Palmy Rocks!

Where was I? I forgot the point that I was making.

I said, if I was smart that I would

save up for a piece of string

and a rock to wind the string around.

Everybody wants a rock

- They Might Be Giants

Palmerston North doesn't have the best reputation. When we first considered moving here, I scoured the various expat online forums to read reviews and get an idea of the place we would be living. To see what was being said about the place, you would think it was Mordor (which was how a friend of ours described Hamilton when we first told her we were thinking about moving to New Zealand).

Mordor

Even John Cleese has gotten in on the action, saying this about Palmerston North ...

"If you wish to kill yourself but lack the courage to,

I think a trip to Palmerston North will do the trick ...

... We had a thoroughly, bloody miserable time there

and we were so happy to get out."

Not exactly a ringing endorsement for our new home.

Palmerston North doesn't have the big city energy of Auckland. It doesn't have the cool, hip vibe of Wellington. We don't have the subtropical weather of the Northland, the wild and rugged vistas of the Coromandel, the beautiful sand beaches and surfing found in Gisborne, nor the endless rolling hills and vineyards of Hastings or Martinborough. Let's not even talk about comparisons to the South Island.  

                                           

  

North Island views

Online reviews and comments generally say, and I have to agree, that Palmy doesn't offer much to attract tourists and adventurers into our city limits. This is a small city, a college town, without a whole lot of excitement going on. One of the reviewers noted that "the town seems to roll up its  sidewalks early." Translation - things shut down around here by 4-5 pm and there isn't much of a night life.

I'm doing a great job of convincing you to come visit us here in Palmy, aren't I?

One reviewer unfavorably labeled Palmy "the most American city in New Zealand", citing its "gloriously" wide roadways, broad footpaths (sidewalks), and its saturation of fast-food restaurants. Interestingly, it reminds me of another small city where we once lived. When I first told Kari that I wanted to move to Iowa City, her reaction was likely what some of you are thinking right now. IC ended up being one of the best places we ever lived and one of the hardest places to leave. Small enough to be manageable and navigable, but large enough to have most of what large cities offer and made to feel larger because of the influence of a major international presence at the University of Iowa. Palmy has all of those same advantages.

Palmy is an absolutely awesome environment in which to walk or ride your bicycle to work or the shops, and to raise a family. Those "gloriously wide" roads include 65 km (40 mi) of on-road, urban bike paths and an additional 10 km (6 mi) along the river. Just about every weekend, there is a Farmer's Market, a festival, or some kind of outdoor event within easy walking/cycling distance. Every Saturday, the local library has some kind of interactive activity "for kids of all ages". One week, Little H created her own "mini Jurassic Park" and the following week there was papier-mache. This week, she decorated/baked cookies and made a Mardi-Gras style mask at the local craft store. All of these activities have been free!  

    

River Time                                                                            Mini Jurassic Park                                                                  She's Crafty 

We are an easy two hour drive to Wellington, an hour to Hastings and Martinborough (the North Island "Napa Valley"), and only 40 minutes to the beach. In a few weeks, we are going to the local sailing club day to have a go at wind-power. Within easy reach of us is some of the most majestic hiking and tramping in the world. While Palmy itself is not very picturesque, it doesn't take long to get into pristine forest or to find a trailhead leading to mountain ridges.

There are 107 parks, reserves and playgrounds in and around Palmy. One of the local moms, in an attempt to get her kids out of the house, started painting and hiding rocks in the local parks then having her kids go search for them. What started out as a mom trying to drag her kids away from the lure of screen time has become an international movement ... Palmerston Rocks! We have eagerly jumped on the bandwagon and Little H spends a lot of time painting, hiding, and searching for rocks. It has been awesome to see the rocks she painted when they are found by others and posted for all to see.

    

   

Not exactly Pokémon Go, but way more creative and interactive ... and no chance of walking into traffic or falling off a cliff.

Tonight, we drove to our neighbouring town of Feilding where we caught a traveling drive-in movie. Last night they showed a Kiwi cult classic. Tonight we saw Dirty Dancing. On Monday (Hallowe'en) they are showing The Rocky Horror Picture Show.

   

We can get so easily dissuaded by what someone else might think, particularly in this day and age of social media. While opinions and reviews can be a valuable tool, I am glad that this time we chose to ignore the opinions of others. So far, Palmerston North has managed to exceed our expectations. Here's to another 11 months full of pleasant surprises.

Party on, Wayne ...

Life in A&E

You say it's urgent.

Make it fast, make it urgent.

Do it quick, do it urgent.

Want it quick.

Urgent, urgent, emergency.

- Larry Johnson/Foreigner

My introduction to A&E (Accident & Emergency) was, fortunately, a slow transition. For the first two weeks, I have been paired with another Consultant (Attending Physician), so in essence I was an extra doctor. As a result, there was no pressure on me to see many patients or to be very efficient. This is in contrast to my usual introduction to a new ED where I have rarely had the chance to shadow another physician before being thrown into the pit. With few notable exceptions (my most recent position being one of them), my orientation is one of "Here's the coffee, here's the bathroom, here are the patient charts, and there are the patients. Have fun!"

The A&E I work in sees about 100-120 patients per day ... pretty close to what we were seeing in my last position in the U.S. The difference here is that I am a Consultant managing a department in which there are a number of Junior House Officers and Registrars seeing patients. The Reg's are pretty independent and need little supervision. The JHO's, like trainees everywhere, are of varying abilities. Some require very little oversight, and some need scrutiny of just about every decision they make. I am also responsible for staffing patients seen by medical students. If this sounds chaotic, it is. At any point in time, there might be a Reg and 2-4 JHO's seeing patients while I am directly supervising 1-2 med students. As a consultant, I will typically only see 3-5 patients of my own in a given shift. I am generally expected to pick up the easy ones to keep the department moving and allow the JHO's the more complicated patients. As a result, I spend a lot of time standing around with my hands in my pockets, trying to ignore the building list of patients waiting to be seen and the backlog of those in triage. This causes me quite a bit of angst and is a source of much humour for the other consultants. I appear to be sitting calmly, but they well know what I look like on the inside.

 "The Scream" - Edvard Munch

For the past 5+ years, I have been working in large, busy ED's in the U.S. I have worked exclusively night shift, typically a 10 or 12 hour stretch. In most cases, I have been the only physician in the ED for 6-8 hours, and in some cases I have been the only physician in the ED for the entire 10 or 12 hours. In a typical 12 hour shift, I will see somewhere between 25-35 patients. Every now and then, we get hammered by patients and I might see upward of 40.

The patient mix is different, too. In the U.S., anyone and everyone comes to the ED for care. We see everything from traumas and heart attacks, to sneezes, sniffles, and colds. ED physicians take great pride in the idea that we treat "Anyone, Anything, Anytime." While this has been a noble approach, in some ways it has come back to bite us in the collective ass.

In many places in New Zealand, lower acuity patients are turned away from A&E ... the sign in the pic above is from in front of the ED in Gisborne. Since our A&E is a large regional health centre, some of the lower acuity patients do end up here, but there is still an active campaign to discourage it.

The biggest difference I have seen here is in the process. The electronic medical record system was designed in the 70's and has been in place since the 80's ... it's DOS based! There is a mountain of paperwork, all needing to be filled out by hand. It's like they have taken the electronic and paper systems, gotten rid of what was actually helpful and useful, and bred the worst aspects of each. The resulting Frankenstein's Monster is an ugly, awkward, and petulant child. Part of the reason I only see a handful of patients in any given shift is simply because the system is so inefficient. It is nearly impossible to carry more than a couple of patients at any given time. When I tell the JHO's that I can carry 6-10 patients at once and see 30-40 patients in a 12 hour shift, they can't fathom how that is possible.

I have always maintained that medicine is medicine no matter where you go; it's the system that is different. "The medicine is easy, it's the process that can make it difficult." The problems we see in the U.S. ... obesity, heart disease, diabetes ... are the same here in New Zealand. There are a few subtle differences though. In my 10+ years since graduating medical school, I have never seen a patient with a history of rheumatic heart disease from childhood rheumatic fever. It is a relatively common condition here. Things that are rare in the U.S. are seen far more frequently in A&E.

The U.S. incidence of bacterial meningitis (approx 0.2-1.0/10K) is low enough that I have never seen a case and so rarely perform LP's ("spinal taps"). By some estimates, the incidence in NZ may be 10x that. Patients for whom I previously would have done very little testing find themselves getting a full work-up, including LP.

In the US, we almost never order emergent MRI's (when I had concern for a possible brain tumor, it took 2 weeks before I could get in for one). About the only indication for emergent MRI is suspicion for an epidural (spinal) abscess. Incidence of epidural abscess in the U.S. is about 1.3/100K. The incidence in NZ is about the same (1.4/100K) but I am 2-3 times more likely to see it here because there are only about 40 A&E's in NZ (vs 5025 ED's in the U.S.) In my previous 10 years, I have ordered 4 Emergency Dept MRI's. In two weeks here, I have already sent 3 patients to MRI. (If you are wondering about the math, 5025 U.S. ED's serve about 320 Million people and 40 NZ A&E's serve 4.7 Million people).

In short, people here are sick as shit.

 Yes, the nurses are wearing shorts.

One last comment on cultural differences. People here are just more chill than anywhere else in the world I have lived or visited. I haven't seen a coat or tie anywhere. Consultants and Reg's from other services are frequently seen wearing jeans. The focus is on providing quality, efficient care, not on the trappings. Every telephone call I make seems to involve at least 5 minutes of social chit-chat ... Little Highstead's school, week-end adventures, stories from back home, etc ... then about 2 minutes of work-related conversation. The high-pressure, high-volume, harried American inside of me wants to cut to the chase, state my business, and move on. It has taken considerable effort, but I am slowly adopting the Kiwi way.

Now my biggest fear is how I will ever function when I return.

Things Kiwi

The times they are a-changin'.

We're here to turn the page.

It's the same old story but it's told a different way.

The more things change the more they stay the same.

The same sunrise, it's just another day.

- Richie Sambora/Jon Bon Jovi

So much of what we see and experience when we travel is familiar. Except for some small cultural differences, life in Canada, the U.S.A., and even New Zealand really isn't that different. Those small cultural differences, though, are so important to identity and it's those differences that make traveling worth it ... and it's those differences that can trip you up.

Renting (hiring) videos at the video store

Kiwis speak English. The accent is a bit nasally, but it is English. It is rife with slang, though; to the point that sometimes it's hard to tell what they are saying even if you can understand the words themselves. There are simple things such as the words in the title of this blog ("Jandals" are flip-flops, and "Togs" are bathing suits), and there are more complicated things ... take-out food is "take-away", grocery carts are "trollies", something for rent (like a car) is "for hire", and candies are "lollies." Something as simple as ordering a coffee requires learning a whole new vocabulary. Kari's favorite coffee drink is a "flat white" and mine is a "long black."

  A flat white

  

When I started work in the Emergency Department this week, I was given a list of common expressions people use when describing how they feel and their health in general. The following is an imagined conversation in the ED provided in my welcoming packet. See if you can determine the what's bothering him ...

Pt: Kia ora, Doc. How's the quack?

MD: Kai Pai, bro. Whassup?

Pt: Got gut rot.

MD: Keep going ...

Pt: Well, I was a box of birds a week ago. I spent a couple of nights in the wop-wop, ate a bit of old pork. We packed in all our water. On the dunny doing the number twos a fair bit since. I noticed a bit of blood a few days ago. Since then my ring's been killing me.

MD: Feeling Ok otherwise?

Pt: Good as gold, Doc. Are you gonna' put in under?

I saw a patient the other day ... she was "taking the piss out of me" (making fun of me a little) and I didn't realize it until long after the encounter was over.

*****

We have mostly tried to eat at home, but in our many wanderings out and about we have taken the opportunity to enjoy local eateries. The first thing we noticed is there are generally no chain restaurants. There are a few familiar fast-food places: McDonalds, Burger King, KFC, Dominos, Carl's Jr, and on seemingly every corner a Subway, but we don't even eat at those places in the U.S., so they certainly have no allure for us away. There is an amazing cafe culture here with small, locally owned restaurants and cafes with limited menus and amazing service.

  

If you're heading out for a "feed", many restaurants require a "booking" (reservation), and even some of the nicer restaurants and cafes require that you order at the counter. For those restaurants that do have table service, if you sit and wait for your bill, you will wait a long time. The custom here is to pay at the counter when you are ready to leave. I have no idea how they know who we are and what we had, but so far the bill has never been wrong.

Our local pub and restaurant ... The Fat Farmer

When paying your bill, the sticker shock is quite staggering. On the plus side, taxes are included in the listed price and there is no expectation for tipping. For those in the U.S. who claim that eliminating tipping will lead to crappy service, I can honestly say that the service we have experienced here has been without reproach in every instance, from small cafes to fine dining. I think that people generally take pride in their work regardless of where they are or where they're from.

I was asked to comment on the booze situation ...

First, I think it says a lot about my friends that all they want to know about is the availability of intoxicating liquids; second, I am concerned what they think of me when they assume that I am well enough versed on this topic to include it in a blog post; and third, I wonder what it says about me that I have been here only two weeks and I considered writing an entire separate blog post to cover this topic alone.

Unless you are a scotch drinker, the choices of "brown liquor" are quite limited. Jack Daniels, Jim Beam, Canadian Club, and Crown Royal are to be found rather easily. Unfortunately, I have scoured the local establishments, and there are only about a half-dozen choices for higher-end libations. There are a few choices for bourbon, but rye is pretty much non-existent. I found a bottle of Few Rye. Unfortunately, at $144 for a bottle, that will not be a daily drinker. When I asked for rye at the store, I was pointed to the Jim Beam.

Their motto:  All the help you need.

The craft beer here is amazingly good. There are a number of small Kiwi breweries and I am slowly making my way through their various offerings. I am generally an ale drinker, but even the pilsners/lagers have a surprising complexity of flavours.

If you haven't heard of New Zealand as a wine growing country, then I suspect that you aren't much of a wine drinker. The wines we have tried have all been more than just drinkable, and when you consider the price point, I tend to prefer it over water.

We've really only been working our way through the various whites but have already bought tickets for the UB40 Red Red Wine Vineyard Tour in January, so we hope to expand our repertoire. The local grocery store offers a 20% discount on the purchase of 6 or more bottles. Not ever ones to pass up a deal on booze, we have been loading our shopping cart.

 

    Sparkling Sauvignon Blanc                                                         Has it really only been 2 weeks?

*****

Today, we took a trip to the local beaches. We braved the wind coming off the Tasman Sea, met some dogs and their people, and were yet again amazed by the local parks. Parks and green spaces are everywhere you turn here. Little H, in particular, has a mission to stop at every park and playground we encounter.

Looking West to the Tasman Sea

The playground equipment? devices? rides? remind me of my own childhood and make me jealous of what I have missed out on. Playgrounds in the U.S. have been sanitized and made "safe" to the point of offering no challenge, no risk/reward, and no fun. Little H says they are "boring", and they are.

Kiwis seem to recognize that taking risks is part of growing up, and without taking risks there is no chance for kids to discover just what they are capable of. The playgrounds are full of equipment that might pinch small fingers, result in a fall, or even cause harm or injury; however, it is through the challenges they offer that Little Highstead has been able to develop strength, agility, confidence, and a certain admirable fearlessness.

 

BMX track at the park.                                                               Zip Line aka a "Flying Fox

Tree climbing.

We have only been here 2 weeks and already it feels like home. We have dinner together regularly, we have family game night almost every night, and we are more relaxed ... more at ease with ourselves and with each other. I don't know that we have changed so much as we have found a place where we fit. While we are here for only 1 year, we are already trying to figure out how and when we can come back.

Sweet as ...

Settling In

I'll light the fire, you place the flowers in the vase that you bought today.

Staring at the fire for hours and hours while I listen to you

Play your love songs all night long for me, only for me.

... Our house is a very very fine house ...

- Graham Nash/Crosby, Stills & Nash

We made it to Palmy! The entire journey was pretty uneventful. We made all our connections without any delays, our bags made it all on the same flights, and the welcoming committee was at the airport waiting for us on our arrival. We had a good number of bags, but we didn't even approach the record of 18 bags (for a family of 5).

We had already scoped out our house on Google Earth and had pics sent to us before the move, so we had a pretty good idea of what it was like. 3 BR, 1.5 Ba with a separate 2-car garage. The house was built in 1960. The kitchen and carpets were updated somewhere along the way. Like any house outside of the USA, rooms are small, storage/closet space is limited, and the appliances are proportionally small. The biggest concern, though not a surprise, is the lack of insulation, heat, or air conditioning. Anyone who comes to visit should be prepared for being sweaty in the summer and wearing an extra sweater in the winter. Windows are single-pane glass, so plastic over-window treatments for winter if you come to visit will guarantee you an extra bottle of wine.  

 

New Zealand "AC" is literally a hole in the windows!

The first several days in our new home have been cold, grey, windy, and drizzly. We set up our bank accounts and cell phone service and we also set up our home internet; however, that won't be functional for about a week. We did manage to buy bicycles but didn't get much chance to ride them because of the weather. Little H was getting a little stir crazy, so we got the bikes out and went to the river. The ride was made a little miserable by the blowing wind and scattered showers. As usual, Little H made friends with every dog we encountered along the way.

We also visited Little H's school. They are on break between the 3rd and 4th terms, so the Deputy Principal met us at the school and gave us a tour. It's an awesome environment with big, open rooms and several areas for instruction. Students can sit at desks, bean-bag chairs, couches, or on the floor to do their work ... whichever suits their personal style. The classes are set up with about a 20:1 student to teacher ratio. Multiple classes are combined so there can be 60+ students in a room with 3 roving teachers. Teachers are encouraged to teach to their strengths and students are expected to work more on their self-identified weaknesses. I am really excited to see how Little H responds to this. I think she is pretty happy about it, though she is not so happy about the school uniform.      

We ate savory pies (our most missed food from our prior New Zealand experience), found a local curry takeaway (Indian take-out), and I can't wait to try the local fish and chips. Mostly, we have been cooking meals familiar to us from home. We did buy a lamb roast and had planned on cooking that; however we decided to leave town for the weekend, so the roast will have to wait until we get back home.

Today, we left Palmy and drove South to Cape Palliser; the southern-most point on the North Island. The trip took us through wine country (who am I kidding ... the entire country is "wine country"). Just a few minutes out of Palmy, we were in rolling hills and farmland dotted with cattle and sheep. Even grey and overcast, the mountains drew us onward. At Cape Palliser, we explored black sand beaches, got up close and personal with the largest seal colony on the North Island, and climbed 250 steps to the Cape Palliser Light-house. 

As we planned our trek up to the base of the lighthouse, the Lonely Planet guide warned that "It's a beaut view from here, and a great place to linger if the wind isn't blowing your eyeballs into the back of your head." The reality didn't belie the description. The climb up 250 steps wasn't nearly as bad as expected, the views were spectacular, and the wind was blowing to the point of being treacherous. Standing and taking pics without holding on is not for the faint of heart.

  

  

One of the most memorable moments of the day was exploring the seal colony. You are warned not to get between the seals and the water, else the seals are "likely to have a go at you" but we were almost among them before we even knew they were around us. The horrendous smell should have been our first clue. The seals themselves appeared as just big lumps of grey rock. Once we spotted one, though, it was easy to pick them out.

  

 

The light on the mountains and clouds as we drove back through wine country was indescribable. Trying to capture it on camera could not do it justice. The bright greens of sun-dappled fields contrasted against the grey skies and mountains looked like a movie-set painting. Driving up one side of the mountain ridge and down the other crossing over to Wellington was a white-knuckler. Speed limit on the two lane "highways" was typically 100 km/hr. For reference to my American friends, speed limit on 8 lane divided freeways in Canada and the US are typically about 100 km/hr. Little Highstead and Kari had much to say about my driving and I totally felt like a rally-car driver (even though I was driving like a granny at a measly 95 km/hr).

 

We finished the day in Wellington, one of our favorite cities. While we don't ever plan to live in a city as big as this, we do appreciate all it has to offer. Wellington has the feel of Austin ... lot's of little restaurants and cafes, a young and vibrant feel, and enough piercings and tattoos to keep it weird. We ate pizza at a really cool, wood-fired pizza joint called "Heaven" (it was) and for the first time in a long time, I felt old and conservative.

Since this is the last weekend of school break, and we planned the trip at the last minute, there weren't many hotel rooms left in the city. We ended up staying at the Intercontinental Wellington, about as swanky a place as I have ever stayed in. Fortunately, we brought it down a notch and trashed yet another hotel room ... though not before Little H went full diva.

This is our last 2 days in the lap of luxury. Tomorrow, we will spend the entire day in Wellington, then return to Palmy after one more night of being pampered. We return home and I start work the same day Little H starts school. I hope all of our friends on the East Coast are staying warm and dry as Matthew threatens.

Alright, alright, alright ...