Charlottesville, August 12, 2017

Today on my way down to Charlottesville for the counter-protest I find myself listening to Joel Orsteen radio.  He’s a southern televangelist, a radio-evangelist I guess.  I figure it’s good preparation for a counter-protest sponsored by the clergy.  And also I forgot to download any podcasts.  

I’m listening defensively; I’m waiting for the sexism and homophobia and racism that I am sure is coming, but it doesn’t.  Joel’s simple message, repackaged twenty different ways over three hours of driving, is that God is in control.  We can all basically relax.  

I do not exactly feel relaxed.  As I drive, I field phone calls from various family members imploring me to turn around.  They are home watching CNN and things are not looking good.  My sister and I confer over the phone and decide to press on - she has heard from the ACLU’s twitter account that the Nazi protest has been disbanded, and the clergy-sponsored counter-protest is regrouping.  There’s like, singing and drums and stuff.  It seems the danger is over.  I finally arrive at the edge of UVA’s campus. Casey calls me again.  

"Where are you?"

"Almost there," I tell her.

"Ok, stay in your car," her voice sounds tight and I can hear her breathing in short little pants like she is running. "We just saw a car drive into a whole group of people. Oh watch out, car! CAR! Shit, I'll call you back."

My heart drops into my stomach and then keeps on going.  My hands shake against the steering wheel.  I turn off Joel, even though he was about to tell me how God could get me out of debt.

Despite my declared pacifism, my thoughts turn immediately to violence.  'I will drive down there, leap out of my car, beat Nazis senseless with my bare fists, whisk my sister to safety, and get the fuck out of town,' I think to myself.  

Then I remember that I'm not Rambo or something, but a pudgy thirty-three year old mother of two.  I amend my violent fantasy: 'I will go home, join a gym, and get really buff so next time I can beat Nazis senseless with my bare fists.' Even in my fantasies I know there’s going to be a next time.  

I drive through Charlottesville knowing this terrible thing has happened, but I guess no one else knows.  Joggers, sorority girls, and dog-walkers are all going about a totally normal Saturday.  Surely they know about last night's tikki torch march, though? I literally haven't seen a single police officer. A pair of private security guards loiter under the bridge at 14th street, and on the other side some guys in polo shirts walk by, undisturbed.  I realize with a sickening chill that I don't know what a white supremacist looks like.  And then I further realize that they look a lot like me.  

I arrive on the scene about seven minutes after the crash.  After the attack.  The scene is chaos, people walking and limping everywhere, a snarl of ambulances and police cars and fire trucks in the middle of a crowd of people.  I park my car and jump out with my little first aid kit and jog towards the fray.

It is awful.  It’s like a diorama about human frailty; about how bodies just . . . break.  My fantasies of violence are not compatible with this.  I can't stand here and think I am powerful, my body is just as fragile as these people lying all over the damn road.  It will still be fragile even if I do crossfit.  It will still be fragile even if I have a gun, or an army, or a nuclear bomb.  I am this soft, delicate, thing. All of us are.

And all I can think is, ‘God is in control.’ We are not in control and we cannot be.  And that does not make everything ok, because things here are very, very not ok. But maybe it is just enough to give us the courage to keep going.  To not curl into a ball right here on the asphalt.  To get up tomorrow and go to another rally.  

Mercifully, I can retreat into doctor-mode.  I haven't even reached the first cop car when I get to the first victim. He is lying on the ground being tended by street medics.  I offer up my help, which at this point mostly involves keeping him talking.  There's a zigzag cut over his left eye that might turn into a pretty cool Harry Potter scar.  His right leg bends out at an unnatural angle.  The street medics have put gauze and an instant ice pack on it and both are steadily turning red.  I stabilize his C-spine and say encouraging things as the ambulances drive by, one after another, passing him for the more seriously injured.  Some folks in Black Lives Matter shirts and a couple clergy members in robes hold a banner over him, shading him from the sun; I hand them water bottles from my backpack.

Finally his number is up.  Since I'm a fancy doctor, they let me count to three as we log-roll him onto a backboard and then again when we transfer him onto the stretcher.  I stand as the EMT's ferry him away onto the ambulance, and Casey suddenly materializes next to me.  Relief washes over me like an actual wave. We hug and her frame feels small in my arms.  It occurs to me that her skeleton probably looks like a child’s skeleton.  

Casey and I on a different, but safer, adventure.

We linger for a little while, taking in the surreal scene.  Antifas in combat boots and ministers in robes, police in riot gear, EMT’s in red and black uniforms, right wing militiamen in fatigues, lots of white dudes in polo shirts who could be anybody really.  There’s the crowds that show up at any protest about anything - the anti-choice bus with pictures aborted fetuses and the topless white women with dreadlocks who are against globalization.  It looks like a natural disaster has struck a really weird American history themed LARP event.  

I spend a lot of time that day trying to get myself together enough to drive home.  My residual terror has manifested particularly in my GI tract and I spend a lot of time in the bathroom while I try to take deep breaths.  Near nightfall I drive back into town, to the Harris Teeter where I used to buy wine for study breaks, and buy a bouquet of flowers.  I shoulder past a swarm of reporters and news cameras to place the flowers at the police barricade.  A single line of police behind their clear plastic riot shields look on.  I say a prayer and return to my car.  

I drive home in silence.  I’m still sitting with “God is in control.” I'm going home to snuggle my kids and get up again tomorrow, and I can’t stomach anymore Joel Orsteen tonight.  

Advice for Those Traveling Around the World With Small Children

1.  Don't.

No, but Seriously.  If you can avoid 30+ hours of travel with a toddler, then by all means, avoid it.  Have you considered staying home? Maybe you are like me and get stir crazy at home.  Maybe you need to visit family.  You know what is great? Skype and Netflix.

Bear demonstrates the preferred way to travel.

Stay in your house.  Ideally in your pajamas.  Wait there until your child can book their own plane tickets with their own money.

If you can't stay home, perhaps your child can stay home.  Do you have parents? Siblings? Neighbors? Strangers from the internet who seem even sort of legit? Perfect.  Leave your child with these people.

But if you really can't avoid it...

2. Bring some extra adults.  I went into this outnumbered, and look, I do not recommend it.  Consider this: when your preschooler has to go potty on the airplane, you will need to supervise.  You can't leave the toddler in the seat alone because she will climb over the seat in front of her onto the head of the nice businessman who is just trying to do some work on his laptop and is already not that happy with you after the apple juice incident.

"Mom, why is it not allowed to throw shapes in the toilet?"

So anyway, there will be three people inside an airplane bathroom.  And not in a fun way, but in a "you aren't holding the toilet paper right!" way.  And then the toddler will be afraid of the very loud flushing and start to sob hysterically.  And then someone will knock on the door and ask "aren't you done yet?" and you will have to use all your adulting power to not kill that person.

At this point I am, I think, contractually obligated to state that Benjamin offered to come home with me, or to take one of the kids with him, but I insisted that I wanted to do it on my own. I don't like to do things the easy way.

Battle wounds.

 3.  Take your time.  I think.

This is where Benjamin and I differed in our planning for the trip.  He's a "rip the band-aid off" type of guy and just wanted the minimum overall travel time.  I wanted to divide the travel into manageable chunks as much as was possible.  I mean, there is really no dividing the Pacific ocean, that thing is just really big.  But we drove to Auckland, stopped and spent the night.  Flew to LA, stopped and spent the night.  Flew to Atlanta, stopped for dinner, and then finally flew home to Baltimore.

Stopping in Auckland was crucial, because it turned out Pax was sick all over herself and her car seat and a few other things.  So having a chance to rest and bathe and do lots of laundry turned out to be really clutch.  Then Bear threw up all over the bed that night - I assume he felt left out. Stopping in LA I think was also a good reset.  Getting to the hotel was a bit more of a pain than I was expecting, but the kids did sleep that night.  Plus hotels often come with continental breakfast, and there is nothing kids love more than making their own waffles.  There is nothing I love more than large pots of coffee.

California!

America, home of proper-sized pizzas.

Stopping in Atlanta was a bit of a disaster - largely because we discovered that US McDonald's is not as evolved as New Zealand McDonald's and does not have a pancake happy meal.  What the hell, people? Bear decided to protest this sub-par customer service experience by lying down in the middle of concourse A and screaming "BUT I WANT PANCAKES!" at the top of his lungs.

In conclusion - stop if you can stop long enough for a sleep and a meal.  Otherwise carry on as quickly as possible.

4.  Seats.  Buy your toddler a seat.  Airlines generally let you take anyone up to age two as a "lap baby." But just because you can doesn't mean you should.  We went without car seats, which I think was the right choice (actually the only feasible choice) for moving through airports, but man would it have been nice to be able to restrain Pax.  Having recently learned to walk, Pax was eager to practice her new skill up and down the aisle of the airplane for the entirety of our thirteen hour flight.

5. Packing.  Pack light.  Once you get two kids settled into airplane seats, you aren't actually going to be able to get into anything in the overhead bin.  Plus that rolling carry-on is just going to slow you down when you have to sprint after your preschooler who has realized the McDonald's thing is entirely your fault and the only solution is to sprint down the moving sidewalk to the international terminal.

Pax, dumping a juice box on the guy in front of us.

So what can you leave out? Toys.  Do not bring any old toys except the special stuffed animals.  Otherwise stick to electronic entertainment via tablet/phone and buy a couple of small toys in the airport.  Novel toys contain more hours of entertainment than ones they have already played with a hundred times at home.  Also bring like two books, maximum.  Those things are heavy.

Thank you, Octonauts.

Things you definitely need: baby wipes, a plastic bag for trash, sippy cups that don't leak, non-messy snacks, chargers for all your devices, and drugs.  For travel with children, I totally endorse better living through chemistry.  I recommend promethazine for the children - it is a sedating antihistamine that also works against nausea.  With my two puke-fountains, that is crucial.  I actually don't recommend adults taking anything too strong, you need your wits about you for all the kid-chasing, filling out customs forms, and making connections.  Except...

6. Wine.  Planes serve wine.  On the international flight it was free.  On the flight from Atlanta to Baltimore, I didn't care how much it cost.  But before I could whip out my credit card, the woman across the aisle said, "I will pay for her wine."  God bless you, ma'am.

7.  When you arrive at your destination - have childcare set up.  Drink plenty of water.  Take a long hot shower.  Sleep for a few days.  Cry a little bit.  Then give yourself a goddamn medal because you made it.

Champion.

In Which We Meet an Assassin

Scene:  A residential street in a small New Zealand town in summer.  Camera pans over peach trees, branches heavy with fruit hanging over a corrugated metal fence by a sidewalk.  From left side of the screen enter Mali, pushing a jogging stroller carrying Pax in the front and Bear in the back.  Mali is wearing a t-shirt with a picture of The Cat In The Hat and the words "Trust Me, I'm a Doctor."  This is important later.  Bear is wearing gray sweatpants and a long-sleeved red shirt with a fire engine on it.  His hair has not been brushed.  Pax is wearing a shirt with a unicorn and miraculously, is still wearing the pink shoes that were forced onto her feet at the beginning of this run, two kilometers ago.

Siri: Your current pace is. Eight minutes, twenty-three seconds per kilometer.  You're behind; speed up.

Mali slows from a very slow jog to a walk.

Bear: Mom, she said speed up! Why are you walking?

Mali: This is my cool-down walk.  We're almost to the playground.

Pax, removing her shoe and casting it to the ground: Gaah!

Scene: A playground in the same town, about 30 years old and showing it.  The ground is covered in wood chips.  A man is slowly raking them off the concrete path that runs through the sidewalk.  He is about 60 years old and has long black hair pulled into a ponytail. As he moves down the sidewalk, we see that he walks with a limp.

Mali, Bear, and Pax enter the frame from the left.  Bear climbs out of the stroller and runs for the swings.  Mali bends down to release Pax from the harness.

Mali, to the man with the rake: Good morning.

Man: Hello.  'Trust me I'm a doctor,' that's good! I had a stroke a few years ago and it's so hot I'm feelin' like I might have another one.  I hope you're a real doctor.

Bear, yelling from the top of a climbing structure: She is!

Man: All right, buddy, thanks.

Bear: What are you doing?

Man: Cleaning up the playground.

Bear: Why?

Man: Because I did some bad stuff in the past, so now I got to do some good stuff to kinda make up for it.  Community service.

Bear: What bad stuff?

Man: Well I used to be in a gang.  My gang name was Possum, and I could make people disappear.

Bear: How do you make people disappear?

Possum: By killin' em.

Bear, totally unimpressed: But did their bodies disappear? Didn't you have to bury them in a cemetery?

Mali, trying to redirect this conversation: Hey Bear, can you climb up onto that big swing over there?

Bear runs off.

Possum, to Mali: He's a smart kid you've got there.  But its easy to get rid of bodies around here - we've got heaps of rivers.

Mali laughs nervously and starts edging back towards the stroller.

Possum: Of course, if you don't want to risk going down for a homicide, there's a better way to get to somebody.  If you just hit em in the knee with a hammer a few times, I mean a few good solid whacks - well then you don't go down for murder bur you can always out run them if they come for you later.  That's why I got out of the gang though, hated always looking over my shoulder.  But now I got nothing.  I got no woman at home, I had one but she left.  Now I find I don't get on too well with women.  I don't even talk to them anymore.  Last time I talked to a woman out at a pub; asked her if I could buy her a drink and she said she was there with her girlfriend.  Now I was raised in a time when that just didn't happen.

Mali, yelling in Bear's direction: Bear, time for us to go!

Bear: But MOM, WE JUST GOT HERE

Possum, continuing as if there was no interruption: If you acted a little gay your parents just beat you till you acted right.  I once put on my sister's shirt.  My dad gave me this (points to a scar over his left eye) with his belt buckle.

Mali: I'm sorry.  We have to get going.

Possum: So anyway, if you need someone to disappear, I have literally nothing to lose.

Mali, grabbing Bear by one arm and wrestling him back into the stroller: Nice to meet you.

Bear: Yeah, nice to meet you, Mr Possum.

Calling it

I am called to declare a man dead between dinner and bedtime.  I leave my son watching cartoons and drive the six blocks to the man's house, where family members have parked on the street, the alley, the lawn, the neighbor's lawn.  Dogs and kids run the block while the adults tend to the business of mourning.  I take off my shoes on the porch and hug five aunties before I reach his body, thin and jaundiced, eyes closed.

My job here is to confirm that he is, in fact, dead.  I have brought my only props, a stethoscope and a pad of carbon paper death certificates.  I lay my stethoscope on his still chest.  I sign the paper, rip the white copy off the top and hand it to his wife.  My hands no longer shake when I fill these out.

When I get home my son is still watching TV, perched on top of a beanbag chair that he has balanced on top of the sofa.  He is vibrating with excitement because, "Mom, this mission needs the WHOLE Paw Patrol!"

That night the baby won't sleep, so I try to bring her to my bed, tuck her under my arm like I used to when I nursed her to sleep every night.  But she sleeps only minutes at a time and wakes crying and thrashing and pushing me away.  I take her to her crib and she eventually settles, but now I am awake.

Last night I told Benjamin that I don't want to be married anymore.  I didn't mean to tell him yet, hadn't planned out what I would say, I didn't have a plan for what happens next.  I hadn't even decided, really, hadn't stopped my constant mental tallying of pros and cons, contingency plans and carefully worded ultimatums.  But it was there like a drum beat I could feel in my sternum, "This is over.  This is over.  This is over."

I sit in bed, hugging my knees, waiting for the grief, waiting for the anger, waiting for the loneliness.  Still wondering if I'm doing the right thing.  But at least now it is real, at least now I have said it out loud.  This is over.

RESUSE

My morning schedule has been a shambles.  Right off the bat my simple follow-up patient became a forty-five minute ordeal of an admission, and I've been behind since.  Finally I am sitting down with Ange to go through the medication refills that have come in today.  I recognize the name of one of our palliative care patients attached to a request for pain killers.  "Oh, he can have whatever he wants," I say, starting to register a repetitive squeaking sound coming from the waiting room.   I assume it's Austin, a forty year old man with cerebral palsy who lives in a group home and makes little vocalizations when he is overstimulated.

But it is not Austin.  It is Ember, a one year old with wide brown eyes and terrible recurrent skin infections.  I usher them into my office - his mum and nan and five barefoot siblings, mostly in swim suits. ("Togs," in local parlance.)  Then I look at him, grunting, the whites of his eyes showing all the way around the irises, his fingers mottled and bluish; and I herd the whole clan down the hall to the treatment room, where there is more space and more equipment and a wide door that leads out to the reserved parking space for ambulances.

I am in the midst of a collaborative project with the nurses to organize our emergency equipment.  We have made checklists of materials and ordered new laryngoscopes and looked at wheeled carts.  But so far the only part of the project that has been actualized is that our existing emergency equipment has been tossed into one large cardboard box that someone has labeled "RESUSE" in black sharpie.

I sit Ember and his mum on the exam table and listen to his lungs.  No wheezing.  They actually sound pretty clear.  But he is breathing 70 times a minute and his heart just sounds like a little whir.  His skin is warm to the touch.  The nurses Ange and Micki have followed us into the treatment room, and Tania the practice manager has shepherded the other kids back out.

Ange and Micki and I begin a scavenger-hunt style "resuse" of our patient - I suggest a piece of equipment that I fancy using, and they paw through the box to locate it.  We assemble a set of vital signs - not a single one is within the normal range.  We put him on oxygen and deliver some antibiotics via injection.  I gather all the smallest IVs and attempt to place a line.  But he is a baby, and very dry, and the dark line on his hand that I thought was a vein came off when I rubbed it with alcohol - not a vein after all, just dirt.

And while this goes on, I am keeping a running tally of the items that I have requested that have not turned up in our box and I am wondering how long until we need these things.

Have I mentioned that the ambulance is 40 minutes away?  The ambulance is 40 minutes away.

I internally debate the merits of throwing Ember and his oxygen bottle in the back of the RAV4 and driving him to the next town myself.  In the US, this would be fraught with liability concerns.  But in New Zealand? In Opotiki especially, we're a practical people.

Then he starts vomiting.  Clear but viscous it comes forth from his mouth and nose, filling the oxygen mask before Ange pulls it away from his face.  And there is a terrible pause in the rhythmic squeaking that has been like a metronome to the whole exercise up until now.  Pause, sputter, squeak.

Even fully equipped and organized, we wouldn't have suction.  Which seems like it would be helpful, I think as I watch another bout of gelatinous sputum pour out of my patient's face.

Last time Ember was in the office, he had multiple open skin sores as well as an acutely exploded poopy diaper. ("Nappy.")  Now I'm not what you call a germophobe, my kids both enjoy the post-dinner course we call "floor food."  But the poop in the skin sores situation was too much for me to handle.  I recall now that my answer was to carry him down the hall and bathe him in the staff shower.

This mum is going to think I am completely insane.  But that can't be helped and isn't that far off.

I wrap Ember in a towel and trot across the parking lot, holding him to my chest so I can feel the little whir of his heart.  We arrive at the Opotiki community hospital and I put him down in their treatment room, next to the suction set up.  I eye the clear plastic tubing and then my patient, daring him to attempt to aspirate his own vomit again.  I'm ready for him now.

Of course by this time, the antibiotics are perhaps kicking in.  His breathing is marginally slower and his color looks excellent.

The ambulance arrives and the paramedics give the IV placement a go themselves.  Nothing.  We debate the merits of an intraosseous line ("bone drill," for the non-medical folks), but I feel certain this thrashing toddler will not respond well to this.  In the end, they just package him up and load him into the ambulance, leaving me to pick my way back across the parking lot to my waiting room full of patients.

Normally I am not too affected by experiences like this.  Since my college days and perhaps before, I have suffered from complete adrenaline failure, even in situations where it would be decidedly useful.  I once came across a bear and her cub while hiking in the woods and thought to myself, "surely a surge of adrenaline and cortisol will soon be released by may adrenal glands and allow me to outrun this claw-covered human-eater."  I waited and waited, but nothing.  Intellectually, I knew it was sub-optimal for me to be standing between a large bear and her cub, but physiologically, nothing happened.  No fast heart beat or feeling of flushing.  I eventually just turned and hiked on, figuring the bear would follow me and eat me or she wouldn't but there wasn't much I could do about it.

Ditto for medical situations, except for one thing.  The only bit of the physiologic stress response that I get is the sweating.  No hyperactive focus or super-human strength, just sweat dripping off my body and face to the point that it stings my eyes.  The paramedics, who I tend to encounter in these situations, must think I have a serous BO problem.

Today was the same.  I was certainly worried about the kid, but it didn't occur to me to be panicking until I heard that anxious edge to Ange's voice and thought, "oh, yes, this is a bit touch and go, isn't it?"  I was, of course, already drenched in sweat.

Emotionally, it was different.  In the best of circumstances I struggle to keep that balance between cold detachment and crippling over-involvement, but my over-involvement tends to be more material than emotional.  Ember was different.  Maybe it's because he is a week younger than Pax, or maybe I feel responsible - if only the crash cart had been ready, if only I had treated his skin sores effectively in the first place, etc.  Whatever the reason, I took this one home with me.

(Not literally, Benjamin won't let me literally take home any patients; he's quite strict about that.)

My Homeland is Still a White Supremacist Police State

I'll start by saying you don't have to read this.  I likely have nothing new to say.

My heart is heavy with all these emotions. The righteous indignation about the electoral college and about white women somehow going for Trump.  The grief and despair for my home.  The gnawing fear for my family and friends.  The flat acceptance.  The embarrassment of being from such a place, of believing that things would be different.

I feel like this is not a place I can go home to anymore.  At the same time, I want to go back and fight - I want to found a safe house for LGBT youth, I want to send my kid to the Muslim Montessori preschool in Baltimore and work at Healthcare for the Homeless.  But I want to tell everyone to leave.  I want to change my visa status to permanent resident and find people jobs here in New Zealand.  I want to get excited about wearing safety pins and I see the hollowness of the symbolism. I want to cling to my belief that these small gestures of human goodwill matter - in some ways, that they are the only thing that matters.  And I also feel the crushing isolation of knowing that my small gesture means nothing in the face of overwhelming fear and hatred manifest in this election.

It's the same feeling I get every time I read another news story about American police killing a black person.  Powerlessness, grief, the aching gulf of injustice and impotence.  But I'm able to tell myself a story about police violence - namely that this is the Old System that is moving on, that is changing, that things are going in the right direction.

And then my fellow Americans voted for police violence.  They voted for white supremacy.  They voted for violence against women.  They voted for more guns.  They voted for mass deportations and economic collapse and the end of our hope to do a damn thing about climate change.

I can't tell myself a story about progress today.

So today I went to the beach. (And yes, you exhausting liberal corner of the internet where I live, I acknowledge the absurd privilege I have in being able to do so.) I took my "gender creative" four-year-old and went to the beach.  And I tried not to think about what country would be safest or best for him to grow up in.  I just watched him play in the sand and I listened to the waves and the gulls.  And for a moment I felt ok.

It All Goes Pear-Shaped (Part 2)

The day after our midnight medical adventure was fueled entirely by caffeine (me) and opiates (Benjamin).  I had the sensation that I was dragging myself through the day by my fingernails.  I somehow got the children out of bed and dressed.  Bear requested a chocolate bar for breakfast, reasoning that he had pancakes in the middle of the night, so this was actually "breakfast dessert."  I could not argue with that logic.

While Bear ate his chocolate bar, I checked on Benjamin.  Having partaken of the aformentioned opiates, his level of consciousness did not engender a great deal of confidence in his ability to care for a seven month old.  Wednesday was not a planned day for Pax to go to "school,"  but I stuck her in the car anyway, hoping they would have space and staffing to take her.  My backup plan involved quickly babyproofing the staff room at the office and/or assigning the medical student to a surprise "developmental pediatrics" rotation.  Luckily, they were able to take her at daycare.

Chewing on a hammerhead shark and talking to her friend

After depositing my offspring with surrogate caregivers, I made my way to the bakery next store to the office and acquired the first of many caffeinated beverages for the day.  When the barista handed me the hot paper cup, I thanked her a bit too emphatically.  Her eyes looked concerned for me.  "You're welcome?" she said.  I was already scalding my tongue and scuttling out the door.

We muddled through the week.  I fell asleep while putting the kids to bed. Benjamin's pain level was up and down.  There was no sign he was passing the stone but it did seem to get better from time to time.

By Saturday we were feeling well enough to attempt another walk on the trail.  My phone rang in a particularly windy area, but I answered it because it was my co-GP.  (I haven't actually gotten permission to use her name on here so we'll call her Laura).  Laura was inviting me to a peer group later that day.  I could only kind of hear her and wasn't that sure what a peer group was but sure, I was game.  Great, she could pick me up.  Did I want to bring the kids? Not knowing what peer group entailed and seeing as it was during nap time, I declined on behalf of the kids.

Guys, it turns out peer group is the best thing ever.  It's a bunch of women doctors getting together to let their kids play and talk about medicine.  And there were muffins.  I think it's lucky I was still moderately exhausted because otherwise my enthusiasm may have overwhelmed them.  I basically want to be at peer group always.

***

On Sunday morning, I was just getting things packed up for our weekly trek into Whakatane when my phone rang - it was Laura again, but this time she sounded like ... like Benjamin sounded the week before, frankly.  She sounded quite sick.  Could I possibly do the weekend surgery hours for her? Of course.

On weekends, our surgery opens for one hour - all patients who get through the door during that hour get seen, no matter how long that takes.  Sometimes there are three patients and sometimes there are thirteen.  The staffing is just one doctor and one receptionist, so it's kind of like climbing without ropes in terms of nursing support.

On this Sunday, there were fifteen patients.  Of them, I sent four to the hospital in Whakatane.  One of the others needed sutures.  It was busy but it was fun.  I hit a rhythm, found my groove, etc.  Part of it is that I've grown accustomed enough to the Kiwi accent that I don't need to strain so much to understand people.  It was one of those days that makes me remember that I really like my job.  I like talking to people and hearing their stories.  I like the puzzle of making a diagnosis.  I like the craftsman satisfaction of bringing two edges of a wound together.

I came home tired but happy.  The week would be slightly disorganised given that we hadn't gotten to do our big meal-planning and grocery shopping trip or the massive laundry turnover that I had planned - but we would manage.

When I got to work on Monday, Laura was not there.  She was not just home recovering from food poisoning; she was in the hospital with appendicitis.  And so our two doctor practice (which was actually already short a doctor - we should have three) was down to one.  And the one doctor was me.  Gulp.

The next week was Rough.  On regular days, squeezing patient encounters into their allotted 15 minutes is difficult.  Now I had my patients to see, as well as some of Laura's patients who had urgent concerns that could not be rescheduled.  On top of that, I was signing off on the notes and scripts for four nurses and supervising a medical student.

Our EMR has a little counter so you can see how long your patients have been waiting.  As I finished with a patient and sent him on his way clutching a script for an increased dose of Metformin and a handout on carb-counting, I thought, "my next patient has only been waiting 45 minutes! That's not so bad in the grand scheme of things!" And then I opened my door and found two nurses, a medical student, and a receptionist all waiting to talk with me.  Rinse. Repeat.

When all the patients were finally gone for the day, the mountain of forms, notes, and lab results remained.  I trudged home with the surgery's laptop.  After putting the kids to bed, I stayed up writing notes and sifting through lab results.  Even after closing down the computer and crawling into bed, I kept jolting awake with thoughts like, "must remember to call that patient about his sub-therapeutic valproate level," and "did I send in the paediatric referral or did I just think about doing it?"  I was on call every night, fielding questions from the nurse about kids falling off horses and grandmas with pneumonia.

Every morning, there is a staff meeting.  The practice manager would report on her attempts to find another doctor.  She did find some locums to help with a day here, an afternoon there, but no one remotely long term.  There kept being whispers about doctors that people knew that might be free, but inevitably it would fall through.

***

There have been many meetings recently about the future of health care delivery in this rural community. As a newcomer and a temporary resident, I have not participated in these discussions.  But now I am right here, living the microcosm of these organisational decisions.  And all that is clear to me is that model of the solo GP must die.  We must have a system robust enough that it does not collapse when one person gets appendicitis.  We must make this work appealing enough that doctors want to work here.  It shouldn't be this hard, given the setting includes the glittering sea and rolling hills of verdant farmland.

Laura told me on the way to peer group that she used to be the only woman.  Now there is only one man, the rest are women, all with kids under six.  The older (male) generation of doctors always seems to be complaining that we younger (female) doctors don't want to work hard, that we selfishly want to spend time with our children and away from medical practice.  And you know what? I'm guilty as charged.  When I signed up for this job, it involved working four days a week and every third weekend.  Because I want to spend time with my family.  And I want to spend time exploring this amazing country.  But until now I have always subconsciously agreed with the assumption that this was to the detriment of patients, that I must be taking something away from the patients to spend more time doing anything else.

And because I learn best by doing, I now know that is not the case.  Right now, I am exhausted.  I cannot give my patients my best self because I am distracted and half asleep.  This is not a problem that can be solved by just doubling down and working harder, the system must change.

Unlike the US health care 'system,' I have faith that things here will change (and for the better).  Sitting around the table of another GP, another mom, at peer group, I saw that we young doctors actually have a community, it's right here.  It's just the organisation of things that make us feel alone - these women work right down the street from me.  And they all want the same things I do - to take good care of their patients and also their families, to have enough time away from medicine that they can bring their best selves to medicine.