Back in the summer of 1982, while staying at a hotel in Ames, Iowa (more pigs than people), where our family was dropping off my sister for her sophomore year at Iowa State University, I happened upon a new cable television channel playing music videos. The video playing at the time was of a punk rock group assembled in front of an oil rig, blasting out the lyrics of "Rock the Casbah". A teenage event that has moved on to define a part of my generation.
Thanks to that, nearly 30 years later, music from the Clash has found its way onto my itouch music list. Instead of "Rock the Casbah", the questioning lyrics of another Clash song have dominated the conversation around our home in New Zealand (more sheep than people) for the past several months. The question has a bit to do with the fact that we should have planned a definite exit strategy for my working sabbatical (or we should have planned not to fall so hard for the beauty and friendliness of New Zealand). It has alot to do with living internationally and learning a different perspective on family/work/life balance. It has somewhat to do with the final resolution of a malpractice lawsuit that drudge on into absurdity over an eight year period of time (over half of my professional practice life). It has much to do with relationships and support of friends and family. It is partly related to my loyalty to my patients and professional colleagues that was attacked by the insurance (malpractice and health) industry years ago. Finally, it could have heaps to do with the unfailing loyalty of our dog, Nellie.
"Should I (we) stay or should I (we) go now?" (Clash, Combat Rock circa 1982)
As I write this, Kim is winging her way back to New Zealand from the US after her successful run at the Boston Marathon. Thanks to Skype, we have been able to keep going with (webcam) face to (webcam) face conversations. While there, she has had to be the one to answer the question many times of "When are you coming back here (USA) for good?" Much like our old Christmas drive to Montana through highway 12 in Central Idaho, I knew how to beg off and be the childcare parent while Kim took the wheel to struggle with the difficulty of the river's edge, ice covered and whiteout conditions of the drive (hey, I was worn out by that 2 1/2 hour drive from GTF to Mizzou). Letting the better looking, most verbally skilled member of the family take on the question was probably a good decision on my part anyway.
First we are extremely blessed to be able to have to answer the question. We are blessed by incredible friendships in two hemispheres with people who are concerned about our family and ask the question because they enjoy us in their lives as much as we enjoy them. (Life lesson 1: It is about the people you love, not the job you have, the places you have been, or the money you make that defines your life). So thank you to those who have asked, and sorry that at the moment our answer has been vague.
"If I (we) go, there could be trouble...."
I now wear the scarlet letter M of malpractice settlement after my name in the National Practitioner Data Bank. Real or imagined, I have angst about reapplying for malpractice insurance in the US. I am a bit snake bit by the way my malpractice carrier treated me when the suit was filed (if you are insured under CNA Healthpro-Continental Casualty, I'm sorry for you). There could be trouble in gaining insurance again, but my thickened skin should be up for the task. Occasionally my colleagues in New Zealand ask, "Why would anyone want to practice in such a dysfunctional lawsuit happy society." On days when my skin is not feeling very thick, that question makes alot of sense and my answer festers with indecision.
"If we stay, it could be double..."
Well half actually. Financial reality check number 1. April 15 has come and gone. IRS deadline was met. When we gaze upon the final numbers, the answer to the question I had about why US physicians usually only work here for six months before returning to the US becomes clear. If money is our only goal, it makes no sense to stay. Reality check number 2. Dumping the mortgage back in the rapidly depreciating "ownership society" (G.W Bush, Misinformation Campaign in the USA, circa 2003) would make things easier. A trip back to the US is necessary to take care of that.
"Come on, ya gotta let me know...."
Our family has moved twice now since the children have been born. We are not restless people. We have learned heaps from each move. I felt the reasons for each move in my gut on both of those occasions. We had to have some extra resolve to navigate through Immigration NZ and Medical Council NZ system to make this move. It has been more than worth the effort. Now that we have moved here, have we found complacency? What a word. Aware of the awards and dangers on either path that we may choose, we have been slow to choose. Life is awesome here (NZ), but life was awesome there too(Idaho and Oregon). How's about that for blessed indecision!
"Should I (we) stay or should I (we) go?"
Then there is Nellie. Dogs know (I agree with the article below).
Nellie becomes Nervous Nellie when poked and prodded by doctor types (People do too. I hope that does not mean that I learned my empathy at the veterinarians office!) Multiple blood tests, immunization updates, implanted identification chip and one month quarantine upon arrival would turn her into Psychotic Nellie. Once she arrives here she would be limited on the activities in which she can join us, due to Kiwi protection zones. I completely agree with protecting the Kiwi, and only mention it as it limits where we can tramp with Nellie.
She is a spoiled dog who, thanks to our living in rural areas, has never had to be trained to be on leash. I trust her more off of a leash anyway, and at nearly age 10, I do not want to untrain her bird instincts.
For the past 9 years, she has been a loyal companion and family member. All those years, Nellie and I have made our morning walk, me with cup of coffee in hand, her with a chance to poo in the bushes (hope I have that order correct), as our bonding exercise. A routine that has been carried out through rain, snow, summer morning sun, and winter morning darkness. Starting from the time of a single newborn child in a relatively new marriage, to the two children in their wonder years and a more experienced marriage household, Nellie has been there. When Joel learned to crawl, she gently allowed him to pull on her scruff without an ounce of upset. She has grown with our children, in fact almost a third child herself (easiest one to train by far).
More importantly, back in April 2005, Nellie was there. After spending two days being twisted, turned and raked over the coals by attorneys in a deposition, what was left of me returned home to my family. I knew then the same thing as I know now. I had tried my best as a doctor (I am a "GOOD, not Great doctor", K.B. Lowder, MD, intern year evaluation, circa 1995). Even so, that did not prevent what was already destined to be the patient's final outcome. Inevitable even before I was asked to provide his care. My Family Practice peers and Neurosurgery specialists have since confirmed that truth, but in the greedy, parasitic hands of a malpractice lawyer, that truth has been twisted into a massive settlement.
Thankfully Nellie was there. I had had enough talking and questions those days in 2005. Enough rehashing of events that had occurred two years previously. The emotions of two days, combined with my sorrow for the patient and his outcome, left me so empty that I could not appreciate the love offered up by my innocent toddler children and Kim upon my arrival home. I chose my easiest option. Escape. Using Nellie as my excuse. Her loyalty snagging what was left of my spirit. A walk to the river on a chilly springtime mountain evening. She untiringly fetched the tear, snot and slobber (all secretions mine) coated stick from the cold waters of the N. Fork of the Payette. My tear blurred eyes lost track of time. We stayed at the river well past sunset. The cold night, casting me literally into an emotional and professional darkness that would take another six years to reach closure.
Back when I was nearing my tenth birthday, I knew I desired two things. I wanted a dog, and I wanted to grow up to be a doctor. My parents relented on my birthday with the gift of my first dog ( I had to promise to pick up the poo that dog, Mitsy-beagle, left behind. As noted above, Nellie is trained to poo out in the bush, so I guess I am still failing on that promise). My parents fostered my other desire, providing education, work ethic and opportunities. As I walked up the hill from the river on that day back in 2005, absolutely shattered, my only saving thought was, " If I can do nothing else right in this world, at least I can still throw an effing stick for my dog." Nellie thanks for being there to bring back the stick and my spirit.
Nellie patiently waits for us in a house that overlooks that same stretch of the Payette River. Cared for by two of the world's best dog lovers. Meanwhile we explore all of our options, with the realization that we are not done with work and travel in New Zealand. Blessed by opportunities in many directions. We pray, ask, question and try to plan. We appreciate the patience of our family, friends and colleagues as we reach a conclusion. But when it comes to the question of "Should we stay or should we go?" the answer is....Nellie knows!
