Friday, July 19, 2013

"Turn your head and cough, please!" Day 5

Coming to you live from my night shift station. Hopefully my two patients will just sleep through the night and I can get some work done. You just never know how the 8 1/2 hours will go. People do crazy things in the middle of the night sometimes. But let me tell you about my day first.

My posse

Rounds were good and we were just a wee bit late for the morning meeting. Probably the most interesting fact from the meeting was that we had an operation happening today because a penis pump dislocated and was actually protruding out of the skin! Obviously I wanted to see that. But first it was off to the wards to get stuff done.

Job description: Vampire
If you aren't lucky and end up in an elective were the doctors don't care and basically just use you, you will be drawing blood all day. Not that fun but great practice. I am in the fortunate position that I have a really friendly team. Nonetheless we are responsible for the blood drawing. I'm quite happy about it because the practice can't hurt and in my other electives I wasn't allowed to even touch the patient (thank you American hospitals). I like drawing blood. Getting a venous catheter in is another story. I really need my practice in that. Anyways, I was happy when I went to draw blood from a patient and he told me I was going to have a hard time since his veins were so bad and it  worked on the first try. The patient seemed more excited than I was telling me no one had been able to draw blood on the first try in 10 years! Booyah!  
Viktoria 1 : Veins 0

Difficulties while drawing blood: If you have a patient that has veins like me or a young male where you could throw a needle from 10 feet away and still hit, you are lucky and drawing blood is easy peasy. Situations in which it gets difficult,
  • Old granny with basically non existing veins (if this is the case, drawing blood from the femoral vein might have to happen. Big ole needle through the groin area. It looks like it should hurt but some patients prefer it so it can't be all too bad. I've personally never done it.)
  • Darker skin color: People usually like seeing where they are sticking the needle which is difficult with pigmented skin
  • Straight up not visible: This is where I give everyone the advice to feel the veins. The ones you can't see through the skin are often the best ones for drawing blood. You just have to trust your visual thinking. But it works, I promise :)
So, when can I have sex again?
Dr. W and I finished up a few patient letters and set up appointments before heading to outpatient care since they were quite busy. Apparently everyone wants to see the urologist before the weekend. A summary of the cases:

look! My outfit goes well with the outpatient floors
  • A man wanting a circumcision because of foreskin tightness. (Dr.W kind of dissed the American's saying if the patient had been born there he wouldn't have this problem since most boys are circumcised without being asked if that's what they want. Can't say I've heard a single guy complain about missing his foreskin but hey, to each his own. The patient responded by saying he wouldn't have minded being born there. I was afraid it was going to turn into a ethical debate.)
  • A man came in and we had no idea why he was there or who had sent him. He wasn't able to communicate with us either. Perfect. We took a look around and I did an ultrasound of his bladder, prostate and kidneys. We couldn't find anything suspicious accept that his penis was a bit smaller than average which would point towards a low testosterone level. We ended up finding out that he was supposed to be transported to his urologist in town for a shot against prostate cancer. This would explain our findings. Prostate cancer patients are given anti-androgens which lower the testosterone level.
  • A woman with bloody urine (I had to go to the OR in the middle of taking care of this patient so I don't actually know why her urine was bloody or what they ended up doing.)
  • An ileum conduitoscopy was performed. An ileum conduit is another form of replacing a bladder in contrast to the neobladder I wrote about yesterday. A piece of small intestine is attached to the outer stomach and is open to the environment. A bag it placed over the opening to collect the urine. The ureters are attached to the ileum conduit on the inside of the body. It looked a bit bizarre from the outside. Anyways, the patient also had bloody urine flowing so the attending took an endoscope to look around.
  • A check up appointment with a young male after circumcision. His main question was when he could start having sex again. His girlfriend was getting ansy after 2.5 months. Oh teenagers...
What is the patient's feeding tube doing?
I headed into the OR to see the second half of the implant removal. I arrived in the OR at the point where they had already removed half of the pump and where working on the other half. It's rather interesting to see how a little pump is implanted into the scrotum and the inflatable tube in the shaft. I just imagine it being too funny to pump up an erection by squeezing the scrotum. But hey....its the result that counts, right? How you get there isn't that important ;) After they had removed the whole pump system (since it was badly infected and the patient wasn't going to need its function anymore anyways we didn't implant a new one), he was given a suprapubic catheter, (The bladder is filled with fluid and then a big needle is poked through the lower stomach to the bladder and urine flows over a tube into a bag.) and sewn up.

All green everywhere

Dr.H is too funny. I was standing by the patient's head with two nurse students watching the operation. Dr.H was holding on to the tube that ran from the scrotum to the penis. As he pulled on it, trying to remove it, he asked us if the patient's feeding tube was moving in further. We three quickly checked to see what the feeding tube was doing not realizing that he was totally messing with us. Lol. It was funny to see how quickly we just obey without thinking about why. He got us.
Dr.H 1 : Students 0 
I really think I'll like working in Urology if those are the kind of guys I'm working with.

I told you it's bad! No's bad!
Back on the ward I was supposed to write a patient release letter. I told Dr.W my German grammar was horrendous and that it would take me some time to get the wording down. He came back so fast though that I had just gotten my rough draft ready (very very rough). He said it couldn't be all too bad and read it. I really didn't want him to knowing exactly that would happen which did. He was completely amazed just how bad it was. He thought I was just kidding. He was quite amused (as are my relatives and friends by my grammar as well.) Of course I don't like not being good at something but honestly people, my German grammar lessons are limited to 4th and 6th grade. I let the people laugh and have their fun and tell them they should speak English or write me a letter and then we will see who's laughing. Being bilingual is a gift but also makes life difficult sometimes because I mix up things from both languages without noticing. A lot of the time my friends will notice and laugh about it secretly or tell me months later after letting me go through life thinking I was saying it right or, if you are like my aunt, will have a good hard laugh at what I said and then tell me and proceed to tell the rest of the family. Dr.W was amazed because he said he doesn't notice anything when I speak to him. I said I just needed to read a lot of release letters to get a gist of the wording and then it wouldn't be a problem. But there is no way I am taking German grammar classes additionally to all the other stuff I have to do. It's just something I will have to work on to avoid another situation like today.

Where is everybody at?!
After that incident, I headed over to the lab to get my reactions from yesterday done. Except for the Professor, no one else seemed to be in the building. It was only 3:30pm. Guess they all left early for the weekend. After 1 1/2 hours I was done and headed home to nap before coming here.

So far my patients are sleeping. Lets hope it stays that way!

Baci, V

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