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).

The Waldorf Tetra- Our "Home Away From Home"

One big difference between Timaru last year and now in Auckland is that I have to provide my own housing here. A cozy three bedroom house just across the street from the hospital and Botanic Garden was NOT included. Fortunately, we had spent some time in central Auckland before, and booked a comfortable one BR apartment for the first week to give us time to search. We were greeted by headlines like those above and found the rental market quite tight. The population in Auckland is growing, perhaps in part due to people relocating from Christchurch to escape the damage of the quakes.
Fortunately, just around the corner a one-bedroom apartment was available at the Waldorf Tetra, an 11-story hotel/apartment rental.

We are on the 9th floor, somewhat ominously in unit 911. It isn't exactly what I had fantasized about before coming to Auckland.The micro-environment on the street is mostly mini-marts and small snack shops amidst the buildings of two large schools, the University of Auckland and Auckland University of Technology (so we don't quite match the demographics of the neighborhood). But it is a 15 minute walk to work, affordable, and very close to interesting things in all directions, so it will do nicely.  
Let's take a tour.
It is my guess that the two rooms were originally two separate hotel rooms, which would explain the unusual configuration of one-bedroom, two bathrooms (no tubs, just showers: tubs are few and far between in NZ). When you enter, you are immediately in the kitchen space, with a dorm-sized fridge, two burner stove, and microwave (we bought a toaster-oven to broaden our cooking options)..

The living room is quite basic, a love-seat, chair, small table, desk, and cable TV.

One of the two bathrooms is off of the living room.

The bedroom is pleasant with a small table and an armoire.

The best thing about the unit is the view of the ubiquitous Sky Tower, by day

and night.

There is even a peek at the Auckland Harbour Bridge over Waitemata Harbour.

It can get awfully stuffy in the afternoons since there is a lot of pm sun,only two windows in each room open a crack, and there is no AC. But enough complaining.
We are enjoying the advantages of living in the major city in New Zealand. Many acts on their way to tour Australia pass by here. We saw singer-songwriter Nick Lowe last week (I saw him before in 1971 in Munich!),

Nick Lowe

and Lucinda Williams and Steve Earle will be performing separately this week at venues just a short walk from here.
Easter weekend is a big holiday here. Most people have a four-day weekend, Friday through Easter Monday. I got Friday off (but work Monday).  We walked the 6 miles to the top of One Tree Hill, a site important in NZ history and also a title of a U2 song.

The view from the top was spectacular, to the north overlooking Hauraki Gulf opening eastward to the Pacific,

 

 and looking south to Manukau Harbour emptying west to the Tasman Sea.

Another Easter tradition in this part of the world is the Easter Show. I first heard of it last year when we were in Sydney, where it is a really big deal. There is one here too, and you could see it from the top of the hill.

See the white tents in the center

It is  like a large county fair, with agricultural exhibits mixed with carnival rides, junk food, and random other entertainments (acrobats, strong men, lumberjacks, etc.) ie: good old-fashioned fun.

Competitive sheep shearing

Adorable piglets

Easter Sunday we were invited out to Waiheke Island for brunch with the Clinical Director of General Medicine, Dr. Robyn Toomath and her husband John. We feasted on smoked fish cakes, salad, orange cake, and local wine on their sunny deck overlooking the Gulf. It was a gorgeous, perfect day.

We had time to pick up a few seasonal treats on our way back to the apartment.

Happy Easter Everyone!

Next post, I'll write about work a bit.