Letter from America

Letter from America

I promised I would write something for Dunstan Hospital’s in-house magazine Endoscoop about my trip to North America, and it does warrant a more complete description than “following the ice-hockey team”.

There were three parts: the cardiology course I attended in Florida, my time with the team and supporters in St Paul and Toronto, and a few days in the Los Angeles area on the way back. The USA and Canada are such big and diverse countries; I think I got some value out of going to a few different corners.

The course was great. I really did learn some cardiology. It is one of a series put on by Temple University in Philadelphia but they choose to hold them in Sarasota, on the Caribbean coast of Florida, because it is such a nice place. It has a warm climate, shops, theatres, restaurants, beaches, that sort of thing. It seems to be a place where rich people retire or go on holiday, a bit like Tauranga but with a few thousand Puerto Ricans and African Americans thrown in to do all the work.

The presentations were excellent, comprehensive, up-to-date, evidence-based. I got the impression at coffee breaks, however, that most of the participants, in their own practices, would recommend the investigations and treatments they could get paid for, not the ones for which there was evidence of benefit. Did you know that the American Vice-President, following a heart attack, which was probably not all that serious, has an implantable defibrillator (that may explain why he occasionally looks surprised at people’s questions on TV)? There is another five-day course available, if you want to get even more immersed in American medical practice, on how to avoid getting sued.

I learnt some other things about Americans. For example, the majority of adults are now obese, from a combination of overeating and inactivity. Of course, I could have learnt that from sitting at the bus station (try fitting in next to one of the locals on a bus), or at McDonalds, or trying to walk anywhere. The course at the Hyatt was two kilometres from the (cheaper) hotel where I stayed. The receptionist could not believe that I was going to manage it each day without a car. The cardiologists said that they frequently have to use dobutamine to speed patients’ hearts up for stress tests as the patients, the women especially, are unable to walk far enough on a treadmill to increase their heart rate themselves.

The ice-hockey bit was great. St Paul was much colder, a big grey town in Minnesota on the top end of the Mississippi. The tournament there was for twelve- and thirteen-year-olds from different towns around the world: in the USA, Russia, Japan, Korea, Canada and Australia, as well as New Zealand. The standard of hockey was high but our team did not look out of place. The kids were billeted with American families and had a lot of fun.

I should mention the war. We arrived in the States just after they had invaded Iraq. There were times, like in a taxi in Tampa, the day after the President had visited the big air base there, that I would have felt more welcome if we had gone into battle with them. There were certainly outward signs of “patriotism”, like American flags and pro-war slogans (and a brave few opposing the war) on cars and houses, and some people had family or neighbours who had gone over as soldiers.

We had thought before we set out that the tournament might have been cancelled if war broke out. This did not happen. I was encouraged by the Mayor of St Paul, who opened the tournament, expressing his opinion that there could not be a more important time for children from different countries to come together to play sport and get to know each other.

Most people though seemed determinedly ignorant of the issues. They had troops “over there” who had a job to do, which they unquestioningly connected with the September 11 attacks, and they felt they should “get on with it”. The major networks had fairly constant coverage of progress, reporting the casualties along with the baseball scores (Americans in general seem not to be great participants, but they like to know how their team is doing), but with little analysis of the underlying issues. The little bit of talkback radio I heard was awful. The Canadians, especially the French language media, seemed to present a more balanced view.

Back to hockey. The team had a couple of games while we were in Toronto. They made trips out to two small rural communities to play other kids their own age. We travelled in one of those old yellow school buses, like you see on the movies. We also took the bus down to Niagara Falls, which were all iced up and looked spectacular. While in Toronto, we also went to worship at the hockey Hall of Fame, where the Stanley Cup (the major trophy played for in the NHL) is held in a domed sanctuary resembling a cathedral, and up the CN tower.

From Toronto, we had the obligatory few days in Los Angeles, visiting Universal Studios, Disneyland, Hollywood and Venice Beach. I think, after three weeks, most of us, including the kids, were more than ready to come home.

For the adults, there were a lot of late nights, hanging around smokers (like the Japanese supporters, who also kept us awake with their efforts at karaoke), then treks through the cold streets and transfers off the overheated bus in Toronto, at the time at the height of an epidemic, the SARS capital of the western world, into the snow outside. Then, on the way back, we were breathing the smog in Los Angeles. By the time we got home we were all pretty sick.

Our team manager, who works for the more sympathetic (or more paranoid) Health Care Otago in the city, was made to stay at home until she was better. One of the other parents returning from the trip caused a stir at the lab when she came in, mentioning that she was just back from Toronto, for a blood test as part of the investigation for a suspected pneumonia. As a hard-working doctor at Dunstan, as was revealed in the last Endoscoop, after checking in with Infection Control, you just turn up for work. And cover your mouth when you cough.

Thanks to the Company for allowing me the time away and helping me attend the course. Thanks also to everyone who contributed to Gareth’s hockey trip. I can assure everybody that both were worth it.