Why Am I Here?

    While on a recent site seeing trip with visiting family, I had some extra time to contemplate life.  The boat slowly motored out to Hole in the Rock/Motukokako Island at the end of Cape Brett on the southern boundary of the Bay of Islands, leaving plenty of time for introspection.  Maybe it was the somber cloudy day.  Maybe it was the proximity of another passing year in my own life.  Possibly it was the seasoned words of the lovely 92 year old lady, my patient on the previous day, whose sharp Irish/Kiwi wit polished by a childhood French finishing school, that had left me contemplative.  "Multus Annos Domini" was her own self diagnosis, as her sharp mind remained well ahead of the failings of her body.  The years passing by, purpose still present, but body unable.  Most likely it was my wife, who reminded me as we got out of bed this morning, that by life expectancy, "Your life may be more than half done!"  (Thanks for the birthday wishes, honey).

     Life itself is a purpose for being here on this earth.  Each day lived is a chance to feel, breath, experience, share, love, and cherish life itself.  For some, end of life comes too soon, for others it comes too slowly, but the reality is that none of us get out of this life alive.  Purpose is simply found by living each one of our days to its fullest.

   If you would have asked me 20 years ago when I was a freshmen U of Minnesota medical student if I was planning on practicing medicine in a foreign country for an extended period of time, my answer would have been no.  Mostly because I would not have considered "God's Country" of Montana a foreign place, but instead my home state that I still miss.  Once again the joy of life and living with purpose that can lead us directions beyond our wildest dreams.

     So with kind regards to Nietzsche and Kierkegaard, instead of asking, "Why am I here?", I will change the question to "Where have all the Kiwi doctors gone?"    Recent media attention in New Zealand, both written and televised, have drawn attention to the ongoing crisis in New Zealand's health care system.  The emigration of New Zealand trained doctors has resulted in a shortage of available physicians to provide necessary medical services throughout the country.  With a country this beautiful, why would anyone want to leave?  Everything is so green....
    Not green enough according to statistics from the NZ Resident Doctor's Association.  The salary disparity for house officer (intern) and registrar (resident or fellowship) level physicians between New Zealand and Australia is one of the first reasons listed for the migration of NZ medical students.  Even with factoring in the recently strengthened NZ dollar, the disparity ranges per year from $7,000 AUS$ ($6,900 US$, thank goodness for our weak economy, as my NZ$ goes further) for first year medical trainees, to as much as $32,000 AUS$ per year for fellowship trainees.  That money easily buys a few plane tickets over the Tasman for visits with the family.  
   Once those physicians leave, it is less likely they will return.  Money potentially being a motivator again, as salary disparity between Australia and NZ consultant level physicians indicate a range of 7% to 30% difference of income depending on specialty.  Data from the Auckland graduating class of 1999 indicates that 46% of the class permanently practices outside of New Zealand, with the majority of them having ceased their registration (license to practice) in NZ.  Similar to the US, physicians in training are more likely to settle in the region in which they have trained.  A losing situation for New Zealand.

    That is where a physician such as myself fits in.  Nearly 41% of physicians practicing in New Zealand are international medical graduates (Damn foreign doctor has an accent and I can't understand him!), compared to 21-25% in the US.  The system does not suffer though, and in some cases benefits.  The majority of foreign trained physicians who choose to permanently relocate to practice in New Zealand tend to be from other Commonwealth nations (UK, India) or Asia.  US trained physicians tend to only stay for a short period of time.  A statement more about our tax structure in the US than the quality of medical care that is provided in New Zealand.  Uncle Sam gets a piece of US citizens wherever we live, whereas citizens from other countries who relocate to New Zealand, are only expected to pay taxes in New Zealand. 
     Despite the challenge of double taxation, and potentially a lesser income, I found another reason for our prolonged stay here in New Zealand.  Interestingly the letter quoted below was handed to me on my first day of orientation with NZ Locums. It is written for new enrollees in the Medical Protection Society (malpractice insurance) when they start practice in New Zealand.  
    
    "Most days, most people will make a mistake, normally small and inconsequential ones that are never discovered or result in no harm, although occasionally they will be serious or embarrassing.  The point is that everyone makes mistakes but most people are fortunate enough not to be a doctor who can be formally investigated two, three, possibly four or even five times over, concerning the same incident.  It is a fact that adverse events will happen.  Everything should be done to try to minimise those avoidable errors but there must be an acceptance that some will occur - it is how we react to these events that is vital.
     My fear is that if doctors continue to believe that they are under sustained attack and fear the stress of prolonged investigation for one or two mistakes in a career, then many of those who are the most caring and conscientious will decide to leave the profession early or, even worse, decide not to train in medicine in the first place.  Can you imagine the uproar if members of other professions could expect to be investigated at some stage in their career?
     The move towards the harder-nosed, thick skinned, more money-oriented doctor has already happened in the USA and has perhaps started elsewhere.  If it gathers pace, then it will be to the detriment of society as a whole."

    Matthew O'Brien, General Manager Asia Pacific
    Medical Protection Society of New Zealand. 

   The erosion of the hole in the rock at Motokukako Island started thousands of years ago.  It started with a few cracks, enlarged to crevices by wind and wave, and eventually resulted in the hole in the rock institution that stabilizes the island.  The practice of medicine and health care in the US is our island for safety.  With the recent passage of major health care legislation that contained no meaningful malpractice reform, the cracks in the US health care system have gone far beyond crevices and become holes in an institution that is necessary to support a successful nation. 
    I am practicing in a country where more and more US physicians are coming to work permanently.  The ER group at Whangarei hospital is nearly all Americans.  Up and down Northland, many of the GP practices have one or two full time American trained physicians.  One excellent young US physician with whom I oriented in Wellington has opted to stay for a full two years.  Two former US colleagues are on their way here to work for an extended period of time.  Makes me wonder when people in the US will need to look through the hole in the rock, and contemplate "Where have all of our American doctors gone?"

Happy Thanksgiving from NZ!

   Normally it would be a morning stumble out of bed to stuff the turkey so that it could be put in the oven and ready for us to dive into a large turkey dinner later in the day.   This year it was a Thanksgiving Thursday stumble out of bed for a 5am departure with friends for a fish and dive in the Bay.  Strapping on dive gear on a balmy day is a far cry from watching leaves (or snow) fall outside while we digest our meals and watch football inside.  But a new kind of abundance was found today.  Kingfish, scallops and crays (lobster).  Plenty of things for which to be thankful this year and every year.
    We wish you all a Happy Thanksgiving!
     

Mullet is Gone. Replaced by a Whale.

   He missed the dinner and camping overnight on his school outing, but I don't think it bothered him.  The smile on his face tells the tale.  Outfished his dad and a near record for the boat.  Schnappa season is on in the Bay.  This is only the second snapper he has caught since being here in NZ.  Right in our new backyard.

21lb Snapper

The Ski Bum and the Single Parent.

   "Daddy, I heard you say the F-word!"

    Mt. Ruapehu, an active volcano on the North Island last blew its top with a major eruption in 1995-1996.  Since then it has had a few smaller eruptions most recently in 2008.  It is also home to two of the major ski fields on the North Island, Turoa and the other one of which I am still working out the pronunciation.  Our neighbor, a mechanical engineer who has been relaxing between jobs (living on the money he made in Aussie) has a ski home there. He has piqued my interest (lucky bastard) with his reports of the ski trips he has taken over the winter months.  His complaints of feeling "shattered" after some hard days snowboarding and the seven hour drive back to Kerikeri have garnered my deepest sympathy (Please get a job).  Why didn't I get to go? Oh, yeah. This is a WORKING sabbatical.

    It is mid October, and I am still trying to wrap my head around this southern hemisphere living.  Usually this is the time of year where the changing leaves and mountain valley rainfall find me nursing my shin wounds from a recent backcountry bushwhack...no..fishing trip while watching the snow reports tally the snowfall at the higher altitudes.  This year the calendar reads the proper dates, but instead of snowfall, I am enjoying the fragrance of orange blossoms while checking the ocean and beach temps. 
    A couple of weeks ago while sharing a beer in our backyard with our neighbor as he pulled his recently caught Waipapa Inlet mullet out of his bait net (Yeah, between ski trips, relaxing mechanical engineers drink beer and fish.  Did I mention the two college female exchange students, one Chilean, one German, neither language hard on the eyes, who are staying with his family?) a ski plan was hatched.  He reminded me that October 23-25 is Labour Day weekend in New Zealand.  The ski fields at Ruapehu were currently getting fresh snow from a southerly storm and another southerly was expected the week before the holiday.   "The ski fields will stay open 'til mid-November with this snow base. Bro,you oughta go."

     Hmm... Saturday morning clinic then drive seven hours.  Ski Sunday.  Hmmm...  I have hiked for seven hours just to make a few ski turns.  Lots of ski gear shipped over here sitting around waiting to be used.  Hmmm.  Day to drive back on Monday.  See more of this beautiful country....I'm in!
      Did I mention that Kim was going to be back in the US during that time.  Due to her amazing (some of my in-laws are following this blog) family, that has bonded together through some very difficult circumstances that I will discuss in a future post, Kim needed to go back to the US for a visit.  I was signed up for two weeks of single parenthood, (As opposed to the life sentence of double parenthood?) from October 11-26.

     Convincing the kids to go was a no brainer.  I have been grooming them as co-conspirators in getting mom back up onto the ski mountain since they were old enough to enjoy the snow.  Yeah, Kim was getting to be a pretty good powder skier, and even headed towards the bumps.  But ever since one slipped past the goalie and became a Joel bump, her skiing days have never been the same.  I am still scarred by my one and only solo attempt to get her back up on the mountain postpartum.  Hence my reason for looking for help from the kids.  Their joy of skiing has been infectious and we have had mom out a few times the last couple of years.  So when I told McKeely that I would take her skiing the week after her birthday, she was all in.  So was Joel.

    Now the part that would take some brains and organization:  Getting through the two weeks before the ski trip.  With a good after school program that the kids loved, generous colleagues at work who volunteered to cover our late acute clinic, and a day off per week to reload the groceries, the majority of the two weeks cruised by without much problem.  I would say I was the king of the daddy domain (it's good to be king when the queen is gone).   As king, I even was able to host a birthday party that included five little princess friends of my princess McKeely.  Thank goodness for an associate queen mum who stood in to help.  No way could I have combed that much candy (pinata malfunction) out of one little princesses hair!



  
     But then there was the full moon Friday before we were to leave for skiing.  The morning was going great before work.  Had the dishwasher nearly loaded.  Ten minutes early too.  Kids lunches packed and homework checked.  I am the domestic king!  Then the largest glass of spilled milk and Milo I have ever seen occurred.  It was also the first time I properly pronounced the name of the other ski area on Mt. Ruapehu.  Somehow as Joel was picking it up to drink, the glass opted to hit the counter ledge, twist out of his hand and spray ,with a couple bounces, the entire volume of milk onto nearly every cabinet front in the kitchen, onto Joel's pants, and the front of the refrigerator.
   So now we were five minutes late heading up the driveway.  Pleasantly drop the kids at school (Bye, get out.  Now!), and race to clinic.  Back to a normal day until the call from school at noon.  Seems that the one holer loo per classroom was not enough for the number of kids with post lunch gastrocolic reflex.  Kid number three in line could not control number one and "needs a fresh pair, so would it be OK for a teacher to walk your child home for a change of undies?"  Bummer.  "Sure that is fine, I am a half hour away."  What was that ski area name?  Thank goodness for some wonderful teachers at the school.
   A little late getting out of work, so the kids were the last ones at the after school program.  No big deal, as it is a holiday weekend, and next week, Kim will be back home for the after school routine.  That is when the volcano blew.  It started with a simple small voice.  "Daddy what are nits?"  Clinically, I have known it was only a matter of time before this happened.  Seems the nice moist warm environment in this part of New Zealand is ideal for the spread of head lice among school children.  Clinic nursing staff have since entertained me with stories of the number of times they have had to treat their children over the years.  At this moment though, I was not being entertained.  "Daddy, my head has been itching for the the past three days too." says the older of my precious children.   A rapid search through each child's scalp, which revealed plenty of crawling parasites, and I suddenly found myself an expert in pronouncing that second ski area name.
    A load of bedding into the washer, a drive back to the clinic to pick up a bottle of malathion, a stop at the store for a nit comb and additional conditioner (works great to loosen the nits for combing) and the battle was on.  By 2pm the next day, thanks to additional help from our unbelievable find of a babysitter, (yes, she rewashed bedding and combed the kids hair, while I finished Broadway's Saturday clinic) we were still able to depart for the ski field.  Hair and scalp hygiene much improved.  I packed the two remaining parasites (the ones that could have only been removed with a preemptive vasectomy on my part) into the car and headed south.

  
     The ski trip was wonderful, as the pictures show.  Turoa ski field treated us well.  It was definitely spring skiing, but the beauty of a snow covered volcano surrounded by the lush greenery of New Zealand more than made up for the quality of snow.  Mt. Taranaki, another volcano near the west coast of the island, even made an appearance on the sunny horizon.   Smiles all around erased some of the difficulties of the preceding weeks.

      As I sit and write this in a Taupo hotel room, kids worn out from the day, already tucked in bed, I do have some remorse for erupting in front of them.  Daily stress can catch up to us, and sometimes blow up to cause damage.  Fortunately, our children are at an age where they are highly inquisitive about the handling of emotional situations.  We had some great talks about words, communication, joy, anger, sadness, and losing a loved one during our drive to the mountain.  As parents and children, we are each growing up a little more each day.  Maybe as a dad I didn't handle full moon Friday as well as I should.

    
     While the sun sets across Lake Taupo with Mt. Ruapehu on the far horizon there is one thing I do know for sure. When they ask to go skiing again, thanks to my outburst, they will at least know how to properly pronounce the name of the other ski area at Mt. Ruapehu.
    "Dad, when can we go skiing at Whakapapa?"
     That's the story of the F-word in our house.  (Read the June 27 post for proper Maori pronunciation help.)          
  
  
               

Cathedral and Train, The Coromandel Part II

   After leaving Hotwater Beach and enjoying a lunch, not spaghetti on toast, at Cook's Beach, we considered our options for additional sightseeing on our way to our overnight destination in Whitianga.  The kids were begging to head to the hotel, as they knew it had a swimming pool.  The weather was not the best, and for some reason the statement made by an Aussie travel mate years ago, while traveling in Europe on a Contiki Tour bus, ran through my mind.
   "Ah, Jeez**!  Not another !%$ D$#% Cathedral!"

   That Aussie bloke uttered his religious observance as our bus pulled up in front of another institution in central Europe.  After several days in a row that involved stopping at a cathedral for a look around, he had had his fill.  Despite the inspired architecture, I too had to admit that they all started looking the same after awhile.

      With Cathedral Cove only a few minutes drive from Cook's Beach, I was hopeful that our family would have a better tolerance before we headed off to the hotel.  We were not disappointed.  Nothing like God's own carving with the help of Mother Nature, to provide beauty and inspiration. I have put in the video, mainly for a feel of the ocean ambiance while you view the pictures.  

   Fortunately the lunch had rejuvenated us, and it was an easy hike along the coast to the Cove.  The heavy ceiling of rain clouds intensified the reverence we felt for this site.  As we hiked back to the car for our final drive of the day to Whitianga, visiting Cathedral Cove was a wonderful way to finish our day enjoying nature. 

    After our overnight in Whitianga, blessed by another ocean front sunrise, we drove across the peninsula to Coromandel Town.  Formerly a gold mining town and port city in which surrounding Kauri trees were harvested for use as ship masts, this town now thrives on the gold from tourists pockets.  It also is famous for its Coromandel Mussels which are farmed in the bays near town. 

     We opted to take on the Driving Creek Railway, a narrow gage railway on private property that travels up into the native bushland.  In 1975 Barry Brickell, a schoolteacher who decided he did not want to teach school anymore, started a pottery workshop on land he obtained fairly cheap after it had been harvested of all its native Kauri trees.  He also was a railway enthusiast and decided that a railway would be the best all-weather transport to bring clay from the surrounding hills on his property to his workshop.  In 1990 the train was safely upgraded to carry people to the top of the property.  



The Snake Train



The potter's work

     





     As we wound our way to the Eyefull Tower at the top of the hill, 465 meters higher than we started, I came to a realization.  It takes a whole lot of wine to build a railroad!  Even though the tunnels and some other major structures were built with pottery tiles, all of the corner terracing of the rail bed was done with empty wine bottles buried neck first in the ground.  Maybe the potter needed to get on the wagon and not on the train!

The view from the top.  Whanganui Island.

Organic Devil's Sugar with Mt. Spaghetti on Toast Lands Us in Hot Water.

    The "spring break" school holiday started off with an amazing health discovery.  We had friends over for dinner whose child has some food allergies.  For dessert we had purchased New Zealand Organic Chocolate Ice Cream, as our friends knew this as a safe food for their child.  So what makes it organic?  I see the herds of dairy cows happily munching on the beautiful green grass hills on my way to work each day, so I am certain the main ingredient in the ice cream is starting from a certified "organic" source.

    So I had to laugh the following morning as I added a healthy scoop of ice cream to my breakfast oatmeal (try it, you'll like it) and read the ingredients label. Fourth on the list after organic cream, organic sugar and organic chocolate was none other than Organic Maize Syrup!  The much maligned sweetener...none other than the Devil's Sugar.  Maker of free radicals and a possible cause of obesity (other than our over eating, lack of sleep, and sedentary life?)  Label that syrup with its Mesoamerican name, and wah lah...Organic!  Bothered me so much, that I added another scoop!  Hope my pre-breakfast, predawn 5K run balanced out the danger of the Maize.

       I did not realize another interesting breakfast choice would be the theme of our travel during the school holiday.  Once again, Kim as social organizer/connector on our travels came through with a real bummer of a place to stay and visit.  A friend Kim met had invited us to stay with her family at their family condo in Mt. Manganui.  (Another postcard picture, but it is the best one I could find.  The arrow points to the little "shack" we stayed in.)  Mt. Manganui is a two hour drive southeast of Auckland, and fortunately it is one of the few places in New Zealand where the coast is commercialized like the California coast.  It has taken on the name of Mt. Spaghetti on Toast after our visit there.
         

   Let me introduce you to Harry, the youngest son of the Hannan family.  He is credited with introducing Joel and McKeely to the morning delicacy of cold spaghetti (canned spaghetti no less) on toast.   Harry is the youngest of the three children in his family, and the picture shows his go get 'em attitude.   His mum is great about balancing nutrition for her family (they own the local supermarket) but sometimes with a strong willed five year old, a mum's gotta do what a mum's gotta do!  So when Harry made his morning demand for the same meal he had for dinner, the spaghetti on toast breakfast was introduced. 

     Being the naive Americans, Kim and I only realized a couple of days later when we stopped at a cafe for lunch, that lo and behold, there on the bottom right corner of the chalk board menu, was spaghetti on toast.  We have taken notice of it on most every cafe menu since then.  Seems we have found a new Kiwi delicacy.  At the end of our two day stay in Mt. Monganui, the children had consumed 6 cans of the Mattie's spaghetti and a loaf of bread.  Nutritional balance, no, but it did give them enough energy to make the climb up the mount.

   

     I showed my appreciation for Harry's introduction of spaghetti on toast to our children on our final day in Mt. Monganui by almost allowing the poor kid to drown!  Bad dad morning.  Both Joel and Harry were keen to get out boogie boarding on the final day.  Problem was, the swell and surf were a little larger than the preceeding day.  I had volunteered to take the boys to the water while Kim, Deanne and her daughter Emma prepared (drank their coffee) themselves for the day.  Joined by McKeely we walked down to the beach.  The boys being boys, headed directly to the water.  Directly at the point where the biggest waves were hitting the beach.  I did my best to guide them further down the beach to the more gentle surf (woke the neighborhood by yelling at them!). 

     They headed down the shore a slight distance.  I was distracted briefly talking to McKeely and unbeknownst to me, the boys had immediately headed back into the water.  Next thing, I look back, and there is poor Harry getting pummeled by big waves while moving further out into the ocean than Joel.  His sudden realization that he is only half Joel's height, and in danger, showing on his face.  His boogie board strapped to his wrist doing a good job of bashing his head with eevery pounding wave.  After each wave passed, as he resurfaced, I could see the tears and fear growing in his, and my own mind.

    Swim bag dumped, warm dry clothing that I hoped to wear home from the beach still on, I splashed out into the surf.  Time sometimes seems to stand still during moments of high anxiety, and this became one of them.  Seems like I could not get out beyond Joel and to Harry fast enough.  Harry's minimal life line of the boogie board strapped to his wrist then separated and floated away from him.  Three more waves crashed over his head before I was able to get to him.  I lost sight of him a couple of times as he went under.  Standing now chest deep in the water, I finally was able to grab him as a fourth wave foamed into both of us.  It was only then, as I turned back to shore, that I noticed the concerned surfer on his board, a few meters from us. A look of relief on both of us, as the surfer handed me Harry's boogie board that he collected shortly after I had grabbed Harry.   

     Fortunately Harry was warmed, dried, and tears resolved, ready for more action by the time his mum showed up.  Me, I was thankful for the extra energy of the morning breakfast of spaghetti on toast!

   The rest of our week took us back up the east coast of the North Island to the Coromandel Peninsula.  As it is still spring time here, activity on the Coromandel is not yet full on.  The Coromandel is a popular summer tourist area, due to its beauty, and its proximity to Auckland. Our first destination after leaving Mt. Monganui was Hot Water Beach (HWB) again on the east side of the peninsula. 

   HWB is a wonderful  geologic feature that exists due to the volcanic nature of the islands.  Hot springs exit the earth along the beach front, and become accessible at low tide.  We had departed Mt. Monganui trying to time our arrival at Hot Water Beach to be just before the nadir of the low tide.  Due to the winding road, and some car sickness experienced by McKeely, we were a bit late, which turned out to be a bonus.    

     As you can see, with a little sweat equity, you can have your own hot tub on the beach.  With our late arrival, some visitors already had turned to prunes with their soak, and were abandoning their tubs.  The nice lady in the picture above to Kim's left, who was hosting a birthday party for 8 year old boys on the beach, saw us wandering about, and pleasantly informed us that the tub next to hers had just been abandoned.  Bonus! I had to show us in the pictures with shovels in hand, just to prove that we were still willing to put in a little effort to be lazy!

   The serenity of the sound of the rolling waves, coupled with the warm soak in the pool was relaxing to say the least.  As the tide came in, Joel and McKeely enjoyed sprinting out to the ocean and back to the pool for warmth.   Once again while watching their joy, I was reminded of the beauty of our world, the friendliness of people, and the thankful heart we all need for being alive each day.    And even though some days I may end up in hot water, while other days, life can be a beach, when you put those experiences together, life does not get any better!