Guest Post By Steve II

Life as an A and E doc in NZ. A and E stands for accident and emergency and we see pretty much everything from febrile infants with dehydration from vomiting and diarrhea to kids with poorly controlled asthma, to young adults with rugby injuries-name the bone, I've seen just about every long bone fracture and I'm getting good at reading the x rays as well, something I rarely did back home. Yes, I would have looked at chest films often but not a lot of radial head fractures or greenstick fractures. We get our share of chest pain and often I'm called to look at an ecg and assess someone for mi, chf, afib, etc. That stuff is good and fresh since my second job at home as a hospitalist kept me on my toes with the inpatients, especially those on the telemetry floor who had experienced an acute MI or acute exacerbation of chf, or afib with rvr. I have found here that my workplace, the 24 Hour Surgery serves many purposes such as a buffer to the hospital er-we actually get paid from the government for each patient we see who does not require hospital admission (bet anthem, aetna and cigna wished they had something like this). As the name implies, we are always open, never close, just like LL Beans. Unfortunately, just like Beans our door stays open '24 hours' everyday. When you see patients acutely, you are always looking to see how many charts are in the box, how many need to get seen. When it's a weekend, or a holiday ro the day after, it can get quite busy and the chart rack just piles up. You feel like the hamster in the wheel, just trying to catch up to that first patient so you can see them as they come in. However, there are days, and lately it seems like everyday, that the magic bus pulls up and drops everyone off at the 24 hour surgery for the day. Or the boat comes ashore, the plane lands, etc. Very disheartening to say the least when the patient who comes in for a supposed 'brief, acute visit', begins explaining that every joint in his body aches and has done so for the last several months and that he has diarrhea on and off for the past several months, and that his back pain is just under this 'rash' (freckle) in his lumbar spine and has been there for 'quite a while'. You end up calling the guy's gp (family doc) to find out what there take is on the patient, find out that they have ordered every test in the book, have sent him to a pain clinic, and that he is anxious and ruminates about every bodily function (oh, all way too clear at this point). Realizing that my initial impression was correct after speaking to the gp I calmly explain that the symptoms have been in existence for several months and that the best person to further work this up would naturally be the doc that knows him the best over the longest time and that as an acute medical center there is no way in hell that I, not knowing the guy from adam, am going to figure out why he is ailing so. Naturally, of course, he threatens to kill himself when he leaves. Great, just great. Why me? Why here? On the other side of the earth, people can be just as bizzaro as in the good ol usa. Mind you, this guy has already taken me away from seeing several patients, tying me up for some 30 minutes. I'm in a new country, not knowing quite yet how to best navigate such scenarios (really having hoped truly yet quite unrealistically, that such scenarios did not exist in Frodoland), and not wanting to do the wrong thing. I end up calling the emergency psych nurse who asks to talk to the patient. The patient talks to the psych nurse for another 30 minutes in my exam room. All the other rooms are tied up and I'm kinda stuck. Needless to say, this patient, who I never really felt was actually going to kill himself finally left after I spoke to the psych nurse again. She informed me that she, in her expertise, did not feel he was going to kill himself. No sh Sherlock! Thanks a mill. So, I advised him to follow up with his gp to cover my butt. That was just one of the many patients I saw today. Thank goodness there is great comraderie amongst the docs and the nurses. Well, Friday we leave for Nelson and the Marlboro Sound. I saw a cop the other night for a septic joint who was visiting from Golden Bay, next to Nelson. He advised me to text him once we got up there to visit. Lonely Planet says the town, called 'Takaka' (kids had a lot of fun with the pronunciation) was settled by many Woodstock children. That's good because Christchurch, though we are getting to know it and like it quite a bit with the awesome surroundings, is quite conservative. Too conservative for my Maine taste. I've wanted to see where the hippies hang out in NZ. Maybe cars might stop at the crosswalk for pedestrians? Another quick story, related. I saw this nice german woman on a working holiday in the surgery 2 weeks ago more or less. She came in because she was having headaches, feeling tired all the time, feeling in a cloud, being forgetful, difficulty concentrating, etc. On the chart it said 'mva' or motor vehicle accident. To my untrained brain, typically that means someone who was in a car on car or car on truck, or car in tree, or car in ditch, etc. It does not automatically bring to mind 'pedestrian victim, hit by car'. Yet that is what his lady was. She had been struck by a car 1 week before. I asked if the driver stopped, she said after a few blocks he pulled over to see if she was ok. He was on his cell phone the entire time and did not even get a ticket because the police said it was HER fault for crossing the street…at the crosswalk. Post concussion syndrome. Classic. But how frustrating that cars have the right of way over pedestrians. One of the thing I miss most about home. Crazy story. I would be more inclined to associate a story like this to Israel but I'm sure it happens everywhere in the world. It just reminds me how special Maine is. Anyway, it is late and we need to get to sleep. Hope all are well. Love to all.