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!


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