So much can happen in a year...

Okay, the title of the post is a little misleading. It implies that I intent to weave the story of a year gone by, a complex tapestry of change, growth, and regression...

But, that is not the topic of THIS post. Oddly enough, what motivated me to write again after a year has to do with an article I read this morning in the New York Times about an iconic midwife and her teachings.  Because this may be a bit of a rant on my part, I will keep it short, but the need to express is overwhelming.   The article discussed her management specifically on breech deliveries, and I have no disagreement with how she describes delivering a breech vaginally. What I took offense to was the statement that very few practitioners in this country know how to deliver a breech vaginally, and the implication that the medical establishment to which I belong, for better or for worse, just didn't even try. I have done several vaginal breech deliveries in my career, all successful (praise God), and I feel the same sense of satisfaction that this woman does when I can safely deliver a baby with the least amount of birth trauma to the mother.  I know the maneuvers, rescue techniques, and medications that may help should the need arise.  And yet I feel constantly vilified by the midwifery community because I do not seek out the opportunity to use them regularly. At this point, I want to also state that I have had the honor and pleasure of working with midwives both in the United States and New Zealand, and a combined licensed, standardized medical and midwifery system is my ideal practice scenario.  But because of the MD behind my name, it is sometimes assumed that I don't want "what's best for my patients" (there are at least two remember), that I am interested in my schedule, my comfort, my well-being, that I don't want to do things naturally. And that assumption offends me.  Not once do I hear the midwifery community giving credit to the majority of medical practitioners who do their jobs everyday with the same consideration and care they would give their mothers or sisters, or BFFs.  Not once do I hear from them a call for tort reform in the United States or recognition that part of the reason that we practice defensively is because of the high rate of malpractice cases levied against obstetricians. When something goes wrong, it is not the midwife who is sued.  It is not the midwife who pays tens of thousands of dollars a year or more to have coverage against legal action. It is not the midwife who has to pay a malpractice tail, a dollar amount (in my case over $75,000 with no judgements against me) that covers lawsuits that may arise after you leave, just to move to a new place and start a new job.  The price of freedom for an indentured servant...Even more expensive than the financial cost is the emotional cost. I know that when an outcome is bad, a midwife feels that pain just as much as I do, as if that was my child injured or lost, as if it was my sister whose life is forever affected. The midwife can't sleep, can't take joy in their own lives until that pain heals.  But, how often do they pay the emotional price of a lawsuit?  Being accused of negligence and malpractice, with the implication of wanton disregard for other's well being?  A process that is drawn out over several years, with each reminder like a punch in the gut until it is dismissed, settled, or goes to trial?  A process that affects confidence, your daily practice, whether you want it to or not.  Because midwives are not often sued (and don't say it's because they don't have bad outcomes, because they do just the same as medical practitioners), they have a freedom of practice that medical practitioners may never have.

So I said I would keep this short, and although I have not, let me at least make the point I am really driving at.  NOBODY likes it when the other side thinks their way is the only way. Please afford me the respect that I afford you. Please consider that your assumptions about my practice and my philosophies may not be what you think, as I do the same for you. Please be open to WORKING TOGETHER, as we each have something to bring to the table, and driving a wedge between our systems through propaganda and popularity contests is NOT IN THE BEST INTEREST OF THE PATIENTS!  And if we can't do this in this country, well, I am moving back to New Zealand...

Namaste...

So, this is one of those times that life is not as cookie cutter as you would like. In an ironic twist, the universe gives you everything you need, everything you want, but in a slightly different way than you expected, in a way that makes it harder for you to be sure about what to do with this gift. Let me explain: for the past several years now, I have been looking forward to meeting someone who gets me, who sees my heart and respects it, protects it, my best friend, my partner, father of my children...now, all of a sudden, in a matter of months, I have met this person, this love, and no mistake I have never felt this loved, but I am having the hardest time not losing myself in this new life. I feel very fortunate to have gotten this far, to have suspended judgement and let myself get to know him. His heart is beautiful, he is talented, humble, kind, polite, tolerant and patient, and he makes me smile in so many ways. He would be a wonderful father, and he is already committed to our relationship. But we started out in different circles, and admittedly I probably adapt to his more than he adapts to mine. On top of that, I find my small New Zealand circle tightening, as my friendships had not been cemented before I started spending so much time with him. A best friend from home has stopped speaking to me over a decision that favored him early in our relationship. I have passed up social opportunities to be with him, hanging out with his friends instead. As a result, when I am not with him, I feel lonely and anxious, two things that can kill any relationship. He in no way discourages my being with my friends, I have just been choosing to spend time with him. I want to shout "Cut me some slack, guys, I am a girl newly in love! Don't you remember how that was for you?!" But I think they just see me as self-absorbed and uninteresting. Now this is where I need some advice, and I ask that it be seriously thought out before it is given. Many would rush to say that this is unhealthy, that it will never work long term, and I myself wonder if I concede too much. But don't many friendships change when two people pair off to mate, to start families? It is not him, her, and the neighborhood, it's just him and her (or him and him, her and her). Should I let this bother me? Should my "friends" be so judgmental themselves? This person has become such a part of my life in a short period of time--all I know is that I would never want to hurt him by exposing him to such judgement... Today this was really bothering me, and he knew something was wrong, but he didn't push me to speak--he left the conversation open and gave me a long hug, kissed me, and told me I was his best friend, that I could tell him anything anytime. And this is where the universe has just given me the gift I have been asking for, someone who knows me, someone who truly loves me...Maybe I am just looking for permission to tell the rest of the world to bugger off, maybe I am scared I have got it all wrong, but I haven't felt this way many times in my life, like I would take a bullet for him, and it is hard to say that it is a mistake. If I give this up for the gift in the more nicely wrapped package, well, we all know how that has gone in the past...besides not good karma to resist the universe...turn down a gift and it may not be given again...

Anyway, enough of my ramblings. Comments? Suggestions? Peace...

As I awoke in the arms of my sweetheart...

GeoTagged, [S39.06716, W177.79890]

Admittedly I am so sleepy this morning. Yesterday we made the hour drive down to Mahia, a peninsula south of Gisborne, for the celebration of a young woman's birthday. Charlotte is the sister of my sweetie's friend, a beautiful girl with a big smile and what seems a bigger heart. Yesterday was her 21st birthday and I had the privilege of partaking in the observance. Two dozen family and friends surrounded her and shared stories and love. She is part Maori, and that tradition was prominent in the day, an educational treat for me as a visitor. There was kye (food), drink, speeches, song, a lovely celebration that continued past the striking sunset, on and on until the orange moon rose above the horizon. The night was chilly and more layers of clothing added to keep the porch hospitable. Finally, tired from a long day, we moved to mattresses put out by the hostess and huddled together to stay warm. All in all a very special night. This morning we were awake by dawn, and drove down to the beach to scout seashells while we watched the sunrise. This place, this country, this ocean...truly amazing, truly beautiful...

This must be what heaven looks like...

Hard to believe I have only been here a month and a half...I have settled into somewhat of a routine, but contrary to my past life, it does not involve planning. Each day is a come what may, very stress free. I have had a chance to do some traveling outside of Gisborne, but not much as that would involve planning, which is contrary to my current philosophy. ;) I have made it down south to Napier, a lovely little tourist town in one of the many wine regions. Three weeks ago my godson's baby mamma made the hop over the ocean for a little girl time and we took my little Nissan hatchback down the coast. It is indescribably scenic and the first part of the drive to a peninsula called Mahia was lovely. In Mahia, we rented a cottage on a farmer's land for the night, completely isolated on a hillside looking out over the sea. Amazingly peaceful, but no provisions, and we brought little with us. Mostly we missed having libations to enjoy as we watched the water lap up against the rocks, so instead we went hiking and scrambling like monkeys down a cliff side to the ocean, scattering sheep in our path. Even interrupted a couple of the beast, uh, going at it! Hmmm, me big ram, see my horns...just kidding...Anyway, we had an amazing crayfish for lunch and the farmer brought us dinner that night, a lovely lamb dish and (finally!) a bottle of wine. Mmmm, slept so well!

The next day we continued our trip south. It was raining heavily, and the roads went from rolling to tight winding, one narrow lane each way, with large logging trucks barreling past. Remember, I am still new at this left sided driving thing, and my poor friend was terrified. By the time we got to Napier, we were both thinking about flying home! But we found a place to stay, wandered around the quaint town, and did some wine tasting, which calmed our nerves. Dinner that night was at a mediterranean fusion place, and after we took a moonlight stroll on the beach. Quel romantique! Yeah, my friend wouldn't let me hold her hand...;) The next morning, we were steeled for our drive home, dreading the distance and drama of that road. This time, however, the sun was shining and all was well. A brief stop in Wairoa for lunch at a great cafe (can't remember the name but it is right on the road), then home in time for dinner and a movie...

So the lesson today folks: New Zealand has beautiful scenery, much excellent wine and food, and terrible roads. May the sun shine for all of you this Mother's Day! Cheers...:)

Beautiful day here in Gizzy! The thick fog that we woke up to has slowly burned off and the sun is amazing. After a couple of weeks of shoddy weather, it looks like another reprieve before winter sets in. That is part of the reason for the absence of blogs--the other reason is that I have been having too much fun out and about! I actually have a, gasp!, social life! ;)

Don't get me wrong, I do work, but it is nothing like my past life. And when I am not working, there is enough to do to keep me out of trouble, surfing, wine tasting, eating all of the New Zealand goodies! Part of it too is that I have been so busy doing that I haven't sat down to do the thinking and writing..I think that is a good thing. Anyway, this entry is really for my benefit, to get me back into posting. I will upload more pictures and try to be more consistent, a promise to myself as much as anyone who follows this..now I am off for a surf while the sun is shining. Cheers, all! :)

Good week here in Gisborne. After a few days of relative isolation (lousy weather, getting dark early, most people have families), I am finally starting to settle in. Thursday was a wonderful turning point--the sun came out, I made progress on getting my luggage (still not here), AND I had my first surf lesson! It was so fun! One of the other docs set up a group lesson for six of us ladies--such fun girls to meet and play with. With wet suits the water was warm and the surf board made for an excellent body board. ;) Yeah, I did not get up on the board that lesson. I think the California surf instructor we had was more disappointed about it than I was! But there is always today's lesson...;)

By the way, this is a statue of Captain James Cook, the first European to come to New Zealand. The statue stands in front of Poverty Bay. Apparently when Capt Cook arrived on its shores, the native population appeared and its warriors performed a traditional dance. Having seen some of the dances, I can tell you that they are energetic, aggressive, and can certainly look fierce with bug eyes, tongues stuck out, and tattoos everywhere including around the mouth. Capt Cook either grew tired of it or mistook it as a threat and shot several of the natives. Not surprisingly, they refused to share provisions with the visitors after that, and Capt Cook thus named the location Poverty Bay. Ha, there is a lesson for you...
Met my neighbors this week, Carlee and Tim, two pilots newly relocated from Christchurch starting work in Gisborne. They have a very interesting story. They actually worked in Africa for 3 years flying there, training for triathlons, until a severe bike meets car accident sent them home. They graced my home last night and tolerated my cooking, which I very much appreciated. I also got a kick out of telling them about the town, me giving advice to newcomers. Becky would be proud--I've come so far in one week!

As for work, Friday was the first day I took on hospital duties. A couple of ceasars (c-sections), a patient on the floor, a retained placenta from a vaginal delivery (pronounced va GI nal). In the first week of orientation at the hospital, however, I have already seen more pathology than the last months in practice. Two postpartum pulmonary emboli, a recurrent ovarian cancer, dozens of brittle diabetics. Gisborne is a central medical center for its region, somewhat isolated due to geography and servicing a low socio-economic center. The facilities are nice, but not quite complete. Different specialized services, such as radiation therapy or oncological surgery, are referred to tertiary centers. Referrals are based on the district, and sadly that can mean one case gets taken care of in three different districts: for example, a Greenfield filter to be placed in one, chemo in another, radiation therapy in a third, and travel to any of these is difficult...not easy to coordinate, not socialized medicine at its best...As for the rest of our speciality, we are considered consultants. GPs in the community address everything and refer to O&Gs (Ob/gyns) only for a problem. With obstetrics, private and hospital midwives manage patients in the community and on the maternity ward, and we only see high risk obstetric patients and only do operative deliveries. So we take a day of call a week, then three speciality half day clinics, and an administrative day. There are meeting and non-clinical duties there as well, but a world of difference from my past life...

Well, daylight savings kicked in for us last night, so the clock turned back and it is only 8 am (five hours behind California, although a day ahead). So I have a whole fabulous sunny day ahead of me! I wish you all the same! Cheers!

Getting to know Gizzy...

Kia Ora! Hello from the island of New Zealand. I am happily settled in here in Gisborne (or Gizzy if you are familiar), and finished with my first day of orientation at Gisborne Hospital. It is also my first day on my own. And driving. Now that's scary...

But let's back up a few days first. I arrived in Gisborne from Auckland on Thursday. Now get this: I go to check in at the Auckland airport for my domestic flight on Air New Zealand, and I approach the automated kiosk. Here I get my boarding pass, AND it prints out the label for my luggage. Huh, interesting. I put my own label on, take my bag to the luggage conveyor, put it on the belt and proceed to security. No one checks my ID, no one screens my bag...At "security", someone looks to see that I am getting on the right flight, and that is IT. No undressing, no liquid check, no metal detector! Whoa...weird. Now that is laid back...

Friday for me, Thursday for most of you, was all about laid back. Slept in, unpacked my backpack (no luggage yet, still true today, boo...), and hung out with Becky, my predecessor. The apartment that I am staying in is on the wharf with a view of the bay. The big double sliding doors face south onto a balcony that wraps around, making breath-taking views of sunrise and sunset possible. In the small harbor, cargo ships come in one at a time and unload goods. This may sound very industrial, but it is actually very cool to watch, and it is impressive how quickly they get in and out. The little tug boats are my favorite and they dredge the waters day and night to smooth disruption from incoming river flow. A five minute walk puts you on Wainui beach, where we headed Friday afternoon to watch the O'Neil Cold Water Classic Surfing Championship. The sun was shining, and the waves were sick, and that is about all of the surfing lingo I know. I do hope to take a few surfing lessons this week, see how it suits me...

The city itself is small, with a one street downtown, shops apparently close before 6pm. There is some diversity of restaurants, but most people eat at home due to cost. There is a video store, a library, an indie theater, and a community theater, but not much more. There is a running club, a tennis club, horseback riding, hiking, surfing, swimming, essentially all things outdoors to make up for the slight paucity of indoor activities. Going to invest in some board games for the upcoming long winter nights...;)

Saturday and Sunday were lovely--some sun, some rain, a couple jogs on the beach. Saturday morning we hit the Farmer's Market, the hotspot for that time of the week, to shop for a little party at the apartment, a farewell/welcome party, since she was leaving. This gave me the chance to meet a dozen great people and their very cool kids, and to start sampling New Zealand wine. A blend I had not heard of before: Shiraz-Viongier. Can't wait to try it...

So now it is Monday...Becky caught a flight back to the states today, leaving me to my own devices. She did leave me well prepared, however. Still, the first time I hit the "driving on the left side" streets, well, let's just say that it was the riskiest and most stressful thing I did all day! God help those around me...I honestly want a sign that instead of saying "student driver", says "American driver"--that ought to scare people! I think tomorrow I will ride the bike to work...

Well, early to bed tonight...still trying to get my sleep pattern straightened out. Cheers to all...