My friends and I just spent the past two weeks travelling across New Zealand in a campervan, dubbed JAC. The hours and kilometers took us past countless mountains, forrests, fields and pastures, alongside the oceans and many lakes, through rainstorms, sunbeams and dark sky reserves. I journaled my observations and understandings of the people and culture of New Zealand as we journeyed, and our adventure developed. If I could use one word to summarize it all, it would be Magic. It was so easy to see and understand why this land was used for the setting of a fantasy world, Middle Earth.
"Still round the corner there may wait
A new road or a secret gate;
And though I oft have passed them by,
A day will come at last when I
Shall take the hidden paths that run
West of the Moon,
East of the Sun."
J.R.R. Tolkien
Christchurch, NZ. Cathedral Square. The Chalice remains erect next to the Cathedral destroyed by the earthquakes of 2011.
Christchurch, NZ. Destruction of the cathedral by earthquakes in 2011
Christchurch, NZ. Bridge of Remembrance
Christchurch, NZ. Avon River
Christchurch, NZ. Botanic Gardens
Christchurch, NZ. Botanic Gardens. Talk about a great climbing tree!
Christchurch, NZ. Botanic Gardens. Fall colors on fleek.
#vanlife under way!
When the sunbeams call, you pull over and chase them! Jenna & I
Jenna & I, chasing sunbeams.
Lake Tekapo.
Lake Tekapo
#thatwanakatree
#thatwanakatree
Wanaka, NZ.
#thatwanakatree
Wanaka, NZ.
You can't camp without having s'mores!
AJ Hackett Nevis Bungy. Queenstown, NZ.
All smiles and ready to go! Jenna, Amanda, me
Nevis Bungy 134m.
Lake Wakatipu
Lake Wakatipu
NZ countryside
NZ countryside
Lake Te Anau
Routeburn Track
Routeburn Track. Amanda & Jenna
Routeburn Track
Routeburn Track: "Look it's a yellow diamond!" A.V.
Earland Falls. Routeburn Track
Lake Mackenzie. Routeburn Track. Jenna, Me, Amanada
on Routeburn Track. Me, Jenna Amanda
Sunrise on the mountain. Routeburn Track.
Sunrise on the mountain. Routeburn Track.
Sunrise on the mountain. Routeburn Track.
Routeburn Track
Earland Falls. Routeburn Track
Lake Howden. Routeburn Track
Routeburn Track
Routeburn Track
Routeburn Track
Lake Marian
Lake Marian. Me, Jenna, Amanda
Hollyford River
sunset on the mountains
Milford Sound - Fiordland, NZ
Milford Sound - Fiordland, NZ
Milford Sound - Fiordland, NZ
Milford Sound - Fiordland, NZ
Milford Sound - Fiordland, NZ
Milford Sound - Fiordland, NZ
Opening of Milford Fiord out to the Tasman Sea
Milford Sound - Fiordland, NZ
Stirling Falls, Milford Sound - Fiordland, NZ
Stirling Falls, Milford Sound - Fiordland, NZ
The Chasm - Fiordland, NZ
International Dark Sky Reserve; one of only 10 in the world. obviously my simple camera could not do justice. But what our eyes beheld looking up that night... it deserved a spot holder here out of pure speechless awe.
Greeted by the sunrise when freedom camping.
Kaikoura, NZ.
Kaikoura, NZ.
Kaikoura, NZ.
Kaikoura, NZ.
Kaikoura, NZ.
Seal colonys at Kaikoura, NZ.
That sun though. It calls you to come play. Kaikoura, NZ.
Kaikoura, NZ.
Picton, NZ. Crossing to the North Island.
Picton, NZ. Crossing to the North Island.
Crossing to the North Island.
Crossing to the North Island. Over the spread of the two weeks, we put away almost that entire Nescafe!
Tongariro Alpine Crossing. Looks a little cloudy...
Tongariro Alpine Crossing. But ahead of us...
Tongariro Alpine Crossing.
Tongariro Alpine Crossing.
Tongariro Alpine Crossing.
Tongariro Alpine Crossing. The Emerald Lakes.
Tongariro Alpine Crossing. #wemadeitoutalive
JAC transitioned into a campervan/place to hang all our wet clothes! me, Jenna, Amanada
relaxing in the natural thermal hot pools of Rotorua, NZ.
finding a cafe to check in on social media! Rotorua, NZ. Jenna & Amanda
Cornwall Park, One Tree Hill - Auckland, NZ
One Tree Hill - Auckland, NZ
View towards Auckland city centre, One Tree Hill
One Tree Hill - Auckland, NZ. Amanda, me, Jenna
University Clock Tower - Auckland, NZ
Albert Park - Auckland, NZ.
Aotea Square & Auckland Town Hall - Auckland, NZ.
New Zealand makes good use of boxcars!
I basically had to climb a fence to get this pic! :) Auckland, NZ
Best Ugly Bagels - Auckland, NZ
Mountain biking through McLean's Forrest on McLean's Island outside of Christchurch, NZ. Amanda & I
Mountain biking through McLean's Forrest on McLean's Island outside of Christchurch, NZ. Me, Jenna, Amanada
Mountain biking through McLean's Forrest on McLean's Island outside of Christchurch, NZ.
Christchurch, NZ.
Christchurch, NZ.
Like I said... Magic.
Much Love.
“I think I’m quite ready for another adventure.” J.R.R. Tolkien
"It's a dangerous business, Frodo, going out your door. You step onto the road, and if you don't keep your feet, there's no knowing where you might be swept off to." J.R.R. Tolkien
"The road goes ever on and on
Down from the door where it began.
Now far ahead the road has gone,
And I must follow if I can,
Pursuing it with eager feet,
Until it joins some larger way
Where many paths and errands meet.
And whither then? I cannot say."
J.R.R. Tolkien
I made a trip into the city yesterday, on mission to attend the Northeast Surgical Society meeting. Mission successful, I stayed as long and as short as appropriate before escaping again. While everyone else was busy socializing and enjoying cocktail hour, I rolled up my poster and slipped out. The doorman the only one to bid farewell and be so acknowledged in return as I left the Cornell Club. I get such a kick out of my life sometimes. I never pictured myself here, nor would have guided myself here on my own. Yet those where definitely my heels tacking down the sidewalk towards Grand Central Terminal.
As I walked to my car from the train, eager as I was to return home, I paused a moment longer to appreciate the fog rolling up the Hudson River.
My co-residents, Monica and Clara and I, all found a rare day when we were all able to enjoy daylight hours away from the hospital. We purchased a group-on and went climbing. It was fantastic fun and I can't wait to go again... just to find the time.
I was doing a case with one of my attendings the other day. She asked for her next stitch. A specific stitch, 4-0 Vicryl, which unfortunately the scrub tech did not have open and on the field. But she did have a 3-0 Vicryl, which was offered to my Attending. The entire room was then strongly reprimanded for not having the correct stitch open and ready. The scrub tech and circulator offered up their defense and counter argument. But in the end, heels were dug in, and everything stopped until the correct stitch was collected, opened and handed over.
I watched the all too familiar scene in silence. Why did it have to be like this? The 3-0 Vicryl would have sufficed for our present need just fine, why couldn’t we have just accepted the 3-0 Vicryl and moved on? There are a few reasons I have pondered, not in any particular order...
1) A surgeon’s OCD personality. Like a check-list, the steps of a procedure are completed routine, sure and safe. Deviation or flexibility allows for unsure steps, mistakes, complications and then death.
2) Responsibility. A patient has put their life in the surgeon’s hands. Taking that trust to heart, the surgeon owes the patient their absolute best in every cut and in every stitch. There is no minor surgery. There is no minor stitch.
Taking it a step further, a wrong stitch placed in a surgeon’s hand in a time of emergency is enough to waste 4-5 seconds of that patient’s life. Take a transplant surgeon, handed the wrong stitch during the venous anastomosis, watches his patient hemorrhage for those 5 seconds while the mistake is corrected. By the second or third time it happens, it has now been 10-15 seconds of their patient hemorrhaging, well past their 20th, 30th, on their 40th unit of pRBCs. They throw the instrument, and in so doing emptying their hand 3seconds sooner and receiving the correct stitch that much sooner in the race to save their patient’s life.
Perhaps is can be argued that by allowing argument in a case of nonemergency like our example, would then make it acceptable in a case of emergency when time and life are in the balance.
3) Hanging onto a time past. The era of the Physician. Their word was golden and followed without argument. That was an era past. We can trace how medicine has evolved from that time, through an era of the Patient into what today could be called an era of the Payor. Greatest evolution noticeable outside of the operating room, but it has now greatly altered the environment within as well. Did you notice how the tech and circulator not only defended themselves by argued back? I personally do not know a time when the nurses did not argue back, but my attendings do. Was this simply the right to be heard and followed?
I did not ask my Attending why we couldn't use the 3-0 Vicryl. I know if it had been me in that situation I would have. But then I think of the possible reasons (as mentioned above) for holding out for the correct stitch, the one that I actually asked for and I feel chastised. Is it just my inexperience and lack of understanding that makes me want to use the 3-0 Vicryl instead of the one I asked for. And then I come to myself again and remember, God may send me to a jungle some day, a desert, a mountain village...wherever I am needed. Where a plethora of sutures and needles (as we are blessed with here) will not be available.
If it’s routine, flexibility will be my routine. If it’s responsibility, I owe it to my patient to use what is at my disposal to make it work. If it’s about time, times change. And I pray God grants me the grace to Love through it all and despite it all.
