A comparison of systems

So the vernal equinox came and went this week, and I have noted a bit of a change in myself, as well. Perhaps because I have also realized that I recently passed the half-way point of work at Christchurch Hospital. It has certainly gone by very quickly. Maybe it is a bit of subconscious self-evaluation, but the honeymoon phase is over, I have begun more to work on the necessary preparations for Sydney, and I have a sense of routine at work, which allows the mind to be on other things while completing tasks. Meanwhile I have noticed that I have not given Aunt Kath the description of work life here, as I told her I would. So I will start there and progress to other observations later.

Work is actually very nice. If I were to boil it down to two reasons, they would be that 1) the union has been strong here, and the registrars are the biggest beneficiaries, it seems; and 2) that I am appreciated there. The latter makes a huge difference. The two trainees here, those who are already designated to become plastic surgeons, are responsible for making sure that all the acute cases from the emergency department are taken care of. At times, that has meant that they were not able to participate in the elective cases they wanted. Most of these acute cases are hand surgery, or skin grafting of acute injuries. With the previous experience with burn intensive care and with the hand fellowship, I provided them a lot of relief to focus on the cases they want. Works out nice.

As for the conditions, it is much more civilized here. Much less of a sense of indentured servitude. Fewer hours, more respect, more vacation time, better pay. Kind of nice.

There is a tradeoff, however. This training scheme is based on the UK system, as are Canada's, Australia's, and a couple of others. The result is a much less direct pathway of matriculation. Basically you graduate from medical school without any clinical experience, so you are not expected to know what you want to do. You apply for positions as house officers, where you manage medications, make the changes discussed in rounds, chase down lab results, take care of the paperwork, including admissions and discharges. Through this experience, you learn about the specialty over about a four-month stretch, and the department gets to know about you. At the end of the run you move on to another specialty. And this rotational progression can be interminable.

The next step is to move from house officer to registrar. At the end of the year, or some year, you declare that you are moving from one role to the next and apply to a department to become employeed for the run of 12 weeks. And herein lies the greatest difference: even though you are taking call, doing the surgeries, attending lectures, giving presentations on the subject, you are not guaranteed to become one of those specialists. You get a better feel for what the field is like, get better pay, that is about it. And again, this process of going from one rotation to another may last one year, maybe several. It depends on when you are ready to apply to one specialty for final training and the fortune of getting accepted into a training slot.

And there are not many slots. For plastic surgery, for example, there are some ten positions in the country-- total. This year there was good timing and five spots were available. Some years, maybe only one.

So the downside is you have no idea how long your training will last. Worse, you may spend several years chasing a carrot that you will never reach. I would think that could be quite frustrating, demoralizing. But in the meanwhile, work can be rather pleasant, you have deeper pockets at an age when many are establishing families, or at the least want to be seein the world.
Pay is fair, resposibility low, and so for a doctor of the same age, these guys are incredibly cultured, well-traveled. But they still have a long road ahead of them before they reach independence.

In the end, which is more preferable? The jury is still out.

Just a great day.

I had to spend a little extra time tonight (way past my bedtime) to blog about a great day. You just never know when they are going to happen. In order for today to turn out like it did, a colleague had to call in sick, there had to be a couple of miscommunications, and my Paypal account had to be straightened out. No pictures this time, so just use your mind's eye.

Layan called in sick on a day when he was on call. I was post-call, thus having booked some of the surgeries for today when the patients came through the Emergency Department yesterday. Normally Layan would have done them, but since I know the cases, and two of the four were hand cases, I took them to the "operating theatre." They were fracture cases, procedures I really enjoy doing. The operating theatre mood was light, with everyone in a good mood. They came out well, too.

Just after the second hand surgery, I had to hurry to a meeting across town regarding upper extremity surgery for tetraplegics. Now it would have been great if the meeting had taken place, but I took full advantage of the opening in the appointment book to.... go home early! (Actually by the time I got back to the hospital and gathered things together, I only got to leave on time, but it was the first time since I have been here.) This allowed me to play with the kids and Ana for a while without the distraction of getting ready for dinner or feeding them (the kids).

Now I have to backtrack a few weeks. I had decided shortly after having arrived here, that the only way I would unite the mountain bike I had brought over with the highly reputed trails around here required the headlight, also brought over. Well, that sucker lasted only a couple of trips to work and back. As soon as it had to be charged, it became clear that the charger didn't work here, despite using a plug adapter. Time to upgrade!

Some time passed with shopping online. After looking at some review articles, chat reviews, vendor and manufacturer websites, it basically came down to two models. Interestingly, one is made in Australia, the second right here in the Garden City! (Ayup and Nightlightning, if you are interested).

The comparison took a little more time. I finally decided on Ayup, picked out the colors that I wanted and bought them from the company. In the process of checking out, it seemed easier to use my Paypal account. Long story slightly shorter, changing your address a couple of times, including to another country, when it has been dormant for months and months somehow triggers some security alerts. It also seems that triggering security alerts at Paypal triggers security alerts at my credit card company.

A couple of phone calls back to the states, during their hours of convenience, took a few more days to manage. If competent people managed the phones at Paypal, the pain would have been less, but after assuring me that all was well, they allowed new purchases to be made but never allowed the transfer of funds to Ayup. More time passed.

Ultimately, the great goods arrived last week, a month later. And tonight was the first opportunity I had to use them in an appropriate venue. These boys would be dangerous on the streets (for the oncoming cars... and therefore for me, I guess), but I found a city park that has trails and doesn't close until 11 pm. Perfect!

Fast forward back to where the great day left off. I found the park (Bottle Lake) and went for a great ride around sundown. It turns out that it leads you alongside the coast, which I found right in the midst of a great sunset. Surf to the east, mountains and sunset on the western horizon, and the emerging city lights and the Port Hills beyond them to the south. A great moment.

The lights worked fantastically. In fact, when I got back to the car I seriously considered going out for another ride. And why not, considering how many Kiwis were still out there; by my estimate more than thirty people were out riding the trails, and there were more cars in the lot that when I got there! But headed for home on time, and, man, am I glad I did. The kids were great, and we sat down to the best dinner Ana my have ever made. It was a wonderful culmination.

Great work, good people, family playtime, exercise, wonderful views, great food. This is what I hoped for coming to New Zealand.

The lights are recharged. You just never know when the next great day will come around...

Orana Wildlife Park

It turns out that there is a a great wildlife park just on the edge of town. The pictures pretty much speak for themselves.

Mt. Hutt

The first of several adventures the past couple of weeks was another trip snowboarding. But this time all four of us made the trip.... in our 12-year old car. But no worries; this time we were going to the most popular mountain in the country, and considering how few there are down here, I think we can safely say in the entire southern hemisphere.

The trip is, in short, hair-raising. Pavement, none. The reason, the road would be slicker, the speeds possibly higher, and therefore they would have to invest more in guard rails. I should have taken a picture of one of them, but I was busy gripping the steering wheel tightly. And the photos in the fog may not have come out well. But they are nothing more than a steel cable running through 5 or 6 rusty posts which angled out of the edge of the cliff. There were only a couple of them on the 13 km ascent.

All of the slopes here are above tree level. No skiing in the trees, and a good uphill climb in the car. And when you get there, it really is a wider spot carved into the hill. See exhibit B.

Really you become convinced that no one else could be on the mountain, so by the time we got there, my disappointment in the road was mixed by the happiness to see any other cars whatsoever.

But up on the mountain, the views were great. We eventually drove above the clouds. This a view back from the top of the slope at the road we used.

And this is view in the other direction. Wow.

We took the long way home to see a little more of the country. We were once again caught off guard. In the countryside, just outside the town of Ashburton, population 14,000, we passed a farmhouse with these signs outside. That will give you a double-take.

The Trip to the Antarctic (Centre)

The third and most recent trip was to Christchurch's International Antarctic Centre. There we learned a number of things, including how close we really are to antarctica. In fact, a relatively large portion of the entire center is the base for the United States Antarctic Program. There were several large exhibits regarding the brutally cold temperatures there, the explorers who had been there (as early as 1820!), the climate changes there, but really we were there to see the penguins.




Ryan got a front-row view of the feeding of the penguins. These were little fellas, which reminds me of how large the bigger species are. I should have taken a photo of Ryan beside some of the stuffed emperor penguins. I am not sure which was taller.


While chasing Ryan around, I did take a couple of photos of some really interesting facts about Christchurch. I hope they come out legible.

Today's post is basically to give some more views of Christchurch, in particular the house. The first photo is from the street corner. As a welcome change from the past 7 years, we have a garage! Wasn't all that handy without a car that first couple of weeks...

The second is of the backyard. I am standing in the bricked area designed for a barbecue pit. Really only half of the building shown is ours; that second rooftop is the other half of a duplex.

Our final photo of the evening I took while I should have been studying. It is taken from the medical school library, located downtown on the sixth floor. Not a bad view. Somehow your thoughts drift off to plans for the upcoming weekend.

Hitting the slopes in the colonies

Okay, I realize we have been talking a lot about the country, some about the people, when all along you have really just wanted to know how the kids are doing. So some new landmarks for the little ones: Ryan and I had our first full phone conversation two weeks ago. Twice since then she and I have talked on the phone. It turns out occasionally when Ana hangs up, Ryan says that she wanted to talk to Daddy, so Ana hits redial and hands her the phone.

She seems to be able to understand over the phone, which is a big step. She can also answer questions atonomously. The last time she answered the phone herself when I called. After a little chit-chat, I asked if I could speak to Mommy now. Very matter of factly, she replied, "No." Long pause. Where does one go from there?

She also surprised Ana yesterday when they were getting ready to go to the mall. Ana was climbing out of the shower when Ryan marched into the bathroom, declaring herself ready to go. She was fully dressed, with dress, tights, shoes, jacket. Ah, the motivation of shopping for these girls....

3-dog is also growing. Ana laughs at all the facial expressions he has. Dry and subtle they are. He also started crawling last week. I don't know how many times we have turned around to find that he had migrated, or worse, to bump into his noggin with a foot or leg. So far no permanent marks. You could tell that he was wanting to crawl for quite a while, likely due to watching the older sibling.

I went snowboarding yesterday, so I can mark NZ on the list of places I have skied. The views are incredible up there. It plays with your mind to be on a mountain top and look out at the ocean. In the other direction, just more and more of the jagged mountains. But it is all above treelines, so when the clouds rolled in later in the day, it caused snow blindness on the the top half of the mountain. No contours, no landmarks. But the snow base is the best that they have had in some 15 years. It even snowed down here in town today. Didn't stick here, but the hills on the south side of town got more than a dusting. The buses didn't run up to those neighborhoods today.

I can't wait for the spring skiing, when the weather is more predictable.

The photo to the left is when you "turn off the paved road," a sign that you may be a redneck if you were in the U.S. From here, we are only about 10 km from the moutain. Notice the one-wayness.

This is the view from the top of the mountain, looking west. They call it the Southern Alps. Who knows why.

The view from the same spot, looking east. Not too shabby.

First night on the town

Tonight we go out on the town. Though it didn’t seem like a big deal at the time, I think it is the first time that we have done so in the six weeks we have been here. We went to a surprise party for a colleague of mine who was accepted into the plastic surgery program here. One of greatest differences between medical education in the states and in the UK system, as is followed here and in Australia is how we get accepted into the training program. While at home, we go straight from medical school into a residency program, here you apply for jobs as house officers. You do what would be considered “scut work” designated for junior residents in the U.S., such as doing the admission or discharge paperwork, following up on lab results or radiographs, then reporting these to the higher-ups. The difference is that junior residents still get to operate (presuming we are talking about surgery). Here, that is all they do. But a house officer may do surgery for four months, pediatrics the next four months, and internal medicine for the “run” after that. In addition, a U.S. resident will matriculate each year, barring disaster. Here a bloke could opt to stay as a house officer indefinitely. And why not? The pay is good, most are young and single and in a position to do a lot of fun things with that money. Relative to the Americans, they are very well traveled and have done a lot in the way of adventures, such as skydiving in the USA, hiking in the China, or snowboarding here.

Then there is the next level, where they work like what we used to call interns. These days in the U.S., it is a term synonymous with rookie, for the most part. But junior registrars are basically trying out some of their favorite specialties, then trying out for senior positions. The advantage is that they have the opportunity to know they like the job they choose, and that the programs hire people they like. They down side, a significant one, is that you can potentially be stuck in this level. How long do you keep trying to get into a specialty before giving up and moving to another? Or maybe you need to change locales to get some face time with another program? It is a difficult game.

So there was a good deal of significance when Kasia got accepted to the program the last week of June. Suddenly her next six years are mapped out for her. And not just for her, but her family, as well. It is a big accomplishment. So her husband rented out the top level of a nice bar in City Centre, with open bar and hors d’oeuvres, for a surprise party for her.

She was indeed caught off guard. Her gestures and face said it all; I wish that I had had a camera rolling. She walked in gabbing then gestured to her friend that she recognized one of the other people in the bar, as if to pardon herself to go say hi. But before she could make a step in that direction, she realized she knew the person behind the previous. Looking around, suddenly she realized she knew a lot of people; in fact, all. After recognizing about ten faces, it became clear. It was clear that the surprise party was a success.

The Olympic Opening Ceremonies

I am kicking back on the couch a little after midnight, watching the ceremonies on Kiwi national television. First, it must be interesting to know that you have just witnessed dawn while we are in the middle of the night, all the while perhaps watching the same spectacle. Beijing is four hours behind us, so they are on the same day as the U.S. while we are in your tomorrow.

Some interesting information:

• The New Zealand TV crew consists of 120 people in the basement of the media broadcasting building.
• NBC: 3000 people in a 7000-square foot space, including its own coffee shop and McDonald's.

The sports with realistic medalist hopefuls from New Zealand:

• Two-man scull
• Individual canoe
• Windsurfing
• Three-day equestrian event
• Men's field hockey

The flag-bearer for the Kiwis: Mahe Drysdale, a rower in his third olympics, but one of the few returners who has not won a medal.

I am looking forward to watching the games from another country. Probably equally biased to their own, but with fewer competitions in which their own are competitive for the medals. So how will they cover these events?

Several other sports have already been touted in the highlights. Among them:

• The Redeem Team in basketball
• 100-meter dash (Gaye from USA, Bolt, and ?)
• Michael Phelps' chances of winning more than Mark Spitz' seven gold medals

Other odd facts:

• Beijing population: 17 million
• Capacity in the Bird's Nest stadium for the opening ceremony: 91,000
• Demand for opening ceremony tickets: 2.3 million
• Bhutan is present for the games. The only sport in which they have competed: archery

Highlights of the ceremonies:

• The fireworks simulating 30 footsteps along a major thoroughfare in Beijing, covering the length of the city in 30 seconds.
• A thousand people with lights, running to form an image of a dove in flight. Impressive.

Well, these ceremonies are likely to go on forever. 204 teams to march in. We are planning on going skiing this weekend, weather permitting.

Let the Indian guy talk

Just a quick blurb tonight and a couple of photos. It made me laugh and I wanted to share.

Ana found a great Indian restaurant just a couple of blocks from our house on the edge of the University campus (another edge besides the one our house is on). Indian restaurants are more plentiful here than Mickey D's are there, but the food is so good.

So we picked some up for takeaway (Yeah, we speak Kiwi.), ordering from the only Indian guy in the place. Clearly he was the manager. I mean, by the way he composed himself and his dress a step above the white folk. So when the food was bagged and brought to the counter, the obviously Kiwi girl stepped up with it and started rolling off some jibberish, Maori or something. Neither one of us could make out a lick of what she said. "Doesn't sound like our order," I said.

The manager overheard and came over, took the receipt from her hand and read off the exact four things that we had ordered! Now how the heck does an English speaking Kiwi sound more foreign than an Indian?! Apparently when reading Indian terms...

I think the take home point is that Kiwi is not a good medium for translation into "Amerkin."

Now for the obligatory photos:

Just us boys getting some work done in the kitchen.

Ryan out in our little "front yard".