Cake Fails and Raising a Sociopath

Scooter. Gumboots.  Rainbow Dash dress. 

My first baby is four years old.  FOUR. He says things like, "Actually I need to use a different piece because this one won't allow the crane to swivel properly."

Excuse me? Weren't you, like, a zygote fifteen minutes ago? Who said you could grow up? Now you're talking about things swiveling "properly."  (He also says "eh?" all the time.  Moving to New Zealand has turned him Canadian.)

Officially the first time he was more interested in the presents themselves than the wrapping/boxes.

As requested by the birthday boy, we celebrated with "a cake with a train on it."

A bit of back story: My mother-in-law is a professional baker and has made two birthday cakes for him with trains on them - the last one had frosting grass and a little hill that the train was on (a toy Whiff from Thomas the Tank Engine).  It was a work of art.  So basically he was asking for a reprise of this.  Unfortunately, we decided to move half a planet away from our entire network of family and friends and that includes the amazing grandma/cake-artist.

So we made the cake ourselves - and a work of art it was not.  It was not so much an homage to the original grandma cake, but to pintrest fails the world over.

Bear LOVED it.  You see, it was chocolate cake and there was a train on it.  So, actually, #NailedIt.

And I loved it, too.  Because even though we didn't have the grandmas to help us, Benjamin and I made his fourth birthday special for Bear.

We has the skills of an artist.
Seriously, isn't there some sort of FoodNetwork reality show we should be in right now?

***

Bear was curious to know what privileges came with turning four.  As everyone knows, when you turn five you're allowed to chew gum.  But what do four year olds get?

He's been four for a few weeks now, and it seems that what he gets is his sanity back.

Three was rough.  There were a lot of transitions - we moved four times (not even including the two months we were nomadic), he started school, and became a big brother.

He reacted by becoming hellspawn.

I mean, I love you, grown-up Bear who may be reading this in the future.  I love you and I have always loved you.  And three was rough.

Three was the year Bear became a runner.  In a crowded public place, ideally near obstacles such as busy streets or open water, he would look me in the eyes, flash a devlish grin, and run.  This was especially great when I was massively pregnant or newly postpartum.  I will never forget holding my belly and waddling with all the speed I could muster as he darted towards the four lane secondary road that borders my parents' neighborhood. (We survived this incident thanks to the help of a quick-thinking landscaping contractor.)

Three was also when he picked up the charming habit of threatening to kill people.  Everyone from his parents to his sister to the extremely sweet student teacher at Nature Preschool.  Occasionally he would pair this threat with spitting on me, narrowing his eyes and growling darkly, "I'm going to KILL you!" before spraying a wad of mucus into my face like some sort of demonic, poorly socialized llama. And lest you think I somehow deserved it, these threats were brought on by such offenses as not offering the appropriate type of cracker for snack.

In general three year old Bear was simply committed to doing whatever it was that people did not want him to do.  We enrolled him in MyGym and rather than learning to 'socialize with his peer group' and 'follow directions,' he treated it like training for the Hunger Games, pushing other kids into the foam pit and then holing up under the trampoline and refusing to come out.  He once kicked the back of the driver's seat for the entire drive from Baltimore to Charlottesville.  Another time he earned twenty-two time outs in the space of three hours.  He's taken marker to the wall in two separate rental properties - and it was not because his art cannot be contained by lease agreements, it's because he knows it gets a rise out of me.

Don't let this cute smile fool you.

Then, the other day, I watched him snatch a toy away from his sister and said, "No, Bear, you have to offer her another toy if you want the one she has."

"Oh, ok, Mom," he said.  And he picked up a toy giraffe and put it in Pax's hand before taking the tinker toy she had been slobbering over.  I blinked several times to clear my head.  "Ok, Mom"? I wasn't even sure these two words were syntactically allowed next to each other in English, they sounded so strange next to each other.

And just like that, my kid is back.  He's still ... "spirited," but no longer demonic.  And when I'm not deflecting death threats and trying to lasso him to keep him from charging defiantly off of cliffs, I can actually see and enjoy him as he builds a lego "snow blower that blows sand," or makes a nest for all his "cuddlers," or pretends to be a "doctor taking care of allllll the patients in the hostable."

I can't wait to see what four has in store for us.

Weekend Call in the Middle of Nowhere

"The coughing is the same. And I haven't felt the baby move since Friday."  My patient is three weeks shy of her due date - I can see her popped-out belly button through the cloth of her dress.

I know what the right answer would be back in the States, at the tertiary care center where I did my training: ultrasound, external fetal monitoring, and then induction or c-section.  But I don't know what the right answer is here, where the midwife is managing the pregnancy and I am managing the pneumonia, where I don't have a doppler and no one has an ultrasound.  I can't even get an x-ray, because it is not a Tuesday or a Friday.

I kill time, taking her blood pressure really slowly so I have more time to think. On paper she seems ok, but she looks so tired.  I purse my lips.

"Go," I tell her, "go to the hospital."  I don't mean the six bed hospital in town, I mean the "big" hospital, forty-five minutes away.  "Just to be safe, you should go."

***

In late-stage emphysema, you often see what is called "an increased A-P diameter," meaning a barrel-chest.  All the elasticity that holds the lungs together has basically given up, allowing the ribs to spread wide.  My patient looks like an actual barrel with squat little legs and balled fists swinging at his sides.  His lungs sound like nothing, as in I literally cannot hear breath sounds.  I trust he is living because he has not stopped talking since I called his name in the waiting room and led him down the dim hallway to the exam table.  Did I mention the power is out? The power is out.

"The pain was so bad I thought about calling an ambulance," he says, "but what would they even do for me? I don't want to just take pain medication."  He grimaces as if pain medication were some known snake oil peddled by ambulance personnel. These Kiwis are tough.

***

I use my flashlight ("torch") to inspect the itchy rash on my patient's arms, on her son's abdomen, on her mother's thigh.  I explain to three generations that you cannot use antifungals to treat scabies.  But that was the thing that worked last time.  Ok, you can use antifungals to treat scabies as long as you also use permethrin.  Deal. I rummage in the surgery's cupboard for both - the pharmacy is closed.

***

I'm reading Thomas The Tank Engine and the Whatever Whatever when the beeper goes off.  I have been living in fear of this sound all weekend.  I call dispatch and read the address to Benjamin, who is ready on google maps.  It's literally around the corner.  I slip on my shoes and run to the car.  I pull open the door and realize I'm on the wrong side of the car.  Damn this driving on the left.

The ambulance is already there. Our patient is conscious, which is better than what I was expecting. His family is big, there are people everywhere.  Even with all their help it still takes what feels like a year to get him into the ambulance at the end of the muddy driveway.

I can't find anything; trauma shears, IV supplies, blood pressure cuff. It's like a mixture of Grey's Anatomy and one of those dreams where you are trying to run but can't move your legs.

I put a hard plastic block in his mouth to stabilize the airway - it comes right back out.  I stick electrodes on his chest for an ECG and they won't adhere to his sweaty skin.  I place an IV and it blows, the bruise blooming under his skin before my eyes.  The more I try to help, the more seconds tick by that he is not on his way to a hospital, someplace with a CT scanner and a surgeon and someone who can place a god damn IV.

"Get out of here," I tell the EMTs  - two women with practical hair cuts and green ambulance uniforms.  They nod rapidly in agreement.  I trip on my way out of the ambulance.

In the morning I hear that he died.

I think of his muddy driveway and the way my needle went straight through the vein and out the other side.

***

Sunday Drives - Gisborne and Tauranga

Countryside on the road to Gisborne

Ok gang, here is another photo-heavy post of our recent explorations.  Also, for everyone who said they wanted to visit - please do! We have plenty of space and would be glad to put you up. Our guest rooms are booked around Christmas, but otherwise the door is open!

The weekend before last we drove to Gisborne to explore and do a bit of shopping.  The drive is through a prehistoric looking gorge and extremely curvy.  Let's just say the rental car has been christened.

The weather for our day in Gisborne was not great, so we ended up skipping the botanical gardens that I wanted to see.  We mostly walked around the downtown and did a little shopping.  We stopped into a noodle place for lunch. Because of the aforementioned christening, we were in need of baby wipes, so we stopped into Pak'N Save, which we were happy to discover is essentially Costco.  So we did a Costco-level of shopping with only a stroller to carry away our loot.  Woops.

Benjamin modeling our new double stroller.

This past weekend, I attempted to make friends.  The city council had posted about a volunteer dune grass planting so I had planned to participate.  Saturday morning the kids and I walked to the farm supply store to buy a spade and some gloves.  Then we got in the car and tried to go to the work site.  But I never found the damn work site.  We drove through some very pretty countryside and found some more lovely beach, but failed to locate the meeting spot for the volunteers.

I was pretty upset about this - to a level I now recognize maaaaay have been unreasonable.  But I was so excited to make friends.  Volunteering, nature-loving people are my people.  I had already fantasized about striking up a conversation with someone and inviting them for coffee afterwards.  (Kiwis are pretty friendly, this might not have been totally weird.)  Anyway, no friends were made, no physical labor accomplished, and I was left to wonder why it is that my navigational skills are so utterly abysmal.

On the plus side, I did see a flock of pukekos, which may be my favorite New Zealand bird so far.

Pax seriously considering crawling.

We were trying to play peek a boo, but she was weirdly content to sit around with this towel over her head.

In the distance you can see Whkaari, our active volcano.

Beach selfie.  I love the reflection of both my arm and my shadow in my sunglasses.

Pukekos!

On Sunday I got up and went for a run.  Ok, a jog.  Ok, mostly a walk.  Anyway, it was good for my mental and physical health.  I took Bear in the stroller.  He may be skinny but he is dense.  On the way back we stopped at one of my favorite cafes.

Sunrise over the Otara river at the Motu trail bridge.

I just love the color of this house.

Hot Bread Shop - one of my favorites.

We got on the road to Tauranga, the fifth largest city in New Zealand (pop 130,800).  We found ourselves my favorite thing: a waterfront park and walk!  The playground was excellent.
We had lunch at a lovely Thai restaurant where Bear and Pax actually both consumed food!

After lunch we went to a holiday park where they had thermal pools.  I only took one picture because I don't like to mix phones and water - but it was really lovely.  There were a bunch of other kids there, and another playground.

We passed through Whakatane on our way back and stopped at that well-known kiwi dining establishment...McDonalds.  The food is actually much better than American McDonalds but the PlayPlace is just as filthy.

Gorgeous rainbow on the drive there - the same day many of my Northern hemisphere friends posted pictures of rainbows, too.  

Dramatic clouds. Bear 2016.

Pax enjoys her toy peacock, George. 

Random body positivity in a mall bathroom in Tauranga - love it!

Bear demanded that we visit this Christmas tree in the lobby of a bank - they were having some sort of Christmas in July promotion. 

It is winter here, but winter is citrus and kiwifruit season and mandarins are abundant.

Tauranga waterfront

"The wind is too windy."

Bear sharing curry puffs with his sister.

Pax refuses to let her lack of teeth get in the way of her love of chicken.

Mmmm, chicken.
While she was eating, she kept shooting me dirty looks like, "why have you kept chicken from me this whole time?"

Thermal mineral pools. The air was cool but the water was nice and warm.  

I have nothing to add.

Apparently this marketing scheme was famous on the internet.  Not in a good way. 

Locum - A Day In The Life

06:00 - Cell phone alarm goes off.  Most annoying sound ever.  Rouse enough to locate baby in our "shared bed" aka mattress on the floor.  She has not rolled off the mattress and crawled off to touch the space heater.  I win at parenting.  I deserve to go back to sleep. Snooze.  The baby snuggles into my armpit.

06:09 - Cell phone alarm goes off.  Most annoying sound ever.  Snooze.

6:35 - Cell phone alarm goes off.  Really must get out of bed now.  It is cold outside of this blanket.  I was pretty sure I was going to a tropical island, why is it so cold? Roll over to get out of bed.  Come face-to-face with the big kid, who has apparently been watching me sleep.  Creepy.
     "Is it morning time? Can we get up now?"
     "Yes."

07:45 - Drop off the big kid at school.  Helpful notice by the sign in sheet informs me that tomorrow is "Pyjama Day." Realize big kid does not own pyjamas.  Or even pajamas.  As a rule, he sleeps in nothing but a iron man pull-up.  Hmmm.

08:05 - Swing by the "hospital" to round on all the inpatients.  All one of them.  Nurse reports the patient is his nephew and the hospitalization has given them some much needed time to catch up.  I also get a full report on the well-being and living situations of every other member of the family vis a vis their ability to care for my patient after discharge.  Not that anyone is rushing him out.  There is literally no such thing as admission criteria.  In fact, I am encouraged to admit people so that the district keeps the hospital open in the future.

08:20 - Morning staff meeting.  My cup of instant coffee is waiting for me.

10:30 - The electronic medical record has a feature where it shows you how long a patient has been waiting.  I am proud to be keeping mine under 40 minutes today.

11:00 - Every pakeha (white person) I see has skin cancer.  Farmers have at least two kinds of skin cancer each.  I have done more punch biopsies in the past two weeks than I did in three years of residency.  All of them have come back positive.  Seriously, northern hemisphere friends - thank your ozone layer.

12:30 - Lunch time! There are seven restaurants within two blocks of work.  I only frequent three of them so my general choices are meat pie, sandwich, or sushi.  Today is a sushi day.  I eat in the staff room while perusing the Opotiki News.  There are two articles detailing the separate perspectives in a dispute between some guests and the managers at the near by campground.  The classified ads have pigs for $250.  After eating I retreat to my office to pump.
     Let me say those words again: My. Office.  *cue choir of angels singing*  My office has a computer, an electrical outlet, a desk surface, a door, and a sink.  It is truly the nicest place I have ever pumped.

14:30 - It is frustrating that I have to stop and look up every single medication to find out what is subsidized/available here.  Some strange things are missing.  This afternoon is a sea of impetigo and I just wish I could just throw Bacitracin at everyone - but alas, it is not subsidized.

15:40 - Afternoon tea!

16:35 - Finished with patients! Now to write all my notes.

17:30 - Done with notes, I head back to the hospital to check on my patient.  We chat a bit, I scribble a note.  I walk home in the dark, thinking about all I left undone for tomorrow.  Glancing up to check the street before I cross, I am startled by the flat disc of the full moon hanging in the sky over the tyre centre.  The porch light is on for me at home.  Benjamin has made dinner.  And bought Bear some pyjamas for tomorrow.

18:35 - "If you eat five big bites of dinner you can have three cookies."  Bear stares at me like I am trying to trick him.
     "I don't really want cookies,' he declares with a flippant shrug of his bony, naked shoulders.  He goes back to playing with wooden trains on the floor.  Thirty minutes later, he does take a single bite of dinner.  It consists of two grains of rice, one of which may have touched some curry sauce.  He chews them for seven minutes before swallowing.
   "See?" I say, "was that so bad?"
    "Disgusting,' says Bear.

19:30 - I am changing into my 'pyjamas' when I hear a knock at the door.  Benjamin answers and I hear him say "oh yeah, she's right here," as I emerge from the bedroom carrying the baby and wearing a nursing tank and sweatpants.
     There is a woman standing in our front hall, where we keep our clothes drying racks and have a spare mattress leaning against the wall at the moment.  She introduces herself but I already recognize her from her picture in the Opotiki News - she's the other American doctor in town.  She works across the street and is from Delaware.  She was walking to the grocery store and decided to stop by and say hi.  I am equal parts happy to meet her and mortified that I am wearing basically underwear.  Bear literally IS wearing underwear.  Oh well.

20:30 - Bedtime ritual is cut slightly short by my work phone ringing. (I am on call tonight.) I listen as the nurse explains the presentation of the patient.  In the end, I advise sending them on to the nearest emergency room, forty-five minutes away.  Using one of my favorite pieces of kiwi medical parlance, I ask the nurse, "Are you happy with that plan?" Yes, she is happy.  We hang up.

22:00 - The eternal question: sleep or Game of Thrones?

23:00 - Bedtime.  We have four bedrooms (one is actually the living room but it also has a bed in it.) We start the night like this: me and Benjamin in room 1, Bear in room 2, Pax in room 3.  It is never the same by the end of the night.  Two nights ago it ended up like this: Benjamin in room 1, me in room 2, and Bear and Pax in room 3.  After living in the RV, we are apparently keen to spread out as much as possible.  Also, I have apparently been in this country long enough to start saying people are "keen to" do things.  And now, sleep.  Because tomorrow I get up and do it all over again.

Ten Things I Love About New Zealand

1.  Beaches - When your country is made up of more than 33 islands, there is a lot of waterfront.  There is so much beach that the beach is not, like, a thing.  Kiwis may have stopped even noticing that their country is made of gorgeous beaches. they're just like "oh, over there, where the land stops." Bam: completely amazing and deserted beach.

Our town beach is on the Bay of Plenty, which is like a cove, not a long brakish-type bay like the Chesapeake.  So there are waves, but they are smaller.  This is going to be perfect for Bear in the summer time.  Benjamin and I explored this area last Friday when Bear was in school.

About 40 minutes away is Ohope Beach, which is also completely beautiful and has a very impressive playground.

2. Coffee AND Tea - In the US, you are either a coffee person or a tea person.  In New Zealand, we find such divisions unnecessary. In fact, a good balance of coffee and tea is probably best.  First, the coffee game is strong - Kiwis don't even bother with drip coffee. There are three kinds of coffee in New Zealand: white, black, and instant.  New Zealand is the birthplace of the Flat White, which I understand just came to the States via Starbucks.  It's a latte without all the foamy nonsense, just espresso and steamed milk.  Blacks, which come in 'long black' and 'short black' depending on size, are espresso over hot water.

Tea is so important that it's not just a beverage, it is also three separate meals: morning tea, afternoon tea, and tea.  That third one is dinner.  Tea is so important that every place I have stayed has provided access to an electric kettle. Our house came with four electric kettles.

The EMR system in my office allows you to send crucial messages to co-workers.

3.  Kiwis - I've only been here a month, but Kiwis as a group seem to be both hard-working and laid back. They are friendly and generous.  And tough.  So far, no patient has rated their pain higher than 6/10 (and that was a completely ruptured quadriceps).

4.  The Government - from joking immigration and customs officials to friendly road signs to easy to understand tax forms, I just get the sense that the New Zealand government is generally made up of easy-going people who are trying to help their citizens lead good lives (with the possible exception of whoever was holding up my family's visas).  Not, you know, suspicious gun-toting maniacs out to catch you in a lie like officials seem to be in the US.

Example: Riding the train in Auckland with Patti, the conductor was walking through the train and saw me standing up with Pax in the Ergo. I was holding on to the little plastic loops attached to the grab bar.  He said, "Miss, it's really best practice to hold on to something rigid when you're standing and carrying a little one. I would hate for you to fall down." His phrasing was so gentle, his manner so full of actual concern.  In the US it would be more like, "I'm going to have to ask you to hold on to something rigid, our policy states blah, blah, blah."

Maryland road sign: "Click it or ticket!"
New Zealand road sign: "Other people make mistakes. Please slow down."

5. "Partners" - This term has caught on here among everyone, not just gay couples, as sort of an unapologetic descriptor as rates of official marriage decline. Partner is accepted without irony and avoids the nonsense of 70 year old ladies talking about their "boyfriends." In addition, since partner is gender neutral, I have several times had opportunity to use the single gender-neutral 'they,' and this has been accepted without question or confusion.

6.  My Job - This should and will be its own separate post at some point.  But for now let me just say that I love this job.  Both working within the New Zealand healthcare system and working specifically in this practice are everything I had hoped they would be.

7.  The Five Dollar Bill - In the US we're trying to get more women on currency.  In New Zealand, there is already a woman on the currency, and she is the god damn Queen.  And the other side? Penguin.  Boom.

8. Sensible Gun Laws - to get a gun in New Zealand you have to have two references, no convictions, pass a written safety test, and have a home visit to prove you have appropriate safe gun storage.  And that's for hunting rifles.  Handgun permits are even more stringent.  As a result, per capita gun deaths are about 1/10 what they are in the US.  Also, New Zealand police have shot and killed 22 people.  Since 1941.

9.  Small Town Life - Sometimes it's a little claustrophobic, but mostly it's really nice.  The town is four blocks long.  I walk Bear to school, I walk to work, I walk to the grocery store.  Anything else I may need I have passed on the way.  Plus I've run into three people I know.

The local paper is the best reading ever:

10. Lack of Antibiotic Resistance - Pharyngitis? Amoxicillin. Sinusitis? Amoxicillin.  Pneumonia? Cellulitis? Otitis media? Amoxicillin! I know some filthy American is going to share their MRSA soon, but it is really nice while it lasts!