Saturday, February 26, 2011


Post-script: I had written a draft version of this post shortly after our visit on January 15 - 18 to make sure I didn't forget our experiences in Christchurch. Despite the tragedy on February 22, I've left my words mostly unedited as I'd like you the reader to view Christchurch as the magnificent modern city that we saw through our eyes and that I have no doubt will be one day restored to the beautiful place that we experienced.

After spending the day farther north along the pacific coast seeing sperm whales and dolphins and seals, we drove to Christchurch with the intention of putting our heels up for a few days. Trish and the kids were psyched to do some souvenir shopping and I was excited to explore New Zealand's second largest city.

Christchurch's Cathedral Square with "The Millennium Chalice" on the left

Typically, we wouldn't pre-book any of our hotels. We would get on the highway and Trish would pull out the free AA accommodations book and start calling. Two of the great things about New Zealand hotels are
  1. There is an appointed "duty hotel" in each town, so if you've called a few hotels without any luck, you can ask for the phone number of the duty hotel. This hotel keeps track of room availability in all of the hotels in the area. So if we were having trouble finding accommodation for 5, the duty hotel would tell us to try this and this hotel who has an apartment that would suit us. It worked great.
  2. While accommodations for 5 are very difficult to find in Europe and North America, nearly every hotel in New Zealand has 2 and 3 bedroom units that include a common room and a kitchen.
As we were approaching Christchurch, Trish found a hotel that was rated 4 stars and was close to the city center. We called the Southern Comfort Motel and hit gold on the first try - they had a suite for us at a reasonable price.

Awesome ... until we got there. This place was disgusting! From the outside, it looked old and worn. We should have fled then and there, but decided to at least see the room. The rooms were worse: musty, dated, worn, dirty. We were contemplating leaving, but it was after 6:00pm and we figured that we'd get charged one night for cancellation. Besides Harrison had leapt at the chance to christen the bathroom when we heard a "Mom! Dad! Come see this!"

There were hundreds of dead bugs in the bathtub.  It was clear that they had fallen from the skylight, but it was also obvious that the place had neither been occupied or cleaned for some time. We found someone to clean it up while the owner made some excuse about the wind, but if Trish had had her sleeping bag, she would have slept in it on top of the covers.

So we sucked it up and decided to stay the night, but the very first thing I did was download the Trip Advisor app for the iPhone (highly recommended). Now with trusted, reliable information, we researched a much better hotel that was spotless and within walking distance of Cathedral Square. We drove over to check it out and laid down the plastic to reserve an apartment for the rest of our stay in Christchurch. I wasted no time in telling the owner of the Southern Comfort that we were outta there first thing in the morning. (The link above takes you to my scathing review on Trip Advisor.)

Once we had solved the accommodation problem, we set out to explore Cathedral Square and find a place to eat. Everyone settled on Japanese at Mom's 24 Sushi. After dinner, Mom & Dad grabbed a Starbucks and the kids took up an impromptu game of tag around the historical landmarks in and around Cathedral Square to burn off some energy.

Christchurch was remarkably well preserved given the two previous earthquakes. There was scaffolding around a few old buildings and we saw one old art boutique that had been evacuated until the building could pass a safety test. But there is probably more construction in Montreal at any given time than we saw in Christchurch.

Although there are pockets of activity in different parts of the city, Cathedral Square is where all the action was. Lots of the touristy things were arranged around the square and most of the shopping was in the streets leading off Cathedral Square.

Take your time Trish - I'll be here.
The next morning, we grabbed breakfast at the Cathedral cafe to fuel our imminent raid on the stores along Columbo St. We all picked up some souvenirs and then relaxed in Victoria Park for a few minutes before lunch. We grabbed lunch on the run and headed to a Haka show in Cathedral Junction.

Harrison with Maori warrior at the Haka

The girls with Maori woman at the Haka

After the Haka show, we went to the small aquarium, Southern Encounter. It was OK, but the best part was seeing a mating pair of Kiwis in a night room squabble over food. They came right up to the glass and seemed oblivious to their human observers 2 cm away. Then we took in some street performers around Cathedral Square and rode the tram through its loop around central Christchurch.

All aboard the tram
Mom & Dad had earned a drink, so we stopped into Bailies Irish Pub for a snack and a pint before heading back through Latimer Square to our hotel. 

None of the restaurants around Cathedral Square looked all that great, so we drove around looking for something better. It was Sunday night and the streets were pretty quiet when we happened to drive down Oxford Terrace that was packed with open air restaurants and people enjoying the warm weather. What a great scene! Nowhere in any tourist book or brochure is there a description of this little strip. The only explanation I could surmise is that Christchurch locals want to keep this jewel for themselves. The vibe reminded me of Crescent St except that the strip was lined with hip restaurants overlooking the Avon River.

We grabbed a cool table at Suede with a fire burning through the hole in the middle. Mackenzie, our 4 year old, declared her heterosexuality when she gave our 19 year old waiter, Oska, a 15 second head to toe ogle. Every time he would come to the table, she would act coy and start tossing her hair around. In the middle of the dinner, she uttered "Jeeesus Christ!" to express her discontent at Oska attending to the two blonds at the table next to us! I was kicking myself as I chose that night to forget my camera. It sure felt like vacation as our kids felt right at home staying out to 11:00 pm dining in chic neighborhood eateries.

Unfortunately, the weather rained on our parade the next day and it was impossible to do any outdoor activity. We camped out at a mall. Harrison and I played video games while the girls picked up jeaggins (tights that look like skinny jeans). Late in the afternoon, we went to check out Christchurch's art gallery. Two of the three kids killed it in under 10 minutes, but one paused to contemplate the artist's message. Guess who?

Christchurch Art Gallery
That evening we 'dined' at the Octagon Live!, a restaurant now occupying the restored Trinity Church. It is an excellent restaurant in its own right, but the real attraction is that the entire staff are musicians and entertainers. The hostess got changed into a ball gown and sang Gershwin; our waitress played Rachmaninoff. Between sets from other artists, Christchurch jazz legend Doug Caldwell filled the room with classical jazz piano.

Cassandra enjoying Havelock greenlip mussels

It was a fantastic experience. Yet again, we were surprised to notice that we were still eating dinner with the kids until after 11:00pm.

The clouds had disappeared, the stars were shining and the rain was receding from the streets. Drowsy from the food and the wine, we meandered through the cool night back to our hotel utterly satisfied with our visit to Christchurch. The city was filling up with Special Olympians and the World Busking Festival was on deck for the next weekend. There were certainly many more opportunities to explore in Christchurch and Canterbury, but I thought to myself that it would be equally cool to come back to Christchurch just to hang out.

The next day, we would start on the road back up to the North Island, but pause before boarding the ferry to put our bags down in Nelson, the area with New Zealand's nicest weather.

Soaking in Hanmer Springs & Whale-Watching in Kaikoura

After an excellent day cruising around vineyards and chocolate factories, we set out for Hanmer Springs, an inland mountain retreat known for it's natural spa. The GPS told me that it would take about 3 hours.

Road to Christchurch. All the beaches are deserted.
I know I sound like a broken record, but once again the scenery was breathtaking. The road initially followed the pacific coast and then turned inland into the Southern Alps.

Crayfish stand in the middle of nowhere
Not lobsters - crayfish (no front claws)

Alpaca Farm beside the highway
 After 5 hours careening around U-turn after U-turn on narrow roads on the edge of a cliff and with a ... dissatisfied and car sick wife, we finally arrived in Hanmer Springs. The error the GPS made was in assuming that I could take hairpin turns in a 2000 Honda Odyssey at 100 km/hr even though it was signposted at 25 km/hr.

View from our apartment balcony over the golf course
Our accommodations were awesome. To date, the Alpine Springs Motel has been our best accommodation thus far in New Zealand. The owner, Robert Sluggett, has put the lion's share of his profits from selling 20 pubs in the UK to restore this once derelict property into beautifully decorated self-contained apartments overlooking a golf course. Every room had a flat screen TV and there were plenty of cool electronic gadgets scattered around the apartment. And it was a leisurely 6 minute walk across the golf course to get to the town's star attraction, the hot springs.

All smiles in a 38C hot spring pool
The hot springs were divine. There were 8 or 9 different pools, three with sulfur and the rest without, all between 34C and 41C. What a great way to relax after a 5 hour drive! We topped the evening off with a bottle of Hawke's Bay Syrah and stone-grilled steak at Saint's Restaurant.

The next day I woke up to a request for a family meeting. A mutiny was underway.

"Dad, we can't stand being in the car anymore! We're not having fun and you promised we'd have fun."

Bored in the car
Alright, time to regroup. I had initially envisioned driving the entire circumference of the South Island during our 9 day trip. The kids opened my eyes that if this was possible, we would be spending most of the daylight hours driving. The distances are very large and the roads are very slow, so I had to replan our trip.

I decided that the most southern part of the South Island, consisting of most of the top tourist destinations (Queenstown, Milford Sound, Mt. Cook, Franz-Josef Glacier) was inaccessible to us by car in a 9 day trip and we would have to go back at another time. [In fact, we're flying to Queenstown on March 18 for 5 days.]

So our trip was now going to be covering only the northern part of the South Island. We would go as far south as Christchurch and then head back to Nelson, the area renowned for having the best weather in New Zealand, for a little beach time before heading back to Palmerston North to start work and school.

After the family pow-wow, we packed up and left Hanmer Springs in time to catch a whale-watching cruise out of Kaikoura.

In the summer of 2007, our summer vacation was summarily canceled at the last minute, so we decided to see a little bit of Quebec for a change. We drove as far north as Tadoussac to stay at the fabulous Hotel Tadoussac and go whale watching in the St. Lawrence Estuary. We apparently got lucky as we saw over 40 whales that day. Most were the smaller Minke whales but we saw a pod of belugas and even one of the 4 blue whales that live in the St. Lawrence, although it was so far away that it was hard to be convinced that we were actually seeing the earth's largest living creature.

So it was with some disappointment that I learned that the goal of the Kaikoura Whale Watch cruise was to sight ONE whale. Our cruise left at 2:30pm and a young woman gave a fantastic presentation about the sperm whales that we were trying to find. We heard that there were two in the immediate vicinity of Kaikoura, although one was sleeping. The passion and excitement of the crew was infectious as the young woman described how we were searching for a solitary animal that lives 3 km below the ocean and surfaces for 10 minutes every 2 to 3 hours. When their radar detected a whale on the surface half a kilometer away, she virtually shouted "Whale on the surface" as the boat did a tight U-turn and bolted at full speed towards the whale. Here are some shots of what we saw.

It was pretty cool. The kids got really excited. However the highlight for me was coming up.

After the whale had disappeared back into the depths, we got back into our seats and started heading over to check out a seal colony when the ocean all around the boat boiled over with dusky dolphins (a separate species from the bottlenose dolphins you see at Marine Land). They were everywhere - over a hundred of them!

The massive pod of dolphins frolicked around the boat for about 15 minutes. When they had swum away, we continued towards the seal colony only to stumble (as much as boats can stumble) 5 minutes later onto another pod of the apparently much shyer and rarer Hector's dolphin who also were content to swim and jump right next to our boat. This species of dolphin is apparently only found in the south Pacific Ocean off the coast of Kaikoura.

The captain of the boat announced that we had already exceeded our time and that we wouldn't be able to see the seals. I didn't mind; I was no longer disappointed and Trish and the kids had loved the cruise out onto the ocean.

Besides, as we headed south down the highway towards Christchurch, we pulled over at a widening in the road to find these lazy guys posing for us.

Seals lounging beside the highway enjoying the late afternoon sun
Next post: magnificent Christchurch

Wednesday, February 23, 2011

Disaster in Christchurch

First, a very sincere thank you to everyone who reached out to us to make sure that we were OK.  We've all been touched by the show of concern from our friends all over the world. So many people called and e-mailed to make sure that we were OK. Luc Miron even called us from Mumbai while traveling on business.

Thankfully, we are in Palmerston North on the North Island, 600km removed from Christchurch, well down on the South Island, so we did not even feel a tremor. I was at work and the kids were at school and it was business as usual for the most part other than the horror and sympathy of a tragedy occurring in a far away place.

The Kiwis of course are particularly affected knowing that their countrymen are suffering through an enormous catastrophe, but I haven't met anyone that's lost a relative or friend in the tragedy.

One of my best friend's from residency, Phil Downer, was visiting Christchurch this week to attend his brother-in-law's wedding with his wife and 3 children. They are all safe, although the pictures that Sasha, Phil's wife, posted on Facebook are truly terrifying. They camped out in their trashed rental house last night but are now with family in the suburbs of Christchurch and will be leaving New Zealand tomorrow.

We visited Christchurch on January 15-18 and it blows my mind to think that the Cathedral cafe where we had breakfast on January 16 is now covered in rubble and the Trinity Church, which had existed as the fabulous dinner-show restaurant called Octagon Live, is no more.

We feel lucky to have seen Christchurch as the magnificent city that it was, although are sad that others will never have a chance to see it as we did.

It feels wrong to post blogs singing the beauty of the places that we have visited while the world's media focus is on the suffering in Christchurch, so I guess I'll give it a break for the time being and resume posting in a few days. If you find that my tone is at odds with your feelings about the events of February 22, please don't take it the wrong way. We visited and experienced the South Island before this catastrophe reared its ugly head and the shattering of Christchurch doesn't deflect from the beauty and warmth of New Zealand's geography and people.

Wednesday, February 16, 2011

South Island: the Vineyards of Marlborough

Despite a fairly rigorous travel schedule on our way to New Zealand and the difficulties encountered along the way, I decided to make the most of my last week before work started and on Friday, January 14 we set off to take a tour of New Zealand's South Island.

I'll make no secret of the fact that this was a fairly one sided decision. After living out of a suitcase for 15 days, 15 000 km of traveling over 18 time zones and 5 stopovers, we had only spent two days at our home in Palmerston North and were once again packing our suitcases.

Interislander Ferry
I had a cursory but mandatory interview with the Medical Council of New Zealand in Wellington to finalize my credentials on the morning of Friday, January 14. Once that was finished, we joined the queue to board the Interislander ferry that would take us across the Cook Strait from Wellington to Picton.

It was a beautiful sunny Friday afternoon. The last segment of the trip was through Queen Charlotte Sound, arguably one of New Zealand's most picturesque waterways. Here are some shots.

Thankfully, we got a free upgrade from "sheep class"
Queen Charlotte Sound
Queen Charlotte Sound
Late in the afternoon, we drove off the ferry in Picton and 30 minutes later arrived in Blenheim, the central town of the Marlborough wine region specializing in ... well, they all rocked ... Sauvignon Blanc wines. There are 79 independent vineyards within a 20 minute drive of the city center. Kiwis take their wines very seriously. The University of Otago in Dunedin offers a diploma exclusively in wine - everything from seed to shelf.

Next Year's Vintage
Young Sauvignon Blanc grapes at Cloudy Bay
To say that Blenheim fills the same function as Niagara-On-The-Lake would be a little misleading as there are several wine towns across NZ that would compete for this honor (Napier, Martinborough, Queenstown) and many of the best restaurants in the area are not in town on the main drag, but among the grapes in the vineyards, featuring complete pairing menus with their own wines. But we did see more than a few well-heeled couples enjoying a romantic getaway from the big cities, presumably Wellington and Christchurch.

Feel like a glass of wine?
We got up early on Saturday and despite my objections, the kids decided that it was too early to go wine tasting. So we took advantage of the weather and went on a short hike along the cliffs skirting Queen Charlotte Sound. Here are some pics.

Interislander ferry

Cassandra's shot.

We made it!
Now that we had worked up an appetite, we were all in for wine-tasting. Err ... well, two of us were. But we soon found something that convinced the kids to give us some time sampling Marlborough's best vintages.

House of Sin
The kids trying in vain to score some chocolate

Now it was our turn. We drink Cloudy Bay at our house in Montreal more than any other white wine. I am a fan of white wines and Cloudy Bay's Sauvignon Blanc is second to none in my books. This one was the very first stop (after the chocolate factory, of course).

Cloudy Bay's cellar door
... and right across the street

Hans Herzog, one of the best of the region, especially for reds
After a few hours of sampling wines and pretending I knew what I was talking about, it was time to leave or risk being unable to drive to our next port of call. While Trish and I longed to stay on for the 8 course meal with beautiful wine pairings at Hans Herzog, it was hard to take the $40 kid's menu seriously.

So we headed south to Hanmer Springs, an inland mountain town famous for it's natural hot springs. That and our experience whale-watching in Kaikoura is the subject of the next blog.

Tuesday, February 15, 2011

Medicine Among The Kiwis

This blog is aimed at the medical people. It talks about what it's like to practice medicine, particularly anesthesia, in New Zealand.

This adventure is all about spending time as a family and showing the kids part of the world before they have no interest in traveling with us anymore. But to keep our life going back in Montreal and fuel the traveling here in New Zealand, I guess I have to work. Besides maybe the Kiwis will teach me a thing or two about anesthesia.

So after a couple of weeks on the job, here are some of the differences I've observed.

Palmerston North Hospital
Everyone is very polite! I haven't witnessed any temper tantrums. The anesthetists really take their time and there doesn't seem to be the production pressure that we have in Montreal. The nurses are always ready before I am and wait respectfully before asking if they can "paint". Although the surgeons are around, they don't hover and there is no deep sighing if things take a bit longer than usual.  Everyone remembers my name and the "theatres" are strictly on a first name basis, whether it be consultant (attending), registrar (resident), house officer (intern), nurse, anesthetic technician or orderly.

The day is divided into a morning and afternoon session. The morning session starts slowly at around 8ish. The surgical team will typically cut skin at 8:45! The morning session ends at 12:15 and the rooms never seem to be overbooked. For instance, tomorrow morning in 4 hours of OR time, I have a "Ceasar" and a tubal ligation. That's it! The afternoon session begins at 13:15 and formally ends at 17:15. Overall, I would say they accomplish about 60% of what we would accomplish at home. An American anesthesiologist from Missoula, Montana has noted the same thing.

One striking difference is that the anesthetist never leaves the room, except if they're working with a registrar. Each anesthetist works with an anesthetic technician, but it is the technicians that wander in and out while the anesthetist stays in the room. I've become really good at Sudoko.  I think I prefer the Canadian setup a little better, although the technicians will bring you coffee and cookies into the operating room. There doesn't seem to be any problem sipping a hot cup of coffee while charting the vitals as the surgeons work just over the barrier.

There are no respiratory therapists anywhere in New Zealand. Instead, for the ORs, there is a 3 year training stream that produces anesthetic technicians. For the ICUs, the RNs manage the ventilators.

Morgan in one of the block rooms
The OR block is huge. There are 7 ORs in a larger space than we fit 13. There is a block room outside of every OR, although because it is unmonitored, they usually use it for interviewing patients and putting in IVs or central lines.

Nurses' Hangout

The nurses have an alcove off of each OR about half the size of our ORs to store all their stuff and to open their sets. They sometimes open all the sets for the next patient before the current patient is out of the room. Once a case is finished, the orderlies help transfer the patient to the PACU and the nurses bring the used equipment into a corridor that surrounds the outer periphery of the OR block. I guess sterilization must be near there.

All the garbage and dirty utensils disappear into this corridor.

Each actual operating room is a little less than double the size of most of our operating rooms at home, is very brightly lit and has a long counter for writing on and huge flat screen TV for labs and radiology.

Big and Bright!

The ORs are arranged on the outside of a U-shaped corridor with the recovery room at the bottom of the U. On the inside of the U, at the top, is a reception area, a conference room and the "tea room", a communal lounge for everyone that works in the OR block. There are a limited supply of free sandwiches in the tea room at lunch and people break out a few bottles on Friday afternoon - nothing crazy - to celebrate the start of the weekend.

The urology team getting an early seat for the sandwiches in the "Tea Room"
Next is male and female changing rooms. Next is a 7 bedded pre-op area with the same function as our holding area, but with considerable more privacy and with pretty lax restrictions on the attendance of family members. At the bottom of the U, opposite the PACU is a small office for the anesthetists and offices for the head nurse and anesthetic technician as well as the anesthesia workroom.

Anesthesia Work Room
Although the OR block is a restricted area that can only be accessed with your ID card, you can walk around anywhere inside in street clothes without hat or mask except in the ORs themselves. Inside the OR, the only people that wear a mask are the people immediately adjacent to the OR table - scrub nurse, surgical consultant and registrars; anesthesia personnel and circulating nurses don't have to wear masks except in some arthroplasty rooms.

Wall of surgical "gumboots" that the surgeons wear in theatre
The anesthesia equipment is more or less the same. Aestiva 5's are the standard with a few ORs being equipped with Aisys. All the same drugs that we have except paracetamol IV, PO and PR and IV parecoxib. They've got Sugammadex! Although it's restricted to emergencies only. They also have etomidate, but no one uses it.

Anesthetics are chiefly Propofol, Fentanyl and Roc. Sux is suxamethonium. They have Remi and Morphine, but no Sufentanil or Dilaudid. They use a fair amount of Tramadol but rarely any NSAIDs. They use Sevo almost exclusively, but have Des on every machine; the registrars tell me they've hardly ever worked with a consultant that uses Des - my mission!

Spinals are pretty similar except that their heavy Marcaine is 0.5% and they put spinal morphine into almost everybody. They also very rarely use isobaric Marcaine - always heavy. Epidurals are very rarely used. First, there are no big laparotomies or nephrectomies or thoracotomies. Second, the surgeons are not so keen. For the cases that they do, PCA usually suffices. In three weeks, I've put in 1 epidural and that was more because the lady had an EF of 10% than the fact she was having a hysterectomy. Their epidural solution is 0.2% Ropivicaine with Fentanyl. There aren't any regional blocks to speak of. A few people will put in TAP blocks every now and then and even less will do single shot femoral nerve blocks, but that's it.

Minister of Maori affairs
As far as the patient population is concerned, I find the level of morbidity a little higher for any given age group. Certainly the degree of obesity and tobacco use is much higher than in Canada, especially amongst the Maori's (42% of adults are obese) and the Polynesians (from Figi, Tonga, Vanuatu, etc - 64% are obese). Also, the descendants of a 17th century whaler and a Maori woman represent one of the world's largest concentrations of malignant-hyperthermia susceptible patients in the world! They estimate that around 10% of their OR population are at least MH-suspect. I would say that the chief research interest within the department is MH. My emergency "ceasar" patient from the other day was a 22 year-old Maori woman with a BMI of 59 (shit!), a family history of MH and a difficult spinal for her 2nd section and a failed spinal for her 3rd section. With Ken Kardash's spinal tips echoing in my ears, I snaked a long 26 in on the first shot! Score for McGill Anesthesia!

The obstetrical epidural rate is only 15-20% here as opposed to over 90% at home. The Kiwi women chalk it up to being tougher but I think the source lies elsewhere. In Canada, labour care is delivered by RNs who find that a comfortable patient is easier to nurse, so they sell the epidurals to their patients. In New Zealand, pregnancy care including labour is with a midwife. Apparently, the standard midwife's training does not include the care of a patient with an epidural - this is extra training which most of them do not have. If their patient gets an epidural, they have to share a part of their fee with a midwife who does know how to take care of a patient with an epidural. So, most of the midwives discourage epidurals. All physicians in the public system in New Zealand are salaried, so the anesthetists are not too put off by the low epidural rate. In fact, obstetrics accounts for such a small proportion of the OR traffic that no anesthetist is assigned to OB. If there is an epidural during the day, the Duty Anesthetist (AIC), who never has a list, does it. Ceasarians are done electively on the gyne list or on the "Acutes" list (one OR per day for doing only emergencies).

I haven't spent any time in the ICU yet, so don't have much to say about that other than they refuse most patients over 75 and with any significant co-morbidity. The Kiwi views on death and dying are very different than what we've become used to at the JGH although admittedly even the JGH intensivists consider our practice pretty ridiculous. I'm worried that if I do some ICU over here, I will fill their ICU up with people they would have refused.  The ICU is exclusively run by anesthesia with the same shifts as the OR (morning, afternoon and on call each covered by a different consultant) but since the ICU calls are generally easier (there are only 5 beds!) than the OR calls, most of the more senior anesthetists do their calls in the ICU. That's just the way it works here, although the younger guys complain a lot about it.

Overall, it's been pretty easy to adapt. Why wouldn't it be - the medicine is the same -  and although they have some options that are different than we have, if I wanted to do things exactly the same as I did at home, they are certainly equipped to accommodate me. The only sense of discomfort has been in leaving very comfortable surroundings where I know which surgeons are slow and which are fast and which are morons, where I know which boxes on the anesthetic record and PCA sheets to fill in without really reading them and where I have lots of friends. But it's healthy to leave your comfort zone every now and then and that's all part of the adventure as well.

Next up: I've got some serious catching up on our travels through the South Island, around Palmerston North and to Napier and Wellington.