I write this actually from Wellington, New Zealand (the Capital).  I got here last night and am leaving in a few hours.  I had to come here to meet with a representative of the New Zealand Medical Council, as part of my final approval to practice medicine in New Zealand.  It's been a huge time hassle and a bit of an expense to do so, but it HAS given me a LOT of time at the airport with just my computer, so now I have a chance to update the BLOG.

We flew to New Zealand to begin our life here last Wednesday.  We left in the evening, and because we crossed the date line, we arrived on Friday morning after a 13 hour flight from San Francisco.  We got a rental "car", actually a mini-bus a HUGE thing, but needed because we checked 10 bags for the flight over, as these were the last of our Oregon possessions we were bringing. 

We spent 2 days in Hamilton, about 90 minutes from the airport.  This is where our daughter goes to college, and gave us a chance to pick her up and to rest and recuperate from the stressors of the move and the mostly sleepless flight over.  While in Hamilton we visited the Hamilton Gardens (a very cool botanical garden) and the next day took a side trip to tour glowworm caves.  Glowworms are sort of hard to describe, but are really spectacular to see! 

After that, the 5 of us (my wife and I and 3 of our 4 kids) made the drive from Hamilton to Gisborne, our new city.  It's a bit of a slog, about 5 hours driving.  In New Zealand many (most) of the roads outside the major cities are two lane, windy things, and so driving is a constant series of slow-down/speed up and negotiating turns.  It makes the driving a bit more tedious. Also, we JUST missed a land-slide (or as they call it in New Zealand, a "slip") along the road we took to Gisborne.  Had we driven through about 90 minutes later than we did, we would have not been able to continue, and would have had to have taken a 6 hour additional detour.  So THAT was lucky. 

We arrived at our home in Gisborne on the 2nd shortest day of the year, but the sun was still out and the ocean was beautiful.  The photo at the top of the page is the place where we're staying till we find more permanent accommodations.  It's a rental home right on Wainui beach (a great surf beach).  It's lovely, and in an absolutely beautiful location, but it's small, and only just fits what we've brought, not even close to what's coming on the boat when our shipping container gets here.  The surf has been great, but I don't have my board with me, so I'm not sure what I'm going to do (maybe find it in the budget to get a second surfboard?).  We got our official NZ phone numbers for our mobile phones, so I sort of feel "official" now that we've done that. 

My job starts in 6 days, so I'll have to post again in a couple weeks to let everyone know how that is going.  I'm a little nervous about how it's going to go, not knowing really how things will be different here compared to USA.

Anyway, that's the quick and dirty in getting caught up to speed on what's happened so far with our move here.  Once I figure out how to better manage this web page I hope to post more pictures of where we are, and figure out a better way to maybe get some feedback / communications with anyone still wanting to communicate with me.

I hope this finds all the people I knew in McMinnville doing well!  I miss you all!

It's Sunday Morning. My typical Sunday morning routine is to come to the office early, before church and when the family is asleep, and finish off any remaining work so I can start Monday with nothing on my plate (till it fills up again, and it ALWAYS fills up again).

So today is no different.  Except it is, because this may be the last Sunday morning I do this.

In the winter, the view out my window here is dark.  I'll maybe catch a sunrise before I'm done, but often not. In the summer, though, it's bright, and I can watch the plaza light up as the day gets brighter. With the parking lot empty, I'll get deer walking past my window, sometimes a pair of ducks that likes to visit the fountain will go by, and once even a heron strutted across the parking lot in front of me. I don't necessarily like the work, but I DO like the peaceful setting of the office on a weekend morning - I'm going to miss that. 

The office threw me a little going-away party on Friday.  Thanks to Dr. Hyder and Jessica (front office worker) and others for putting that together. Thanks for the nice send-off for those who were able to come, but rest assured I didn't expect most patients to be able to show up.  It would have been chaotic if they'd tried. There were some neat cards, some nice gifts (mostly of the chocolate variety), a lot of conversations and memories, a LOT of hugs, and some tears. 

For the longest time my leaving seemed "out there".  Yeah, it was going to happen, but it was a long way off.  Now I've reached the last week of my time at West Hills; I have 3 office days left. I'm going to have to spread out the emotions of all this, the thanks to the patients and staff, the admiration of my partners and colleagues over many blog posts, of course.  There's just no way to put all that down in one sitting. But I had a little time this morning, so I thought I'd write a bit, since it's the start of my last week here. 

I'm grateful for the patients and families who've trusted me and this office for their health over the years. I think the best part of being a family doctor, is knowing so many people, being a small part of so many amazing families and their lives, watching kids grow (and grow and grow) over the years, and moving with families and individuals through the good times and bad times in their lives. 

This Friday is the local High School graduation.  As the school board chairman, I get to shake every graduate's hand as they walk across the stage to receive their diploma. There will be several graduates among that group that I was there for their birth, and have cared for them their whole lives up until this point. That is such a privilege, and it's part of the joy of doing what I do. 

So three more days in the office, and then off to new adventures.  For those who are interested, I DO intend to be more active on this site, and update with words and photos and videos all the stuff that happens next.  I'll have a lot more to say about the time and people of West Hills, so this is not the end of that. But it IS the end of my routine at this place, the job I've been doing for almost 21 years here.  I'll miss it a lot, and I'll miss even more the people and relationships I've built over that time. 

I type this from PDX, waiting to fly to New Zealand.

I'm taking my daughter to Hamilton, NZ, where she begins college at the end of the week at Waikato University.  After dropping her off, I'm going to travel over to Gisborne, where I'll meet with my future practice partners and bosses.  While there I'm also going to look at where we'll hopefully secure some temporary housing, look into schools and maybe meet with the headmaster of the boys school where our son may be going.  And surf.  I'm definitely hoping to get a few surf sessions in while there. :) 

It's a liminal time for us.  I'm finding more and deeper appreciation for where I'm leaving, and also more and more excitement for this next step in our lives.  It's a weird sort of place to be, not FULLY here in Oregon mentally, with all the planning and details, but certainly not in New Zealand yet either.  McMinnville is a great place, and the Pacific Northwest, I'm convinced, is one of the most gorgeous places on earth.  It'll be hard to leave. But we're headed someplace pretty spectacular as well. 

Stay tuned, I guess. 

For now, I have about 24 hours of travel ahead of me (and my daughter as well).  We're flying from Portland to San Francisco.  We'll be able to see my brother there, and my nephew and niece, as they live right by the airport.  That'll be fun.  Then it's a 13 hour flight that evening overnight to New Zealand.

More information, and photos to come when I get there. 

OK, here we go, 2018 is officially here.  It's 0830, 1/1/18.  I got to the office early this morning to catch up on the work that accumulated over the Christmas break when I was gone. 

I continue to be so thankful to my partners and colleagues here who do such a good job of handling all the work when I leave.  I don't know if people realize how many phone calls, refill requests, lab reviews, messages from nursing homes and consultants and insurance companies we get on a daily basis.  It's a LOT of work to handle, and it's such a benefit to have great colleagues who can handle those issues when I'm gone.  Thanks to all!

I spent the Christmas Holiday with my family at a place called Holden Village.  I've been going there since before I was born (my first time was when my mom was pregnant with me).  It's deep in the Cascade Mountains in northern Washington, and accessible only by boat.  We had a TON of snow; it was definitely a White Christmas!  Here's a link to some video and pictures I took during our time there this year.  It's a very special place for my family and me.  I'm not sure when we'll be back.

So, 2018 is the year I leave West Hills (after 21 years), and move to New Zealand.  The closer we get to June, the quicker the time seems to move.  And that's a bit frightening, as we have SO MUCH to do first.  It's going to be a weird 5+ months.  I know it'll be filled with lots of tough goodbyes with patients I really like and have come to know so well over my time here.  I'm hoping this web site is a SMALL way we can at least keep in touch and have me not totally disappear for those interested in what the next things happening in my life are to be. 

2018 is going to be a crazy year.  I hope for everyone (patients, colleagues, friends, staff), 2018 is a year of health, happiness, new adventures and surprises, time with friends and family, and of appreciation of the small and large blessings that come our way.  I will be very deliberate about appreciating the people (patients and fellow workers / colleagues) here at West Hills as I know my time draws to a close. 

It's going to be a crazy ride in 2018.  Thanks for sharing it with me!

It's the second night of my 7 day call week.

There was a time, when I first started, when we took call one day a week (my day was Wednesday, if I remember), and then rotated call with my partners through the weekends (Friday - Sunday).

Back then, no question, we were busier.  If memory serves me correctly, the pager went off most of the day.  I was still admitting people to the hospital, even seeing them in the ER.  If they were in the ER and needed admitting, I went to the hospital and got them "upstairs", orders written, chart notes written AND dictated.  And I followed them through the hospital stay, and discharged them home at the end.  And the babies - I was still delivering babies then, too.  It didn't matter if I was on call or not for the babies; if it was time for mom (and baby), it was time for me, too.   With an ER admission, even if I had to crawl out of bed at 2:00 AM, I could generally count on being able to crawl back INTO bed between 4-4:30 AM.  I'd get my patient "tucked in", and I could go home.  With the babies, I was up for good; I would not see my bed again.  In fact, I would hope to be done in time to arrive, bleary-eyed and rumpled, for my first patient of the morning.  But the trade-off in time was made up for in, generally, joy.  To this day there is nothing so miraculous in medicine to me than to be there at the birth of a child - to transition a life from the warm, dark intra-uterine world into the bright, noisy, chaotic love-and-touch-filled extra-uterine one. 

Little-by-little, though, my time transitioned to more and more "outpatient" and less and less "inpatient".  First, I stopped delivering babies.  I was the last of my practice to do so, holding out for as long as I could.  But the risks and economics of obstetrics changed through forces beyond my control and I eventually had to just stop.  I did not miss the sleepless nights and the stress-filled deliveries - hours spent at the nurses station, watching fetal monitoring strips of "stressed" babies, misbehaving enough to need constant vigilance, but healthy enough to not "call the section". But I do miss the OB visits and "uneventful" deliveries (there's an oxymoron for you).  I miss the office OB visits: the happy couples, the waxing fundal heights, cm by cm, month by month. I miss placing the ultrasound on the tummy and watching the faces in the room as we all listened to the fetal heart beat - whoosh-whoosh-whoosh-whoosh-whoosh.  Next came the hospitalists, which freed me from taking care of my patients in the hospital.  This was a blessed relief, as the increasingly complex and procedurally unique world of inpatient medicine was taken off our duty list.  At first it was weird for both patients and me to "hand off" to another doctor during their hospital stay, but it soon became clear that they were going to get better care, and everyone was good with it.  Finally, we stopped seeing "high-risk" newborns. That eliminated the middle-of-the-night calls to rush to the birthing center to resuscitate a baby in distress, or to be present in the OR for a C-section for anything but routine reasons.  This change, finally, meant that I could be on call and not have to be within 30 minutes of a hospital.  For a doctor who spends about 15-20% of his work life on call, this was huge.

So these days the only trips to the hospital on-call are for low risk newborns.  Our call years ago moved from one day a week with rotating weekends to rotating 7 day weeks all at one time.  This was a good move overall.  It meant vacations could be planned for weeks when I wasn't on call, and I didn't have to arrange coverage EVERY time I wanted to be away over a Wednesday.  And so it's been for the past several years. The weeks can get a little long.  But at the end, I can hand off the pager and not have to think about being on call again for generally at least 2-4 weeks.

I wish I could say that the time given back in terms of ER visits, hospital admissions, delivering babies, and attending high-risk deliveries was able to be used instead on time with family, or sleep.  Some small part of it was, to be sure.  But the rest has, unfortunately, morphed into the increasing amount of time we doctors are required to spend in front of screens (which is a whole other blog topic).  

Call is unquestionably less of a burden these days.  But it is still a burden.  It is still the pager that cannot leave your side for a week, buzzing at any time day or night.  It can be sleep, quiet time with my wife, a car ride with my kids, sitting in church, or trying to go for a run when I will get the sudden interruption to stop whatever I'm doing to attend to whoever is calling.  It is not a big trauma by any means, but it is a hundred little ones. So much so that when a pager goes off on a TV show I instantly feel my heart drop and my pulse quicken.  So much so that typically during the first couple days OFF call, I will momentarily panic when I touch my R waist and don't feel the pager there.  I have horrible insomnia, and I am convinced call is to blame.  Decades of nights where I've been abruptly awoken to rush to the hospital to attend to a baby in distress, or helping an anxious mom with a sick child, or (even worse) called for a trivial problem that could have waited, have left my brain primed for interruption and disturbances any time I try to sleep, not just the call nights. I don't (usually) begrudge the situations, or the people calling; that's the job I signed up for.  And being able to help is personally and professionally satisfying.  But it doesn't help me sleep any better.

The reason I mention all these things, is I now have a very finite number of call weeks left.  After this current call week, after all the call I've taken for the past two decades, I will have 4 more weeks of West Hills Health Care Clinic call remaining.  To me, that seems like very very few.  

I don't know exactly what the call will be like when I'm in New Zealand, but I do know that the worst will be very far behind me. I'm thankful for that.  I'm sad, in a twisted Stockholm Syndrome sort of way as well - mostly for the "ending of an era" type of thing, I guess.  But mostly, it's just one more way to measure the rather profound changes that are coming very soon, and one more cause to reflect on all (good and bad) that's come before. 

This first post is just a community area for people who know or knew me to leave any comments / questions / clarifications or other information if they want.  I will try to read them regularly, and respond when I'm able.