The mundane

View from College Hill: on my commute to the train (only it is dark then)

Lest you think that all I do is bike, run, swim and dine with new acquaintances, I want to relay some of what takes up a good part of my daily activities during the week, the mundane, work.  For fun, as work always needs some spice, kiwi phrase-ology I have come across will be randomly interspersed, in blue.

It is an odd place to be in the midst of my medical career.  Fifteen years of medical practice and I am again a student and in many ways, a neophyte. The role of a physician assistant is uncharted territory here in NZ.  In these foreign waters, I need to learn the currents, tides, and shallows.  I am a student of NZ, a student of medicine, and examine my intentions in coming  here regularly.

"I had a little tanti"  Tanti--> to  throw a tantrum.  Get angry.

The lay of the medical land:
(Of  course, this is my perspective after being here for one month.  Ask me again in 6 months and I am sure the reply will vary).

Walkway to the water at the end of my road

New Zealand has an enviable lifestyle.  Universal healthcare. Care for the elderly.  There is a secondary private system, for those who can afford it, so wealthy have access to quicker, though not necessarily better, care.  Private insurance exists, but at a fraction of the cost.  All accidents are covered, but if you accept the coverage, you cannot sue your provider in most cases.  Heinous/egregious negligence can be sued. As a result, medical malpractice insurance is not needed.  The whole medical culture of defensive care does not exist.  Tests? Less frequent, and so far, I think appropriately so. 

"I was really stuffed at the end of the week" Stuffed--> tired

In this culture, patients' expectations are different as well.  Folks don't come in asking for a test or a particular medicine.  Yes, there are advertisements for "Panadol" (over the counter Tylenol), but not for the prescription drugs.  (At least, I have not seen them).  Tylenol with codeine is over the counter.  Pharmacies are small.  The pharmacist comes out from behind the counter and asks you if you need any help or advice.   It seems that the length of stay in the hospital after an operation is longer here, but I am told it is shorter in the private, quieter hospitals. ( The thought being that people recover more quickly in the more peaceful, less busy setting,not that there was a difference in the actual medical care).

"You have to use the portaloos in winter, dear"  Portaloo--> porta potty

The pace of work is different here as well. I work in the busiest surgical department in the country. I start at 7, never earlier, says the registrar (chief).  Phlebotomists do their rounds at 8 or later.  If something is needed earlier, you do it yourself.  Work is done at 5pm.  If you get it done earlier, go home.  If you don't get your work done by 5, you are just inefficient, but you should still go home. No kudos are given for a late night at work.  6pm is late for staying at work.

"How long have you been crook?" Crook--> sick, ill

  In many ways, the system has many redundancies and inefficiencies, particularly surrounding the ordering of tests.  Xrays, Ultrasounds, MRI, referrals for other procedures (like colonoscopy) each has its own form.  I fill out the form with a somewhat detailed history and why I want the test.  For folks in the hospital, I fax the order, then run down and speak with someone about the patient.  If the doctor (radiologist, gastroenterologist etc)  feel it is appropriate, they will schedule it according to their thought as to its urgency based on the case presentation. There are some enviable efficiencies as well.  The computer system is accessible by all physicians in the greater Auckland area and will eventually be nationwide.  So when someone comes in to the emergency department, I can look up their medications, allergies, and medical problems, if they do not remember.   At the end of the patient's stay in the hospital, I send them an email with a summary of what happened in the hospital before the patient has left the building.  Prescriptions (except narcotics) are computerized. 

"I thought I was going to suck the kumara, mate.  I really did"

Kumara: a root veggie like a  sweet potato.

Suck the kumara--> akin
to "bite the big one"..." keel over"... die

Enough about NZ in general.  (Focus the microscope lens at 50x).  I work at Middlemore hospital.  I feel lucky that this hospital was chosen for the PA pilot.  Middlemore has the busiest emergency department in Australasia.  Its catchement area comprises a more diverse population than any other hospital region (District Health Board, DHB) in NZ.; more underserved, more Pacific Islanders, more Maaori.  Interestingly, the patient population is younger than many other DHBs.  I am honored to be a part of this hospital.  Other than the locums (foreign temporary docs), changing career locations is unusual at Middlemore. 

"I am going to go suss out this issue"   Suss--> figure out 

On yet a more personal level (turn the head of the microscope to 100x)
My job is again in general surgery and hospital medicine.  I need to learn the new studies, refresh my knowledge base.  Between work, transportation and getting settled, there is precious little time for study.  It gets squeezed into train rides, a few minutes after dinner, and surplants some of my bedtime novel ritual.  Weekdays are too busy to get lonely.  Weekends, I hope to do/see/find one new thing.

How folks often sign their texts: "Ta" --> thanks

I moved in to my new apartment this week.  I am living in Herne Bay, an affluent area about 4.5km from downtown Auckland.  My typical day (Monday-Friday): Wake at 5am.  Leave the house no later than 5:45.  Run with my little pack on my back to the train station (25 minutes).  Read on the train, arrive at work in 1/2 hr.  Shower, put on pajamas (ok, they are scrubs), go to work.  Gather labs, see patients, coordinate work with the team, go to educational meetings, go, go, go, but don't forget to meet up with everyone for tea in the morning.  (All the break rooms have free tea and instant coffee or machine-latte/cappuccinos). Lunch is also important.  And maybe (if you have time) afternoon coffee.

The self-check at the grocery store is interesting: capsicum = bell pepper, tomato sauce = catsup, courgette=zucchini

5-6pm, best be getting on the train! Check my email from my phone.  Run home.  This takes me 1/2 hour as there is traffic to wait for and the hill is up, where in the morning it is down.  Make dinner, skype, if I can, read and reply to emails, go to bed.  Thanks for all your comments on FB, the blog, and for the emails.  It helps me feel connected to all my friends and that helps me from feeling too lonely.

"That fellow is two sammies short of a picnic."  Sammie--> sandwich.... Two sammies short of a picnic--how I felt (a little thick headed) listening to the conversation.

This weekend?  Mostly I recovered from moving, had some frustratingly unsuccessful attempts to buy a car, and purchased things for my apartment like dishes, a toaster and silverware.  I am coming down with a cold as well.

home sweet home  (on the right side of the first floor of this house)

Don't worry, I did get out for an easy, investigatory bike ride.  Found a bike path that took me into Western Auckland, from which I will be able to bike in the Waitakere Ranges!!  Tended to a woman who tried to jump the curb and ended up fracturing her collar bone instead. (Dial 111 for emergency in NZ)

"I could do with a stubby right now"  stubby--> small bottle of beer

After the ride, I planned to swim from my "beach." I walked to the end of the road and trotted down the stairs with my wet suit in hand.  The beach is hard pack at the high tide mark, but quickly turns to muddy clay.   Mired, yet again, in mud, I abandoned my plan.  Best to do this at high tide.   I managed to drop my camera in the water.  If the pictures and my camera survived, there will be lots of pretty pictures interposed in this blog..

A blog with missing pictures might be appropriate for this more mundane post.
Tomorrow?

Rinse and repeat.
Well, not exactly:

This week, I get my first visitor!!!  Leslie Kineson, my son Morgan's friend, arrives in Auckland Tuesday night and leaves for the US on Wednesday.

 It may be the Speight's Pub or the wine and tapas bar for us Tuesday night...


"it turns out that VEGEMITE is just as great on the barbie as it is on your morning toast!" ..Barbie - not the doll, the barbeque, of course.   

I perhaps should  mention marmite, or its cousin, vegemite .  The former is supposedly MUCH better than the latter. (Vegemite IS from Australia... of course it cannot be as good as the kiwi version).  Both are a dark paste reminiscent of a blend of  yeast and soy sauce.  Spread on toast makes a much favored breakfast.

Miss you all heaps and heaps!

of Australian magpies, rides, runs and mud

Of Magpies:

Australian magpie defending its nest from a brown goshawk: Thanks to:

Wikipedia and noodlesnacks.com

The Australian magpie was introduced to New Zealand in the mid-1800s.   In the past 150 years, the magpie has displaced many native birds and is now classified an "invasive species."  In the early 1900's, when it was known as "the piping shrike,"  it became the official emblem of the Government of South Australia.  Indeed, the magpie is a common sports team mascot in both Australia and New Zealand.  With Spring comes "magpie season" when some of the breeding males become quite aggressive, especially toward bike riders.  There are web page instructions for walkers and bikers.  The first rule of WALKING during magpie season is to wear a helmet.

Of course, all of my knowledge of magpies came after my first encounter.  Last weekend, I planned to meet an amazing kiwi athlete, Vinnie, for a bike ride from Half Moon Bay to Maraetai where we would meet my friend, Kay, for lunch.

Kay and Vinnie at lunch

Vinnie is a 48 year old, mother of ten (?), seven-time ironwoman, breast cancer survivor who is training for IM Australia.  I tried to keep up with her, but mostly rode a meter or so behind her.  We were coming up one long hill when I saw a magpie swoop down on her, but there was no contact.  Unfortunately, he had a second chance with me slowly climbing the hill.  "Sitting duck", said the magpie when he saw me. "Yup, easy pickin's." He grabbed my cycling vest with his claws and perhaps his beak not once, not twice, but three times.  I was riding with cars on my right and could not do much more than continue my ascent.  I did try to keep him off me by waving my hand above my head, but I  later read that this antagonizes the males and makes them more likely to attack again. Great.  Cars were trying to help by honking, but all that did was surprise me.  After three attacks, I reached the top of the hill and luckily he gave up.  The ride was lovely despite the magpie.  After 50 miles of chasing Vinnie, I was ready for "tea" (evening meal) and bed.

(http://connect.garmin.com/activity/48606631, if you are interested in maps/details of the route)

Of mud:
The Waitakere Ranges lie west of Auckland and are famed for their rugged coastline, beautiful vistas, trails and surf.  I knew many folks did weekend trail runs in the "Waitaks" and decided I would give it a try.  Stethanie, my friend and fellow PA, wanted to try a trail run there as well.  I also wanted to see kauri trees, one of the most ancient trees in the world.  A coniferous tree, it grows to 50m and is one of the largest trees in NZ.  My idea: to run trails through the kauri bush in the Waitakere Ranges.  Perfect!  The morning proved grey, though still dry when we left Auckland.  After a 30 minute drive, we pulled off at the trailhead.  At the beginning of the "track" (meaning trail in kiwi), we found a milk crate with disinfectant and a scrub brush with instructions on cleaning footwear upon entering and leaving the forest to protect the kauri trees.

We dutifully cleaned our relatively clean sneakers.  A few meters further on, the track became quite muddy.  We soon learned the soil in the Waitaks contains a fair share of clay.   The rain that had held off, began to fall in earnest and the footing became increasingly slippery and treacherous.  The run slowed to a "tramp" (hike/walk).  Drenched, we conceded defeat and turned around.  I know I will return when the days become dryer in search of kauri trees and beautiful vistas.  Hopefully I will have better pictures than this:

attempting to clean my feet AFTER the "run"...Should have had a "before" shot.

After hot shower and dry clothes, Stethanie and I headed north.  My initial plan was to camp in Leigh near Matakana Saturday night.  We had decided that a night in a tent in torrential downpour was not ideal and we settled on a short drive through the wine country of Matakana, with lunch in Orewa.  

Heron's Flight vineyard

Orewa beach. Kiteboarders were out, but they are too small to see well in this photo

of races and runs:
The following week, I was describing my running misadventure to a fellow Middlemore employee and runner.  Janet is a member of the Glen Eden Harriers.  There are many harrier groups in Auckland, she noted.  Harrier clubs in NZ are groups of folks who do "bunch bush running."   As the Weds night and Saturday morning session don't start until November when the tracks are more passable, (should have talked to her before the weekend trail run ;)) she suggested Steth and I enter Arthur Lydiard marathon or Half Marathon the following weekend.  So we did.

Today I raced the half marathon in honor of track and field coach Arthur Lydiard on legendary routes where he trained and trained others. He was an advocate of an active lifestyle for everyone and introduced jogging to NZ in the 1960s.  He believed that if a man could run one lap of the track in under 60 seconds, then they should be able to do a mile in under 4 minutes, with adequate training.  Arthur was his own guinea pig.  He worked up to running 250miles/week (a marathon in the morning and a second in the evening!)  to learn what the body could endure. His training regimen included daily runs averaging 100miles/week.  He went on to coach many Olympians throughout the world, most notably the Fins in the 1972 Olympics where they took the gold in the 1500m, 5000m, and 10,000m.

I arrived at the start of the race to find that it is billed as the toughest road marathon and half marathon in NZ (but I think our Langley 1/2 has more challenging hills!).  The advice from the harriers: don't burn up on the hill.  It just goes on and on.  When you think you are at the top, you are really only half way there.  With that in mind, I took to the course conservatively.   When I did reach the top of the hill, I thought I was only half way!  It felt good when I finally figured out that I was done climbing!    It really was a lovely run.  Runners were treated to undulating hills, small communities with vistas of the coast from time to time. The easiest way to describe it: the first part is mostly up, and a little after half way, it is mostly down.
  
Stethanie rocked the course with 1:54:13. I was about 30 seconds shy of a PR, which is surprising, given my general laissez-faire attitude towards training these days.  The kiwi are a little more subtle in their age groups: Junior, Open, Masters, Vets, and Legends.  I was 8th female master, 38 OA woman.
(again, for those interested in maps etc: the garmin version of the run: http://connect.garmin.com/activity/49421310)

Janet  invited us to a pot luck breakfast after the race with the Glen Eden Harriers.  The harriers met at the finish line and toasted the run with about a tablespoon of whiskey from plastic shot glasses.  We cheered everyone across the finish line and walked back to John's house for a breakfast feast of scrambled eggs, baked tomatoes on toast, homemade muesli, curried pasta salad and smoked salmon.

Glen Eden Harriers (Janet on the right)

? and Stethanie (bandana woman)

Talofa Lava

Cockle Bay, NZ

Greetings, in Samoan. or "Fakaalofa lahi atu", in Niuean.  Both of these greetings, translated literally mean "lots of love from me to you."  In many Pacific Island countries, the greetings are about the person being greeted.  In Tongan, the greeting is "Malo e lelei" or "Thank you for being well."

My first week of work included several cultural opportunities that I will not likely forget.  On Monday, our week started with a Powhiri.  This Maori honoring ceremony welcomed Stethanie and I to the marae, or sacred place and meeting house, on hospital grounds.  We were greeted by elders of the iwi (tribe/family) that have inhabited the land around Middlemore Hospital for centuries.  It was a lovely ceremony that left me feeling quite honored.  One of the elder women came up to me later and exclaimed at how I was so small in every way except one... "you have long feet!"  We had a good laugh.  Perhaps my little duck feet make good paddles for swimming.

Marae on University of Auckland campus

Beyond the gates... University of Auckland

Another day, we met with a Samoan on the Middlemore staff who talked to us about some of the cultural differences of the Pacific Island people.  In Auckland, there are more Pacific Islanders (non Kiwi) than in the Pacific Islands!  Indeed, the area around the hospital where I work has the largest population in Auckland.  Unfortunately, poverty rates are higher in this group as well.  They have such a lovely sense of community and support, however.  If a Samoan shows up on another's doorstep, they will find a place for them to live.  Many garages have been converted into living spaces for family, friends, and fellow countrymen.  For them, the most important things in life center on family and connections with others.  Middlemore employs a group dedicated to cultural diversity and a specific mental health unit for Pacific Islanders and Maori.

 Alongside the cultural education has come a medical-cultural education.  The medical system here has a few different twists, many of which I am still sorting out.  I have arrived when the lab techs, rad techs, and interns have been in various stages of strikes.  I have also found it interesting here that in order to get a CT scan or MRI, a person has to review the case with the radiology liaison for approval.  Indeed, although sometimes the information may have been helpful, the  therapy has not varied.  Medical costs are certainly regulated yet the care is excellent.

Wednesday evening marks the official "over the hump" in my first work week.  I think I have run the gamut of emotions from excitement to being overwhelmed and wondering why I have chosen to come to NZ at all.  If there is one constant, it is that this work will be different.  My work will be a specialty position, where I have been working in a more generalist internal medicine position.  I will again switch from outpatient to inpatient care.  This time I will also  learn a new health care system, and introduce of the role of Physician Assistant. New protocols, new drugs, old drugs with different doses and schedules,  new abbreviations, conventions, and terms to describe the same illnesses all contribute to my need for further education.  I vacillate between being rabidly protective of my workout and private time and earnestly studying swearing that I will not be training for any events this summer!

As I write this, I am falling asleep.  The other consequence of all the unfamiliarity, is that I have been waking at 3 in the morning.  When I can't get back to sleep, I get up read and then run.

I have found a place to live in Herne Bay, Auckland.   I hope that it will provide that much desired sense of home.  A place where I can relax, enjoy the denoument of the day. Watch the sunset.  Where I can walk to the shore and swim, watch birds, enjoy the contrast of quiet after a busy hospital day.   I hope that I will meet and get to know more folks, my neighbors and coworkers.

My apartment faces NW on the ground floor of this house

The physician assistant pilot in New Zealand has hired (in addition to myself), Stethanie Jacobs, a delightful young woman from Guyana who has been living in the States for the past 10 years, most recently working in NYC.  I am lucky to have her as my comrade in arms.  Tomorrow we hope to head for Matakana, north of Auckland.

Good night, Kiwi.

Former TV sign off cartoon, Goodnight, Kiwi

First day of Spring

In New Zealand, Australia and South Africa, the first day of spring has no relation to the equinox.  September 1 and March 1 mark the first day of spring and autumn, respectively.  Auckland's first day of spring this year proved to be sunny and mild and the only day without rain since I arrived.  This week has been dedicated to walking (mostly)  Auckland and looking into places to live.

I have found many pockets of quiet parks and beautiful vistas.  In the midst of the city, I came upon a marae, a Maori sacred place.  I ran along the shoreline through the city center, past the Auckland Bridge and into Herne Bay.  At the base of the Auckland bridge there is a park, with a pool and some running paths: Pt Erin Park.  The marina in the photo above sits on one side of the park.  In honour of my friend, who shares the name, I ran around the outside of the park and took a picture of the sign.  (Not bad for cellphone photos!)

What I have not yet found is a place to live.  I am weighing the different aspects: commute time and method (train vs car), in town or in country, ambiance, noise, cost. These pictures are from a park in Parnell, my favored neighborhood, where I have not found a place to rent in my price range...

(I had a grand chat with an older fellow who was perched on a park bench under the branches of this beautiful tree.   Harry, the soft coated wheaton terrier, was enjoying the first of spring as well).

I drove out to Cockle Bay to look at another rental, much less money, but would require a drive to work  I would also be farther from the city center and amenities.  The single BR overlooks this vista and the beach. Serenity, beauty, and many birds serenading are the best benefits of this rental. It is small, though. Essentially one room with a porch.

I have logged miles of walking, running, some biking, some swimming.  (Tuesday morning was spent riding with a group of 30 cyclists  that meet each Tues and Thursday at 6am to do a hard ride around town before heading off to work. It poured. This did not deter them).

My work starts on Monday after which I will not be able to meet folks for morning swim, rides or runs as I will start rounding at 7:30am.  I am glad to have had this week to sleep, walk and acclimate to Auckland.  If the weather breaks this weekend, I may take the ferry to Waiheke Island and hike, oops I mean tramp.

I almost forgot!  I have promised some folks that I would keep up with posting the swim workouts...

Today's workout: I would call this the 100's...

Warm up: 100 x 4:  1st=swim, 2nd=fingertip drag, 3rd=three point drill, 4th=IM
25 Underwater, no breath
4 x 25 kick, sprint
4 x 100,  1st and 3rd swim,  2nd 100 all head up freestyle, 4th  flip just before the wall/no push off
   repeat the 4 x 100's above, but with Paddles  (ha, I don't have any yet)
4 x 25 kick, sprint
6 x 100: odds free, evens: 2nd: heads up, 4 and 6: no flip
100 backstroke
4 x 100: "110%" race pace on the 2:15.  Goal: come in < 1:30
100 IM, easy
100 swim anything but free, 100 pull, 100 kick
DRY LAND TRAINING
60 seconds of plank, 30 seconds of side-plank then switch sides
repeat
60 seconds of side-ups: 30 seconds per side (from side-plank position)
60 seconds of back kick (lay on your back, head up, small of your back on the mat, kick str legs)
60 seconds of bicycle (elbow to knee)
60 seconds of dips
60 seconds of front crawl stroke with high elbows/ elastic bands
3 x 10 push ups
60 seconds triceps with bands
60 seconds of high elbow pull only (with bands)
Cheers to spring...