Friday, October 11, 2013

"BAM I got your Appendix!" last day -- So, do you have a windmill?

I definitely woke up on the wrong side of the bed this morning. It was not my day.

My "I am not amused" face

It started off with the intern not being there again. As it turns out, he had stayed longer on Wednesday, allowing him to take off Thursday and then he used one of his off days today. Essentially giving him a really long weekend and leaving me to get the work done alone. Luckily, Friday's are usually calmer for us students since there aren't a lot of things happening and the doctors have to write a bunch of release letters.

The chief asked us how our week was at the end of the morning meeting. For some reason, I was the only student that opened her mouth and said anything. I told him I enjoyed the week in the department. He inquired as to why. I replied that I felt welcomed and that the team was very friendly.

He proceeded to mention to the whole conglomerate of doctors that he had enjoyed operating with me yesterday and learned a lot from me. (?!)

During his morning rounds on the ward with all of the regular suspects and two more attendings in his entourage, he asked me if we had a wind mill on our farm like in the movies.

We do.

He got all excited again and mentioned the dog and the porch and the Samuel Adams. The other attendings seemed a bit confused. The situation appeared as though cheif and I were total buddy buddies. Not bad I guess, lol. I told him he can stop by. He said he would really love that because he is a huge fan of America.

So Mom and Dad, we might have the chief of general surgery stopping by for a cold Samuel Adam's on the porch with Toby laying by his feet. Just heads up.

At the end of rounds he shook my hand and told me it was a great pleasure having me on the team that week, enjoyed operating with me, I could come back anytime I wanted and even would enjoy having me there for a 1/3 of my internship year. Funny story, that was kind of the plan before even having this week. We shall see.

I won't bore you with all the things that upset me today but it just seemed to all hit today.

One thing needs mentioning however. I was on the ward getting my work done when the intern (that also happens to know me and works in my lab with me) responsible for making sure the ORs have students present called me and asked if I knew where the student was that signed up for the thyroid operation starting in a half an hour. I had not signed up for one today because of my circulatory system not being nice and my stomach being mean. I told him I would run to the other ward and let him know.

In the doctor's room on the other ward, I only found a doctor and no student. He told me the student had gone to eat lunch. Here comes my critic point. If you know you are supposed to be in the OR, you better check the schedule before just frolicking off to lunch.

Since I had talked to the intern, I was in some way responsible for the OR to have a student in half an hour, be it that I find the guy or that I have to go myself. Any other day I wouldn't mind operating but today was not my kind of day. So I preceded to walk from one far end of the hospital to the other to find this guy. I hadn't really paid attention during the week and didn't remembered what he looked like so I was going off of a hunch. I looked through the cafeteria and restaurant but found no one that fit the image in my mind.

Back on the ward (and exhausted from climbing 6 flights of stairs because the elevators where taking forever and I was working against the clock AND had just gotten news from a friend which led to personal stress), I only found the same doctor that had been there. I asked if the guy had left a number or something to reach him by. "Yes he did. It's right there on the table." Well thanks for nothing sir! You could have told me that the first time I was here telling you I was looking for him!

I talked to the guy and told him he needed to be in the OR in 15 minutes. He said he would head there. As soon as I got back onto my ward, Dr.L said the OR called for me and that I should head into OR09. I told her I JUST spoke to the guy and he is on his way. Not even 3 minutes later, I get called on my phone by the intern telling me I had to go to the OR. I told him the same thing I told Dr.L. But if for any reason he shouldn't be there in the next 5 minutes, he should call me again and I would go. Luckily, that call never came.

So at this point in my day, my blood pressure was probably around 190/110 and a pulse rate of 120. I sat in the doctor's room and tried to calm down.

I hate when people make insignificant things to huge issues. Stop it.

I had an evaluation talk with Dr.L about my week and my doctor release letter and happily received an "A" for the week.

The afternoon meeting was an hour earlier and quite short since it was Friday.

I went home and tried to come back to a normal state of mind. My 1.5 hour nap helped.

I spent the evening hanging out with some friends, eating good Italian food and drinking good Italian Chianti wine. These are the moments that are priceless after an exhausting week, professionally and personally.

I really did like the team and am excited to see if I will be doing my internship there as well. I still am sticking to Urology over all though. However, one year of residency in America will be general surgery so it's good to work on my skills in that department.

Next week I will be in the Lab. That was it then. My semester starts the week after that.

Not enough interesting things happen to keep a blog working on a regular basis. However, I have a week long Neurology internship sometime in November I believe. I'll report what happens then when the time comes. Hope I could entertain you a bit during my semester with stories from my life and would love to welcome you here again once interesting things happen. Thanks so much for reading. It is very much appreciated! Stay healthy!

Baci, V

Thursday, October 10, 2013

"BAM I got your Appendix!" Day 4---sucked the life right out of me

The sleep I got last night just didn't seem like enough. I woke up feeling really good....must have not woken up in my REM sleep. Score. But I felt the lack of sleep later on in the day.

The intern on my ward wasn't there today. Unannounced. This left me to do all the tasks that doctors like to give the interns/students. Greeeeaaaat.

During the morning rounds, I had to take the (as Dr.I calls it) Jimmy Book. It's a big hardbound notebook that is used for notes during rounds as to what needs to be done with the patients. Then the list can be completed during the day. I wasn't completely positive what all I had to write down because no one told me. I opted for writing down more than less just to be safe.

Then I was supposed to lay an i.v. It's the same thing over and over again. If I haven't laid one in a while, I really dislike having to do it. However, I think I recently got the hang of it down so that my success rate is much higher. I'm not the only one who feels hesitant about laying i.v.s after not having done it for a while, a few of (if not all) my friends feel the same. It's just so upsetting when the needle doesn't find it's way and you have to repoke the patient. Luckily, my i.v. yesterday and today went just fine. Boo-yah!

I hurried to the morning meeting and got myself signed up for the first operation in OR 09. It was a hemi thyroid removal with the chief. I immediately went down and got dressed for the operation.

This was my first thyroid operation since the other one (thankfully) didn't happen the other day. It is always a new learning experience with new operations in completely different body areas. Each operation has a certain flow to it and I try to interrupt this flow as little as possible with my lack of experience.

The chief started asking where I was from. I told him Wisconsin (you Rah-Rah).

Hardly home but always reppin!

The following conversation was entertaining.

"Do you live on a farm?"

"Yes." (well sort of, nothing compared to the actual working and money making farms out there.

"Do you have a porch?"


"Do you sit out there in the evening with a cold Budweiser?"

"Not necessarily a Budweiser but yes we do."

"Samuel Adams?"

"More likely, or spotted cow."

"What kind of dog do you have?" (notice the question wasn't IF I had one, he just assumed we did.)

"Golden retriever."

"I think you will have to take me to Wisconsin so I can sit on the porch. See, Dr.S, you can come too and then drink a beer on her porch with the golden retriever laying by your feet with view on it flat land there?"

"We have hills behind the house."

"....with a view on the hills. Wouldn't that be great Dr.T?" (Dr.T was rather speechless haha)

"Well, you are more than welcome to stop by Wisconsin."

"So your name doesn't happen to be (I forgot what he said but I think it was meant to sound American)?"

"No, its not."

"Well what is it?"


"No way! Related?"


"That is fantastic! You know, that was my generation. What a great guy. Cool."

He really seemed happy about that fact. At the end of the operation he thanked me for my help and said it was a pleasure. ... Thanks chief, for me too. Lol.

After the operation, I grabbed a black tea (first caffeine of the day) and headed back up. There was a bunch of blood to be drawn again. My doctors seemed to have disappeared and I knew for a fact that they were not planned to be in the OR today. I finished up my doctor's letter so that I have that done for tomorrow.

I got the male nurse to open up the learning studio for me and I spent two hours practicing suturing and knots. I was tempted to do some more molding with the clay but figured if someone walked in on me doing that, they might think I was wasting time where as suturing seemed productive.

Left: subcuticular suture Right: single knot, Allgöwer and Donati knots

practice makes perfect
Back on the ward, there was still no sight of a doctor. I looked at a few files and just waited for it to be late enough for the afternoon meeting. I headed there early and sat way in the back as the tumor board (a panel of doctors that discuss a patient to construct the best treatment plan with doctors of different specialties) was still going on. I couldn't understand a thing they were saying because A) they all spoke to the front of the room so the sound waves where not coming in my direction and B) they were all so quiet. I proceeded to see what Facebook was up to. Dr.F (the attending from the operation yesterday, the funny one that asked how tall my non existing boyfriend is) came in and sat next to me in the last row and joked that I should be learning something. I told him I totally knew what was going on and besides I couldn't understand a thing due to the points mentioned above. He told me I should go sit in the first row since that was the row for me. Mmmhmm, sure, right next to the chief, right? Silly Dr.F.

The afternoon meeting was short and sweet and I was out of there. I stopped by the transfusion department and donated blood.

I already felt weak from the lack of sleep and not eating much during the day so I figured getting half a liter blood drawn wouldn't make much more of a difference. The donation went great (not that you think I might have fainted). After that, I headed home and took a nap....that ended up being two hours. I woke up 10 minutes to 7 and almost had a heart attack because I thought it was the next morning and I was for sure going to be late for my last day. Luckily, my brain started functioning again and I was happy it was still the same day. I felt like death though. I'm glad I don't have plans for tonight...I will probably go to bed again any second here and hope to catch up on sleep.

Baci, V

Wednesday, October 9, 2013

"BAM I got your appendix" Day 3--Social Butterfly

I've been quite the social butterfly today with these few minutes writing the blog being the only ones for myself besides riding my bike back and forth. So please excuse me if I am brief and try to get to bed for some rest.

The day seemed to pass pretty quickly today.

Call time 7AM, morning rounds and then morning meeting. Same old, same old.

I signed up for a 90 minute operation and headed back to the ward.

I started working on the doctor's letter we have to hand in as part of the week's assignments. I picked a case that wasn't too extensive, not wanting to torture someone with my amazing German grammar skills...(not).

I was almost finished when I got called into the OR.

The procedure was putting an ileum conduit back. The conduit was put there after surgery on rectal cancer to allow the new connection created to heal. The little intestine is attached to the outer wall of the stomach with an opening to the outside world where the body's waste can exit. After enough recovery time, the small intestine gets closed back up and mobilised back into the body.

The surgeon operating was below the assistanting surgeon in the hierarchy of the hospital but this was also the surgeon's first operation as main surgeon. Because of the learning process, it took longer than 90 minutes. The attending assisting was funny though. Most of the time serious and watching and advising the other one on what to do but he also made a few jokes. He asked me how tall my boy friend was. I told him he needed to tell me who that might be so I can answer that question for him.

The attending also taught me things during the operation, systematically going through the procedure and other procedures that relate.

After the operation was finally done, I stopped by the urologists quick. A second after I entered the OR, the OR nurse asked me to tie up Dr.H's gown. I helped out with a few other things and joked with my favorite male nurse that I should probably be the one getting his pay check since I was doing his job.

After the operation, Dr.H needed me to untie his gown. I tried to untie the knot I didn't tie until I realized it wasn't the one I tied. He told me that just goes to show that I need more practice in undressing men. I told him I let my men undress themselves. He said that was why the quality in service in that department is going down the drain. Lol. I love urologists.

Back up on the ward, one of the doctors held a lecture/discussion with us. The room already had clay there and molds of operations. We discussed a few and I happily made this little guy while listening:

After that class, we headed to the afternoon meeting and then I was done. I had tea with a friend, then proceeded to go grocery shopping and made dinner for some friends before going out to the main med personal bar for Wednesday nights. I'm spent. If I forgot anything, I'll add tomorrow :)


Tuesday, October 8, 2013

"BAM I got your Appendix!" Day 2-- Nice to see y'all again :)

Call time 7AM.

Getting up early is just no fun. It would be more fun if I actually could fall asleep 8 hours earlier to be ready to go in the morning but I can't seem to fall asleep in time. Ugh.

We did morning rounds before the morning meeting. Dr.I, the intern and I went and saw the patients. Nothing exciting really happened here to talk about.

The morning meeting was on our level this morning for reasons I don't understand. Maybe its a Monday thing to meet in the big conference room. Who knows.

Today the interns got their introduction and "applause". I still think it is a very nice gesture.

We got to sign up for the operations we wanted to help in. I've always wanted to see a thyroid gland get removed and today we had a complete and hemi on the plan. I signed up for the complete since it was on the second position in OR 11 and would allow me a bit of time rather than head to the first point. There was a lecture for the interns that I attended. We discussed thorax emergencies with a cardiovascular thoracic surgeon.

So...about those knifes stabbed into the heart....

On the ward, I had to draw blood from two patients. The one had to have about 10 syringes removed. I felt like a vampire.....I have the teeth for it.

When I looked at the OR plan on the computer, I realized that "my" operation had been moved to position 1 and the other one was moved to the end of the plan in OR 09. Great. Now the other student was already down in the OR operating on the thyroid gland I wanted to help with and I was stuck with the other one that wasn't planned to start until 1:30PM. Boo.

I tried to find some work on the ward to keep me occupied. Unsuccessful, I asked Dr.I if it was okay if I went into the OR and looked at various operations until mine started. He said that was fine and that I should watch interesting things. Well...haha...I didn't say I was going to watch only general surgery procedures and Dr.I told me to watch interesting things. I find urology quite interesting.

I looked up who was operating on the computer and what procedures the urologist were doing. I got dressed and headed to the urology break room. There, I found my favorite male nurse. We chatted a bit and he told me to go into OR 03 and go visit Dr.H. That was the plan my friend.

I walked in and greeted everyone and they all seemed genuinely happy to see me there. Dr.H said he was waiting on one of my fellow students to help him with the varicocele operation he was doing. I was very tempted to just scrub in myself and help. We've done the operation together a few times. Sadly, two seconds later, the mentioned student showed up. She seemed to be quite new to the whole surgery thing. She seemed very nervous and even made herself unsterile once almost fully clothed and had to start all over again. I helped her out a bit here and there.

I stayed to watch and realized...I miss penises......on a professional level (seriously people, get your head out of the gutter.) I miss the atmosphere of the urology OR and the procedures and the humor! They invited me to stick around during their break (my operation kept getting pushed back further because the laproscopy was taking longer than planned). I stayed for the second varicocele operation as well. Once that was finished, I headed to my OR room to see what the deal was. It's my best friend's birthday today and I had told her I would be out of the hospital by 4PM. With all the delays, my operation wasn't planned to start until almost 4PM! Dr.K who was in OR 09 operating said she would let me know when the second laproscopy was finished.

I grabbed a quick tea and headed back to the ward. Both of the doctors responsible for the ward where in the OR so it was up to me and the intern to keep things going (which in reality didn't require much work) until the attending came to do rounds for the chief who was on a business trip.

I was very happy that the intern had been on the ward the last two days doing admissions because he knew what all the patients had whereas I try looking at files whenever I am on the ward to have somewhat of a clue as to what they have. We went through all the rooms and checked on the patients before heading to the afternoon meeting.

The doctor that did rounds was also the one doing the operation I was supposed to help with. I figured as long as I follow him, I can't miss the operation. One of the other interns said he would do the operation since it wasn't scheduled to start until 5PM and he figured I didn't want to stick around for that. I told him that if it didn't happen to be my best friend's birthday and/or he had a hot date, I would stay. He talked to the doctor about it starting at 5PM and all the doctor said was, "Unless they start in the next 20 minutes, I'm not doing any more operations today." Well okay then. Sucks for the patient that hasn't eaten all day and has been waiting for this operation but at the same time the doctor has been working since 7AM and maybe it's better he operates when he is fresh. That's just how it is in a big hospital like ours.

I am going to try to really read up on our patients tomorrow and find an interesting operation to watch otherwise I might have to stop by urology again :)

Baci, V

Monday, October 7, 2013

"BAM! I got your appendix!" Day 1

Well, wasn't expecting that....but then again, who am I kidding.

Wasn't expecting that off the bat
First of five days general surgery.

Call time this morning was 7:25AM. I luckily planned in enough time for wandering around the hospital looking for the right room to show up at. The door was open but the lights were off and I was the only one there....and it was 7:23AM.

So I sat in the dark (it was early and that was comfy) and waited.

A few minutes later, a girl I study with showed up. We sat in the dark and waited. Two more students showed up. We all sat on the side of the room, in the dark, waiting.

Finally, the doctors started rolling in for the morning meeting.

As a medical student, you are at the bottom of the food chain and sit either in the back of the room if it is filled with rows of chairs or on the side if there is a conference table in the middle (Unless you are in a smaller department such as Urology. But even there, you typically sit as far away from the chief as possible).

The morning meeting commenced as though we weren't even there. The chief kept asking his doctors more questions about their patients, their conditions, the circumstances and so on. It was very detailed and I just sat there hoping they could answer all of his questions. The did a good job :)

At some point, he brought up the education. Our names were read and we were given our ward assignments. When they said, 'Hasselhof, Viktoria on ward 6013' he stopped and asked which one of us that was. I just raised my hand and said hello and smiled. Who knows why that happened....
Once everyone was introduced, all the doctors knocked on the table (our substitution for clapping). We suddenly felt awkwardly touched that they cared enough to welcome us with that. But thanks :)

After the morning meeting, the other students and I left the room wondering if we should just head up to the wards or what the deal was. Luckily, doctors approached us, introduced themselves and took us to the wards.

My doctor was a younger looking woman with a friendly smile, Dr.L.
She showed me around the ward. There were 6 patients that needed their blood drawn. A meeting was planned for the students and interns at 10AM and she said it would be great if I could get the drawn blood before that. Easy peasy.

I guess I should add that I am on the private patient ward belonging to the chief of general surgery. This shouldn't make a difference in the quality of care but in reality it does. In the end everyone gets treated... the private patients just experience a more pleasant treatment. The only thing that is relevant for me regarding them being private patients is that I have to see that they are happy.

The first lady I wanted to draw blood from started saying she had bad veins and that she doesn't necessarily prefer a student drawing the blood because she doesn't like the pain from the needle. Student or not...that needle is going to have to penetrate your skin....if its in the hands of a student or the chief. It's not like he can beam your blood into the syringe. But okay...I'm not going to argue and of course "I am looking out for your comfort (blah blah blah) during your stay here so I will let the doctor know she should come by and draw the blood. Have a great day."

The third patient I drew from was a professor of mine. The pressure is kind of on in that situation to get it done right. I was just glad it wasn't my professor of hygiene. Although I draw blood according to protocol, I would have the feeling I did wait a half a second long enough or sprayed a milliliter too little of the disinfectant. I have rarely had issues drawing blood and I was glad it was the same for this time. We even exchanged pleasantries about our respective dogs.

The fifth patient also immediately started telling me how she never really thought students drawing blood was a kosher thing. "They always stuck the needle in and then prodded further and that hurt terribly". I told her that was completely unnecessary if they were drawing blood. Laying an i.v. maybe....but not drawing blood if you find a good vein and know what you are doing. I drew her blood and she was just so thrilled about how that didn't hurt one bit......See.

After getting all the permitted blood drawn, I went to tell Dr.L she would have to do one herself. She was on the phone with the intern (his first day on the ward) standing next to her. He was supposed to go into the OR but his card wasn't activated for entrance to the OR. She asked me if I had been in the OR here. Affirmative. She asked if my card was activated. Affirmative. She sent me into OR 09.

And what about the meeting at 10? She said if I got out early enough I could go but otherwise I already knew everything I needed to know. Because of her statement and it being 9AM I concluded I wouldn't be in the OR for much more than an hour. Wrong.

The first operation, I stood for 4 hours. Not having been prepared for OR work again (aka forgot my fancy antithrombotic socks) I struggled again for a bit there. I have mastered my circulatory system freaking out to the point that I don't have to sit down or pass out but it still is a very uncomfortable feeling. I started sweating a lot (which made my dang glasses slide) and my eyes started being super sensitive to light (as though you cranked up the contrast on a picture). I started breathing like I would during yoga. In and out throw the nose and deep belly breaths (those made my stomach growl due to lack of food). It was amazing how much that breathing technique helped. Chief at some point noticed how bad my forehead was sweating and asked if I was okay. I said I was fine, had he asked me 5 minutes ago my answer may have been different. He stopped operating, put his hands and mine, looked me in the eyes and asked if I was sure. I told him I was positive and that I experience this sensation on every first day in the OR if I haven't been there a while. He was impressed by how well I knew my own body. (Enough electives in surgery fields has taught me to manage.)

After those few minutes I was fine but bored. I've said it before, surgery is an exciting field and fun but if all you do is hold hooks although you are capable of can be very boring. What kept me awake is that fact that I was working with a new team and the radio they turned on half way through the procedure.

The patient had a bile duct tumor that needed to be removed along with the pancreas head. This required cutting up the duodenum as well and reattaching everything. At the very end, after reattaching the loose ends and sewing subcutaneously, I got to help with the intracutaneous stitches.

I was given a 10 minute break to eat and drink something...this ended up being a half a liter of water and 8 almonds. Better than nothing.  

I headed back into OR 09. This operation was supposed to take about an hour. It was just the attending and I operating. We were operating a pilonidal cyst. From the Latin pilus (hair) and nidus (nest) = hair nest. It is often located right above or on the natal cleft of the buttocks. The patient had a reoccurring cyst. We basically cut it out and left a tennis ball sized hole in the top most part of his buttocks. I was contemplating how we might reconstruct the defect but then the Dr. just put gauze on it and started removing the OR what?! He said it would heal like that. Oh ok.

After we were done I headed back up to the ward. No doctor to be found. I started looking through patient files to get acquainted with what the patients were there for. Soon the doctors returned from wherever and we did afternoon rounds.

The intern and I headed to the conference room after that. The afternoon meeting was done at 4pm and we were released.

I was so tired and exhausted from the day and thought I would just fall into bed once I got home. Whilst leaving the hospital though, I saw a man having a epileptic attack outside of the entrance. I (and about 3 other people) ran over to see if we could help. While running the few feet my head started going through things that might need to be done. I was the third person to get there so I let the other two do exactly what I would have done. Immediately someone ran inside and got emergency help. I was surprised at how long it took the emergency team to get there although we were just outside of the hospital. But of course it makes sense, they have to be notified, the gears have to start turning in their heads, they have to run up and get to us. Once they arrived, I left. They can do more than me and there were enough people just standing around watching. That woke me up.

Hopefully I will be able to fall asleep early so that I am good to go with call time at 7AM tomorrow.

Baci, V

P.S. the header of this week is dedicated to Brad S. Even years after first saying it, it still makes me laugh and was fitting for general surgery.

Sunday, October 6, 2013

"Boom Baden Baden" the Photoalbum

Long time no see.

I successfully survived Oktoberfest with 4.5 liters of Oktoberfest beer and a week long vacation on Tenerife with my mom and grandma (not much survival skills needed there). It was relaxing and for the first time this year, I got a bit of color.

As promised, the pictures from Baden Baden.

Tomorrow, I start my one week internship in general surgery at my university hospital. So, as always, I will be letting you know what goes on in the OR, on ward and any interesting gossip that so frequently happens in hospitals (they are their own little world).

In traditional garments
They bought us cookies, how fitting
First night dinner in Le Bistro

PKay's Birthday cake in Strasbourg





Flamkuchen in Strasbourg

The fancy schmancy private hospital

Our humble abode for the week

The lunches at the hospital were WAY better than what we have

Getting work done.....sort of

YUM! Herb Spätzle
Off we go to the spa

The birthday treats the department got for PKay

The Barium (Elmer's Glue look alike) I drank

Our Area

See y'all tomorrow!

Baci, V