Work

(Author's note: Most of what follows is about my work. It may be a bit dry for some. If you do go down to the bottom there is some stuff about Greek Easter 2012.)

Auckland City Hospital

The reason I am in Auckland is the work (and the reason Fayne is here is because I am here.) It was a revelation when I worked in Timaru for ten months in 2010-11. I had no expectations, only that I would come, work, make some money, and see the country. How bad could it be? Well, it wasn't bad, it was extremely opposite of bad. I worked in a team with people I liked as a mentor to young, curious, enthusiastic junior doctors who were not jaded or cynical. My years of experience and knowledge were appreciated and rewarded. The schedule and pace of life were extremely humane. Paid vacation and educational leave, public holidays, and overtime was something I never had before.
And so, before leaving Timaru in March 2011, I started the process to get a permanent medical license (called a vocational medical registration here), with the thought that if I do future work in NZ it  will be easier to arrange. The Medical Council declared if I worked three more months, at least one in a big hospital, I could undergo a VPA (vocational practice assessment), the final piece of the puzzle. I should sit for the VPA in July 2012. As I understand it, two physicians follow you for a day, "make sure you are not an ax murderer" (although how they will determine this I am not sure), review charts and clinic visits, and interview colleagues. People who have been through this say it is basically pro forma.
Initially I inquired about going back to Timaru but they had no openings, so I worked with a kiwi woman who helped me find the Timaru job, and we found an opportunity at Auckland City Hospital, the central hospital in New Zealand's biggest city. I thought if I was successful here as well as in a smaller rural setting, it would bode well for working anywhere in the country.
The hospital is a 15 minute walk from our apartment and the complex houses several buildings. For me, the two main ones are the new and the old adult hospital buildings. The new building opened in 2003 and is nine levels high and houses the ED, acute wards, and ORs. It is designed around two large atria so that even internal rooms have windows and a source of daylight.

On the third level there is a very pleasant coffee area for staff. (Tea or coffee with the team mid-morning is a tradition.) The elevators are unclad and you can see their workings, a design which reminds me of the Pompidou Center in Paris.

The medical wards are on Level 6. The whole complex is complemented by many carefully-chosen New Zealand artworks.
The old hospital building has been converted into the Support Building, with clinics, medical offices, labs, etc., although there still are a few rehab wards on upper floors. It is an impressive 14 stories high, and has commanding views of the city center, Auckland Domain, and the harbor and gulf islands.

I appreciate that the two buildings connect smoothly at each level, so going from my 6th floor office in the old to the ward in the new is easy. Speaking of my office, it is in a large space where senior and junior medical officers, clerical, and other support people in General Medicine work.

A few people have doors, but most are like me and don't.It is quite a change from Timaru where we each had our own private office converted from the old nurses' dormitory rooms.

My desk on the left

How does the work compare to Timaru? It surprised me to find things were more similar than dissimilar. I thought things might be more posh in the big city, but New Zealand is a very egalitarian society.Most patients are in four- or six-bed mixed gender rooms with no TV's, which are down the hall in the lounge. There are many more specialist services here (neurology, cardiology, respiratory, etc.) and getting their input in consultation is quicker and easier there still is a significant queue for MRI's, elective surgery, or anything invasive if you are over, say, 70. In fact, the critical care unit here is run like a closed shop by the Critical Care doctors. It is much harder to get a medical patient into the ICU in Auckland than in Timaru.
The population here is more diverse, with over 1,000 distinct ethnic and national groups. There is plenty of work for translators. All of the different South Pacific island nations are well  represented, and certain problems (such as very severe gout) are much more commonly seen.
One other obvious difference here is the larger size. In the South, we had one medical ward, four or five consultants each with one house surgeon and maybe a medical student per team. Here there are four medical ward services, each with 5-7 senior doctors(like me) on the roster. My squad with the Black Team changes weekly and includes one Registrar (like a US senior Resident or Fellow), one or two house officers (think intern or junior Resident), a junior medical student, and sometimes a senior student (called a Training Intern, or TI). Keeping everyone straight is mind-boggling to me and to the patients, but somehow it works.
As in Timaru, the staff come from many countries around the globe, and they have been friendly and welcoming to me, but it not going to be the same camaraderie as in a small town. I just learned of a weekly Wednesday pub trivia quiz that some of the staff frequent, so maybe we will add that to our schedule.
My main job is conducting the ward rounds and directing the care plans, but also includes some clinics, teaching sessions, and attending various educational sessions. I will also be involved in an audit of patients admitted here with diabetic ketoacidosis over the last 15 years, so I am managing to fill my time.
The Auckland District Health Board (ADHB, the entity which pays me) announced that they have an unexpectedly large deficit, and will institute austerity measures such as a hiring freeze and reduced cafeteria service. Hummm....It's a good thing I am not paranoid, otherwise I might think it is my fault.

On a different topic, Sunday April 15 was Greek Easter. There is not a huge Greek community here, but I did find the local church in the phone book. I couldn't tell if any activities were planned, but made a point to go out and walk by hoping to pay my respects. At first, it was not clear if anything was going on, but on looking in there was a lively traditional celebration happening.

We were warmly welcomed by the priest and the parishioners, and invited to partake in the roast lamb with all the trimmings, red eggs,
 
and home-baked bread and cookies (kouloudia, not as delicious as my yaiyai  or sister Angela made before we left, but nourishment for my soul none-the-less).