Sunday, December 28, 2014

Week 6: Short but sweet (like all those cookies and yummy treats you've been eating)

First, let me wish you all a Happy Christmas (as the Queen of England would say) and/or Happy Holidays! I hope you are spending some quality time with loved ones and if you can't be home with your family (as I wasn't home in Wisconsin this year) I hope you used today's technology of Skype or Facetime to stay in touch.

I wish you all.....a Heppe Christmas

I showed up for work on Monday and Tuesday. Other interns decided not to but I didn't want to risk my vacation days being used for days I could easily be working. I think my colleagues were quiet happy that I showed up.

Monday morning, still during rounds, the chief attending told me I'd be assisting in his operations that day. This was after we had almost seen all of the patients and about everyone of them had labs ordered. The ward doctors had hoped I'd be around to draw all the blood for them, when the announcement came that I'd be in the OR, even before the morning meeting started, the realization dawned on them....and their facial reaction was a little bit priceless.

We had two operation to perform. The first was a smaller one that was finished relatively quickly. The patient had a hydrocele. A sack filled with fluid in the scrotum essentially. This patient had decided to walk around with it for years and thought three days before Christmas would be a fabulous time to have it operated.......

Great Idea sir......

After the fairly quick first operation came the second, somewhat lengthier one. The patient had had his bladder removed at the beginning of the year and was back to have a incisional hernia repaired. The chief attending and I were joined by the general surgeon that I helped operate Pat. X with. Since hernias aren't part of the field of urology but the patient's incision was due to an urological problem, the departments worked together. Additionally, the surgeons are friends and don't find much time outside of work to see each other so they use operations needing both specialties as opportunities.  The chief attending and I were also interested in how hernias are being treated currently. Basically, a big sheet of material was inserted and sewn onto the abdominal inner wall.

After the operations, I returned to the ward for lunch and finishing up whatever needed to be done.

Monday night, I attended a basketball game with some of my girlfriends.

Tuesday, I was called back into the OR. This time however after rounds, morning meeting and blood drawing. This was the first time operating with this particular attending. We removed a testicle due to testicular cancer. The patient had noticed a swelling only two weeks earlier.

Public Health Announcement: Men, check your balls. Seriously, know what your testicles feel like and notice when something changes. It can go faster than you think. I have many guy friends, your guyss hands are in your pants 95% of the time anyways. Optimize that time ;)

I was allowed to leave after the operation was done in order to catch the train to Hamburg, where I spent the holidays with extended family.

My adorable little godchild

Hamburg Rathaus

In this time, I found a TV show to watch while babysitting my godchild. Cosmos: A Space Time Odyssey. I fell in LOVE! I've always been fascinated with astronomy and even took a class back at UW-Madison. This show is beyond fantastic! The information, the graphics, the facts and the way it is hosted by Neil Degrasse Tyson is just great. I read up a bit and found that it is a sequel to a 13 show series done by Carl Sagan. After I'm done with this series, I'll look at the older ones and see how far we've come. The show has resparked my inner super nerd. I would love to return to college after med school and take more classes in Astronomy, Biology and so much more. The world we live in, the present time, and we ourselves are so insignificant in comparison to the time of the universe. At the same time, this show portraits the stories of people who were so vital to our time and how the smallest of coincidences lead to where we are today. If you want your mind this show!

I'm in LOVE. I'm also a HUGE nerd.

Its back to work tomorrow and Tuesday. We have off Wednesday and Thursday, which I will hopefully spend in the lab and library. New Years Eve will be a quiet one (as of now) with a good friend.

I wish you all a great new year of life, filled with happiness, success and most importantly health! I hope that our civilization calms down with all the havoc going on in the world and focuses on the good and comes together instead of driving itself apart. Happy New Year!


Sunday, December 21, 2014

Week 5: Vasovasostomies, tumor removals and Mozart!

I have a hard time keeping days straight during the week. Multiple times a week, I don't know what day it is. I usually know what number of day it is because I document the date so often....but the day of the week? Always lost. Monday night, while sitting at my desk at home, I suddenly yelled outraged that I had forgotten to attend the intern lecture that afternoon which takes place every Tuesday!.....I was about to grab my phone and text the other intern that we had forgotten the lecture when I realized that it was only Monday. If it wasn't for Throw Back Thursday on my Instagram feed, I wouldn't know it was Thursday. I'm not the only one with this problem and so we colleagues often confuse each other even more.

I had a visitor on the ward on Monday. The patient (from here on out referred to as Pat. X) with the tumor from last week, came to say hello and introduce me to his wife. He informed me that we was being operated the next day. It was important for him to come tell me personally because he wasn't sure if the other department was staying in touch with me. I told him I would talk to the surgeon and see if I could assist.

This I did and was granted permission by my ward doctor and the surgeon to assist in the surgery. The whole thing took about 4 hours and went really well. We were able to removed the tumor in basically one big piece.....weighing in at 3kg (6.6lbs). It was a rather impressive mass. It still amazes me that the patient had no other symptoms but the varicocele.
Thursday, during the morning meeting, the senior consultant summoned me into the OR. I had no idea what operation I'd be helping with. My back has been hurting the past week and I already thought I might have to help with a fairly long operation that day. Luckily for me, I was assisting the senior consultant with a vasovasostomy! The operation reverses the result of a vasectomy, in the hopes of re-fertilizing the patient if he decides, for instance, to have kids again. The operation is done in part through microsurgery which requires sitting! Score! It was a 5 hour operation but it was all spent sitting. I helped cut, hold, coagulate, find, position and in the end sew throughout the operation.

Dear men, please think about what it is you are doing when you get a vasectomy because the work that goes into reversing it is a lot of fiddly work for the surgeon. The surgeon told me I better find a guy that hasn't had a vasectomy. Will do sir.

Lemon juice + honey + hot water = deliciousness and cold fighting power!

I felt bad leaving my ward doctors by themselves while I was in the OR. Who would be around to make sure the guys ate breakfast and make them lemon and honey tea because they started to get a cold. I've definitely taken on a motherly role with some of the guys. They haven't been doctors long and get caught up in all the stress and forget to look after themselves. I do it because I care, not because its expected (just thought I'd point that out for anyone starting their internship soon and thinking they will have to do all sorts of non-medically things and become personal slaves).

Some days get so busy, I just grab lunch for everyone and we eat on the ward.

I stopped by the ICU on Thursday to visit Pat. X. He was awake and happy to see me. He himself was amazed at how well he is doing. This guys spirit is so great. More patients need to have his attitude. He intends to stay in touch with me, even after he is out of the hospital.

Thursday night, I met up with 4 of the guys for some spiced hot wine at the Christmas market and afterwards a drink in the Irish pub. Live music was being played and we all sang along with the chorus of one of the songs at the end of our night (about the same time that all the students were starting theirs). The next day one of the guys sounded 10 years older due to his rough voice (he obviously does not sing along loudly to music in his apartment...)

Hennessey & Ginger Ale

Friday was a rather slow day. The other intern and I spent some time doing ultrasounds on each other. We figured it would be super easy to find and evaluate our kidneys since we are young and slim. We thought wrong. We actually had a really tough time. One of the doctors even came and helped us. Luckily he informed us that it usually is hard finding the kidneys in young, slim women. Thankfully it's a lot easier with our patients!
Hello Kidney

Best Moment: The continuous positive progression of Pat. X and his treatment.

Worst Moment: Nothing bad happened. I wasn't in the best of moods at times. Mainly I think because Christmas is getting closer and usually I'd be on my way home to Wisconsin around this time. Sadly not this year.

Off Topic: My uncle and I surprised my grandma this weekend with her Christmas Present. A trip to Hamburg for dinner at Opera Ristorante followed by Mozart's The Magic Flute in the Hamburg Opera. It was a great night and a lovely show! I can recommend it greatly for anyone interested in opera.

Music: I downloaded the new J. Cole album "2014 Forest Hills Drive" and love it! In general, I like all of J. Cole's music. This album has a different vibe than his last one but great nonetheless! For any R&B/Rap/HipHop fans out there ;)

This coming week is a short work week for me. I'm only in the hospital Monday and Tuesday before heading to Hamburg to spend Christmas with my extended family.

I wish you all a very happy 4th Advent!

Stay healthy!

Sunday, December 14, 2014

Week 4: Blood wurst, Basketball player, and bewildering patients.

This past week was a wee bit stressful.

Besides the normal work that needed to be done, we had to teach students almost everyday. This entailed about a group of 30 people showing up on the ward. I had to get them all situated and was running around like a chicken with its head cut off some of the time. I also had my catheter class everyday expect Wednesday. That meant staying at the hospital until 6 pm on those days. To top it all off, there were multiple instances were patients/relatives got on my last nerve.

It seemed like I lived in the hospital the whole week so I am having a tough time even trying to remember what happened on which day.

On some days it seemed like anything walking was getting a needle poked into their body by me. The patients even joked I was making blood wurst and that was surely why I was drawing so much blood. My ultrasound game was up too. I started to recognize the patients by their kidney ultra sounds.

If you have veins...I am drawing your blood. Beware.

I had another patient on the ward who didn't mind at all when I was there to do an ultrasound.....really didn't mind, if you get my drift. He asked about my life and what part of school I was in and complemented my personality. All very kind but it got a tad bit awkward when his wife came into the room to come visit him and he said comments which seemed to incriminate us of something we weren't even doing. "Oh see, my wife always catches us talking Miss Hasselhof!" (as wife walks in)......well yea, of course I was talking to you, asked me a question about your further treatment....wasn't about to spell it out for you in interpretive dance.

Yes sir, you may leave tomorrow unless some foreseen distress arises!

Tuesday, I went and donated blood (or at least attempted) and dragged a colleague along. My hemoglobin level was too low. My colleague didn't hesitate to blame my vegetarianism as the culprit. The nurse basically egged him on though when she suggested I eat more meat....not knowing I don't. My colleague could hardly contain himself. Yea, yea.......

A little success story. The other intern was having a bit of trouble drawing blood from a few patients on her ward. I offered to help but also failed with one patient. The other patient was one of a 60 kg/m2 BMI. After two failed attempts, I was not about to give up. I had to make this work.....and I did! Little superficial vein on the side of the arm was the winner.

Wednesday night, we gathered on the Christmas market again before heading to good ole Thanners (the bar filled with med students every Wednesday). It was another fun outing.

Thursday, the Göttinger Eltern kardiologischer Kinder Organisation (GEKKO) (Göttinger Parents of cardiology children) had their annual Christmas event. I was able to get Jamal Boykin, from the local pro basketball team, to come and say hi to the kids and sign some autographs.

Thank you Jamal Boykin for coming over to say hi!

Friday was stressful. The day started bad when we were in need of beds for patients and our ward had 4 rooms occupied by patients paying for a single room (usually it is two per room). Now, everyone might have their own personal view on this topic and so do I. I hope I don't offend anyone with my view but it is how I feel. I work in a hospital. Not a luxury hotel. Yes, this is Germany and we have one of the best systems in the world and everyone is used to high standards.....but again.....I do not work in a hotel. Our main priority is to take care of patients. I also realize a hospital needs to work economically but then things need to be restructured if there is so much emphasis on patients getting their own room for a few extra bucks rather than caring for the patients who need our help. If we are not in need of beds and a patient wants to pay more for a single my guest at Hasselhof Hospital Hotel. If we need beds because we already tried finding beds to put our urological patients  in on other wards (with less specifically trained staff ) before putting them in "your" room then hotel very quickly turns into hospital so that everyone can be taken care of.  The people responsible for arranging beds for patients were going half insane because we didn't have enough beds. (People against my view might argue that it is the hospitals problem and not theirs if there aren't enough beds.....well then I hope you experience wanting to come to the hospital because you are sick and not getting a bed because other people with your selfish mindset won't give up "their" room).
So back to the ward. We needed beds and none of the patients were willing to share "their" room....not even after being asked a third time and told how we had tried to arrange something else but it simply wasn't in the world were they not feeling the slightest bit guilty?! And to use the excuse that it's your last night and you would like to be undisturbed....the nerve! Exactly, it is your LAST you can sleep at home tomorrow if the patient we decide to put next to you is a horrifically loud snoring, foul smelling beast of a human being......(all of which we are doing to intentionally pick on you, by the way)

Then, relatives accused us of not doing our job in contacting them after a patient's operation although we had tried several times with the number they left us. The relatives walked in the room all ready to complain about how unbelievable it is that we wouldn't call them. Even after explaining that we had tried to call several times and that in the end, perhaps it was the technology that failed.....nope, they persisted that we had failed and that technology couldn't be the culprit. You are right Ma'am...we are evil, so we decided not to call.

All that had me feeling an inner rage. Then the topic of drawing blood started again and the patient I had successfully drawn blood from now needed a new lab work up. I volunteered to draw the blood thinking it would take me away from the stress for a few minutes. Oh naive, sweet naive little Viktoria.  The patient complained left and right about drawing his blood. He went on about how all other doctors didn't have problems drawing his blood (I refrained from enlightening him that I was the only one that had been able to draw blood from him while in the hospital). He continued with telling me drawing from the back of the hand was so painful while I merely inspected his hand as a possible location. I replied that I was fully aware of this fact and that was precisely why I was spending so much time looking for a suitable vein else where but that his veins weren't exactly jumping out at me and that he was more than welcome to show me where these "great blood drawing" veins of his were located. (I remind you of the 60 BMI) He only took a glance at his arms and then refrained from making suggestions. There were multiple more comments that I had to suppress a reply to. In the end, I had all the blood I needed from one try.

My ward resident was in the OR for the second half of the day and I was alone on my ward. At about 2PM I realized that 30 students would be arriving in 15 minutes for class on the ward and my doctor was still AWOL. I took matters into my own hands and organised three patients to participate in the teaching and gathered all the necessary material. I coordinated the same procedure for the other ward as well. In a bit of a frenzy and more headless chicken runs, I had all 30 students distributed amongst the patients with the necessary documents and appointed doctors and rooms for the discussion that followed the patient interviews. I inhaled the lunch the other intern had kindly brought back for me. My ward resident strolled onto the ward about half an hour into it all and was glad to see that I had it all under control. While the students discussed with the doctors, I took a yogurt and hid in the admissions room for 5 minutes of peace.

Friday night, the department had their holiday dinner and I met up afterwards for some wine and some good laughs. A good way to end the week.

Best Moment: A few:
1. My patient from last week with the tumor called to give me an update because he wasn't sure the other department was communicating with me. I'm going to try to be at the operation.
2. I now have a pager! The doctors say I'll regret having one but I'm excited.
Next level!

3. Another colleague brought me chocolate! Yes!

Keep the chocolate coming please!

Worst Moment: Well the Friday work day kind of sums that one up.

Here's to a better week starting tomorrow!

Stay healthy!


Sunday, December 7, 2014

Week 3: Catheters and Prostate checks!

This past week definitely had some highlights.

The work on the wards was rather limited after the ultrasounds were done and the blood was drawn. Two of my three peripheral lines I laid worked on first try (it might sound ridiculous to report something like that but its a little victory for me every time it does work.)

Urology bouquet

The urology rotation started this week for students. I applied and got the job for the teachers assistant position. My main job is to conduct the catheter class. This entails me standing in front of 15 students or so and showing them how to place a transurethral catheter with the help of three male and one female plastic model....consisting of the waist down to the upper thigh. There is always a low key giggle that goes through the room when I bring out the models. The three classes I had this week were all really good and everyone took the task seriously.

One of my colleagues was in Belgium for a daVinci training session and brought back Belgian chocolate for me! Yum! (Have I mentioned I really like my colleagues?!)

Breakfast with the nurses :)

Wednesday, all the interns, residents and even an attending met up at one of the guy's house for dinner. He cooked sweet potato curry and I made an American cheese cake. It was all very delicious and a really fun night.

Since work on the ward was usually completed relatively quickly, I looked for good things to do. I helped with admissions throughout the week. I was allowed to interview the patients and physically examine them and the doctor would have to do the informed consent discussion. (I did one discussion since the patient had had the procedure two times already and the doctor was still right next to me in case I forgot something). After having worked in the urology department last year for a month and this year three weeks already, I finally checked prostates! That isn't supposed to sound like I enjoy doing them but it is a part of urology and I really just wanted to get started with them.....the more prostates you check, the better you are at defining your findings.

I also spent time in the outpatient clinic. I was allowed to interview the patients, examine them and then report my findings back to the doctor.

A little urine analysis here and there
One patient came with a heavy feeling in the right scrotum. The patient's history was rather insignificant to his current complaints. I did an ultrasound of the scrotum and found a varicocele (which is an enlargement of the veins within the scrotum). One of the residents came into the room and confirmed my findings. He then had the attending come have a look to decide if an operation would make sense. 

The attending also did an ultrasound but then started to do an ultrasound of the patients stomach and started to palpate around the abdomen. At some point the light bulb went on in my head! A varicocele is typically on the left side due to the nature of the veins. On the left, the vein flows into the kidney vein in a 90 degree angle. Since an angle is not very smooth for fluid to come around, the blood can pool back into the scrotum and cause a varicocele. The vein on the right, however, flows smoothly into the vena cava. Consequently, if a varicocele presents on the right side, there is most likely something inside the abdomen compressing the testicular veins. This thought process was the reason why the attending spent so much time examining the patients abdomen. 

We found a hard resistance and an undefinable structure with the ultrasound. The patient was admitted to our ward for a CT-scan. The results were back the next day and this patient has a HUGE tumor. The current suspicion is a liposarcoma (fat tumor). The following day, the patient had biopsies taken and we are waiting on those results. The patient was transferred to the general surgery department but I continued to go visit him there because he is such a nice person and I really am interested in how this case goes. He told me he is so thankful towards me since I was the first person to examine him and kick start this whole process. We agreed to stay in touch during his treatment. 

It really is insane. I did not go into that examination room that day thinking this would be the result. The patient thought he was just going for a quick doctors visit and ended up with all that. I met some of the family and they were of course also shocked, not having expected anything wrong with their very healthy appearing relative. The prognosis is good. Of course it will be a battle and obstacle to go through for the patient but he has a great support system. I've dealt with a lot of patients with tumors but I've never been there for the moment of diagnosis.

December = coffee in a boot

Best moment: I won tickets to the Semi-Live Congress Urology 29th-31st of January over Facebook. They were giving away 10 tickets (350€ each) for the congress in Heidelberg. I've always wanted to go to Heidelberg and its my birthday so this should be a fun trip.

Worst moment: I don't really think I had one this week. A funny moment was when I was told to get an ultrasound machine while in the outpatient clinic and I asked three people if I could take the one from the back right room and they all said yes. As soon as I was out of the room, all the doctors (including the chief and attendings that had just walked in) stopped dead in their tracks and looked at me. I probably looked like a dear in headlights. The chief said he never had to fill out a death certificate for an intern before. I just smiled and asked if had gotten to that point now. Apparently that ultrasound machine is the chiefs and not allowed to leave the room......well I did ask 3 people and no one seemed to I don't even feel bad. 

My Saturday morning working on my doctor thesis

Hope you are all enjoying the holiday season! Stay healthy!