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...