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!