Tramping! Mt Ruapehu and Tongariro National Park NZ

This weekend my wife Bonny and I decided to go tramping (hiking in New Zealand). We booked a room at Chateau Tongariro in Tongariro National Park. We arrived on Saturday to a misty,cloudy, windy day and wondered what all the fuss was about. We had a wonderful dinner that night and went to bed early. The next day we awoke to a brilliant blue sky with the sun coming up over a conical volcano Mt Ngauruhoe.

We now knew what all the fuss was about. We had a wonderful breakfast and ventured

out to the amazing view of the sunlit snow covered peak of Mt Ruapehu.

We packed our lunch and warm clothes and set off for Taranaki Falls. We hiked along a stream in the sunlit forrest and thought what a beautiful country New Zealand can be on a sunny day. Forrest bathing is my favorite sport so I was in heaven and so was Bonny!

Beautiful Bonny

We arrived at Taranaki Falls after about a hour of tramping and what a magnificent site of water cascading over a cliff into a crystal clear pool below. Paradise found!

Then it was off through a barren moon scape for a two hour trek to Tama Lakes a high altitude  turquoise lake.

 At Tama lake we had lunch and a nice chat with a New Zealand  journalist who had been assigned to cover the United States from Washington DC. Then it was another 3 hour tramp down the mountain to the Chateau Tongariro.

We were tired trampers after a 17 K trek but happy and satisfied that we had achieved our goal.
So we set off back home with this epic view of the late afternoon snow covered Mt Ruapehu. I love New Zealand. Kia Ora!

Dawn service to commemorate ANZAC day in New Zealand

Today John and Reena invited us to join them for a dawn service in Feilding at the Cenotaph.

The Cenotaph in Feilding at dawn

On the 25th of April every year New Zealand honors the members of the Australian and New Zealand Army Corps (ANZAC) who fought at Gallipoli. The ANZAC landing occurred at dawn on April 25th 1915 and over 2,000 New Zealanders died at Gallipoli. The service now honors all veterans who died in service to their country. A very moving moment occurred when two young children came forward to lay a wreath in honor of their father who had died in Afghanistan. All branches of the military marched in with a band from Feilding followed by the war veterans including those from the Maori battalion. A high school student from Feilding gave a excellent speech wearing the medals of her grandfather who fought in World War II. A lone bugler played the Last Post and the New Zealand Army performed a 21 gun salute. Everyone sang the national anthem and then the band played as everyone marched off down the street. A very moving ceremony of unity and remembrance. Kia Ora!

The band from Feilding

The New Zealand Army

21 gun salute

   

Excitement on Rounds!

My first day on rounds we arrived in the MAPU (medical assessment and planning unit) to find an excited nurse telling us that our new consult had a heart rate of 220/min. The patient was stable and in no acute distress so we gave him a 12mg IV bolus of adenosine. The patient blocked down to a 4 to 1 conduction with clear atrial flutter waves on the monitor. Due to the short half life of IV adenosine he quickly shot back up to a ventricular rate of 220/min.  We talk about giving him IV midazolam and shocking him with 50 joules at the bedside (my suggestion). Instead we called anesthesia who wanted him taken to the OR and intubated so they could protect his airway as he had just eaten breakfast. So we started a IV infusion of amiodarone and it was off to the OR with our patient for urgent cardioversion. In the OR we changed into scrubs and arrived to see the anesthesia staff administering IV propofol and preparing to intubate the patient. We quickly hooked him up to the biphasic cardioversion device placed the paddles on his chest, synced to the ECG trace and set it to deliver 50 joules. I looked over and saw his blood pressure had dropped to 70 systolic and stated we better shock him back to sinus now. I turned to see our Cardiology Registrar who was going to perform the cardioversion  had on a mask that he had been handed by the house-staff (Kiwi sense of humor). C shouted clear hit the button and the patient returned to sinus rhythm rate of 70/min, blood pressure returned to baseline and we were off to finish rounds. So thats the end of excitement on rounds. Kia Ora from New Zealand.

The Masked Registrar

Powhiri,Maori welcome with a press of the nose.

As part of my orientation at Palmerston North we took part in a Maori ceremony called a powhiri (pronounced po fier re). The powhiri is the ritual ceremony of encounter and signifies two groups coming together in the sacred act of hongi, singing songs, pressing noses, exchanging the ha or breath of life and joining as one.

We were called into the room by our hosts after friendly intent is established and a formal welcoming of guests (manuhiri) by the hosts (tangata whenua or home people) begins. This is performed by the lead Maori male. He acknowledges our ancestors who support and surround us with pride. He then acknowledges the sacred mountains and rivers that make up this part of New Zealand. We sing a song and then come together in the center of the room and move down the line pressing noses, exchanging the breath of life and joining as one with our hosts. Wonderful welcome to New Zealand!!! Kia Ora.

THE MAORI WHO WASN'T THERE

Today in clinic I saw a Maori gentleman (not the man in the photo) as my first patient in Cardiology Clinic. He was in his 50's not married not employed but had a daughter. He had been newly diagnosed with Atrial Fibrillation and been referred by his GP for evaluation. I gave him a my standard history and physical and then explained to him why he needed to be on a blood thinner called Coumadin (Warfarin in NZ). He seem to understand, so I further explained he would need blood tests and a echocardiogram to see if he would be a candidate for cardioversion. He nodded his head during my explanation of his treatment plan so I thought we were communicating well. I gave him a prescription for Warfarin and spoke to his GP about a referral to hematology so his blood levels could be monitored. I then asked him to wait in the exam room while I got him a educational pamphlet on Warfarin. When I returned to the exam room he was gone. I suddenly realized that he and I had not communicated, and that I need a lot of work on my Maori communication skills. To me he will always be the Maori who wasn't there.

Kiwi Rodeo

Bonny and I went to a New Zealand rodeo today in Felidling. Finished my first week of work and still looking for a house.

First Day and CPAC

 Today was my first day as a senior consultant in Cardiology at Palmerston North Hospital (Mid Central DHB). The day started at 8am with Christine taking me to "hand over" rounds where the house staff present cases that come in over the weekend. Patients are assigned to different specialty services or stay  on the medicine service with a specialist consult. The Cardiology service took 2 patients onto its service for a total of 10. I was impressed with some of the house staff  presentations and not so impressed with others. Following "hand over" I was taken to Infection control met Lisa the administrator for Cardiology  and got my ID badge and beeper. I reviewed a exercise stress test on a patient who had a ventricular triplet  with  exercise. Navin the  Registrar was concerned about the ventricular triplet so I gave him a article from the NEJM on ventricular ectopy and exercise. Finally I was instructed on how we refer cardiology patients to Wellington using CPAC.                                                                                             

*http://www.oag.govt.nz/2011/scheduled-services/part5.htm

Clinical Priority Access Criteria (CPAC) refers to an outpatient categorisation system that allows the prioritising of clinical conditions. CPAC assists Cardiologists to assess relative patient need and in doing so, ensure that patients who require treatment more urgently are seen first and treated first. For example if a patient scores high he is moved up the list and receives CABG surgery as a priority and will have surgery scheduled in less than 48 hours.  While a lower priority patient may have to wait 90 days for bypass surgery. I had a great first day and am looking forward to a wonderful experience in the New Zealand health care system. So stay tuned to kiwicardiology. Cheers from New Zealand!