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.

A Word About the Weather

Weird.

One of my good friends, Rachael, asked about what is different here, and there is both a lot different and not much. It is a western society with strip malls and box stores, Mitre 10 instead of Home Depot and The Warehouse instead of Walmart, but it is also a place of wee villages and walking tracks, paddocks and rising hills of burnt out volcanoes outside everyone's back door. One thing though which is quite strikingly different is the weather. I know it sounds mundane, but it isn't.

New Zealand is a bitty island in the middle of a vast ocean, hardly a blip of land from a meteorological point of view. The weather and the wind, particularly in this part of the south island blows across without a thought that there is even a bit of ground to stop it on its way. There is a saying here: "Four seasons in a day." And it is absolutely true. The weather isn't a bit connected to what came before it by a day or even an hour. It can be blowing a "Southerly" out of Antarctica like Robert Frost's end of the world by ice in the morning and in the middle of the day it is a "Westerly" a hot wind that locals say make the children and old people crazy. By evening a cloud of cold mist might have rolled in down the hills and be sitting on the coast like a blanket, and the weathermen may be calling for a clear, fine day for the morrow. There is a fifty, fifty chance they will be right by the time tomorrow comes.

Like the landscape here, the weather is an active part of life. It is not a background figure. It has a presence and weight in life. Like the winter and the snow has in Maine, because of its impact on living and the glorious summer day as well because it was…well so glorious by contrast. But here it is all the time (at least so far, and I have been told it is always like this here in the south island.)

So that is my word about the weather: weird, very, very weird.

Falling Off the Horse and Getting Back On Again

So this post is both metaphorical and literal. We have all fallen off the metaphorical horse and had to get back on again, but two weeks ago, I fell off a horse...literally.

I had taken up horseback riding here in Sumner, in the most beautiful spot nestled in a valley at the back of town. I was having a really smashing lesson, my fourth, when my horse, Spud, (yes, I was riding a potato) had enough of me and decided it was time for some of the nice hay one of the little homeschooled girls who are endlessly scurrying around the paddock had place in the bins. Instead of continuing to trot back and forth across out in the field, as I had requested, he took off for the barn. To my credit, I did manage to slow him down, but much not to my credit (read: I'm an idiot). I decided I wasn't going to let him win. I was going to take him back out to the lesson. I turned him out and demanded he return to the field when he promptly took off around the mulch area nearest the barn at a gallop. (Okay, for truth sake here...I think it was a gallop of 40 miles an hour, but my riding instructor, Lisa, the most fabulous, spit-fire of a woman, who says she's dyslexic when she wants to be, Irish when she has to be and Kiwi the rest of the time, or maybe its the other way around, but either way, you never have to guess what she's thinking, informed me it was a trot and more like 4 miles an hour. In any case, it was bloody fast.) At some point, I knew I was coming off. I hit the ground thinking simultaneously, "Please G-d, don't let him trample me" and "This is going to be a serious hurt." I landed solidly on my lower back and there wasn't a mark on me, but something inside moved.

I have been hobbling around for the past two weeks. Slowly coming back to myself, though occasionally, as my balance is off and I am tender (think prolonged back labor without the drugs or baby at the end), I keep falling over and hurting myself again. (Sneezing is also a real b_ _ _ ch.)

But that is the literal story. The other story is that when we moved here, I sort of fell off the metaphorical horse. Transition was much harder than I thought it would be, particularly when we arrived and it seemed to some degree that NZ was "here (home) with an accent." But it is different, and I did fall and fall hard as some of you who got some fairly dark emails can attest to. The good news is, that though I (and we) are all hobbling a bit, we are definitely on the upside of our metaphorical fall.

And as they say (who are they anyway) the trick is to get right back on the horse and gallop away. (Which I will as soon as I can walk standing up straight again.) Till then, we are off to Nelson tomorrow and more adventure.

Giddyup!

Cricket Season

From Wikipedia: Cricket was first documented as being played in southern England in the 16th century. The game may have Flemish origin as the word krick(e) was Middle Dutch for stick and there was heavy trade between south east England and the county of Flanders. By the end of the 18th century it had developed to being the national sport of England. The expansion of the British Empire led cricket to being played overseas and by the mid 19th century the first international matches were being held. Today, cricket is the world's second most popular sport after association football, (soccer).

So what in the world is cricket? Well it is not an insect. And it is not baseball, but the season did begin. In a moment of characteristic insanity about three weeks ago, in an attempt to give the boys a genuine Kiwi experience, I signed all three of them up for it. So, Saturday morning at nine a.m. they had to be in three different places across the city to play. (Three boys, two parents, one car, Oy!)

The gist of the game is this. There are two teams. One bats, one fields. Two batsmen are up at a time standing in front of a two different wickets, a three poled thing with two little things balance across the tops of the three poles. These are called bales. The wickets are across from each other at the end of a rectangle called the pitch. The fielding team bowls the ball to just one wicket trying to knock the bales off the top of wicket. The batsman standing in front of the wicket hits the ball away protecting the wicket using a bat like a golf club. When the ball is hit away he and the other batsman can run back and forth between the two wickets scoring as many runs as possible till the ball is thrown back to the wicket keeper (like the catcher) and the play is stopped.

You can score runs this way or in other ways such as how far out of a field of no specified dimensions, (though often an oval) and how you hit the ball out, (did it fly over the line, roll out, bounce out, etc.) . You can get out if the wicket keeper gets the ball before you get back to the wicket or in other ways such as if the fielder catches the ball before it touches the ground or with one hand if it bounced only once, 'one hand, one bounce' rule. All fielding is done barehanded

Depending on the kind of match you are playing it could go on for 20 runs, 3 hours or like a Grateful Dead concert, 5 days. Oh, and you wear all white to play, preferably pleated pants.

If I have made it sound confusing, arcane and indecipherable, it is. I must admit, to my dismay, I did not get to see the boys play their game, only their practices. I was on Ruby duty and went to the 'Have a Go' program and watched seven 3-6year olds alternatively start to learn cricket skills, burst into tears (not Ruby) and eat. It was delightful. I hope to get to to switch with Steve and go next week's games. I will give you an update then. Till then, surf the cable sports stations and find one of the international test matches. Those are the 5 day one. Have a gander and see if you can figure it out.

Happy Cricket Watching.

What is a Library?

What is a public library? Merriam - Webster defines it as a place in which literary, musical, artistic or reference materials (as books, manuscripts, recordings, or films) are kept for use but not for sale. But is it really just a collection of books and other media available for use? Ben Franklin and his fellows thought it was more than that. They thought that they were so important they chose as the motto of the original charter of the first public library a Latin phrase which translates to "To support the public good is divine." And later Franklin said of the libraries which sprung up in the colonies copying his own: "these Libraries have improved the general Conversation of Americans, made the common Tradesman and Farmers as intelligent as most Gentlemen from other Countries, and perhaps have contributed in some Degree to the Stand so generally made throughout the Colonies in Defense of their Privileges."

I too think a library is desperately important, though I can't articulate it nearly as eloquently. For me, it is not only a place to get the most important item in the world -- books --for free mind you. It is a place to go; to be; to gather; to meet; to dream. In the first few days that we moved here, I was most concerned that we get a permanent address quickly so that we could a) get the kids enrolled in school and start them getting acclimated and b) get a library card. It took us ten days and let me tell you, for a woman who frequents her public library two to three times a week, it was a long ten days.

You are probably wondering why I am dithering on about libraries. On Monday, the Sumner library finally reopened after the earthquake. It was the last one in the entire city still to be closed. After a false start last week, when I was given bad information by the staff on the mobile library bus parked outside of the supermarket, and checked the website yet again to see that it said it would be closed "Until Further Notice", I was certain it was never going to reopen, and I despaired. I couldn't believe it. I was living in a town without a library. I wasn't certain how it happened, that we had moved half way round the world to a parched and barren place such as Sumner.

But now the town is in bloom with books again. There is an oasis by the sea. Words wash up on Sumner's shores. There is light and hope and lollipops.

So, what is a library to you? It is everything to me.

Oamaru and Dunedin

A blog should never be quiet. At least that's what they say. But for all my moaning about having nothing to do here, I've been incredibly busy. The kids have two weeks off between terms and we have taken our first big excursion into New Zealand. We traveled south about 5 1/2 hours to the towns of Oamaru and Dunedin to see the penguins and the royal albatross for Ethan's birthday. For those of you who don't know him well, he is crazy about animals.

Oamaru was a booming town in the late eighteen hundreds into the early nineteen hundreds. Then development stalled and the town was over mortgaged. It hasn't really recovered. It has a large deposit of limestone in the area and the downtown is all built in a really regal fashion out of the beautiful white stone. It is very majestic and striking. Now a days the town is known as an arts town and known for the little blue penguin colony that has always been there, but they have protected and cultivated into an eco-tourism site.

The penguins come in from the sea at dusk, where they have spent the whole day diving for fish. So we had to wait till about 7:45 pm to see them. During the day, we drove inland to a place called Elephant Rocks, and outcropping of limestones once underground and underwater one of many of the stops on the Vanished World Fossil Trail. (The whole of the Otago region was once under water, as was all of NZ, I quess, so there are fossilized whales and dolphins and pleiosaurasus and other-a-sauras all over the place.) But much more interesting than this, Elephant Rocks was where the final battle scene of The Lion, The Witch and The Wardrobe was filmed. Pleiosaurasus phooey! That is cool.

So on toward dark we went to the Oamaru Blue Penguin Colony. They have a grandstand set up. There are orange lights which the penguins can't see, so they think it is dark. It was cold, but we wore hats and coats and wrapped up in a blanket and waited for the penguins to make an appearance. The penguins came in from the sea in groups or rafts, quacking like ducks. They were 30 cm high, which is about a foot tall and they were cute! They crawled out of the surf and onto the rocks where they preened for a few minutes pumping oil back onto their feathers from a gland just above their waddly little tushes. Then they did indeed waddle off to their nesting boxes across the road in the sanctuary. Well, most of them did. Some were, as we joked (if you know our family well you get the joke), ADHD penguins, and seemed to get distracted and had to do it their own way waddling off in odd directions and trying to get through the fence in spaces that didn't fit. Overall, in the course of an hour, 154 penguins were counted coming home.

The next day we spent the morning in the Oamaru Botanical Gardens before heading off to Dunedin. The Gardens deserve a mention because they were a spectacular place. Each separate little garden section was a surprise, popping out at you in an unexpected way with something new. The Wonderland, an english garden delight, designed to evoke Alice's journey made it feel like magic was possible. The aviary hidden in the trees behind the duck pond was like finding a hidden treasure with an errant roosters your guide pecking the way. The Japanese garden that sprung out of the NZ fern enclosue shocked you with it's pristine lines after you forged the wilds of the native bush. It was a masterpiece of planning. If you ever get to Oamaru, go to the Public Gardens.

Statue in The Wonderland - wish I had a better picture.

On our way to Dunedin, a city of Scottish origin, the name itself is the Gaelic way of saying Edinburgh, we stopped to see the Moeraki Boulders. I bought a pamphlet on the boulders and have read about them online. I am still a little iffy about the process. Here is what I know: Though it looks like the boulders were washed up onto shore by the sea, they were actually eroded out of the mudstone cliff (unpictured) and left on the shore. The stones were formed millions(?) of years ago through a process of concretion on the sea floor, then pushed up through the ground then exposed through erosion. A better explanation can be found here: http://en.wikipedia.org/wiki/Moeraki_Boulders

After that, we got to Dunedin through the ever larger rolling hills, covered with bright green grass and sheep. Dunedin is a great city. I think it is about 160,000 people. It has Otago University so there are about 20,000 students in it. It is clean, modern, cool, but also some old buildings. I forgot to take pictures. It has a very nice vibe.

In Dunedin we went to the Cadbury factory (no oompa loompas were spotted, but they did wear cute purple overalls), to Lanarch Castle, took an hour cruise to Tairoa Head to see the Royal Albatross, a bird with a three meter wing span (9 feet), and spent a day at the Otago museum. Gobs of chocolate was eaten (not by me for those readers who might be wondering), birds, fur seals and spotted shags were spotted. For the sailors who may be reading, we did reach the roaring 40's and were at the top of the southern ocean on a calm day (thank God) only 20 knot winds, 2 meter swells and a small amount of sea sickness by me and Ruby. Steve was, as some of you can image, delighted to be out on those particular high seas.

I think there is a fur seal in this picture, but it is hard to see.

Finally, one other quirky thing Dunedin has is the "steepest street in the world." According to the Guiness Book of Records, Baldwin Street has the steepest slope at a certain point. It is very steep, but as Steve said, I can only imagine there is a street in Nepal somewhere that is steeper. Anyway, vini, vidi, vici. Or however that is spelled. They didn't teach latin in public school in Florida.

So that was our four and a half days in Oamaru and Dunedin. We were supposed to stay out five days, but as my grandma, Nan Sarah, used to say: "It's good to go. It's good to come home." It was time to come home and have some regular life. At one point Sam said, "Traveling is good and all, but I'm tired."

Picture of Tairoa Head from the roaring 40's (40 degrees latitude)