On Ice

On Ice

Tetanus vaccine boosters must be repeated regularly. I can never keep up with the changing recommendations, especially since I have not worked in primary care for a long time, but I think they are needed about every ten years. There are now also stricter requirements for making sure the vaccines are properly sourced and properly chilled, so that they are more likely to work. Fortunately for me, I have managed to have a cut requiring medical attention about every ten years and so my immunisations have been able to be kept up-to-date.

          About twenty years ago, well maybe more, I fell and cut my face at the Avondale ice rink. We had been going regularly to the rink with the kids. This activity started happening in a strange way. We had somehow got talked into attending an event that turned out to be a promotion for a time-share company, something that had been popular in the 70s and 80s but I thought by the 90s would have become so unfashionable that nobody would be likely to take it seriously. This was certainly not the case. There was a colourful presentation by a young man in a cheap sports jacket and a pair of jeans, who did take it extremely seriously, then we were sat at a table with an unconvincing young woman who had recently returned from her own overseas travels and had the job of convincing us of the advantages of part-owning property in random countries. When we remained doubtful, the young man came over and tried to tell us we were depriving our children of a normal childhood by not buying shares of accommodation in places like Disneyland. We had no trouble turning him down, but there turned out to be other advantages. Part of the inducement for attending was a booklet of other promotional offers, including a double pass to the Avondale ice rink. I decided to go skating the next weekend with our daughter.

          Skating was something I had done a lot as a child. Growing up in Central Otago in those days, when it was much colder than it is now, there was always natural outdoor ice in winter. We would skate regularly on the irrigation ponds on the farm. Or at the outdoor ice rink in Cromwell, surrounded by pine trees. It was where we met friends, and where I first heard the new music of the time from the Beatles, or Herman's Hermits, or Simon and Garfunkel. Everybody seemed to know how to skate. It was colder then. At university in Dunedin, we would plan weekend bus trips to Naseby or the Manorburn dam near Alexandra, confident that there would be ice that was safe for us to skate on. I flatted close to the ice rink when I studied in Christchurch, but didn't go there much. Working in Palmerston North, or England, or especially in in the tropical climate of Vanuatu, I forgot about it.

          After coming back from the tropics, we lived in Ranfurly for five years, where it was definitely not tropical. There were good skating facilities, and a few people played ice-hockey, but the real game was curling. I would spend evenings or weekends, mainly with older men, trying to develop some skill at directing the heavy stones. There was much to learn that wasn't obvious, about having the stone the right side up for the ice conditions for example. Most of the time it felt more like organised good luck. Weird Al Yancovic, the satirical American singer, in his song "Canadian Idiot" makes fun of Canadians for, among other things, thinking “curling is a real sport".

          Curling has a strict etiquette, which many of the players seemed to value and even enjoy. All players had to keep to their own side of the ice. No swearing was allowed. And no talk of religion and politics, a rule that I would often like to see extended into other areas of life. When a player did a good shot, the skipper would instruct him or her to "take your partner for a drink," usually meaning a glass of whisky or a special concoction made up by skilled and anonymous helpers. When the going got tough, this rule was loosely interpreted as a drink break being required every time one player of a pair did a better shot than their partner, which was of course most of the time.

          These games were magical occasions. Typically, they would be played on a cold evening on a farmer's irrigation dam, with electric lights strung up in the willow trees, a generator humming, the stones roaring on the ice, and the skippers roaring at the players—"play to the broom", "crack an egg on that one", "sweep it", "brooms up", and "have a drink". There was a proper outdoor curling surface in Naseby, not an indoor facility at that time, where the ice was more reliable but less fun.

If it was predictably cold enough, the curling hierarchy would call for a "bonspiel" to be held at the Idaburn Dam. Teams from all over the country, each dressed in different-coloured jerseys and wearing distinctive hats, would cover the surface of the dam, with their stones, brooms, special rules and special drinks. There was only one such occasion in the five years I worked in Ranfurly. Most years, even then, it was usually not cold enough. On the day of the bonspiel, I cancelled all my appointments and made sure I attended. There is still curling in Central Otago, but now mainly on artificial ice on outdoor and indoor rinks in Dunedin and Alexandra, and on the purpose-built indoor rink in Naseby. I have tried it, but it doesn't have the same appeal.

          We moved to Northland for four years and promptly forgot about ice sports. Then we moved to Auckland, and skating was an activity I never thought of until we got our promotional ticket. It turned out to be an easy trip from our home in Manurewa to Avondale. The moment I stepped on to the ice I immediately regretted the time I had spent curling in Ranfurly and the lack of practice I had had of skating while I had the opportunity. Slowly it came back to me, and our daughter quickly got the hang of it. It soon became a regular family activity. Our two younger children, and eventually my wife, none of whom had ever skated before, started coming along. All three children have since had fun with recreational skating, sometimes in exotic locations, competitive figure-skating, or ice-hockey. But those are their stories to tell. We all went through the Kiwi Skate programme with professional coaches, learning skills I had never been taught as a child.

          My first injury, where I cut myself on the ice, was after all these lessons. For some reason, maybe because it was an evening session, I was at the rink without the rest of the family. I knew how to skate by then, and was probably practising some skill such as skating backwards, trying to dodge the crowds. Like most skill-based sports or recreational activities, skating is addictive. Once you learn to do something on your left foot, you want to do it on your right foot; once you master a skill on the inside edge you want to try it on the outside edge; once you can do something forwards, you need to try it backwards. For whatever reason, I fell flat on my face. I drove myself to the nearby Accident and Medical after-hours centre. I didn't need stitches or dressings, just a clean-up and some soft antibiotic ointment. But I did need a tetanus booster. After that injury, I developed an ugly fat vein on my upper lip, which was tidied up a few years later at the dentist's.

          My improving skating skills were noticed by the ice-hockey players in Auckland. They suggested I take some lessons to develop the necessary skills for their game. I attended the sessions, played a bit of social hockey in the evenings, but never got any good at it. When we moved back to Central Otago, I joined the Alexandra club, played some social hockey in Queenstown, and signed up for the competitive non-checking team at the weekends. I never reached the required level of skill. Most of the players in my team had played representative age-group hockey in the past, were self-employed in some form of trade, and were only in the non-checking competition to avoid the injuries associated with the more gladiatorial full-contact version of the game.

          One year, a couple of us bravely joined the Gore team to play in the Masters competition in Dunedin. You needed to be over forty. Unfortunately, for me, that was my only qualification. Again, most of the other players, many of them with Canadian accents, had played the game all their lives. I needed to be in a separate league for people who had not started playing ice-hockey until they turned forty. It was the first time I have felt really old. I could skate, but the bits of my brain connected to my eyes and ears couldn't work out where I needed to be. There is a famous piece of advice from the great Canadian player Wayne Gretzky: "Don't be where the puck is; be where the puck is going to be." I spent most of my time where the puck had been some time before. "You're supposed to be over there," people would tell me. I knew, but I needed my eyes to see better, my ears to hear better, and my ageing brain to work better and tell me much earlier so that I would have had time to get there.

          My next serious cut was ten years ago. Not from skating or any other ice sport. But it was in winter. We were short of firewood. I went out with the chain-saw to cut up a few dead logs. There was a big branch hooked in the tree. I managed to support it at the bottom end, so as not to get the saw stuck, and cut off a couple of neat usable rounds. Then the top end of the branch, shortened by my efforts, became dislodged and started to fall towards me. Instinctively, so as not to have it fall on my head, I put my arm up to protect myself, rewarding myself with a deep gash across the palm of my left hand at the base of my thumb. I must have looked an alarming sight driving back to the house with one hand on the steering wheel, the other hand soaked in blood inadequately covered with my work jersey, and the chain-saw beside me. I phoned the doctor, who asked me to come in, and did a good job of stitching my cut. And gave me my tetanus booster.

          Once I stopped playing hockey, I skated less frequently. I tried to go occasionally, in addition to walking, running, biking, swimming, and skiing, as well as my farming work. I had the idea that a range of activities would be good for my fitness and balance. I got to the point where I had not been skating for a few years. On a cold winters day, between meetings at the hospital. I decided to give it another go. It would be easy to pick it up again, I thought, like riding a bike—or maybe falling off a log. A school group was supposed to be booked but had cancelled. I had the ice to myself. I felt exposed, on show, like the figure skaters I had seen previously practising their routines, with everybody watching, but without the required skill. It slowly came back to me.

          As I found with other activities, like biking or swimming or skiing, there is a sweet spot between remembering how to do it, and becoming fatigued. I pushed myself do develop a bit of speed and style—there was nobody in front of me—and came off with tired legs. I decided to stop for some hot food, but because the school group hadn't come, they hadn't cooked any. There were no hot chips, which is what I had wanted to eat. I took my tired legs back out onto the ice. More people had arrived on the rink. I spent time looking around me, wondering who else was going to turn up, not concentrating on what I was doing.  My legs tangled while I was doing a tight turn. I crumpled forward onto my knees, as I had been taught, and used my elbows and forearms to break my fall. But I had too much forward momentum. I pivoted forwards over my hands and landed hard on my forehead. It was embarrassing!

          I was not knocked out. I heard someone call out, "Are you all right?” and I muttered something in response. I wasn't sure if I could get up off the slippery ice surface. It was a long time since I had fallen like this. I thought of crawling across to the boards at the side of the rink. Too far. I organised my feet underneath me and willed my now-aching thighs to move myself upright without falling again. I carefully made my way off the ice. blood, I noticed blood pouring from my head onto the ice. The manager at the rink brought me a cloth to contain it. She had a brief look and told me it was a deep gash that would require stitching. I said I would drive myself to the doctor in Cromwell. They wouldn't let me. Someone said they should call an ambulance. I managed to talk them out of this idea. A nice man called Murray took me to the doctor in Alexandra.

          First, I had to get past the receptionist. I had forgotten how hard this might be. Somewhere a few years ago I read an article about an assertiveness training group. More than half the people in the group were there specifically because of problems they had with their doctor's receptionist. At the Alexandra practice there were two of them side-by-side. One of them was busy taking money off an old lady. Holding my blood-soaked cloth to my head, I cautiously approached the other one. "Is it ACC?" she asked. "Yes," I said. "We've got another walk-in," she said to her colleague. Not asking me anything about my obvious injury, she typed in my name and date of birth and discovered my National Health Identification number. "You don't belong to this practice," she said. I explained that I was from the Cromwell area and added what I would have thought was the obvious information that the ice rink where I had injured myself was in Alexandra.

          Someone who turned out to be a final year medical student came and collected me and took me to a room away from the public view. She sat me down. I asked her for a glass of water. A nurse came and greeted me. "Hi, I'm Steph," she said, as most humans called Steph might be expected to do. It made me feel better immediately. Steph and the student asked me about my injury, lay me down and had a look at the cut. "Do you do stitching?" Steph asked the student. To my relief at the time, the student was of the opinion that this one would be a bit beyond her. She went off to talk to the doctor. She came back. "What do you do for a job?" she asked me. I admitted that I was a doctor at Dunstan Hospital. "Leon will be here soon and will stitch it for you," she said.

          Leon came in looking as confident as possible. We are both about the same age, have known each other for years, and have each done a lot of this sort of thing in the past. We asked each other about our plans for retirement. Leon described my cut as a "starburst". He said that he would do his best to bring it together but there would be no guarantees. He asked me if he could inject some local anaesthetic. I told him I would be very happy if he did. Wanting to give him some advice, I told him to think of it as a jigsaw puzzle; if he put the right bits in the right places, the body would do the rest. I was thinking of the quote from Voltaire: "Medicine is the art of amusing the patient while nature heals the disease." The local worked well, and in the end, Leon was happy with his work. He organised for Steph to give my tetanus booster injection and advised me to phone that afternoon to arrange to get the stitches out in five days with the GP in Cromwell. Steph applied a big dressing, held in place by a bandage, which she said was to remain in place for at least forty-eight hours, then I could shower, let the dressing come off, and apply another.

          That year was my year of vaccinations. In the previous few weeks, I had had my two COVID 19 jabs, 26 days apart. I still had the bruise on my arm. The COVID vaccine had been difficult to organise. It is stored at 30 degrees below zero, and at the time we were given it they believed it could only be stored in a normal refrigerator for three or four days. People around the country had difficulty with the on-line booking system. But for our staff immunisation at the hospital, it had gone well. I also get a staff 'flu jab every year at the beginning of winter and was planning to get that in a couple of weeks. My upper arms, to be honest, were getting a bit tired of it all.

          Once I was home, I looked at myself in the mirror. The dressing was soaked in blood; the bandage was huge; I was developing a massive bruise around my right eye. I texted my wife: "I enjoyed my skating. I fell and cut my face and have a bandage on. I'm just letting you know so you won't be alarmed when you see me." She texted back with the right tone of concern and sympathy, but when she saw me later she was alarmed.

          I called the medical centre in Cromwell, as instructed, to arrange to get my stitches out. It was an automated message: "If this is an emergency please hang up and dial 111"—meaning, to me, “if you really have an acute medical problem call a charity.” I had already decided not to involve the ambulance when I cut myself in the first place. I waited for the message to tell me which button to press for a real human to answer the phone.

          When I first worked as a GP in Ranfurly we had a manual telephone exchange. It was the last place in New Zealand, possibly one of the last places in the world, to get an automatic system. If you wanted to place a call, you wound a handle on the side of the phone, and the operator would ask, "Number please?" You gave them the number you required and they would push a plug into a board to make the connection. If that system had continued, by about 1990 every woman in the world would have needed to be employed as a telephone operator to keep people connected. The old people in Ranfurly found the change really difficult. They had got used to calling and asking for "the doctor" and depending on the time of day, revealing a suspiciously detailed and accurate knowledge of my movements, the operators, who were able to listen in to the calls, would put them through to the right place. When the system changed, several people were unable to get hold of me or the practice to make an appointment.

          To talk to a receptionist in Cromwell I needed to press 1. I pressed the right number and after some time a receptionist with a name I recognised answered the phone. I explained that I had some stitches and needed to have them removed in five days. "Did you have them in here?" she asked. "No, I said, "I had a cut stitched in Alexandra," this time not explaining that is where they have the skating rink. "There are no appointments available that day," she claimed. I made one for the following morning. "Make sure you bring your ACC paperwork," the receptionist instructed me.

          I turned up before my appointed time so that they could do the paperwork. Diane the nurse came out to get me, confirmed that they had been busy the day before, and took my stitches out. We spent most of the time swapping stories about what our kids were doing. And Diane checked that I had had my tetanus booster.

          With an increased emphasis on compliance and accountability, the health system has become more complex. I was looked after by skilled, friendly, helpful people, but accessing the help I needed had become difficult. Perhaps it will become easier in the next ten years, when I am that much older, have my next cut, and am reminded that I need my next tetanus booster. I hope so.