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.