The last time I was in the City for any time I was 11 years old. My mom roomed with an exchange student from Finland when she was in college, and they came up with the idea to swap kids. So in 1965 I took my first plane trip with my father to New York City, on my second visit to the City. He was working a packaging show, so he gave me some money and subway tokens, and sent me off to spend an entire day at the American Museum of Natural History. I remember the dinosaurs, of course, but other highlights in my recollection included the Star of India, the Hall of Mammals (the one with the elephant herd) and an exhibit showing giant models of fireflies, termites and ants. The next day my dad took me to Kennedy early in the morning and left me to catch my flight to Finland. I flew Pan Am alone, met my host family and spent 6 weeks there. On the return, their son Toni and I traveled together and arrived in New York in time to be stuck in the City again for two days due to an airline strike. We flew back on the Swiss Air Service, who found us a room in the Bowery YMCA, but we were otherwise on our own. Times were truly different then, and it was safe for two pre-teens to wander the city. Since I had been to New York before, I acted as tour guide to Toni. We took the subway to the Battery and visited the Statue of Liberty, Chinatown, toured the U.N., ate at the Automat, and dodged drunks in the street on the way back to the Y. The subway cost a dime then. Coincidentally, Vicki had similar experiences in the City at the same age. She and her brother Howie had the run of the City while their parents were learning Spanish at Berlitz, preparing to move to her fathers’ new job in South Americal.

We’re now on the plane to Fort Myers, Florida after spending 3 days in New York with Leah. Sunday was catchuponsleep; then Vicki baked cookies all day for the Recital Monday, and I cleaned, gassed and washed Leah’s car. Then Monday she played her Master’s Recital at noon, a program featuring Mozart, Schnitke, Brahms and a modern quartet including a bassoon instead of a 2nd violin. This was held in the local Unitarian church, with a lunch-hour audience consisting mostly of her coworkers from the SUNY Stonybrook Admissions office. We repaired back to the office afterwards, and fed the staff with 12 feet of New York submarine sandwiches, the cookies, veggies and other goodies. We are so proud of her organized, mature approach to life. Her coworkers had tons of praise for her work habits, and Leah’s playing has become outwardly relaxed and confident (although she says it is still very stressful inside). One of the joys of parenting is having one’s child grow up and not need you anymore. This certainly makes it easier to fly to the opposite side of the planet- we both know they would be okay if anything were to happen to us.

Yesterday the three of us took the early morning train into the City. Living so long in “flyover” country, the Midwest, I am very impressed by the sheer size of New York. The millions of people are a huge contrast to Iowa, not to mention the amount of infrastructure. I look out the train window and think, “someone built all of this brick by brick, rivet by bolt by shovelful of dirt”. And walking down the street or riding in the subway I wonder about the life stories of the people. Here are the nannies- African-Americans, Asians and Hispanics pushing the strollers down the street of Central Park West in the crisp early morning light. A crowd of elementary kids play basketball in a fence schoolyard. Businessmen plug in their i-Pods and listen to ..what? I wonder… while riding the subway and reading the sports section. Two guys walk down the street behind us arguing about the Knicks coaching. A Korean women cuts me off as she heads into a posh store, her face so beautiful I am stunned for a few moments after it flashes by me. Old men sit in the winter sunshine on this unseasonably warm afternoon in Central Park, feeding the pigeons. Two little girls are sitting on the steps of a Brownstone at dusk on the Upper East side, running a hot chocolate stand, for $1.50 a cup…

My senses are not swamped by the tall buildings nor the flashing lights nor the noise- I am not the stereotypical Iowa rube, walking the pavement, staring upwards, exclaiming “Golly will ya look at that, Wilma!”. But thinking about all these life stories, not to mention the medical histories boggles my mind.

We spent the morning at the American Museum of Natural History. This was Leah’s idea, after hearing my stories for so many years. And I have to say there was no disappointment. The exhibits have all been redone. As the guard in the Minerals exhibit said to me while we where chatting in front of the Star of India, “When they remodel here, they do everythin’ perfect!”. I was pleased to note that the entire museum reflects current thinking in cosmology and evolution. For example, the dugongs and manatees are included in the exhibit next to the mastodon and elephant skeletons. The birds begin at the end of the dinosaur skeletons, with a discussion about whether or not dinosaurs may have been warm blooded. And the Rose Space center has a wonderful exhibit displaying the scale of the universe, with visual models that provide an excellent sense of the Powers of Ten, from the level of the quark to the size of the entire universe.

Art history buff that she is, Leah’s plan included an afternoon at the Metropolitan Museum of Art. Vicki had visited it during her childhood ramblings, but I had never been here. We enjoyed the Rodin sculptures, the Moderrn art, the Medieval “Angels” Christmas tree, and the Egyptian artifacts. One could become lost in the Egyptian wing, there are so many galleries and artifacts. I had to ask for help to find the famous blue hippo, who is much smaller than I had imagined from the pictures in the annual holiday catalog.

We finished the day by meeting my niece, Karen for dinner at an Asian/fusion restaurant, “Spice”. She is in her second year working in the city as a marketing assistant, and obviously loves it.

Overall the last few days have been a cold slap in the face to my Midwest provincialism. This is a huge, complex, overpopulated City. There is more to History than the settling of Iowa in the 19th Century. It is easy living in the Midwest to forget the larger picture. Yet there is a gritty, hard-working vitality to New York that I admire. It is so alive. It is so changeable. I can understand the attraction it holds for Leah and Karen.

(Pictures for this posting are in this Picasa Web Album. )

The words of the old Peter,Paul and Mary song have been going through my head all week:

Leaving on a jet plane
Don't know when I'll be back again...

"Overwhelming" would be the word that best describes these last weeks in Cedar Rapids. In the nine days before last Monday, I had 5 nights of call, and was up in the wee hours of the morning delivering babies on all of them. This leads to a chronic sleep deprivation that colors all of my perceptions. For one thing, lack of sleep makes me very emotionally labile, so that an old song on the radio while driving between hospitals elicits tears, and I have less patience than usual. Add to that the sense of finality to all things that leaving entails.. So this last week has rushed by in a haze of images and sensations, like a fractured dream. When we finally got into our B&B here in Long Island last night we both fell asleep at 6:30pm and slept for 12 hours.

Vicki and I had a conversation about this change. "Doesn't it feel like planning your own funeral?" she said. "Yes, exactly, only its more like we have had to organize our own funeral and all the other details," I responded. And it IS like that: we've had to get rid of a lot of household items, sell the house, sell the car, cancel insurances, make arrangments at the bank, forward our mail, stop our magazine subscriptions, and disconnect our phone. The only thing we haven't had to do is arrange for cremation and pick out an urn (although I did thow away the papers I have had in my desk forever, for donating my body to the University of Iowa, since I didn't think anyone would want to pay shipping all the way back from Australia). Dying would have been easier!

The good part about it has been having an opportunity to say goodbye to everyone in our Cedar Rapids lives, and to tell them how much they mean to us. I ran out of time to write all the thank you notes I wanted to, but I did hit on the idea of gifting a lot of the little knick-knacks I had on my desk to some of my coworkers. So the "Believe" rock goes to our Program Administrator, and the bendable ostrich to my successor as FPC Director ("so you can do what I did whenever there are problems- hide your head in the sand"), and the fake "arrow-through-the-head" goes to the best boss in the world, Gordon, who is always saying "the Pioneers take the arrows". I tried to write 2-3 notes every chance I could the last weeks, but time ran out. Let me just say that I so appreciate everyone I worked with at CRMEF- a large group of people who are totally dedicated to our patients and to educating our residents and students. I realize that I have been fabulously lucky to have worked with them the last 14 years. For the last few months Vicki has also been saying goodbye to her friends here, having a lot of lunches with the girls at local bars, and frequenting the local coffee shop. We both went to church the last 2 Sundays to also say aloha. We have belonged to a "foyer group" which met monthly for the last 12 years. Until recently we were the youngest members of this group of 6 couples, which has weathered a divorce, a marriage and two funerals of members during that time.

Which brings me back to change. One of my residents asked me how it felt, was I all packed and excited to go? My answer was, "I am actually terrified now, having no regular job, being homeless, and heading half-way around the world to a foreign country." She nodded her head in agreement- "Yes, that is exactly the way I felt when I left France and came to this country, to only stay a short while, and stayed many years.." she said. Which reminded me that we have been wrapped up in this daily, comforting routine which we can no longer tolerate anymore. We have had to change or suffocate. And we are oh so lucky to have this opportunity. Life is short, brought home to us last month by the untimely death of our dentist of 14 years, Christine Waste in an MVA. She was so excited and interested to hear about our trip on my last visit to her. Her loss just highlighted our need to GO even more. If we don't try new things, we don't grow. And if we don't grow, we die.

Last Thursday my co-workers tricked me into attending the case conference, which was a post-mortem on my career at CRMEF. Highlights included embarrassing pictures from my childhood (thanks to Vicki's collusion), testimonials from Residents and finally a mass "light-up" of candy cigarettes in honor of my teaching them smoking cessation
techniques in all their patients. Overwhelmed is the only word that fits. (Check out the pictures.)

So where is Derby, Western Australia?
2391 Kilometres (about 1600 miles) North of Perth, only 13 degrees South of the Equator. (Its closer to Bali than to Perth!)

And how did we end up going to the "back of beyond"? Its a simple story. An Australian physician had worked in Winton, New Zealand a year or two before my stint there. We both knew the local practice nurse, Dawn. I had emailed Dawn that I had a job offer for Queensland, and she passed on that I was interested in Australia to Professor Murdoch. A few more emails ensued, I mentioned that a warm beach would be attractive and the good professor sent me the following pictures:

A week later I received the following description of my post from Dr. David Atkinson, who is the regional coordinator for the Rural Clinical School of the University of Western Australia and University of Notre Dame.

"Hi Chuck

I am the medical coordinator for the Rural Clinical School in Broome and have responsibility for Derby as well. Apart from the Rural Clinical School I work for the Kimberley Aboriginal Medical Services Council (KAMSC a cooperative of Aboriginal community controlled health services in the Kimberley - member services are in Broome, Derby, Gibb River Road communities, Halls Creek, Balgo, Kununurra and a range of remote communities associated with these services). See our website http://kamsc.org.au/

The Derby Aboriginal Health Service (DAHS) is a great place to work and our premier service in spacious new facilities. Derby is a small friendly town (around 4000 people serving with another 4000 or so people scattered across a large surrounding area). Derby is a service centre and base for tourist visits on the Gibb River Road, with easy access to some of the Kimberley's great wilderness areas from late April onwards, after the wet season. Derby has a large jetty into King Sound but no nearby beach, some of the largest tides in the world (second to Nova Scotia I think) and has usual small town facilities, swimming pool, library etc. There is what has been the regional hospital with some speicalists based there and others visiting, that is mainly a Government employed procedural GP run. Everything is air-conditioned because weather is hot &/or wet and humid until mid April and then becomes what I consider to be the best weather in the world - dry, warm and sunny in the day with cool nights for about 6 months before slowly warming up again in October/November. Only 2 hours drive from Broome which is a town of around 15000, popular tourist destination, beaches, cafe's restaurants etc and better facilities than you might expect in a town this size - I have lived here for 3.5 years and intend to stay. Derby people dislike being described as 2 hours from Broome, since they think Derby is better (even the students based in Derby last year supported this view, although they also came down to Broome reasonably often for their fix of western decadence)!

A reasonable plan would be for you to work half time for the Rural Clinical School and half time for DAHS. Currently no on call (while there may be a change at some stage, if there was any on call it would not be onerous). Involves the opportuinity to fly or drive to Aboriginal communities for day clinics (2-3 trips from DAHS per week to 8 different communities, 6 in the Gibb River Road area visited by air and 2 by road - usually shared by all DAHS doctors so no more than one per week) with 50-130 people in each community visited between once a week and once a month) with the main task being to provide a primary care service at the DAHS clinic supported by Aboriginal health workers and nurses. DAHS ideally has 3 to 4 doctors plus with any luck a GP registrar (trainee family physician), they have consistently had one trainee at DAHS over the past few years and would expect to get takers next year.

We plan to run an integrated program for up to 12 students in the region next year - some based mainly in Derby (3 or 4) and the rest based mainly in Broome but with regular interaction between Derby and Broome students and also visits to other towns in the region. Most of the students are 22-23 years old with a smaller number of older students. Students arrive in the Kimberley in late January and leave early November, so if you could start in early Jan straight after New Year you could start to get used to the tropical wet season.

For an alternative look at RCS, from the students point of view, you can check out this video that medical students in Broome posted on YouTube for their end-of-year report.

So now you know what I know about where we are going. Oh, and you can check it out more on the web (if you are really interested), at http://www.derbytourism.com.au/