Saturday at the Mount. (more photos Mom!)

The day started with me off to the Tauranga Rowing Club to check it out and see about rowing possibilities.  There is a master's club, they scull mostly, and take it pretty seriously in the country!  The boys are signed up to do a Learn to Row session during their two weeks of holiday starting Monday!

Too windy to row for us, so I found myself next at the Farmer's Market where asparagus and Protea were plentiful!

Home in time to find the boys off at first aid class for the entire day (phew!!) for their lifesaving, and Maggie begging me to take her up to the top of the Mount, again!  This time with no breaks and no side ache.  She's got some legs of steel!  

Nothing like some retail therapy and sampling of baked goods at our favorite new cafe, Cafe 88, after a hearty hike!

Surfer girl, surfer girl, my little surfer girl indeed!  She waited 3 hours patiently while I looked at cars to buy (maybe a Honda Odyssey??)  until she could wait no longer to go to the beach and put those boogey boards to some use!  It is so much fun to see her go after this new sport.  She told me as she was lining up for her next break, "Mom, it feels so good to float like this in the water!" "Why is that Mags?" " I don't know, just feeling the salt water on my skin and  in the wetsuit...." and off she went with the wave.

Clash of Kids and Clans

Friday afternoon here, a slow moment at work between patients allows me to jot down a few thoughts before the afternoon rush and then home for the weekend.  Feels like it has been a long week.  Amazing what we have been able to squeeze in to those five days when I look back.  some things don't change no matter what hemisphere one is in.  By week's end I am tired and in need of some down time, though not sure if that will come soon.
After the boys' admirable attempt and failure at the swim test for surf lifesaving  (400m in under 9"!!) this week has been highlighted by our new training regime in the pool.  With a fantastic aquatic and fitness center here, the boys and I have been swimming laps daily, totally new and different thing for them, soccer players that they are.  At first there was some kickback from boys, esp Jack, who thought this was a "dumb" idea all together, but after I got them a lesson with this cool swim coach who after an hour totally transformed their stroke and helped motivate them (also told me that Jack really has some swimming talent!), he now thinks swimming is not that bad.  Seemed hard for them to get their heads around the idea of learning something new at this age.  So old, really!  But now Jack wants to play tennis and surf as well.  More lessons to come I guess. 

Week was also highlighted by the America's Cup and yesterday was a dark day indeed as after a stunning early lead, the Kiwi boat lost to the Oracle USA boat 9-8.  Amazing what a national event this was, and the fact it lasted so long, meant it permeated out lives for days/weeks.  All eyes peeled to the tele during race time, usually around 8:15 am each day.  Kids were late for school, patients were not seen during that time, all we heard on the radio was race commentary.  Actually was fun to see such a small country be contender for such a big deal.  Well, at least to those in the yachting world!  A treasured sport here, not so in the states I know.  Did any of you, besides Wylie, even watch a race?  Now we are back to hearing about rugby and cricket with All Blacks playing this Sunday...if only we knew how to play these sports.

I have struggled at times this week, mostly with the raising of two teenage boys and their hormonal rollercoasters.  AW and Michael Gurian, where are you??!!  It is amazing to me what comes out of their mouths-starting to see where the writer of the Excorcist got his/her material! Not that bad really, but I do have illusions of Noah with his head spinning at times!  I certainly can do no right, at least initially, I am the source of all problems in their lives and to blame for anything that goes wrong, until something goes right and then life seems to be ok.  Like the swimming or lifesaving.   At least they can still admit it and thank me when things do turn around.  Without totally losing it and decapitating one of them, I find retreating to my room a good solution.  And yet, before I know it one of the boys is pushing me over in bed, wanting to snuggle or talk, or they are arguing about who will sit next to me on the couch while we watch a movie.  Lord help us!  The lows are definately highlighted by brief moments like the swimming in the pool together, having them share the condom experience in science yesterday, and more recently my education about Clash of Clans, a favored new iPad game.  If you can't beat them, join them, right?  From what I can tell this game involves the joining and building of clans, something about aquiring gold and elixirs; there are battles fought and trophies won.  Something like an advanced Lego game.  I have yet to join or create my own clan, despite the intense pressure, but as they are tending toward obsession with this, at least I can engage them and hear their tales of clan building and destruction.  Who knew?  But I seem to win points for showing interest, so I'll play along for now.

More thoughts about schools, Maggie, round abouts and left hand driving to be continued.  THe work day is done so home I head.
Was up walking early on beach and the water with the early sun was a glorious turquoise color.  Mother Nature is incredible in the gifts she has to offer.  Need to reread Gifts from the Sea!
Daylight savings this weekend and we will Spring Ahead!!

PS: Neoprene and Health homework

As the sun is making its presence known now and Maggie is clamoring for my attention, I see some beach time in my near future.  Took kids out Wed after school and got us all wetsuits. Need them now as water temps are in the teens, and in summer when the water warms they are worn for sun protection. And let's just say neoprene suits at this stage of life are a challenge on so many levels!!!  Function over fashion indeed!!

And for those of you sharing adolescent parenthood at the moment or in the past, wanted to share the conversation I had with Noah on Friday.  Albeit brief, he called me at work to ask me what a vulva is.  HA!!  This weeks assignment in health here is all about the female genitalia.  Warms my heart to think of discussing this with my boys.  Jeez!

Few choice photos from the day...

Surf Lifesaving

It is Sunday and I awoke to gale force winds, thunder, and sheets of rain.  It being still dark, I was not eager to jump out of bed anyway, but the thunder kept me deep under the covers.  Felt like a true tropical storm.  Despite the winds, finding sleep here to be much deeper and intense than anytime in SPokane I can recall.  Maybe it is the mental fatigue from work and life, but I fall into bed and don't rise for at least 7 if not 8 hrs later.  Lots of dreams too!  Feels good to sleep like this, to really let the body rest.
Hours later now and with a few cups of tea under my belt, the sun is attempting a showing, the laundry is hanging outside, and Maggie has remained the Go Fish queen yet again!  Darn it, can't seem to dethrone her!
Up early for Sunday to get boys to the local aquatic center for their swim practice for the surf lifeguarding class they are now taking.  (Thanks, Mom, for signing us up for something we don't know anything about or want to do!!)  Yesterday they learned all about waves, tides and such, today they had to try to swim 400 m in under 9" (they will be expected to do this in 3 weeks for their test; my guys finished just over the 9" mark.  Guess we will be doing some swimming coming up here.  Lovely aquatic center so I'm thrilled about going!!)  and will spend some time this afternoon in the ocean swimming and learning rescue techniques.  Next weekend is first aid class.  When all is said and done, assuming they pass the test, they will be jr. patrollers, and can patrol the beach with more experienced guards.  This is a big deal around here and in NZ.  Surf clubs are the center of life in this community in the summer, great gathering place for families, the kids compete in beach related events, patrol, and there is even a group for Maggie to join on Sundays.  I'm still not completely sure what is all entails, but sounds like a good way to meet some folks.  The boys were not thrilled about taking this class, Jack not able to see any benefit, he just wants to learn to surf.  They both are so eager to head out and spend all afternoon boogey boarding and playing in the surf, and it really does seem like benign waters, compared to SF Bay that I grew up swimming in.  But this class will make me feel better about them going out on their own.
Maggie, Lina and I explored some local hot pools here in town yesterday.  We took two other kids along that belong to Dawn Picken, previous news anchorwoman from Spokane, who is also living here now.  There are 13 hot pools in the near by area, all developed at least somewhat, and Fernland, where we went was small, quiet and lovely.  Very relaxing for a rainy day.  Then we hit the local park to burn off some excess energy.

Realized yesterday that I haven't stopped and sat down much or at all since we arrived.  Lina had to remind me of this as well.  Not really a new concept for me, but today deserves some down time.  If nothing else, writing seems to force me to stop and reflect a bit, and thus justifying this blog a bit more!!
Now that we are here and most of the to-dos are done for the moment, hard to recall all those years and months and hours planning to be here.  Does feel like I jumped off a small cliff holding on to these kids and just prayed for a soft landing.  And I'd say we landed very well, still brushing ourselves off a bit, and now just waiting for life to unfold.  Already a year seems like a very short period of time.

Moving into Spring with a Scrum

Amazing morning to wake up to, scurry out to the beach for a jaunt before work and see the early faces of Spring coming our way.  There is a nice energy brewing as people anticipate the coming of summer!

After another nice day at work, ended the day with the full local color at a Bay of Plenty Steamers rugby game.  These are the local boys, and our clinic takes care of the players as needed, so we are gifted some comp tickets.  They played the Southland Stags, and unfortunately our boys lost 33-25.  

Reminded me of going to a Spokane Indians game, local scene, chilly in the stands, great support and obvious love of this game.  Still not sure I get the scrum concept, but boys did a good job translating rules that they have learned to date.  Definitely a rather rough and tumble sport.  We had fun and now that we own a rugby ball we can get serious at home as well.

My place of work

Early musings on clinical practice after Day #3 of work:

1.     The clinic is an efficient, busy machine.  It is 8.9 km from the house, over the Tauranga Harbour bridge and through the main downtown of Tauranga.  takes me 15-20" to drive depending on traffic. will try to ride bike when weather warms a bit.  It is a compact place, all rooms and space are used majority of each day, not much dead space.  The staff and MDs all work as one big team, even though there are smaller team divisions of MDs and RNs.  I can feel that despite the Team 1-4 delineation, we are all there to do the same job-take care of folks and do this the best we can!  

2.     Generalization so soon after arrival and starting work, but folks here are more active and fit and generally healthier than what we are used to in America.  BMI average of patients is much lower than in Spokane, and people seem to take more responsibility for their health and welfare.  Many are low intervention, not wanting meds and such, but curious to come find out what the MD thinks.

3.     I have now discovered the answer to what is wrong not only with Group Health but with America:  we have no tea breaks in our day!!  This is the most brilliant idea on so many levels and here is how it works:  our work day begins betw 8-9 am, at 10 am there is 15” in everyone’s schedule for tea break.  If you can, and we all do, we gather in the big room upstairs (lounge equivalent at GH) between 9:55-10:15 am for tea or coffee (all supplied by clinic!) and maybe a snack you brought, we visit together, laugh, tell stories, get to know each other, share recipes, stories about life, love, loss, and then return to work until noon, when we gather again for lunch.  And then again for tea at 3pm!  Talk about team building!  This is it, the answer to making it all work better.  Gets folks out of their offices, interacting with one another, you feel refreshed and ready to go back to the pts and work hard, gives one something to look forward to, more exercise as you have to walk down hall or upstairs and out of computer chair, maybe a bit of a caffeine hit depending on your choice of beverage, and then the purpose of why you are there in the first place feels even that much better!!  It gets one away from the computer and forces a break in the day which we know can get crazy fast!  And the culture expects this so everyone feels good about taking part.    I may have to petition GH for this upon my return, and encourage all to follow suit.  No doubt there are good things to be learned here.   As you can see from above photos, there are many services offered pts here, including an acute walk in clinic open from 8-6pm every day.  There is an after hours clinic in town as well where I can work as desired.  You can also see from the two lower photos, shot in my exam and office room, that it is all in one, and I mentioned that I am the one who rooms my own patients.  They may or may not have vitals done, only if I take them.  Keeping notes is a bit different as well.  The template keeps things on the short side, no verbose notes where one feels that have to cover one's a__ for fear of litigation.  There is no litigation here.  Very nice!!!  By days' end today, I was feeling more in the swing, had made a few referrals, ordered an ultrasound, some labs and taken care of 23 patients, including a pt from the acute track during a free spot in my schedule.  Even had a kind elderly pt bring me some flowers as a welcome gift!!   Day off tomorrow to catch up on life at home, looking forward to it.  

4.      

where are the stirrups?

So after much anticipation, I survived my first day at CentralMed clinic here relatively well!  It is a busy place, 2km from downtown Tauranga, near the hospital.  Open about 10 years to help take pressure off of the hospital.  There are about 12-14 MDs, all General Practitioners, many who have some sort of specialty-sports med, women's health, travel med, etc.  Reminds me a great deal of Group Health at Riverfront as there is also a lab, radiology, pharmacy and PT on site.  Physically a smaller space and all rooms are being used all the time!  Staff are incredibly welcoming and kind, also like GH!  Here's where the analogy breaks down:  Each MD has their own office which also double as their exam room.  WHen a pt arrives, it pops on my schedule as such and then I go out to waiting area and call that pt back to the room.  No vitals are taken unless I take them, or ask the Nurse to do so, even after the visit.  RNs on the other hand are able to do so much more here-like PAPs!!!  They also take care of much of the chronic disease management as we are used to, but seems they are more involved.  In my room there is one exam bed, dressed neatly with a pillow and real sheet, and when asked where the stirrups are, turns out there are none!!! I have yet to do a proper pelvic exam (they charge much more for the MD to do it, so many will wait for the RN), but I'm sure I'll figure it out.  The biggest difference is the medications, same drugs but different names and they not only have generics, but then many meds are govt funded with little or no cost to pt so ideally those are the ones to prescribe.
I get 15" for each pt and the EMR is solid, still figuring it all out.  Seems record keeping is more terse, notes are not nearly as long as what we keep back  home, truly just the basics.
And everyday at 10 and 3 there is 15" carved out for tea break, and they take this very seriously!  If one can't get upstairs to share a cup, the nurse may ask if she can bring something down for you.  How much do I love this!!  And they supply the tea, coffee, milk, and sugar if desired.  Seems to bring everyone together more, there is conversation, laughing together, sets a nice tone all around.  Great way to build camaraderie, team spirit!  Something to consider for GH maybe???
At the moment they have me scheduled for 4 days work/week, 2 more days than I was hired for, but a good way to jump right in.  Days start at 8 sharp and we are there until about 6.
Boy are then left to get themselves to school and back by bike rain or shine.  School yesterday for them seemed no problem, even a bit easier than they expected.  Two more weeks until school holiday and then we can revisit their situation.

Sunday we took a jaunt to the beach two blocks from here and before I knew it all of them were in the water, Noah on the new boogie board, Jack in his underwear and Maggie fully clothed, playing in the waves!  TIme to get some wetsuits for this gang and a few more boards.

Hope to send a few more pics but internet is slow today.  Full moon is coming, isn't it the Harvest moon? looking forward to a beach walk under that!