientific reasoning. I hope that our efforts have demonstrated a new way to look at how to structure medical staffing issues. How to think outside the box.
There are so many ways to solve these issues.  It takes flexibility on all fronts.

Another week lays ahead. I best get to bed!

Malcontented

It was one of those days.  The alarm clock rang several hours before I was ready.  The memory of the warm bed remained there even as I got ready to run for the train.  I think I left part of my brain on the pillow, for I was still in a daze at the start of my day. I yearned for coffee.
Everyone has these days. It was all about me. How hard it was to get to work.  How I really did not want to go to work.  How much work there was to do.  How I don't know what is happening next.  I was grumpy.  I was "not on."



  At first I thought my morning consisted of one disaster after another.  A code on a patient down the hall from mine-- I ran that code.  One patient who needed urgent surgery.  A chance meeting of a former patient who had suddenly gone blind. Rounding on several patients under our care who have been in the hospital for months.  At some point during the day, and it is funny that I don't remember when, I thought about each one of those people.  What their day must be like.  My day wasn't one disaster after another, it was one lesson after another. 

One thing about working in medicine.  I am always learning. New techniques, new ideas, new studies.  Today I had a little lesson in perspective, humility.
Today's lesson was about grace.
One of my patients was admitted in February.  She is a small, frail woman in her thirties.  She looks older than me.  She greeted us with a smile and entreated us to take some chocolate.  She can't eat and gets all her nutrition intravenously.  She loves chocolate; so she buys it to give away to us.  One night, before going home, I found all the nurses on her ward were setting down to a large  "take away"  meal.   When I asked who had arranged such a feast, they pointed to her room.  She had bought them all dinner and had her mother deliver it.  Yes, she has some bad days.  Mostly, she triumphs at small successes.  Like today, she got out of bed with help. Stood for a few seconds and made it into the chair next to her hospital bed. 

Tonight on the train, I tried to go back, to remember each person and imagine the day through their eyes.

None of these patients. NOT ONE complained.
Most of them thanked me.
and I thought I was tired.

Vacation, Italian style.

f

Reading on the patio @ il Baglio, Sicily with Morgan.

Ten days, sandwiched between four days of the longest travel days I have yet to experience,  the privilege of travel has been mine, yet again. From Auckland to Sydney, Hong Kong, Rome and finally Palermo,Sicily, I wended my way to a week long family reunion followed by four days in Rome with Morgan and Caleb.

The swimming hole at the villa on Sicily, reefs all around.

This trip has been a lovely repose. Rest from work and from my persistent self-examination of my future plans.  Within our group we had historians, anthropologists, health care providers, psychologists, musicians, writers, geologists, world travelers, thinkers, activists, environmentalists, intelligent and  creative minds.  The ages spanned from 8 to 80.  Each  perspective a different view of the world.  A lovely panoply  with which to experience Sicily.  I let others plan this vacation and as a result I have been a hitchhiker of sorts.  It has been delightful.

Bella, my niece, in the amphitheater in Segesta

In Sicily, we stayed in a lovely villa on the water between Catellemare de Golfo and Scopello.  The deep blue Mediterranean water was the perfect temperature for long swims, the days were mostly sunny and warm.  We dined exceedingly well, but the best food was what we prepared ourselves from the local cheese, olive oil, tomatoes and wine.  

Lion statue that guards the "fountain of shame", Palermo

One of our first excursions was to the ancient city of Erice.  We took the gondola  up through the mist to the walled city and wandered the cobbled streets to the ruins of the cult of Venus.  That night, we dined in nearby Trapani , nearly filling the exquisite trattoria with our party alone.  Sicily, being only 100 miles from Tunisia, has a multi-cultural history from Greeks, Romans, to African travelers.   The ruins were less crowded than those we were to visit in Rome and Pompeii.   Our next archeological site was Segesta.
There, on a sunny day, we viewed ruins of Muslim mosques,  the most well preserved of Greek temples, and whispered messages in the amphitheater.   Availing ourselves of the blue water, the ocean rejuvenated us after hours of viewing ruins.

Daedulus' wall, in the Temple of Venus, Erice

About 3miles down the road from our villa near Scoppello, the Riserva Nationale de Zingaro offered a place to hike, run and swim.   This nature preserve wrestled from road construction through protest of 3,000 people, was the first in Sicily formed only in 1980. I gladly paid the 3 euro entry fee thrice.  The water teemed with fish that were not present just a few km down the road at our house.  Fishing was not permitted in the reserve.  Although fishing has been a way of life for many Sicilians for centuries,  newer fishing methods have nearly demolished the Mediterranean marine life.

Zingaro National Reserve and Marine Reserve, Sicily

Palermo, home to the airport, lays claim to being the largest city in Sicily.    We had planned a birthday present/cooking class experience for my father in Palermo.  There we braved the traffic and met at the palazzo of a duchess for cooking class. Inside the walls, a magnificent home, full of history, secret passages and elegance, hides from the chaotic Palermo street traffic.  We ventured to a loud, bustling street market to buy ingredients for our feast.  Our “graduation”  was the dinner, the sum of our efforts. 

Shopping for our ingredients in Palermo.

As with many places in Rome and Sicily, resplendent churches may have humble appearing exteriors and set in the most unassuming places, providing a sharp contrast to the hustle of the life outside its doors.  A modern city has grown up around many of these churches and ruins, almost despite them.  How does it change one’s perception to grow up in a country where ruins from thousands of years ago exist next door?  Do you have the sense things do not change much?  Or rather does the contrast of modern and ancient remind one of just how much our actions influence the world/earth?

Palermo market

Caleb and Chloe, Palermo

 Our final group archeological visit was to Salinute, the largest archeological site.  Andrew, a historian who had written about the area, guided us expertly through the streets of Salinute.  He embroidered history, recent events, engineering theories into  a lovely background that made the experience much more meaningful.  I regretted not doing my homework more thoroughly prior to my visit for all the other ruins I had visited.  Andrew joined us for dinner at a small inn nearby.  Simple, delicious, set on a patio with overhanging grape arbor and gracious hosts, it was one of my most memorable dinners with the family.  

Temple at Segesta, Sicily

Our best meal, however, was not in a restaurant, or catered, it was a pot luck birthday celebration.  The impetus for our trip and family reunion was to celebrate my father’s 80^th birthday.  His actual birthday, March 12, was the day following the earthquake in Japan, a day I had essentially missed all together, as I was preoccupied trying to reach Caleb in Japan.

Dad, Kate and Chloe at dinner in Trapani

Thankfully, I was able to celebrate his birthday during this visit.  A slide show with pictures from Dad’s life had been created, a collaboration by Lynn, Kirsten with some input from every family member. It was a lovely tribute to a kind, generous man. There were many causes for celebration during this trip; Margaret’s birthday (June 3), Kimberly’s recent graduation, Brent’s upcoming 50^th birthday.

I have a lovely, loving extended family. This trip represented a perfect time to renew our ties.  If anything, I wish I had more time to spend with each of our family.  More time to discuss what was meaningful to their lives.  I hope to make more time to continue to connect with each member.  

Following our Sicilian family reunion, Morgan, Caleb and I returned to Rome, to spend a few days together before dispersing to different sides of the globe.

Cobbled streets, Erice

Fountain of Shame: Why? "Because the monastery faces the sculpture devoted to nudists" said the carbinieri of Palermo

Rome.  A city of ruins, art,  and food.  Cobbled roads leading to piazzas with magnificent statues, ruins from ancient Romans reused, or strewn on the ground.  Yesterday, we walked to the historic city center.  We walked on streets that thousands tread annually. The same the Romans built. We visited the Colloseum, Roman Forum, Piazzas that Michelangelo designed, we made wishes at the Trevi fountain, climbed the Spanish steps, and ate fried artichokes in the Jewish quarter.  With guidebook in hand, we recalled the lives of Caligula, Nero, the Renaissance.   

The Colliseum, Rome, of course. Only a 3 hour wait to get in.

We have been accosted and succumbed to some of the typical tourist traps in Italy. Our “apartment” has no kitchen,  just a hot water heater and a refrigerator.  It does have bed bugs.  The train tickets we purchased were done so at the assistance/insistence of a woman who later asked to be paid for her help.   Sometimes ordering in a foreign language leads to interesting meals, but it is Rome, and the food has been sublime.  Particulary at a small trattoria in the Trastavere neighborhood.  The chef sat on the steps of his establishment, smoking.  He later came by to each table, talking.  Through stilted Italian, I asked if he could teach us how to prepare his dishes. He volunteered that we could come and cook with him. Perhaps on another trip to Rome...

Morgan

Caleb

It is 11:38pm the night before we depart Rome for our various homes.  The day  was spent in Pompeii wandering ruins of a city that dates to the 2^nd century BC.  Copulating frescoes, amphitheatres, wagon ruts in cobbled roads, and casts of bodies, caught fleeing the gaseous emissions of Vesuvius will live in my memory. In Pompeii, we met Kate and David (sister and her partner) which provided a sense of completion to our adventures.

Home, Pompeii

  It intrigues me that the Romans lived much as we do now.  What we revile in their culture (gladiator battles, brutality) we mirror in our own reality shows, violence on TV.  The walls of the city of Pompeii were plastered (pardon the pun) in political graffiti, dating from 2 BC!  The town was comprised of many houses, a central living area, atrium, kitchen, bathrooms.  

Fresco, in the house of prostitution, Pompeii

Mosaic floor from house in Pompeii

Large houses (2000 square meters) were built by the wealthy, while the merchants lived in the rear of their stores (bakeries, wine merchants) or in smaller homes removed from the pastoral view or main attractions.
What have we learned since Pompeiians walked these streets... in that 2000year span of time?  Electricity, the industrial revolution, democracy, nuclear reactions, motor vehicles, flight, space flight, the internet… where has it brought us?

House of Mysteries, Pompeii

 Art. Music. Sport.  All  ageless, favorite pastimes evidenced in Pompeii, Rome and Sicilian archeological ruins.  After spending the day with frescoes by Raphael and Michelangelo, I also thought about how growing up with them might impel one to sketch, to aspire to venture more into the arts than if one lived in a newer culture or lived within a more electronic/internet aged culture.

Outdoor market, Hong Kong... (with similarities to Palermo)

Outdoor market. Hong Kong

  The internet has brought us the ease of answering questions, of witnessing great art, music, of connecting with others across the globe even as I do now.  Standing in the Sistine Chapel,  walking in the footsteps of ancient Romans, seeing walls purportedly built by mythical heroes, swimming in the blue ocean, smelling the sun baked earth of Sicily, hugging my sisters, playing with my niece… the richness of experience cannot be surplanted by tales and photos delivered on a screen.

Eat. Converse.  Seek out art, music, people.  Live history.  Experience.  This is what I bring home with me. Hopefully, I will remember to do the same once I am back in my usual routine!

Ciao Roma!

Downtown Hong Kong fountain

Roof top in Hong Kong with windmill. Green energy at work