"Turn your head and cough, please!" Day 4-ever long

Today was a busy day. Started at 6AM and ended at 6PM.

Rounds were completed early today. Booyah. After the morning meeting I talked to the chief because I wanted in on his operation. A Neobladder. I'll explain below. He said he'd page Dr.W when it was time for me to head into the OR. Very friendly man.

WWVD: What would Viktoria do?
It was very important to me to check on the patient that wanted to talk to the pastor yesterday to make sure the nurses had arranged that. Just for the case that they didn't, I took a picture of the flyer and realized that there were two numbers. One if I needed someone evangelic and one for the Catholics. I had to draw her blood anyways so I decided to get all my questions asked. She informed me that there hadn't been anyone religious to see her yesterday but that her daughter had stopped by. I asked her what religion she was so that I could personally call and get a meeting organized since the nurses had failed me in that aspect. I told the patient that I hadn't forgot about her and was on ward personally 4 times yesterday and reminded the nurses that that needed to get done. As soon as the other patients' blood was drawn I called the number. I only got the answering machine but left a message with all the important infos for someone to find my patient. (I stopped by at the end of my day to see if anything had happened. The patients daughter happened to be visiting so I was able to introduce myself to her. I was very happy to see the patient in much better spirits and happy to hear that the pastor had stopped by, he was a very nice man and was coming back tomorrow. Sometime you have to take things into your own hands to get stuff done.)

Neobladder
I was paged into the OR and had luckily completed all my other tasks in time to head down and get changed.

A tip for anybody who plans on being in the same situation as me. When you get into an operating room. Say hi and explain your function. You can only see the peoples eyes and stature so you aren't always recognizable and these people work as a team day in and day out. You are invading. So introduce yourself at the beginning and thank them for their help at the end. It will make your life easier.

I got myself scrubbed in and had the OR nurses help me get dressed. The chief and one of the attendings were the main operators and I got to assist. They were currently removing the patients bladder. This patient had an advanced bladder cancer which is treated surgically by removing the bladder and in the case of a male, the prostate as well. The chief explained a bit to me and also asked me a bit about the anatomy we were seeing.

I luckily didn't have major circulatory issues. That is in part because I've been on my feet the last three days and secondly certainly because of these hot anti-thrombotic socks (I call them med-Spanx). Patients wear them so they don't get a thrombosis from standing, medical personal wears them to keep the blood in the upper body while having to stand for longer periods of time. Life savers.

Another tip, if you are standing or on your feet for a long time and aren't used to it yet, definitely get yourself a pair from the ward. It can help you avoid embarrassing (but also normal) falling over in the OR.

Once the bladder was out, the cool part happened. A part of the small intestine was removed, the other parts of the small intestine just reattached to each other. With the part of the small intestine used to make the new bladder the following was done.

• The tubular intestine was cut through from one end to the other to have a long narrow sheet of intestine wall if you will.
• This sheet was formed into a W and sewn together. So the long narrow sheet turned into a more rectangular/square piece of intestine. 
• The two ends were sewn together to a ball
• The ureters were attached to the top and the urethra to the bottom
• Voila! A new bladder
• If you can't quite picture what I mean (and I'd totally understand) just google neobladder and look at images and you'll get the idea.

It obviously doesn't completely work like a regular bladder but it keeps the people continent with a few things to watch out for on a daily basis.

I could live off its contents for at least a day.

My lab coat. My portable locker and cafeteria. My survival kit. My entertainment.
Thought I'd give you an insight into all of this and all the things I carry around with me.
In the picture:

Top left: 4 pens (the doctors keep stealing mine so I stock up) / 2 highlights for important notes that shouldn't be missed / flash light for pupil exams / mini notebook containing notes, numbers, cash and coffee card / I.D. so I can buy food (if money is on the dang thing) / iPhone (duh!)

Bottom left: Urology book / lab cheat sheet / granola bar / Tums

Bottom right: Stethoscope / water bottle (not pictured, just finished) / keys / alternative iPhone location

It's a bit of weight I carry around but it gets me through the day.

I grind because I want that doctor title

In Germany, you have to do a doctor thesis in order to call yourself Dr. Hasselhof. Otherwise I would just be Mrs. Hasselhof. I want that title. So after the OR and checking up on my patients again, I headed to the lab for 3 hours to get a bit more work done. Not gonna lie, while waiting for my last reaction to finish up, I took a 15 minute nap at my desk. I was exhausted.

Tomorrow I am hoping to get out a bit early to get some hours of sleep in before my night shift starts. We shall see how well that works.

Baci, V