Thursday, September 19, 2013

"Boom Baden-Baden" Day 4- "will that be all your highness?"

After all the excitement of yesterday, I was tired all day today. 

We showed up for the morning meeting at 8 again. This morning we discussed a poly trauma case from last week. Guy fell while climbing and basically broke every bone in the upper spine and rib cage that was possible. 

Then we dispersed again. It was my day to be with Dr.D. We looked at a few cases before leaving for the private hospital. 

The car ride there was gorgeous. The scenery really is unbelievable. Right along the Black Forest. The little towns had beautiful fachwerk houses with pink flowers hanging from the balconies and along the railing along the water. The towns look like the setting of old fairytales. The ride up the hill was long and winding through the Balck forest. Germany truly is the land of fairytales. Snow White probably lived right around the corner and her friend Cinderella was chillin in Schloss Neuschwarnstein (where I will be tomorrow). I would really enjoy living in this area for a while. I think it is especially nice for kids.

The private hospital is located on top of the hill. Driving up the winding, tree lined alley certainly didn't feel like the concrete pavement that takes you up to our hospital in Göttingen. The hospital is inside of what looks like a hotel. If it weren't for the few doctor rooms and exam rooms, it would be a hotel. The lobby is large and spacious with a winged piano and velvet seats. There is a reception area, a pool, a golf course, fitness studio, sauna and more. There are two suites situated at the top of the building each about 100 square meters large. The "patients" can either enjoy the dinner in the dinning area or if you are too famous or don't want to mingle among others, you can have your food served to your room with lovely silver bells covering it (like in the super fancy hotels in movies). 

The medicine practiced here is very different than that in a "normal" hospital. Here, the "patient" really is king (and sometimes literally are). They want it? They get it? Medically necessary....maybe not, but they are paying customers. I feel there are two kind of patients that visit the hospital. One group really is sick and maybe too famous to get good, quiet help or sick and can get better care in Germany than in their own country. And then there is the group that just has the money and wants to have a full body CT or MRI. They turn into somewhat of their own doctor. They think they know what they need. If they pay enough, they get (almost) everything. Lets just say there is hardly a German name in the mix (unless they are royal, famous or filthy rich). Historically, Baden-Baden is very well known in Russia. The Zars would come and visit there and in more recent times (although there aren't Zars) come for their medical care. There are also a lot of people from the Middle East. Because of all the international patients, there is also a good business for translators. I read one doctors letter that started with, "your royal highness, we allow ourselves to report to you about your stay with us in our hospital..."

As a doctor in this hospital you almost purely provide a service. I don't have a problem with people having a full body MRI if they have the money and are interested. The issue with that is that the risk of being over treated with all the "pathological" things you find is high. I do however have a issue with patients requesting CAT scans for their abdomen and thorax. If its medically indicated, no doubt, do it if there is no alternative. But for the hell of it? I think many just know it exists but don't know how many rays they are exposing themselves to (which heightens the risk of developing ray induced tumors). They didn't study medicine and have the necessary hours to make the right indication for a CAT scan but yet they demand it. In the end, whatever. If I was the doctor and made the risks very clear to them and they still wanted it and are paying the money they should go ahead and fry themselves. I just won't be the doctor doing it.

I do think this hospital is a nice option if you are filthy rich and sick and want a relaxing, quiet place to get your treatment. The view is amazing and I hear the wine and champagne list has the finest.

The coolest diagnostic thing we did today was a virtual colonoscopy. You might think its for people who don't want anything going in the backside but you are wrong because they don't get around that. The correct medical indication for a virtual colonoscopy is if a normal colonoscopy is not possible due to blockage. The patient still gets a probe inserted and the intestine is inflated with air. Then the patient is sent through the CAT scan. The disadvantages to the normal way are the ray exposure and the inability to take a biopsy directly while performing the exam.

After the scan is processed in the computer, it is reconstructed 3D and you can navigate the colon. It looks like a video game.

The other exams were x rays and MRIs. I didn't see anyone being really sick. One had a slipped disk that might be giving the patient some trouble but she indicated pain on the opposite side of the slip. The slip could have been purely coincidental.

It was definitely an interesting day up there. Our lunch was so-so. Of course we weren't eating the 5 star menu. We are the working personal. Anything not in the sight of the customers doesn't look any kind of special. Everything they see looks glamorous. 

Once back in the real world, PKay and I made our way to the trains station and headed to Munich. 

Hopefully the relatives I'm staying with have wifi and I can post a bunch of pictures tomorrow!

Baci, V

Wednesday, September 18, 2013

"Boom Baden-Baden" Day 3.... Help! Get us back!

What an adventure today was.

First of all I'd like to officially wish PKay a very happy birthday. 

We had to be in the hospital by 8 again so we walked over at 7:30 to have a little birthday breakfast. At 8, we walked into the chief's office to find a little cake and a lot of baked goods for the special occasion. The whole team came to congratulate her and ate baked goods with us during the morning meeting. We discussed a few cases and then dispersed. I seemed most motivated of the bunch today because when we didn't have explicit assignments, I went to the computer and looked at random cases trying to figure them out.

The attending came and got us for two esophagus x rays. She even let us try the contrast solution. A iodine solution which tastes really bitter and a barium solution that looks like Elmer's glue. I don't remember eating that in kindergarten but I can't imagine it having tasted much better than the barium.

We spent a lot of time looking for work again. The secretary helped us look for connections to Strasbourg for the day. I also organized my early departure tomorrow instead of Friday so that I can take a friend to Schloss Neuschwarnstein. We had planned on leaving by 1pm today but where still sitting in the noon discussion. 

Finally, they released us to have lunch. Since we had missed the train we wanted, we still had 1.5 hours before leaving for Strasbourg.

Strasbourg is in France. Everyone told us we had to go because its so lovely. Luckily, it wasn't raining when we left. It was downright pouring when we got there. So much so that I finally bought myself an umbrella. 

We waited for the worst to be over and then explored the city. It really is a nice place. Probably even nicer when it's not raining. I'll post pictures once I have regular wifi.

We had yummy cake for PKay's birthday and at night we ate in a local restaurant. We didn't check when the last train left but knew one ran every hour. 

When we got to the train station, we headed to a machine which told us the next rain didn't leave until 6:22...the next morning! We freaked. I went to the ticket office which was luckily still open and got us the last connection tickets. The train wasn't running the first part so we had to catch a bus to Kehl. We got the ticket 2 minutes before the bus departed and luckily made it.

In Kehl, we had to wait 20 minutes until the train left. That took us to Appenweier. Appenweier is in the middle of no where without so much as a store to buy something warm. We had 1 hour and 15 minutes to kill there before the next train finally took us back to Baden Baden.

We weren't about to take the bus and then run up the hill so we spoiled ourselves and took a taxi for 10€.

It was a long and tough but also enjoyable day. Now it's quickly off to bed since we have to be back in the hospital by 8!

Baci, V  

Tuesday, September 17, 2013

"Boom Baden Baden" Day 2... Boom as in more rain...ugh

Another long day in the hospital is over. Today it was PKay's turn to go to the private clinic with the chief. In hindsight, she wishes she would have let me go instead because there was a little photo shoot that happened for the website and she had to pose as a patient. Her response to the chief after he asked her if she'd be willing to do that was, "oh that's really more of Viktoria's field." Lol, now she had to suck it up and do it.

On the other side of town, G and I hung out with Dr.D. He is very chatty. The chitter chatter is often not necessarily radiology related. We did look at a few cases and wrote our reports. Since we weren't running from A to B all the time I became very tired. I kept running over to the secretary's office to get coffee and snacks to keep me awake. 

At some point, Dr.D left the room to take a call and told us to have a look at the CAT scan. They use a dictation device here in the hospital which you speak into and it writes it into the computer. We obviously used this opportunity to try it out. It didn't work well at all. We tried multiple times but the results were always nonsense. Dr.D told us that the devices are trained to their voice. Since he has a very strong southern German dialect, it was no surprise that our clear [ ;-) ] northern German dialect showed bad results. 

After the afternoon discussions with the pediatricians and neurologists, G and I were let go to have lunch. I was starving. Being bored makes me hungry. I had a large portion of Käsespätzle. It's a southern German dish consisting of a special type of noodle mixed with basically the German version of Mac and cheese :)

After lunch, G and I worked on the cases. Chief had told us about them yesterday. We are given cases to look at and have to do a bit of diagnostic work up. G kept falling asleep while I tried to figure out what our ailed patients had. The five cases were all different kinds of brain bleeding (epidural, subdural, intracerebral, subarachnoidal) and the last was a poly trauma patient. I wrote down all I could find in the hopes it would be enough. We were done at about 2:50pm. None of the doctors really felt obligated to take care of us. We asked the secretary when we could expect PKay and chief back and I texted PKay to text me when they leave the clinic. The secretary said he should be back by four. Since we were both so tired and since no one seemed to know what we were doing or where we should be, G and I headed back to our respective rooms and took a nap before heading back to the hospital at ten to four. We were back in our work room looking at a few other cases when two of the doctors came and checked on us. They probably even didn't notice that we were gone for about an hour. The resident said we should just go home since its so late but we said we'd better wait on chief. 

I was in contact with PKay regarding their arrival time when she told me that the chief had let her go and we should come meet up with her. So we left.

We headed into town for a bit of shopping. Or window shopping in my case.

PKay and I ended up going into the Caracalla Baths. It's a nice spa like environment for 15€ for 2 hours. We relaxed in the warm and hot waters and I checked out the aroma therapy and sole inhalation rooms. All very nice and relaxing. Afterwards we headed back out into the rain and back to our humble abode.

It's PKay's birthday tomorrow and we only have a half day so we are taking the time and traveling to Strasbourg in France (one hour train ride) to celebrate. Hopefully the weather will be nicer than here.

Baci, V

P.s. I apologize for the lack of pictures and untidiness of my blog. I am working purely off of my iPad and with my phones bad 3G connection as my Internet source. Sorry.

Monday, September 16, 2013

"Boom Baden Baden" Day 1 I thought this place always has nice weather!?

Boom Baden Baden! (We wanted to make T-Shirts)

Pkay and I made it to Baden Baden. The journey here was quite comedic. The train was so full that we had to stand for the first 40 minutes. The AC broke down on the train so they handed out water for free. We get to Baden Baden and the people are all super unfriendly and pushy. We catch our first bus to the point we have to transfer. The next bus wasn't going to be there for another 20 minutes and so we decided to walk to the hospital. We are in southern Germany, which means basically everything is on a hill. I only had my purse and a weekend bag but PKay had a huge suitcase that needed to be transferred up the hill. We took turns pulling it up. We were exhausted by the time we got to the top. The reception gave us our keys and told us where our apartment was... down part of the way we had just walked up! The room is a nice size but there is no TV or Internet! However, we had coffee, tea, milk and cookies waiting for us.

We quickly got situated and headed into town on the bus. Sadly it was raining (which turns out isn't a rare thing for this week although my former roommate kept saying how wonderful the weather is in southern Germany....mmmhmmm.) We walked through the streets looking for a good restaurant. None seemed cheap... But we are in southern Germany so I don't know why we would expect anything else. We ended up in Le Bistro. A French style restaurant with French pricing. We had a small salad and a really delicious pumpkin soup. I couldn't even finish all of it so it was worth it in the end and not as expensive as I had feared it would be. We used their Wifi for a bit hoping it would be enough to download a movie for the night but we had to leave and catch the bus back.

We met the other student here for the course before heading to bed. I slept like a rock. I don't even think I dreamt anything because I was so exhausted from the weekend.

This morning we showed up in the radiology departed. The secretary greeted us. The chief came a few minutes later and welcomed us to the week long class. He is a very nice guy who clearly enjoys teaching. He showed us the facility, the colleagues and explained what to expect during the week. There is a private hospital nearby that we each will visit a day. Apparently it is run like a 5 star hotel. I will probably be going Thursday. G (the other student) went today. PKay and I stayed in the hospital with the chief.

The morning was spent looking at cases, doing a kidney puncture, swallowing diagnostic and mammography. About an hour into working, we were called to do a shock CAT scan. The man had fallen from 5 meters. We were told he was just found somewhere without a wallet or any form of identification. Just for this CAT scan, 13 people were standing behind the glass window. Doctors, MTAs, us students and the emergency crew. It's insane to see how much know-how from so many different people is used to save one life, everyone's full attention is on that one human being.

We had meetings with a few of the other departments to discuss their radiological findings and then were let go to have lunch. We get free lunch and the food is way better than the food in our hospital. Sadly, I am still not able to eat large amounts of food and therefore I always have a bad feeling leaving food on my plate. 

The second half of the day was spent doing ultrasounds on various patients and looking at other cases. PKay and I thought we would be out of there by 3pm at the latest. The chief had a meeting at 3 so PKay and I did ultrasounds on each other. I can say my liver looks good, my kidneys healthy and I am not pregnant. 

At 3:30 we went to see if the chief was back yet. The great thing about his secretaries, besides them being very nice, is that they make us fresh coffee and give us candy. Once chief was back, we went through a few more cases. He said we'd be done by 4 since he had an appointment but we were still looking at x rays at 4:10 until his appointment knocked at the door.

We had planned on going back into the city. The weather was crazy bad though. We walked down to the grocery store with the intention of going into town first but it started to rain so bad that my feet and pants up to my thighs were soaked. All we did was buy food and walked back to our room without tv and Internet. I personally could just lay down and sleep but understandably PKay would not be too amused about that. 

Tomorrow we don't have to show up until 8:30. Thankfully we don't have to sit in a dark room all day and I'll get enough sleep so that I don't feel like falling asleep all the time.

I'm going to try to download a movie with the hospital Internet (which I have to pay for!) for tonight. Sadly it tells me it'll take 250 minutes to download :(

Baci, V

Friday, September 13, 2013

"Doc meets Dorf" Day 9 -- No, I am not the new doctor, calm down.

Due to Dr.D's niceness of letting me come into work 2 hours later and us getting through the patients quickly and no house calls being requested, my work day was only 3 hours long.

The 2.5 hours of sleep I got made a world of a difference in how I felt today compared to last Friday. First up was a complete physical for me to do. Nothing suspicious was found. 

The other patients where quick visits as well.

There was a call that came in where a mom asked if I was the doctor that would be replacing Dr.D. Lol. She was asking because her 19 year old son would rather go to a male doctor. Oh kid, first of all, suck it up and secondly, you are 19 and having your mom call? Oh and thirdly, I've been clearly wearing a name tag the last two weeks with my name and "Medical student" written on it and we always introduced me as a med-student so learn to pay attention. Puh.

I had finished my log book today at 3:30AM after my non-breathing patient was on IMC. Dr.D had to look through them and grade the reports. He also had to evaluate me online. I am very happy with my grade :) I thanked him for the great time and that I felt very comfortable in the office. He was also very satisfied with my work and attitude and was sad I was leaving them. So was I.

I also thanked the doctor's helpers for their warm welcome and hospitality in the office. They were also sad I was leaving and the one said that I was the most involved, friendly and motivated student they have had in the office. It always makes me happy when people acknowledge my dedication. I quickly had Dr.W leave his examination room so that I could personally thank him for his help in the days Dr.D wasn't in the office.

And then I was on my way back to Gö.

Conclusion of the two weeks: as you can probably imagine, I love the little city. The people are all very friendly, yes there are some rather weird people as well but where don't you find people like that? I was pleasantly surprised with many of the nursing homes. I loved seeing the great relationship the two doctors have to their patients. I enjoyed getting on the train in the morning and being there. I could see myself also being a family doctor but I also have been missing the OR quite a lot. So even though the last two weeks were lovely (minus the lack of sleep and cold symptoms) I will still most likely be going into urology. But nothing is set in stone.

Stay tuned next week for my adventure to Baden-Baden with my friend P-Kay as we go to southern Germany for a week of diagnostic radiology.

Hope I could give you a little insight into the world and relationship of a family doctor and the importance they have for the patients on a daily basis. They have a lot of crap to deal with and have to keep an overview of everything happening medically to their patients. So the next time you are at your GPs, thank him or her for the work they do. It takes a certain personality to do the job and choose to work like they do.

Until next week!

Baci, V

Thursday, September 12, 2013

"Doc meets Dorf" Day 8 -- Oh, so I'm really that weak.

After a good night sleep, I still felt crappy. Few more symptoms but no days off and off to work.

Since it's Thursday, I was picked up at the train station by Dr.D and we went to draw some blood on house calls.
For some reason I really like these tress. Random fact.

In my favorite nursing home we go to, the nurse was so nice and gave us coffee. I usually don't drink coffee during the day before my night shift but it was cold and icky outside and I could basically sleep while standing so what the hell.

No longer summer....layers layers layers.
Back at the office we were back to the grind seeing patients. It seems that every patient mentions Dr.D's leaving the office. The reactions are all very different. Some say he is not "allowed" to leave, some say they totally understand and some say they at least thought he would be around until they weren't.

When it came back to the actual reason for the visit, we had a lovely mix of GI-tract, heart issues, lung problems and wounds to be taken care of. Two people came in with the exact same symptoms that I have and got sick notices until Sunday. As lovely as that sounds, I have to many things to get done and would hate to miss. Also, in my case of the night shift, I would hate to say I'm not coming and then have the management have to look for someone last minute. Not many people enjoy last minute night shifts.

Also love these lined up trees in Germany. Another random fact.
Dr.D was very generous and let me leave early to get some sleep in. He mentioned this 7 minutes before my train left. I quickly grabbed all my things and ran to the train station. The train station is only about 250m from the office. I ran over...and felt like I was going to die. The last 30m I honestly thought I wasn't going to make it to the tracks. I arrived 2 minutes before the train was supposed to leave but it had a 5 minute delay. I needed that time though to recover from the run. My heart was burning. I guess I'm a lot weaker right now than I thought.

Now I'm back in the hospital for my night shift and it has been calm so far. Good time to catch up on paperwork, research and talking to some friends back in the states. Dr. D said it would be fine if I came in 2 hours later than usual so that I could get some sleep. Three hours sleep sounds a lot better than none. Tomorrow is my last day in the office. On Sunday, I head down to Baden-Baden for a week long diagnostic radiology internship with my good friend. Due to the night shift, I don't have time to get something baked for the team. Maybe I can work something out last minute.

But first it is 6 more hours here :)

Live from the UMG

P.S. I clearly spoke too soon, about 2 minutes before wanting to post this, one of my patients stopped breathing and we have been dealing with that the last half hour. Always exciting.

Baci, V

Wednesday, September 11, 2013

"Doc meets Dorf" Day 7 --- So, you think you are sick?

I'm not a fan of colds. I'm wearing three layers of (white) tops and a wool scarf. There is no time to be sick. Too much happening.

Today was a relatively calm day. We didn't have too many walk-ins. That was probably due to the terrible weather. (also the reason why this post is picture free, sorry)

At this point, I know about every third patient we see. A lot come back for check ups and wound care. 

There was a little excitement when one of the patients fainted while having her blood drawn. (Easily entertained in that setting I guess)

Two younger patients came in today (independently). They described their symptoms, one with a cough that is in the morning and at night but won't go away and a another with GI-tract problems. After examining them, we didn't find anything. Just before we wanted to say good bye they asked for sick notices. One for court and one for school. Hmmmm.....weird how that came last minute. I don't want to say they were necessarily lying, I don't know what they are feeling but it was rather suspicious. Especially because for us, they were each two healthy people sitting in front of us. Maybe the court date gave the patient GI-tract issues but they didn't seem so bad that you can't go to court. And the other patient's lungs were so clear on auscultation and nothing in the throat that it seems unlikely that he is coughing nonstop all night and can't study and thus needs a sick note. In these situations, we kind of have to give them one. But the one didn't get it covered for the exam he missed yesterday (should have came yesterday if it was really that bad. So now he has to deal with a missed exam.)  I am sure court is not giving in that easily either and the patient will eventually have to show up. Just get your stuff done kids, do not let a sick notice be your excuse if you aren't sick!

We did two house visits in the afternoon. Both with old grannies that weren't quite all there. It's cute to see how a lot of the old ladies just start glowing when they see doc walk in. Since the weather was so bad, we had trenches on. Walking in and out of the places, with all the faces turning to us made me feel like we were in a slow motion clip from a movie where very important people walk into the room. Lol, sounds ridiculous but that's just how my brain works.

Like this, but less guns and more elderly people.

We were done with everything early enough for me to catch a train home earlier. I'm quite excited about these extra 60 minutes! Off to my warm bed with some tea and force my body to stop being sick ;)

Baci, V

Tuesday, September 10, 2013

"Doc meets Dorf" Day 6 -- stop it immune system, you're embarrassing me.

Gosh darn it. I think all the sick people are making me sick. I started feeling a cold yesterday and had difficulty breathing normally when I went to bed. Great. During the course of the day it just kept getting worse. I was about to ask Dr.D if he'd prescribe me the pills and sprays we prescribe the patients when they come in. But I don't like medication. The patients usually come for a sick notice anyways. Don't think I can ask Dr.D for that. And I don't want to. So toughen up immune system. We ain't got time to be sick!

How I start my day in the office.
Last week was full-on hot summer and over the weekend we have arrived in late fall. I was freezing all day again. 

The days seem to go by quicker now. 

Patients in the morning and house visits in the evening. Nothing spectacular happened in the office and nothing crazy in the nursing homes. But let's talk about the crazy interior design of these nursing homes.

I am amazed at how different all the nursing homes look. The only thing that seems to be the same is the hospital bed in the rooms. Most of the interior decorating seems to be a mash up of all the furniture from all the residents. Or anything that was on sale and decorative in the store. There isn't really a theme. Maybe the residents like walking around and seeing furniture similar to theirs but I don't understand all the big dolls all over the place we went to today. At every corner, there was a bigger version of the American dolls. It's a bit creepy. And the residents aren't little kids so why are the hallways decorated like a child's room? 

I will say that the lay out of the apartments on the most part are nice. To the point where I would like to have the same apartment.

Speaking of own apartment. Another issue I'd like to share with you all is about being understanding

Very often I think about how my life would be easier if lived alone. My roommates are both great girls but its just not my lifestyle anymore. I need to be able to do the things on my own time and terms.

A big reason, what I feel, is lack of understanding from their side. They both obviously have stuff to do but more often than not I see them enjoying life. This is completely OK and I am happy they are content. I am content too (in most aspects). I chose this life style. I don't blame anyone, I don't want sympathy from anyone. I want understanding. I chose to have this much work (it's just part of the dream), I chose to be good at what I do, I chose to be social during my day of work and I chose to take extra classes and be involved in organizations to expand my horizon. I don't think I'm better than others because of this. I do it for me and I do it for my future patients. I don't have a problem with my life being stressful. 

I have a problem with people creating unnecessary stress in my life. I hate gossip. (Don't spread rumors if you don't know what's going on. It's unnecessary) I hate little problems being blown out of proportion. (Little problems are problems too, it's how you deal with it.)

I deal with very sick people on a daily basis that wish nothing more than to see their kids but they have leukemia or would love to be able to walk again (that isn't meant to sound sappy, it's just supposed to help put things into prospective).

The problem with certain people in my life is that they are not very understanding. I get this feeling from my roommates sometimes. 

For a long time, I had a problem with one of them because she thought I was not interested in her life. Wrong. She thought this because I would come home and go straight to my room, not leave and then go to bed. So in grave detail I had to explain that the second I come home, I sit down at my desk and study for hours. I'll grab something small to eat quick and eat that at my desk because I still have research papers to read, lessons to prepare and courses to get ready for. From there, I fall into bed and the whole thing starts again the next day. Again, I don't want sympathy. 

Since explaining this to her and letting her know that I am not sitting in my room bored and avoiding her, we haven't had problems in that regard.

Then they want to require the cleaning be done by Friday before the weekend. Ummm....have you noticed I leave the house early and don't get back till late.... and that's only my unpaid job. There is no way I'm agreeing to that. I mean, am I wrong? They told me I had to make time. Well, if it happens a day earlier or later, you will just have to live with that because I don't have all day. (And they aren't the angles in regards to cleaning either)

(obviously not every single day is packed from beginning to end but I also enjoy a little break once in a while.....sue me.)

I hurried back from work yesterday to be on time for dinner and the people who don't work get there 15 minutes late. I guess I can't apply my own standards to others but then please at least have the courtesy of understanding my time schedule.

My life would be a lot easier if there weren't situations like that. The next year and a half will nonetheless be nice with the two of them (I'm hopeful) but they will have to learn to understand. 

In conclusion, if everyone is a bit more understanding of their fellow humans, this world could be a bit more pleasant. Lesson done for the day.

I really hope this little cold is gone quick! Otherwise my night shift Thursday might not be so fun..


Baci, V

Monday, September 9, 2013

"Doc meets Dorf" Day 5.... Do I know you?

Another day, another dollar! .......wait, I'm not getting paid. :(

In comparison to last week, Mother Nature decided to be pissy this week and have it rain. No morning commute with the bike is fun in the rain.

Today was my longest day in the office. 8am to 5:40pm. It would've been there longer if I didn't have a dinner to go to at 6. 

This morning on the train I was looking to see how much time I could miss of the two weeks. While looking for this information, I found out that there is a log book for the internship. Well thanks to no one for ever telling me that. Luckily I only have to write up 6 patient encounters (four of which I got done on the train to work). 

We started punctually at 8:30 again and started seeing patients. This went on to about 1:30PM. I've apparently been in the office long enough because I am starting to see patients again from last week. It's funny the tid bits of information I remember about the patients. It gets even more interesting when I all of a sudden know more about the patient than the doctor because the other doctor saw the patient the last time and now the patient was with the other one. 

I got to question and examine two patients again today. One man with a hurt knee that I correctly diagnosed and a man with GI-tract problems. 

Today I finally had a lunch break. I went into downtown and found myself a grocery store to buy a salad. I need more vegetables in my life. All these baked goods I've been buying (out of convenience) just aren't doing it for me. I sat down by the church and did a bit of people watching. I came to the conclusion that all the people in this town are either way younger or way older than I am. Not a single person looked to be my age. It's actually quite sad. I keep wishing this town had a university because its so pretty!  I seriously think I'm a bit in love with the architecture of this town (I've probably proclaimed my love 4 times already in this blog, lol). Today while doing house calls we drove by some gorgeous houses. If I ever win the lottery I am buying a house there just for the hell of it! 

When I was back in the office we did the house calls. Two patients had to be seen. The first older lady is living in the apartment above her daughter. She was so confused and disoriented that we decided she needed to go to the hospital. Her daughter has a chronic illness herself and is now to the point of not being able to take care of her mother by herself anymore. I felt really bad for her. Not only was she dealing with her own sickness but also the severe sickness of her mother. She wants to help her mom but in her state she's just become to weak, I can't imagine how awful that must feel. Her mom just kept looking at me during the visit and then finally said she recognized me. I told her that can't quite be true since I've only been there a week. (FYI, she had a great glamor shot on the wall as well)

The second older lady is living with her son and daughter in law. The daughter in law was there with us. The old lady has somewhat severe dementia. She broke her arm and wasn't complying with the sling. A positive aspect of dementia (if there is even one or can be put that way) is that they seem to recover quickly from injury. It's not a central topic in their daily life so it doesn't become such a mental fixation. I they move the injured body part and it hurts, it does for a bit but then they forget that again. She was using her arm almost as though nothing has happened and it was healing nicely. You also have to weigh the benefit of physical therapy with a patient with dementia and maybe better movement over not putting her through unknown situations and having her get by just fine in life (I don't think she has the ambition to become a pro athlete anymore at this point). She also seemed quite aware of my presence and kept looking at me. At the end she also said that she seemed to know me from somewhere. Do I have such a generic face?!

We headed back to the office for a few more appointments. Dr.D also dropped a surprise announcement on his team today. He is going to retire by the end of the year. Of course everyone should retire at some point and enjoy their free time but I to also a shame that such a good doctor won't be working regularly. Makes me think of what kind of impact it has on his patients. Especially the older ones that he has known for 15 years. Sure the new guy or girl will know the medical infos from the computers but there is no way that person can know the last 15 years of that person's life, family circumstances and life events. So the word was out. Dr.D told me that there had been rumors going around town before in the last years that he had retired but now it was official. As soon as we has our next patient, his retirement was already a topic of discussion. I assume this is how it will be from now on until he actually leaves. His reason? Well, first of all his age and second of all, to put it in his translated words, "medicine is a wonderful thing but I've gotten sick of the surrounding circumstances. I'm over fighting with the insurance companies all the time." It's unfortunate that the system has gotten so whack that it will actually convince doctors to go into retirement. 

I asked if it would be okay to miss the last scheduled patient so that I could hop on the train back. I didn't want to miss my train and be an hour late for my planned dinner. As I've said, I really try to stick to my commitments because I know there will be enough instances in my life where it won't be as possible. Unfortunately I don't have enough time to stop by my apartment and change. I hate walking around in white running shoes unless its in the office or hospital. On well, at least they will be hidden by the table.

Baci, V

Saturday, September 7, 2013

"Doc meets Dorf" Day 4 (or continuation of 3?) -- 4 of 41 is not a high percentage.

Well hello world. I hope you can excuse the tardiness of this post. Yesterday, well, yesterday and the day before, 41 hours, I only slept 4. I was not capable of thinking last night, let alone write a post. But here it is in all its glory and now you have a little something to read on a Saturday :)

The rest of the night was good. My patient only tried leaving his bed multiple times but for the most part, I was able to get work done.

Once done with me shift, I took a shower and had breakfast at home and was off to the train station again. I had survived the night with out coffee or energy drinks so I thought the red bull shot I took in the train would definitely get me through the day feeling good. (Wrong)

I was working with Dr.W again. I tried to find a good way to inform him that I hadn't slept except for two hours the day before at 5pm. We started seeing patients at 8:30 again. The first ones went fine and I wasn't feeling too bad but definitely not awake. After some patient, I said I finally felt the tiredness kicking in. What did Dr.W say? "Too much partying last night, Ms. Hasselhof?" .........ugh.....No! I was working for gods sake! I really think I need to start partying again because apparently everybody just assumes that's what I'm doing anyways.

Patients just kept coming in without appointments. Get all the problems dealt with before the weekend I guess. 

It started getting really tough to pay attention or answer questions. I was surprised just how well my brain actually was still working when it came to questions. But sitting there was the worst. My eyelids kept wanting to fall shut. But even if they were closed for a sec, I was in danger of falling into a full on deep sleep. There were points in some of the conversations where I am pretty sure my brain shut off for a few seconds because I found myself following the conversation again and being confused as to how we got to that point.

I was banking on the doctor having a bit of sympathy for me and letting me go after the appointments and walk ins. No chance. To be fair, once we were over the point of sitting and examining patients, I was quite awake again. The doctor's helper even made me a cappuccino. We then headed to do some house visits and a postmortem examination.

The appointments went as usual. Interesting mix of things, a few things having to be treated and a lot of psychological things. Dr.W (being the chatter he is) always gave me a summary of the patients life and the interesting connections to other people. 

(While writing this, I thought, oh dear, people reading this that aren't in the field probably think we are a bunch of gossipers and go around telling everyone everybody's deepest secrets. No, this is not the case. Yea, we doctors know a lot about the patients lives, especially general practitioners, but the things Dr.W tells me are actually relevant even if it isn't a lab result or x ray image. The details of the patient's life, social life and surroundings are very relevant to the treatment options involved. The GP will be the best doctor to be able to say if his patient is able to handle a certain treatment plan or if certain circumstances in treatment work with the patient's life style. To add to all of this, whatever Dr.W tells me falls under doctor patient confidentiality and I can't tell anyone else. So don't worry about telling your doctor something and don't think it could end up on some blog of some med student some won't. Unless someone wants to go to jail.)

Our first stop out of the office was at one of the nursing homes to do a postmortem examination. Dr.W had told me a little about an older man who hadn't been doing well lately and how he also treated other family members. My brain must have been off at the point he told me the man had died and we were off to do the postmortem exam. In the ca,r I asked him how the patient was doing now. He was like, "he's dead". Oh. Oops. I told him my brain must have missed that vital piece of information. 

In the nursing home, we went to the room. It was locked. (Understandable. With all the confused older people there, I don't think it would be uncommon for them to walk into the wrong room and no one wants to walk in and see a dead man there. We did the exam and filled out the papers. Dr.W had said I could take the train an hour earlier than usual. We didn't start filling out the papers until 5 minutes before my train would have left though. He just looked at his watch and looked surprised. I told him at this point, an hour more or less wasn't going to make a difference and I would just leave as usual.

We visited two more ladies. So sweet but they also complained to Dr.W that he hasn't come to visit in a long time. One lady was 98 years old and sassy as hell. Dr.W already warned me before entering that she would probably complain about him having not visited. And so it was, after greeting him, that was her first complaint. She also had a beautiful glamor shot of herself on her wall. Along with pictures of what I assume were her husband in the military and her family. I can only hope that I am as sassy as she is when I'm 98. Doc did the routine exams. She asked me if I'd be so kind to help her get all her shirts tucked back in when he was done. Of course I helped the lovely lady. I love how old woman still make sure they look good. 

The other lady was also very sweet. She offered me to sit (as most of the others do as well but I usually say I'm fine standing because I feel weird chillin on the couch while doctor works and the patient is usually in their wheel chair.) All of these people probably have the coolest stories to tell about their lives. I could easily spend the afternoon just listening to their life stories. Younger kids usually think they are so cool and don't have the time for their grandparents. Out of routine living we often don't take the time to really listen to them because they require so much help often that our mind puts them into the same category as children. But the elders have lived such a long life, made mistakes, learned a lot and have had so many experiences that I can only advise you to take the time (while they are still amongst us) and ask them about their lives and the things they experienced. It's so much more real than any film that takes place in that time. 

I can speak from experience. I lived with my grandparents for two years in Germany to attend school and learn the language some more. During that time they were my parents, the summer visits after that the atmosphere felt the same. Nowadays, sadly my grandfather is no longer alive. When I do visit my grandma though, I often ask her about her life. I only know her as my grandma and the setting she lives in now, but there is obviously so much more life she lived before I was here. She fled during the war. The boat they fled on almost went down with them on it. There is so much to be told. It's interesting to hear how they lived in comparison to how they are now. So I urge you to pick up the phone, call your grandmum or papi and ask them what they were up to this time of the year 50 years ago and see what they have to say.

We stopped at one more place before I jumped on the train. The house was located right across from the train station. It looked lovely from the outside and it most definitely was from the inside. High ceilings, large windows, a porch. It was such a beautiful atmosphere. The decorating included what looked like expensive paintings and sculptures. We were there to look at the mans wound on his feet. He was a very friendly man who offered me a spot to sit and was chatty as well. I know I keep writing how everyone is so nice but I really do get along with these complete strangers off the bat. I think it's because they get along with Dr.W and Dr.D so well and since I get along with the docs, the patients accept me into their home as well.

I had to leave before doc was done though because my train was leaving and I was not about to wait an hour for a later one.

I slept for two hours before heading to a friend's house for dinner. I had said I would come and I try to stick to my social commitments as much as possible. I don't think I was legally allowed to ride my bike in the sleepless state I was in but I made it. I even ended up staying until 11:30PM, stopped by another friend's real quick to drop off some food and was in bed by 12:05am. This morning I got up and drove to hamburg to visit me mom and grandma. I can sleep when I'm dead...right?!

Baci, V

P.S. I REALLY love sleeping. It's become a hobby I've sadly been having to neglect lately.

Thursday, September 5, 2013

"Doc meets Dorf" Day 3, Throw back Thursday old-school style

So I really thought I had this morning commute thing down.

After having forgotten my tea and my jacket yesterday, I managed to have those with me today. I really dislike looking like a tourist or someone who doesn't know what she is doing. So when I am traveling I try to hide my map as much as possible or memorize as much of the map and route as I can and just take quick glances. In the case of my morning commute, I got to the train station (rather early, not so professional commuter of me) and bought some breakfast and headed to the platform. I was surprised to see the train pull in already and was a bit irritated that it said "Fulda" on it (for a second I thought it might be coming from there and would move on to "Kassel".) Without verifying this (remember, I'm a cool morning commuter, I don't need to look at information signs) I hopped on and sat down. This was at about 7:00. My train to Kassel doesn't leave until 7:14. You can imagine my confusion when the train started moving at 7:02. Luckily, I remembered looking at one of those information posters on Tuesday and seeing that the train to Fulda and Kassel had the same first stop. Thank god!
My unexpected stop.

I had left so early to make sure I don't miss my train (I don't trust my bike) and then it all could have been ruined because I thought I was too cool for school.

Good morning, sunshine!

So I ended up in Friedland. It was a rather chilly morning with a lot of fog and the sun started coming up. It was relaxing and actually quite nice in comparison to the Göttinger train station.

I was able to catch the right train a few minutes later and got out a stop before the usual. There, Dr.D picked me up and we went to do house visits for blood draws.

The first lady was a sweet older lady. I quite liked her apartment actually and instantly imagined the lay out with my stuff. She is almost blind but the things she is still able to make with her hands crocheting and knitting is amazing.

The second lady was also very sweet. She kept thanking doc for all the wonderful help he gives her. She kept saying that I probably think she is crazy. But I don't. These doctors are so important in these patient's lives. If they didn't do their job and drive to visit these people, they might never see a doctor. Her husband was also very caring and it is great to see such a loving couple. He himself is already old but puts all his energy into helping his sick wife.

We stopped by two nursing homes as well to check on a few more women.

Cute entrace at the Hedemünden Trainstation
What I ended up observing in the different rooms and apartments of these ladies is that almost all of them have some sort of glamor shot on the wall of themselves (be it a school picture, professional portrait or something like it). The old school version of today's "Throw back Thursday" I guess. They were all beautiful in their own way and that is still true for how they are today. I am a huge fan of wrinkles. I think its terrible that people make them disappear with Botox. Wrinkles show you've lived and seen something. I think they make you look wise.

It is crazy to think about how their lives must have been and how they got to the point they are now. The pictures on the walls and memorabilia on the shelves show moments from their lives.

All these ladies also really seem to like doc. They almost begin blushing when he walks into the room.

He really is great with his patients though. Me and him get along just wonderfully as well. He reminds me of the caring feature in my dad. I feel comfortable in the environment. To the point where I could see myself being a general practitioner and doing my job well and liking it. It's a bit crazy because it makes me rethink my going into a specialty for a second (then I remember how much I love to operate and I'm back on the Urology mindset). I think I can probably have a bit of both worlds if after having worked in the hospital for many years, eventually relocating to a more rural area. Maybe I'm just living in nostalgia as well and will get over it once the two weeks are done.

But jokes aside, general practitioners are seen as the lesser doctors a lot of the time in med school (or the not so cool ones anyways) but I beg to differ strongly. They are the only kind of doctor that really know what's going on in the patients life over a long period of time. They aren't just a symptom or an easy case to earn some money, they are people with a history of disease that this one doctor has the overview of while specialists only have a snap shot of their life (unless of course they have a chronic illness and then even the specialists know what the patient's neighbor and cat are up to ;) ) General practitioners are also more likely to be the ones receiving Christmas cookies than any other specialty I'd say.

Back at the office we had appointments and walk-ins to attend to. Again, a mix of all kinds of things. I even got to examine another patient. Symptoms: weakness and constantly being tired (well I know that feeling) I wasn't expecting to find anything with the physical exam and I didn't. I'm interested to see what her blood work shows, particularly her hemoglobin level and her thyroid hormones.

Around 2PM we headed out for more house visits.

Dr.D knew that I had to work a night shift today so he asked me when I wanted to leave. Nice thought, but unfortunately he asked me about 5 minutes after my train had left. So I told him I'd leave like I did the last few days and would return to the office first and see patients until I had to leave.

I was home by 5, took a 2 hour nap (well, on and off nap I guess) and am now in the hospital watching two patients. It looks like it should be a relatively calm night and I should be able to get a few things done. After work I will only have time for a shower and breakfast before it is off to the train station and off to work. I'm hoping Dr.W (since I'll be working with him again) will be sympathetic to my lack of sleep and will let me go early.

Baci, V

Wednesday, September 4, 2013

"Doc meets Dorf" Day 2...that moment when a patient hits on you....

Day two of rise and shine.

I got to bed early so I felt better getting up this morning. However, I kept dreaming that I overslept or that I was throwing my Halloween party and didn't have a costume to wear so I tried stopping the party. My brain just can't shut off during the night. I've been trying to think of a good Halloween costume for my fourth annual Halloween party for a while now. Wish I had Heidi Klum's team.

I'm off subject. Sorry.

All my essentials for the commute...except my tea which I forgot on my bike :(

So, Dr.D wasn't there today so I got to work with Dr.W. He is a very nice man and quite the chatter box (so obviously we get along). He also looks like what you might imagine a general practitioner to look like. Gray somewhat longer messy hair, glasses and friendly tone.

We started seeing patients at 8:30 again. Before going in to see the patients, Dr.W would give me a quick run through of their medical and social history so I was up to date.

It was a very interesting mix of people. We had an abscess to take care of, sudden hearing loss, screw removals, stomach aches, insurance paperwork to deal with, people wanting to get a sick notice for work, shortness of breath, heart issues and flues.  There were also many patients with psychological problems or at least their psyche played a role in their illness.

Then there were two male patients that gave me compliments about my looks multiple times. I always feel really awkward in those kinds of situations. I don't think it's very appropriate in that setting. I just don't really know which is the best way to go about them. I usually just smile politely and hope we can get back to their complaints. One comment Dr.W made after a patient talked about me (while I was right there) was that I was there on my own terms and he couldn't give me away to go with the patient. Again, I sat there awkwardly and smiled politely. 

I was hoping Dr.D would decide not to do any house visits today so that I could get home a bit earlier to get a few things done. Again, thought half wrong. Dr.D did decide not to do any house visits however, so many people came in without an appointment that we saw patients until 3PM and then did paperwork and discussed things and I wasn't home until 5PM again.

The train gets me to work 25 minutes before I have to start so I walked around down town again a bit. It really is a beautiful city. It's so sad to see it dying out like it is. So, if you happen to be around the Göttingen/Kassel area....please please please go check out Hannoversch Münden!

And if you do end up going and sadly fall ill while there and are looking for a doctor, I can only recommend the office I'm working in. The doctors are great that I work with and really care about the patient. Dr.W told me today that he could have just ushered patients in and out and we would have been done earlier but that he would rather give the patients time and enjoys chatting with them. I can tell his patients really like him.

Because it did take so long, we didn't eat or take a break. I tried eating some cherry tomatoes once between patient visits. The first thing I did when I got home was eat a whole pizza....ugh. Bought a banana and an apple for tomorrow and hope that works out better.

Good night!

Baci, V

Tuesday, September 3, 2013

"Doc meets Dorf" Day 1....I thought wrong.

And I'm back! Back to work, back to getting up early. (Little German lesson for all, Dorf means village)

For the next two weeks, I am working with a general practitioner in Hannoversch Münden. It's an hour commute with the train every morning. (Hann. Münden is small with 28,000 people compared to 129,700 in Göttingen)
I was super tired this morning but definitely did not want to miss my train so I got my butt out of bed.

Having grown up with a dad who is a general practitioner, I kind of knew what I would be dealing with. Patients with small (or big) problems, a very intimate doctor-patient relationship and generally nice atmosphere.

I quickly found the practice. The secretary showed me where I could put my stuff and I waited for the doctor to arrive.

Dr.D is how you would imagine a general practitioner in a rural area. He arrived in slacks, white shirt and vest. He has a mustache, glasses and is an older sir. He showed me around the place and then we immediately started seeing patients.

It was a mix off all different things. Since Dr.D has worked in the area the last 15 years and before that in the hospitals in the area, he knows his patients very well and the appointments go very quickly.

Weakness, stomach aches, head aches and such where some of the complaints the patients had. Since one of the other GPs from the area is on vacation, his patients come to Dr.D in the time the other guy is gone. I got to take the history of one of the patients and preceded to examine him as well.

The time seemed to go by quickly because we constantly had something to do.

I had a 45 minute break and decided to go to the bakery and check out a bit of the town. It has a very lovely "downtown" with fachwerk houses, an old church and little forts scattered around.

I only have 3G in very limited places so I couldn't even spend my break on my life problems.

After the break, Dr.D and I went on house visits. We went to two nursing homes and a house. 

The first seemed very nice and the nurses where very sweet towards the patients. The patients all really like Dr.D. The older ladies often flirt with him. One even offered him to stay with her. Oh my.

The second was also nice. The corridors where decorated as though they where part of a museum with old furniture and old clothes hanging from a clothing line, old sewing machines and pictures. 

We then drove about 10 minutes to get to the home of a nice older couple. We checked on the husband, chatted with the wife and then made our way back.

Dr.D dropped me off at the train station and I had to wait a half hour before my train left.

I had checked the opening times of the practice online and it said they were only open from 9-12. I thought for sure that I would be back home everyday by 1PM.  I thought wrong. I wasn't back in Göttingen until 5PM today (and went directly to my lab). Dr.D said we would be done a bit earlier today because his daughter is in town which means the next two weeks I might not be getting home until even later. I had originally planned to spend the morning in the practice and the afternoons in the lab. Looks like I will be having long days (plus a few night shifts) the next two weeks. Can't wait for Saturday to sleep in!

Baci, V