TOO HEAVY

12 FEB 09 (THU)

It is a late Tuesday night in Christchurch. Outside of my window I can see right into the downtown of the city; it is about as active as I imagine a Tuesday night is in downtown Scappoose. There is not much going on and the only people out and about are the shop owners closing up for the day and the occasional stray men who are going into the door that is beneath a neon sign that’s flashing ‘Kitty Cat Lounge’ in pink, purple and blue, but I don’t think it’s the household kind of kitten they’re going in to find out about...

I am at our apartment finally getting down to tying up all of my loose ends from our wedding last summer and Heather is working the evening shift at the Hospital. This is a perfect, quiet time for me to get my thoughts right.  It blows my mind that I have to use both hands to count how many months it has already been since August 30^th but, then again, I guess that’s the thing about time and how it goes. I compare this feeling of life going by so astonishingly fast to the feeling I have when I check my final bank balance after a weekend in Las Vegas.  I absolutely cannot account for where most of it went but I am sure that I must have had fun while it was being spent.  At least that is the way I prefer to justify both of these anomalies!

TOO HEAVY

This is an anecdotal piece of news I found on the side column of the second page in this morning’s local newspaper, The Press. It amused me and I think it perfectly sums up what I love about the general perspective down here!

"A large Timaru woman had to be airlifted off Mt. Nimrod on Sunday night, prompting police to remind people that a reasonable level of fitness is required before taking on the track. The woman was taken to Timaru Hospital by the Westpac Rescue Helicopter after she tripped and fractured her ankle in three places and rescuers were unable to carry her massive body off the mountain. It is understood she weighed about 130 kg (286 lbs)."

I swear to you that I did not make this up. But it does make me wonder about a couple of things. Namely:

1. How is it that the police are the one’s who would make this kind public announcement?
   
2. Wouldn’t anybody need to be airlifted off a mountain if they broke their ankles in three places?
   
3. What is a lady, weighing a couple sugar packets under 300 bills, doing climbing mountains anyway? I mean, that is impressive! What American fatty would try a feat like that?
   
4. Mt. Nimrod? Seriously?
   
5. Is this mini-article more about the public awareness regarding ‘the importance of fitness on hiking tracks’ or ‘the importance of not being fat?’ I don't know, I can't figure it out. 
   
6. What sort of feelings would you have if this is what you read while laying in the hospital bed the next morning after being airlifted off a mountain? 

This little tid-bit is not unusual. I've been coming across many of these quirky anecdotes. It's great. I think my favorite one so far, other than the one above, was the one I heard about a guy who was arrested after being caught posing as a female nurse at the Christchurch Hospital! 

Apparently some nut case had somehow snuck into the security room, put himself into the Canterbury Health Care's personnel system and printed off an ID card/badge which had a picture of him dressed up as a woman. He then was able to have nursing uniforms issued to him and was going floor to floor posing as a float nurse. He would show up to random floors during shifts just as a normal nurse would except he wasn't really doing anything other than changing bed pans, putting lotion onto old men's feet and cleaning people up. I guess he was just faking all the rest of the real nursing stuff. The best part is how he got caught.  

Nobody really knows how long he was doing fake, weird shifts at the hospital, dressed as a woman, but he finally got caught when he tried to return the Canterbury Health Care company car, a 2002 Nissan sedan, he had checked out from the District Administration Building. He, posing as a home health nurse, checked the car out saying that he was going to be using it for patient home visits over a weekend. But when the car went missing after two weeks, the people at the hospital began to wonder what had happened to one of their cars. Seeing that no other record of the person who checked it out existed in the entire Health Care system, they issued a missing person advisory through the Police Department. The local news even did brief public announcements during the evening news for a couple evenings. They showed a picture of the missing car and a fuzzy picture of who they believed stole the car. 

But then the car shows up a couple days later when the guy brings it back. He/she shows up dressed as a nurse like everything was completely normal. The administration employee who was working when the guy/gal returned the car thought something seemed unusual about the missing nurse who had all of a sudden shown up. The employee didn't say anything to him/her that he/she was a missing person or that the police could be looking for him/her. He/she then goes about like it's a sunny day in his/her strange world and goes up to a floor to do some fake nursing; that's when the police were called and the guy was arrested. 

CREEPY!!!

HEATHER SAYS, NURSING IN NZ IS... 

I am having a great time so far!! It is going by too fast- I have been here for 8 weeks now in NZ and have just finished my 2nd week off orientation on a vascular surgery floor at Christchurch Hospital. It is VERY different. I am trying to keep a diary of some of those obvious differences, as I know they will become 2nd nature soon-- just in time for me to get back to "American style nursing". Which is basically nursing with a LOT of charting... Also, I know it will be interesting to read this assessment of my new working environment in 1 year from now, and see what was reality vs initial perception.  

Ward 15 consists of 25 beds- 1 large room with 4 beds used as an intensive care/ post-surgical ward manned by 2 nurses, 3 large rooms down the hall lined with 6 beds each (boys in one, girls in the other) and 3 VERY small single rooms for any isolation (MRSA is treated as some sort of plague here-- apparently it is very uncommon but very feared... ahh NZ!) There are no TV’s on the ward, but your family member can rent a small TV on rollers from the hospital for $10.00 a day and the pt is allowed to watch it from 0700-2200.

The pt bathrooms are lined up down another hall (not in pt rooms) and we use metal, re-usable bedpans for those who are unable to make it to the brm. (brm is not an acknowledged abbreviation here- another issue for me! I feel like I am learning a new language! The slang here is incredible--on the bright side, I have now made it to a 20% comprehension rate!! All the diagnostic procedures are the same or similar, the post op care for a vascular pt is also the same-- I have memories of my first year as a nurse with Janoff pts-- racing out to the pt rooms to make sure they have an IS, but NOT if they had a carotid end.- and tracking down the doppler so I wouldn't look like such a fool when I had to call for that docusate at dinner-time, and did not have that pertinent info! Those were the days huh!! My scope of practice is very different here too. As a nurse, I am "allowed" to perform certain procedures if I have been checked off by the head nurse (such as placing a catheter for a male, drawing bloods from a peripheral or central site, or changing a PICC dressing) but that is 99% done by the Dr. -New IV's are also always placed by the doctors if they have "tissued" (infiltrated). Here is the part I am loving-- no computers! Only paper charting, the chart is kept for the pt and built up on each admission so everything that has ever happened is there.

I can see the advantages of the history being on the computer now, but my only charting requirement is a nursing note at the end of the shift and a quick update on the care plan sheet that is located at the bedside. (Also, there is also no suing here- you can file a grievance with the government and they will settle your claim if it is approved with the exact amt of the bill- there is no charge for hospital stays here in NZ, and no such thing as emotional damage fees- so I don't know what the grievance would relate to exactly, but it is comforting info as a nurse to know) There are no actual order sheets, but the notes that are written by the Dr's and medication and IVF orders. Very confusing at first- the note will read that “the pts catheter is to come out tomorrow”…. I am supposed to take this out at that time based on the note- there is no order that says clearly to me.. “take it out at such and such time”. I had looked for orders like this long and hard the first week… blood that is ordered is written RBC over 3-4 hrs in the IVF sheet. The nurse then checks the T&C, sends away for the blood and for a lab draw several hours after the infusion so the Dr can see the results the next day—for example. These are just a few examples, most are very small and obvious- but the patients are great, the nursing staff are awesome-- so welcoming and helpful, and the doctors are very easy to conference with... they prefer to be called by their first names only.. or by Mr/Mrs but never Dr so and so... apparently that is so "Grey's Anatomy"!!-- I was told that by a group of Drs on my first day.

There is a set time (or tentative set time anyway) for baths, meds, visiting and eating-- it is crazy! Very routine however, and the patients get to know it quickly:

0645-0700- Paper report (night to day shift)

0700-0720-ish- Group rounds for the nurses (walk around and give a small

verbal report about each pt from the off-going to the on-coming nurse.

0720-0800- Read through the charts and orders- figure out the days surgical schedule and when to have your pt ready for what.

0800-0930- Pass meds, assist everyone up for breakfast and shower or bed bath. Also the time to have any dressings “taken down” for the surgical rounds. These may get re- dressed by certain Surgeons, but most likely, nursing staff will re-dress after rounds. There is a certain method of taking each dressing down as well… they use sterile technique with sterile dressings when dealing with any wound. You have to get a wound cart from the supply closet and set this up prior to entering the pt room. The wound carts are also used when setting up supplies for the Doctor to insert a male catheter (which nurses are not allowed to insert, but are required to set up the equipment. 

0930-1100- Surgical rounds are from approx this time MWF. Weekends

and holidays, an “on-call” resident will make rounds to see each pt and write orders if necessary, and T & Th are “grand rounds” where the entire “team” vascular surgeon, Cardiologist, wound care RN, Physical therapist, Social Worker Ect, get together to go over “the plan”. 

1100-1300- Visiting hrs for no more than 2 family/friends at a time.

1300-1500- Quiet time where all lights are actually turned off and pts Curtains are closed so they can rest.

1500-1700- Visiting time again.

1730- Dinner is served! (Although they call this “Tea”)

1900-2200- Pts are coming back from surgery or getting ready for bed.

Nursing staff is required to go down to post-op and retrieve face-to-face report about the surgery from the nurse and accompany the pt up to the ward. We will also use this time to assist our other pts with a partial bed bath or evening shower set-up in order to sleep better. There are orderlies that are called to actually move pts from surgery to the ward, or assist with heavy pts in transfers or turns….yes, they are big, strong men just like in the movies!

I am not sure what happens on night shift yet, as I have not had to work one but as I am leaving at 2300, the night shift nurses are walking from room to room with flashlights that they call “torches” and looking at every patient. There are no vitals (they call them observations, and do not know what I am talking about when I say vitals… although I didn’t know what they meant the first several times they said “obs”) The main thing I have noticed with this very strict looking outline of the day, is that it is really just a schedule to go by. Everything is meant to happen in this order, but the pts are sick, they don’t sleep well even with the dim lights and no vitals. There are emergency surgeries, and the actual critical nursing care is pretty much the same. The nurse is still expected to call for assessment from the Doctor when the patient’s status is declining, and they just introduced a “rapid response” type system this year in keeping with the worldwide standards. I am not finding the nursing any different. I am comfortable taking care of these patients, but I am noticing that the style of what is expected is very different. The nurses make the beds neat and tight, their uniforms are all identical- neat and pressed, there is usually one way of doing things… and the nurses will stop you to let you know if it is done any other way than how their used to… hence the sterile technique used with the most foul mess of a wound dressing change.

Hopefully you are not shaking your head at my babble-- kind of went on a rant there... like I said though, soon it will all be second nature, and my next U.S. nursing co-worker will be very confused at my use of sterile technique, or calling the doc to come place my catheter or IV site… I apologize in advance “next co-worker”… but in the mean time, I am looking very “smart” in my uniform!!

 

 

Riverside entrance to Christchurch Hospital

Victoria Park

Above Sumner, 15 minutes east of ChCh. 

This is the Scarborough Walk. It lies between a cluster of design-magazine quality houses and the cliffs of the Banks Peninsula. 

"Your head is humming and it won't go, 
In case you don't know,
The Piper's calling you to join him.
Dear Lady can you hear the wind blow, and did you know,
Your stairway lies on the whispering wind."

Two donkeys and an ass.

Taylors Mistake is a hidden-ish beach on the other side of Sumner. Here is a string of 'baches' along the rocky shoreline. A bach, short for bachelory, is a modest, second home that some Kiwi families have. They are usually in secluded areas. In New Zealand, these kinds of areas are not hard to find... 

How classic of a New Zealand shot is this? If reincarnation does exist and if I can't come back as a human in another life, then I'd like to come back as a NZ sheep. Spend all my days hanging out with my friends, growing fro's and day dream while looking at great scenery all day... that's the life! 

It came as a huge shock to me that New Zealand took assertive action in safe guarding it's homeland during WW2. Apparently there was a real concern that the Port of Lyttelton would come under enemy attack during the war. Couple this with what Adrian told me about the Japanese fly overs during that time period as well, it finally occurs to me the meaning of World was in the title World War. I mean, outside of Gallipoli, I just never associated New Zealand with war; especially war in it's back yard. Who would care about a tiny island in the south pacific? But I guess war is everywhere when there's far reaching socio-political implications. 

(duh, right?)

Well, anyway, just to the east of Christchurch is the Port called Lyttelon. You can drive there in a car over a small mountain or through a big tunnel. Ships get there by passing between two massive heads of land; the Godley Head and the Adderly Head. As you can read from the description below, there is a decommissioned battery there on Godley Head. We hiked out to it during Heather's day off last week. It blew me away and reminded me off Battery Russel near Astoria, Oregon. 

Standing where a huge cannon was once mounted. These goliaths were capable of sending hunks of solid metal, the size of a healthy thanksgiving turkey, up to 10 miles out into the sea. Crazy!  

Through the rusted barbed wire fences is the fuzzy grouping of ChCh's downtown buildings.

Inside the 'war room' in one of three gun placements. 

Heather and a salami sammy share a moment with a relic. 

Beneath the Godley Battery Compound are two smaller concrete gun rooms. They are situated against the rocks where the ocean meets the cliffs. To get down there, we hiked through this 100 meter tunnel that was blasted through rock. For someone who thinks claustrophobia is fake, I had a difficult time slow stepping down the tunnel. It's funny how earth quakes and cave-ins become legitimate fears when you find yourself in a tiny hole in a big rock. 

Warning: poor visibility and unleveled floor for 103 meters.

Happy to see day light. 

END.

M&H