Why New Zealand?

I've been everywhere, man.

I've been everywhere, man.

Crossed the deserts bare, man.

I've breathed the mountain air, man.

Of travel I've had my share, man.

I've been everywhere.

- Johnny Cash

The flippant answer to the question often asked, "Why are you going to New Zealand?", would be a quick and simple "Why not?" The thing is, "Why not?" is not that flippant and is pretty much the answer. Of course there are multiple underlying motivations driving it. 

A few years ago, somewhat in jest, Kari suggested we pack up and go live/work in New Zealand. We frequently get solicitations from staffing companies to work throughout the U.S. and also internationally. We were both at a particularly frustrating time in our careers and saying "Fuck it, let's go" had a certain appeal. I don't think she initially thought I was serious when I said "Let's do it" but we were both serious enough to start looking at the possibility.

Luck is where preparation meets opportunity.

- RGH

Packing up and leaving behind everything you know, everything you are comfortable with, can be frightening, but I have a pretty long history with it. For years, I bounced from place to place, trying new things. In highschool, my parents allowed me to travel and explore with friends and by myself. When I left home, I went to college in Hawaii for two years, then transferred to Boston University. 

That transitional summer, I shipped my Jeep to Oakland CA and spent the summer driving around the U.S. Just before leaving Hawaii, I had my wallet stolen. I had closed out my bank account and an entire summer's worth of cash saved was gone in an instant. What was supposed to be a fun, frivolous, and lazy summer turned into a lesson in how to make do.

From there to here has been a series of jobs, careers and adventures. Along the way, I worked as a diver for NASA training astronauts in the lead-up to the International Space Station, I lived in Honduras and Belize working on coral reef research, and I tried my hand in the oil industry (what Texan hasn't?) working for a company that had me living in Brazil.

I once was asked "Why are you always moving? What are you running from?" and I got a little pissed off (needless to say, that date didn't go well). I thought, and said aloud, something along the lines of "Why do I need to be running from something? Why can't it be that I'm running to something?" 

Now I realize that I have never been running from, nor running to; I'm just running for the joy of running. I was lucky to find in Kari someone who enjoys the run with me. I have also been lucky to settle into a career that allows me time and resources to continue that run.

Uncle Grant spends his money on either experiences

 or making memories instead of just stuff.

- my niece

Sometimes, you need a launch point, and as I stated earlier, Kari and I were at a point where we were pretty unhappy with our jobs and needed a new start. She wasn't doing what she was trained to do and what she came to Myrtle Beach to do, and I felt trapped in a high-volume, high-acuity practice in a hospital where patient safety and physician retention seemed to be after-thoughts. My astute neighbor made the comment that he had never seen a hospital that was so anti-physician. I was only 3 years out of residency and burnout was already staring me down.

This seemed the perfect time to seize an opportunity and start something new. We looked into what it would take to get us to New Zealand and then planned a vacation there to see it in person. After the vacation was planned and essentially paid for, my physician group lost our contract for our Emergency Department. I was in a whirlwind of doubt, not sure where or if I was going to find work and panicking because I had just spent a huge chunk of our savings on a trip to the other side of the world. Had I known just a month before that I wasn't going to have work, I never would have booked the trip. At the time, it seemed the height of irresponsibility, but in retrospect that trip saved our sanity.

 

 

We rented a caravan and spent 2 weeks living on the road in New Zealand. It was a magical place and re-affirmed our decision to keep moving. Along the way, I reconnected with an old friend who had left her medical practice in the U.S. and taken her family to New Zealand to start again. Her happiness there and the obvious way her kids were thriving served to bolster our plans.

The signs were encouraging ...

I am under no illusion that life there will be idyllic. Living somewhere is far different from being there on vacation. Life in New Zealand will come with its own set of challenges and disappointments. Good or bad, it will only be for one year. When we return to the U.S., our house will be the same, my job will be the same, and in many ways our life will be the same, but our experience will be different, we will be different.

And that's kind of the point.

Home Automation

domo arigato misuta Roboto

hata au hi made

domo arigato misuta Roboto

himitsu wo shiritai

-Dennis DeYoung/Styx

When it comes to technology, no one has ever accused me of being an early adopter. I prefer hardcover books to my e-book, I compose my blog stories in a notebook with a pen before I commit them to the electronic ether forever, and I would still happily be using my iPhone 4 if the battery hadn't failed. When I had to replace my phone a few months ago, I only moved up to the 5s because the 4 was no longer available. In college, my friends referred to me as the "Old Man" and in residency I was called "OB" (I would have preferred OG, but we don't often get to choose our monikers, and I guess I'm not gangsta' enough). Consequently, it has been an enlightening, and often times frustrating task as I seek to put my house on autopilot for the year that we will be gone.

We are all, by any practical definition of the words, foolproof and incapable of error.

Growing up, we didn't worry much about home security. We never locked our doors, even when we went on vacation. I'm sure our doors had locks, but we never used them. I was a latch-key kid without a key. Fast-forward to now and the situation has changed somewhat. It's 40 years later and I'm living in the U.S.A. My car has been vandalized at work, and I frequently get threats of harm to me personally, my property, and my family. I have a concealed weapons permit and even though I live in a gated community patrolled by police officers, and my next door neighbor is a police officer, I now lock my doors and I have a home alarm system with video monitoring.

 

I can see my house from here!

When we first moved to Myrtle Beach, we didn't have the budget to activate the security system, and not ever having one, I didn't really miss it. We travel a lot though, so as soon as we could, we signed up for home monitoring. The monitoring includes the security system as well as smoke detectors. The original security system for our house is hard-wired and was probably installed when the house was first built in 2003. As such, it was a little antiquated but functional. My biggest gripe was that it was not very convenient to use. Over the past several years, I have updated the system and added some enhanced security features. Adding battery back-up means the basic system functions continue to work even when the power is off.

Modern security systems can interact with the house as a whole. Security cameras allow me to see what's happening in and around my house in real time and they keep an electronic video record of events, but what's really cool is my ability to control aspects of my house remotely. When I had the cameras installed, they threw in a plug-in controller for lamps, etc. Modern plug-in modules work much the same way as the old-school timers people would plug lamps into. These newer plug-ins can be programmed from anywhere you have internet access. In addition, they can be programmed to turn on if one of the motion detectors senses movement, and they can even be programmed to follow a random on-off schedule.

 

Installed (just ignore the cosmetic work that needs completion)

As I researched other add-ons for the system, I discovered hard-wired, programmable light switches that can also be controlled by the security system. These super cool devices replace any wall switch and still function to turn lights on and off. These too can interact with the security system, coming on with motion or programming. The first couple were a little tricky to install, but once I figured out which wires went where, it was easy to add more and more switches to the system. The system as designed can handle up to 160 different devices! From a single app on my phone or tablet, I can control the alarm system, lights, and cameras for my home from anywhere in the world.

We have had to replace both the downstairs and upstairs HVAC systems. When the upstairs unit was replaced, it came with an internet enabled wall control. Our downstairs system is pretty much a higher-capacity version of the upstairs unit, but when it was replaced 5 years ago, the internet connectivity wasn't an option. I recently had an internet enabled thermostat control installed for the downstairs as well. Remotely, I can control the temperature, humidity, and programming for the entire house. I could get a different controller for each unit that would interact with my security system and allow me to control everything from a single app, but at $600 I will stick with the controllers we have and use their (free) app.

Isn't technology fun?

I previously posted about spending 5 days in the garage getting it cleaned up and ready for us to leave. Part of the garage project was installing a modern, quite, internet capable garage door opener. The install was pretty easy and I was able to do it myself. The hardest part of the install was removing the old motor and track. It's a really cool opener, with its own battery back-up and remote access through (yet another) app. After much research, I chose this opener because it was pretty freakin' cool and (mostly) because it was compatible with my home security system. I called my security company to send a tech out and link it to my home security network. When he arrived and inspected the unit, he said that it would need a second module to link it in ... $178 and an additional $5/month added to my monitoring contract. Once again, the app for this unit is free and everything functions perfectly well in isolation, so I chose not to hook it in to the home security system.

Another cool piece for the "connected home"

For the final piece of the puzzle, I installed an electronic door lock. We have several family members and friends who will be staying in our house. Trying to coordinate keys and access was going to be a nightmare. Once again, modern technology rises to the rescue. I was able to find an electronic door lock capable of storing about 30 different codes that I could link into my home security system. Not only can I create and delete codes remotely, but I can actually physically lock and unlock the door remotely. In a pinch, it still accepts a key and I was able to have it re-keyed to work with my old locks and keys. Alas, while both the lock company and my security company say that they should be compatible, I am having difficulty getting the lock and security system to communicate reliably. It will be awesome if I can get it to work, but the lock itself still works in isolation so I'm not worried if I can't get it to sync with the security system before we leave.

More cosmetic work that we need to be repaired

Therein lies the problem with home automation and "the internet of things". It's great that there are all these devices out there that have all these fantastic functions, but they don't all "speak" to each other. For any device I want to add, I have to make sure it is supported by my security system, and once installed, I have to get it to actually function within my home network.

As of now, I have a central security system with a bunch of cool features, I have some peripheral devices that work within that system, and I have a few devices that should work with the system but don't. At least those devices work in isolation and they have their own apps. I may not be able to open one app to control everything, but I can still do it all from my phone or tablet, all while sitting half way across the world, and that's pretty cool.

Perhaps not having all of the components interacting, providing multiple points of access to my central system, ultimately makes it more secure. More likely, my entire security system is kinda' like the TSA ... it's aggravating, frustrating, and time consuming; it makes things appear more secure and makes me feel more secure, but in the end it may not be very effective.



I guess I'm okay with that.

An amazing man ...

... who in parody captures so much of what it means to be a modern physician.


This doesn't have anything to do with our New Zealand excursion, but if you aren't already following ZDoggMD, posts like this are why you should be ...

7 Years

You may be right, I may be crazy ...

... but it just may be a lunatic you're looking for.

- Billy Joel

Through college, grad school, med school, and residency I did well academically, but I struggled with the tests. Until my junior year of college, I had never taken a multiple choice exam. I know that sounds ludicrous to my American friends and readers, but it's true.

Growing up in Canada, the school system was very different from what I have encountered in the USA. There was no emphasis on standardized testing. We did have high-stakes exams in high-school, but they were nothing like what I have seen here. We had mid-terms and finals. Exam week was set up much like college exam week in the US. Exams for any given subject were given on a specific day and time. You would show up to the gym and there would be a dozen or more rows of desks. Rows were divided by subject with three or four subjects being tested at the same time. Like in college, you may have had to take more than one exam in a single day. I once took the wrong exam (French, I think) by sitting in the wrong row and didn't realize until the exam was over and I looked at my schedule. My next exam ... French (oops)!

Exams were multiple pages long, and they were all long answer, essay, diagrams, etc. No matching, no multiple choice. If I recall correctly, they were usually 2-3 hours duration.

When I moved to the US, I started out at a small college in Hawaii.

Can't believe I still have this old thing

Most of the classes were smaller than my highschool classes ... 20 students in a class was pretty big, and I had a few classes with less than 10 students. Again, the depth and breadth of our knowledge was tested with explanations, answers, and essays. No multiple choice.

Imagine my shock and dismay when I walked into my first class (chemistry), held in a movie theatre, at Boston University my Junior year. There were 300+ students in that class. Exams were given in a booklet with answers bubbled in on the familiar Scantron sheet most Americans remember with much adoration. I actually had to read the instructions to figure out how to take the damned exam. The next two years of classes were mostly like this. I did well, graduating with honors, but it was more of a struggle than I expected.

A consistent theme ever since has been that I know the material, can explain and summarize the concepts, and can usually even draw an accurate diagram, but I just can't pick the best right answer from the list of 4-5 similar sounding phrases on multiple-guess exams. This problem followed me through grad school, med school, and two residencies. I was never able to overcome it, despite my best efforts and the best efforts of my tutors and mentors.

After my Emergency Medicine residency, I moved to a high-volume, high-acuity practice. I thought that my practical, every day experience, coupled with what studying I could fit in would be enough to pass the Emergency Medicine Boards. Boy, was I wrong. I failed my first attempt by 2% ... probably 3-4 questions. My next couple of attempts had similar results. I was working in a place that didn't require board certification and we were happy where we were, so I had decided not to continue further attempts. I was a good doctor, but not a good test-taker and I was ok with that. I knew it would limit our options a little, and my income would max out somewhere south of my potential, but again I was ok with that.

Then we decided to go work overseas. I was able to find some jobs without being board certified, but the locations and pay were terrible. No way we could afford to go with what I was being offered, so the pressure was on to once again attempt board certification.

I took yet another expensive, out of town, board prep course and I significantly reduced the amount I was working to focus on studying.

Working nights, I tend to be most awake and productive at night even on my days off, so most of my studying was done at night. Late at night, in my office, I started smelling cigarette smoke. Not every night, but most nights. I hadn't really noticed it much before and it was definitely cigarette smoke. None of my neighbors smoke, but there are several houses with tweens and teens. I have a creek and woods behind my house and I assumed that someone was sneaking off into the woods at night to smoke. The problem was that the woods are easily 50+ feet from my house and it smelled like someone was smoking right outside my window. On more than one occasion, I walked out of my house, creeping along trying to catch Steve Miller* in the woods.

One night, the smoke smell was so strong I swore the smoker was next to me. And that's when I lost it. In the recesses of my primitive lizard brain I dredged up a memory of reading a news report describing someone with a similar experience. I can't remember if it was smoke, or noises, or what, but she had had multiple service people out to her house trying to find the source. Finally, one of the service people entered her crawlspace and discovered someone living there.

See this link: Stranger Living in Crawl Space

I was convinced that there was someone living in my crawlspace smoking cigarettes at night. I put coveralls on over my clothes, grabbed my MagLite and my Glock and headed outside.

Mice, snakes, and hoboes beware ...

I was going under the house and I was prepared to shoot if necessary. I briefly thought about calling my neighbor, a county police officer, but it was 3 am and I realized how crazy I might sound at that moment ... "Hey Joe. Do you mind coming over and backing me up while I crawl under my house to shoot the person under there smoking cigarettes at night?" The thing is, he probably would have said "I'll be right over."

So there I am, crawling around under my house, flashlight in one hand, semi-automatic pistol in the other. And I found nothing. NOTHING. The crawlspace was empty and there was no evidence anyone had ever been under there. While I may be crazy, I do not lack insight. I realized that I was going nuts chasing after phantom cigarette smoke in the middle of the night. I engaged my scientific and medical brain and set about diagnosing myself. I discovered a condition called Phantosmia. In short, the cigarette smoke was an olfactory hallucination. Usually phantosmia can result from stress or nasal polyps/infections, but occasionally it can be caused by a brain tumor known as a neuroblastoma.

I saw an ENT who put a camera up my nose and took a look around, and then I had an MRI.

It's not a tooma'.

The smells went away shortly after having my MRI and I passed my boards about a month later.

I finally have that piece of paper ... I'll let you know later if it was worth it

I haven't smelled cigarette smoke late at night since.

Not for any related reason, of course, I added a padlock to the outside access panel for the crawlspace.

Not sure if I'm keeping things out ... or in!

*He's a joker, a smoker, a midnight toker.