Mission accomplished!

Well, its been completed. I'm officially a physician in Germany!

But let us rewind a bit first. About 5.5 weeks ago, I had my last day at work in Hildesheim. Apart from a little trip to Ludwigsburg right after that and a weekend in Hamburg babysitting my godchild, all I did was sit at my desk and study. Since I only had about 4 weeks, I didn't leave a day out to rest. The time flew by.

Sleepy godchild

cozy sunday

I started with 5 days of urology, thinking it would be a nice ease into studying again. I continued with surgery before moving on to internal medicine and neurology. For some of the professors, protocols from previous exams existed that helped narrow in the topics they ask.

The other two examinees and I also personally introduced ourselves to the professors ahead of time.

Neurology was probably my biggest trouble child. Its just a wide field of information for a specialty I hadn't exactly spend much time in. (To make things even more exciting, the neurology professor was switched 4 days before the exam date.)

my too-cool-for-school study buddy

My mood kept swinging between "Viktoria, you've totally got this!" and "Oh F**k. I don't know ANYTHING!". I spent a lot of time talking to myself out loud and explaining all kinds of diseases.

Knowing enough information to pick the right multiple choice answer is just something else from being able to explain a disease to someone else in coherent sentences. 

When I did take a break, it was either to take my aunts dog on a walk to clear my head or I skyped.

Day trip to the European Bread Museum

The other students in my group had about 3 weeks of more studying than I did. This is totally my own "fault" since I took my days off during the year. I don't regret that one bit though. Those vacations all over the place were worth every minute and cent. In the end, who knows if that what I could have looked at in those days would have then been asked in the actual exam.

study break

I was never really nervous about the exam (except a little bit the morning before the second day). I can't decide if I was really good at suppressing those feelings or if I just had given into the situation I was in. I couldn't change the fact that I had to go through with this exam, so why stress? Instead, I decided to use my energy to get more studying in. My biggest thing was, I didn't want to have put in so much work over the past 6 years and then look like an idiot in front of the patient, the four professors and the other students. I know my strength is in the doctor-patient-relationship. I know what is practical and necessary to know but I don't get hung up on absurd details. My brain has too many other interests for that space to be occupied by exotic facts. Nonetheless, in the exam situation, it doesn't really matter how many other great hobbies you have, how much other knowledge in other fields you posses, its all about medicine and the doctor situation. 

The weekend before my exam, I temporarily moved into a more or less empty apartment, that belongs to my aunt, in town. I spent two days in the kitchen with nothing there to distract me and looked at my notes. It was really productive. 

My parents spent that weekend at a huge 3 day long party at my dad's fraternity (they were celebrating their 125th year existence). I received a motivational call from them the night before. A few friends of mine, the ones that knew I had the exam the next two days, sent my good luck wishes. I spent about two hours prancing around the apartment listening to uplifting African music. I needed to move, I needed to dance and get out of breath a bit after sitting for so long.

I had a few nightmares the weeks leading up to the exam in which I overslept or couldn't find where I had to go. The night before my exam, I slept quite well. I got ready in the morning and headed on my way to the hospital.

Day 1 Exam:
8:00am: received our patients names and wards from the committee chair
8:00-9:00am: interviewed the internal medicine patient and performed a whole body examination
9:00-9:20am: interviewed the surgical patient and performed the relevant body examinations 
9:20-11:50am: looked through all the files and wrote a release letter for the internal medicine patient
11:55am: release letter drop off
12:00-1:45pm: trying to look at as much relevant information to the patients diseases as possible, stuffing a sandwich in me and following it up with a coke for caffeine, sugar and fluids. 
1:45-4:50pm: all four professors and all three examinees went from one patient to the next, starting with the internal medicine patients, and each examinee was allowed to present their patient and was asked questions for about 20 minutes.  

When we were given our internal medicine patients in the morning, we all tried to hide our shock when they ended up all being some rare cases of cancer. I had studied a lot of oncology before the exam, my patients diagnosis was not one of them. To top it off, the professor said my patient had some nice neurological side effects to show and be asked about (ugh!). Luckily, the professor said he wouldn't ask details about the rare disease specifically but rather the broad spectrum of similar diseases and relevant information.

Before even looking into the files once I got them on the ward, I went to talk to the patient. I wanted to hear it from her first hand. She was a very nice lady with a very positive view on her situation. The dynamic between us was great. We felt like a team that would get through this exam together.

I was relieved when I arrived on the surgical ward to find my patient only having broken her ankle. Rather simple case. Young girl, broken ankle, typical fracture, no comorbidites. 

I quickly got to the library and started looking through my first patients files. She had a rare manifestation of a B-Cell-Lymphoma. It took a while to go through all the files and put together a coherent timeline of the events. Once that was done, the task of writing a letter with a good flow was much easier. Once the letter was dropped of, I tried to stuff as much information as possible into my head and as much food and energy into my stomach. 

I was the first one up to present my patient and get asked questions. My first few sentences probably sounded as though I was a bit nervous. I just had to get into the mode of actually talking after having spent the last few hours cramming information and not talking. The first patient went alright. I was allowed to show some examination procedures to the professors and more or less could answer all of their questions. 

While the other students presented their patients, I tried to answer the questions they were asked, in my head. Most of them I could. Others I didn't have a clue. 

The second round was with the surgeon. I had hardly spoken the first two sentences before me interrupted me to ask questions. I was prepared for this since the protocols of previous exams all mentioned that he did that. He was a cool professor to be questioned by. He also threw in some fun facts to lighten up the mood. I was done before I knew it and then only had to deal with my back hurting while standing through the other 40 minutes of examining. 

I was glad when the day was done and was content with how it had gone.

My parents, uncle and grandma stopped by that night to bring me some food and say hi. It was great seeing them and being able to report about the day I had had.

As mentioned, I was slightly nervous the morning before the second day. This was mostly due to the way the neurologist asked questions the day before. She asked some specific things that I hadn't dealt with either at all ever or since the lectures. 

We were all dressed up and ready to go. The second day took place in the oncology meeting room. One side of the room the professors and on the other side of the table, us three students. 

I was once again the first to go (ladies first) and started off with urology. It went well and I was feeling fine. After the first round, the committee chair offered us all some coffee. 

My second topic was surgery. That also went well. 

At this point, I had calculated that my next topic would be internal medicine, leaving the one thing I wanted done and over with for last....neurology. Not only was it my last topic, but I also calculated my topic. She was asking major neurological cases in the emergency room. The first guy had meningitis (man, I would have killed that round of questions) and the second guy had stroke (also a topic I felt confident in answering). So what was left for me? I would have put money on it and would have won......epilepsy. Great........ugh. 

First, I still had internal medicine to complete. There was no knowing what topic he would ask. The EKG interpretation went well and the case scenario did as well.

Last round and last topic for me: neurology. Of course, she started telling a story about a patient and it fit 100% to epilepsy. She didn't go extremely into any details and I was actually able to answer all of her questions. 

And with that, I was done and only had to wait the next 30 minutes until the other two had their last round behind them. We did take a break in between and the coffee ran right through my system so I had had to pee really badly for about 1.5 hours. As soon as we were out of the room so that the professors could discuss our grades, I ran to the bathroom. I was relieved to see that the other students and the neurology professor did the same. Apparently neither of us wanted to be the one to ask for a break in between. 

They asked us to come back in and gave us our grades. I'm very content with the result. Its exactly how I would have given the grades had I been the professors. I was happy it was over and I was even happier to get out of there and get to my family. 

While walking down the hallway with the surgical professor and the other students, my family crossed our path looking for the meeting place. So the hugs and congratulations took place right then and there. 

 

We drank champagne, took pictures and since I wasn't the only one who had passed, I congratulated the other group as well. My family and I went out for a lovely dinner that night, followed by drinks with some of my urology colleagues. Since all of my close med school friends don't have their exam until after mine, we have to push the crazy partying back a bit. 

In the end it wasn't all that bad. I'm happy I didn't get crazy nervous or regret that I didn't have more time. The four weeks of non stop studying were necessary (even if it was mostly to feel like I was just doing something) but I wouldn't have changed anything about it otherwise. 

I don't feel much different. Its nice to not have the pressure of the exam weighing on my shoulders but I still won't be just chilling for a while. The day after, I made a list of things I had been putting off and the list didn't seem to stop. I organized all the things I had to do now that I'm not a med student anymore. I was a bit overwhelmed at first and decided I didn't want to be an adult and wanted to sign up for the first semester of a different field right away. Student life is rather simple in many aspects. But I've organized a lot since then, had some informative meetings and am a bit more on track with my new life now.

I spent a few days at the lab. I need a few more slides looked at before the work that needs to be done with me physically at the lab is done. Then its time to write my doctor thesis. It won't be long before January gets here and I start studying for the USMLE again. 

As you can see, my to-do list is far from finished. But it never will be finished, I'll just be crossing things off of it while new things get added. Such is life and that is good.

So for now (don't worry, I'll be back soon, so stop by occasionally!)

Become a physician

If I'm ever lost....I can always just go here.

Stay healthy!

V

Week 47/48: Wait?!....is it really over?

First, so sorry for the massive delay and non-existence of the Santorini post yet. Let me explain, the last week of my internship, I moved out of my apartment to the largest extend....all by myself. 

You'd be surprised how much fits into such a small apartment. I've been sorting trough and getting rid of things for weeks now but yet, there was still so much. 

So, moving took up all my free time. I also finished up my internship year. It was rather non-ceremonial. 

Monday was spent in the pneumology department as usual. 

I did meet up with the chief of thoracic surgery in the afternoon so that he could show me pictures from his recent vacation. I was supposed to reciprocate but had forgotten my iPad so we pushed that to Wednesday. 

Tuesday, my exam group and I went to introduce ourselves to the neurology professor partaking in our exam. He was nice. He tried to tell us what to focus on while studying and at some point realised that neurology is a rather wide discipline in terms of topics.......uh......yea. Glad you realised this now.

Wednesday, the day was spent running around the hospital taking care of business. And with business I mean distributing cookies I had baked the night before to all the surgical and internal departments. I still had a few signatures I needed and I had to return keys. On my second round (some people weren't present on the first round), I got stopped by the chief of surgery's secretary. The chief more or less demanded that I write down the recipe for the cookies. While I did this at her desk, the chief walked in and says, "Ms. Hasselhof, you have made the most delicious cookies in this world. I insist that you give me the recipe!" Way ahead of you, sir. 

In the surgical department doctors office, two more surgeons couldn't stop gushing over the deliciousness of the cookies and I had to write down the recipe for them as well. They were certain that they wouldn't get the recipe from the chief if they asked.

I'm not complementing myself here because I didn't come up with the recipe. I just baked them. So I feel that all those compliments really go to the recipe creator...not me. 

I stopped by the chief of thoracic surgery's office again. He had coffee ready for me and I showed him a selection of pictures from my Santorini trip. Some doctors stopped by to wish me well. 

Before I left, I tracked down the chief of children's surgery to say thank you and good bye. I stopped by my favourite residents and hugged them good bye. 

On my way out, I ran across some of the attendings. One was completely in awe of the cookies. He wished me all the best and said he had full confidence in my ability to be a great doctor.

It felt bittersweet leaving. I have the tendency to turn any work environment I am in into a family more than just coworkers. I'm the intern that will chat with the chiefs, talk to the attendings about their kids and travel plans, hang out with the residents. I care about the people I work with and see on a daily basis. I'm not just there to do my internship and leave. It makes going to work a lot more fun every day but also makes leaving tougher.

I am very thankful for all the doctors that took the time to teach me over the last year. Every single one of them. In some cases they were obliged to do so but some went beyond what was absolutely necessary and let me learn more, do more, see more and in some cases, teach others. 

Thank you to all the patients for their patience with me, their interest in my life, their well wishes and their confidence in me. The patients are the reason we go to work. They are in terrible life situations sometimes and I am a part of their hope, of their healing process and the fact that so many allowed me to be that for them, is amazing and heart warming. 

Packed and ready for this last train ride from Hildesheim

I've come out of this year with many new friends, great experiences, funny stories, tragic stories, new work connections, and have grown as a medical student and as a person. 

Just last week, I received an email from Patient X. He is doing great, loving and living life and thinks of me often. We plan on meeting for coffee and I really hope it happens before I leave Germany.

As a medical student/intern/doctor, you have many patients and some find a special spot in your life. As a patient, you have a few doctors (at least most) and look to them to help you out of a life situation you'd rather not be in and thus, they acquire an important part in your life. That connection, between doctor and patient, is a sacred and very unique one.

I now spend my days studying day in and day out for my practical exam on November 16./17.

After spending 6 years of my life dedicated to medical school, I just want to perform great in this exam. 

I'll post about Santorini in the mean time if I have the energy to do so in a study break. I will for sure post once I have the exam done and over with and am hopefully a German physician! 

Thank you to each and everyone of YOU that followed along on this past year. It flew by. Your comments and compliments to continue up with it have been a great support. I love hearing that you enjoy reading what I have to write! I hope I could give you a little bit of insight into my life as a German medical student.

Stay healthy!

V

Week 45-46: A little bit of work here and there

Kalimera everyone! (That's good morning in Greek)

Although you can't see me while reading this, take whatever image you have of me in your head and make my skin multiple shades darker. 

This obviously is not a tan from the OR lights but rather from a truly wonderful week long trip to Santorini, Greece with my family.

But first the work related topics.

Two weeks ago, I once again found myself not working in the pneumology department as originally planned but rather back with the thoracic surgeons! The chief was still on vacation and the attending and resident needed my help since the resident's left hand was still in a cast. 

I did all the bandage changes and pulled all of the chest tubes on rounds. On Tuesday, I assisted the two operations of the day; a biopsy had to be taken from a patients pleura (the inside lining of the chest) because it looked weird on the CT-scan and a tracheotomy. 

The first operation was really interesting to see. We performed the procedure thoracoscopically This means we made two small incisions, one for the camera and one for the instrument. My jaw dropped once the camera was in the chest and I saw what was there. I can't explain it better than: it looked like a bubble gum/bouncy ball pink wonderland you'd see in a Dr.Seuss book. It actually looked pretty although completely out of place considering we were in a patients chest and horrific knowing that the cause of such a landscape was cancer. What type of cancer is still unclear (at least at this point unclear to me since I'm not in the department anymore but I'm positive they have the results back by now).  Pleural carcinomatosis can have its origin from different types of cancer or it can even be a cancer originating from the pleura itself. It really was fascinating to see what the body is capable of producing, even if it is a terrible thing.

The second operation went fairly quick since we only had to perform a surgical tracheotomy. The patient was suffering from pneumonia and had been ventilated for a while and now had to be switched over to tracheotomy. 

This past week, I finally had my day in the pneumology department! Although there once again was another intern, I wasn't going to not be there for the last few days of my internship year. We spent the first part of the morning watching the chief perform bronchoscopies. They were all pretty quick.

The rest of the morning, before lunch, was spent on rounds with the resident. It seemed to take a while for the few patients we had but we spent a good amount of time with each of them. One patient was being trained to use a "cough-assist"-machine. Its a device that helps mobilize the secretions in the lungs when the patient isn't able to do it themselves. 

Our patient is an older man that has reoccurring pneumonia. The training session was rather entertaining. He went from not wanting the machine at all and having to talk to his wife about it first (since they don't make any decisions without having discussed it. How cute.) and asking how many Deutsche Mark (the German currency before the Euro was introduced back in 2000) he'd have to pay for the machine. We had to explain to him multiple times that his health insurance would be covering the costs. 

The training isn't a comfortable procedure. The patient has to do about 4-6 breath cycles with the mask held over the nose and mouth. A positive pressure is applied during inspiration and a negative pressure is applied during expiration. So when you breathe in, air is being forced into your lungs with a certain pressure (not much different than scuba diving I imagine albeit more powerful) and then the machine basically sucks the air out of you. In those two seconds, you feel like you can't breathe. What that does though is pull up the secretions from the bottom of the lung. In fact, the patient was able to cough up more after just a few cycles. At first he didn't like it at all, by the end of the training session, he hardly wanted to stop. He admitted that he understood why it helps and that he can, in fact, cough better but that he still needed to talk to his wife before buying such an expensive machine. We kindly informed him once again that he wasn't paying a cent and that after training with it over the weekend and talking to his wife that we would reevaluate the situation. 

I had to place another line on one patient which worked great. Afterwards the other intern told me that the patient he was supposed to draw blood from not only was known for her bad veins but also only let him try to draw blood once and was now refusing to let him try again. So it was up to me. 

I've drawn quite a bit of blood over the years and there are just some patients that need you to be more of a psychologist during the procedure than others. This patient was scared, frustrated and unhappy. She was always afraid of having her blood drawn because she knew she had bad veins and she frequently needed blood drawn. The vein that her general practitioner usually uses had a i.v. line in it. She is the type of patient you can't just walk into the room to, say your going to draw her blood and get it over with. I went in, told her why I was there, shared with her that I was aware that her veins weren't the easiest to work with and that all I wanted to do first was have a look at her veins to assess the situation for myself. Her first statement was that she was over it and wasn't letting anyone poke her again. This is were the psychologist comes into play. I told her that all I wanted to do was look and then reevaluate if I felt confident enough to try to draw blood. I also just chatted with her while doing so. Some patients have a huge urge to just talk about their problem and if you let them and you listen, they are much more open to you doing things. I genuinely want them to feel better too, I'm not just letting them talk so I can get my work done quicker. I even had to try twice before being successful but she said she didn't even feel the first try. Having the patients talk can nicely distract them from concentrating on the poke of the needle. By the end of all of it, I had the blood I needed and the patient seemed relieved that it worked but also that she had someone listening to her problems. I know for a fact that her resident wasn't sitting there listening to her woes. 

This coming week is my last week of my internship year. I've noticed that somewhere in my counting of weeks in my blog posts, something went wrong because I'm off by a week. The internship year is 48 weeks altogether and I'm only at 47 for next weeks post. Oh well. 

I'll be in the pneumology department for a couple of days before saying me last good-byes to all the departments on Wednesday. 

I've been busy sorting through my things at home like a mad man. I move out of my apartment in a week. If I were just moving into a new one, it would be easy. I, however, have to decide what I want to keep, what goes to America with me right away, what can stay in storage for a year, what am I donating and what am I throwing out. And since I'm in Germany, throwing out isn't just throwing everything into a big trash bin, it all has to be sorted accordingly. This all is making the process slower but I'm seeing less and less in my apartment each day so I know its working.

My tan works well with the white lab coat

I haven't downloaded the Santorini pictures onto my computer yet. I will do a separate post about Santornini here in a few days. I will leave you with this: if you have a travel bucket list, Santorini NEEDS to be on it. It is as beautiful as you would imagine it to be. The people are nice, the food delicious and the views on the Caldera breathtaking. Hopefully I can convey some of those feelings in the post. 

I wish you all a lovely rest of your Sunday!

Stay healthy

V

Week 44: Ultrasounds, chocolate and happiness

I spent the first part of Monday organizing where I'd even be the rest of the week. 

Originally planned was that I would start in the pneumology department. This is a rather small department to start with and they still had an intern planned to be there for the next two weeks. One intern is almost an overdose, so two would have been overkill. I ran between various secretary offices and making calls to the chief of the department. I saw on the official plan that the gastroeneterology department I had been in the last few weeks and which is the biggest of the four internal medicine departments, didn't have an assigned intern. The chief of the department was ecstatic and told me I was more than welcome to stay in the department another week. After talking it over with the pneumology chief and having it noted by the secretary, I was back in the gastro-department. 

The set up of doctors was a bit different this week. I spent a lot of the time placing i.v. lines and drawing blood again but I also spent a lot of time on rounds with the doctors. The two doctors I went with were great! They asked me a bunch of questions. Some I could answer really well, others not so much but they were great at explaining the answer to me and helping me understand why things are as they are. I had some mind blowing moments there. Little things that I just learned during my studies but never really understood why were explained to me. 

Smaller wasn't an option?

I quite enjoy rounds where I'm asked a lot. I don't expect myself to know everything but it gets my brain working and is practice for my exam. The annoying this is when the brain doesn't work. I was asked by which system liver cirrhosis is classified. I definitely knew I knew the answer but all type of other scores started popping into my head and blocking my thought of the right answer. After a few moments I had it but that just felt annoying because I don't want that happening during my exam.

I went on grand rounds as well. Since I had had an informative day of rounds the day before, I was hoping I could shine because the chief would ask about the same questions. Oh how naive Ms. H. (Miss H Dot is what chief calls me, although he actually knows my name). He ended up asking questions that luckily the resident couldn't answer in it entirety either. Its just how chief is. He asserts his superiority with it. That's fine because I end up learning something as well. 

The one doctor took me along to do ultrasound this past week. Instead of him doing it and telling me something, he immediately had me sit down and do it. I'm rather good at finding the kidneys and bladder due to my urology rotation but for the rest of the abdomen, I didn't have a clear system. It ended up being a lot easier than I had imagined it would be. He showed me how to find all the things I needed to look at. Of course, each patient is different and some are easier to examine than others but I definitely feel more confident in examining many parts of the abdomen. 

I watched a few colonoscopies throughout the week. It really is a super important exam everyone over 50 should have. If you fall into that group and haven't had one. Go get it done. Its not a big deal and you're thinking about way to much in your head and worrying about things.....its not a big deal. But it can be a big deal if it helps find something that can be removed.

There were so many sweets on the ward this week. I really tried to hold back most of the time but sometimes it took so long for everyone to be ready for lunch that I just had to chow down a bit. I need to make sure to take more healthy snacks with me in the future so that I'm not as tempted. 

Tuesday evening, I went to see Ali and his family and give them the money I was able to collect. Thank you from the very bottom of my heart to every single person that donated. I can't express how happy it makes me feel inside that there are such nice, helpful people out there. Being able to help Ali and his family is one of my proudest accomplishments and those who donated or donated their time to help me are a part of that happiness. So thank you!

This coming week, I'm only at work for 2 days before heading to Santorini with some members of my family! WOOHOO! I can NOT wait! I've wanted to go to Santorini for the longest time. I hope to have a relaxing week that will get me ready to get down and dirty and study for my practical exam!

Have a good week! Stay healthy!

V

Week 43: Oh the redundancy......

I'm coming off of couple of very sleep deprived days.....for a change, this time medical school was not the culprit.

The work week was rather redundant. I spent most of the days drawing blood and placing a series of i.v. lines every day. It has gotten to the point were I almost enjoy placing i.v. lines. I've been so successful that I see every new line as an opportunity to keep my stats up and take on challenges to push my abilities. 

"Hey Viktoria, want to place another i.v. line for me?" my facial response. Pure excitement

There were so many to do though that I didn't even attend rounds the first few days! Except Tuesday for grand rounds. Chief asked a lot of questions again and I was more graceful with my answers than last week. I even low key impressed him when I answered a question. He told me that most gastroenterologists didn't even know that answer....which again surprised me because you could easily answer it if you knew the blood vessel anatomy of the stomach and spleen (which I guess I assumed most doctors did). 

I admitted another patient. She was an elderly lady and the conversation went much longer than it needed to be. We ventured off into none medical topics as well. I think the two years I spent living with my grandparents and spending so much time with my grandma and her friends really influenced me. The idea of a big round of older ladies, coffee and cake sounds great to me....I'm guessing that's not the case for most 25-year-olds. 

Giving your intern ample amounts of chocolate for her help is most definitely appropriate

Since it was my last week in the gastroenterology department, I really wanted to make sure I get to see some endoscopy procedures. 

I watched an ESD (endoscopic submucosal dissection). It is a procedure in which, for example, neoplasms (new formation of tissue that shouldn't be there and could possibly be cancerous) in the colon are removed. Older procedures would use a type of electrical sling to remove that growth but the reappearance rate is high. With the ESD, the layer between the mucous membrane and the muscle layer is cut apart and if done correctly, practically  diminishes the recurrence of new formations at that location. This procedure can take anywhere from 2-10 hours according to the chief. Its basically an operation an internist performs. 

Oh hey there BFF Coffee......what a surprise to see you here!

I also was shown an ERCP (endoscopic retrograd cholangiopancreatography). Essentially, you go through the mouth, through the oesophagus into the stomach and on to the small intestine. There you'll find the opening from which the pancreas and gallbladder excrete their fluids. The passage ways of the bile and pancreas can be displayed using contrast medium. This is good to see where strictures or obstructions in the passage ways might be. The doctor also performed a 360° ultrasound of the upper gastrointestinal tract which was interesting to see and not so easy to interpret.

Besides that, I spent my time with the patients and their terrible veins. 

Thursday, I left for Berlin after work to meet up with friends that were on tour in Germany and hung out with them for a few days, watched the shows and just had a great time getting away from it all.
 

The Badder

DJ Premier and the Badder

Posers. Practice. Preemo.

Tomorrow, snap back to reality, Oh there goes gravity.......ok I'll stop there ;)

Stay healthy my friends!

V

Week 42: The chill life of thoracic surgery and my little man Ali!

That was easier than I thought it would be.


The past week was less stressful than I expected it to be. Not because I'm some sort of natural at being a doctor but rather because the work load I had anticipated didn't exist. 
The chief, the attending and I did almost everything together. Sure, I got to change the bandages and remove chest tubes and suture at the end of surgery, but this wasn't anything I hadn't really done before. The only difference really was that I wrote a few release notes and my computer access was upgraded to full access of a doctor instead of my limited intern access. A lot of time was spent in the chief's office drinking coffee and eating snacks.

It was fun being back in the surgery department for a week. I all of a sudden saw a lot more of my surgical colleagues than before (the internal medicine department is on a different level of the building so at most I would see the surgeons in the hallway or at lunch but due to politics, you ate with your department). My time in internal medicine did shine a bit through while writing the first release letter. 

Surgical release letters are quite straight forward and to the point with little story telling involved. Patient had this. We did that. He left in a good condition.

Internal medicine release letters are some what of a novel about the patients life. It includes a long history of the patient, all the ailments he has, all the medications they are on, all the diagnostic tests that were run and the interpretation of them, how the treatment will go on from here.....they are easily 5-7 pages long compared to the usual 2 in surgery. 

So when I was working on the first release letter for my thoracic surgery patient, I started with a good thorough history of all the doctors the patient had already been to and had lead them to us. Continued with all the x-rays we had done and the interpretation of each. And filled the rest of the slots with ample information. When the attending came to look over the letter with me, he deleted about 2/3 of the text. From that letter on, my letters were short and to the point. 

We operated Tuesday through Thursday and had 4 operations. Removed a segment of a lung, a small part of a lung, took samples of a lung with a lot of adhesions and removed a lipoma on a mans chest. Most of them went as planned and only took 2-3 hours. The one that really got me was the patient with the adhesions. 

It was on Wednesday that we had two operations. The first one wasn't a problem and even finished a smidge earlier than expected. The second one was only supposed to be taking a sample from the pleura (the tissue covering the inside of the chest and the lung) since it looked thick in the CT scan and the patient had a history of working with asbestos (needed to see if that was a mesothelioma (I'm sure you've heard the commercials on TV about asbestos and mesothelioma and how you should hire their lawyer to get money)). The operation was expected to take 1.5 hours. It was already hard enough gaining access to the inside of the chest due to the adhesions but once we had an opening, we saw just how stuck together everything was. The surgeon just sighed and said this would take a bit longer. I sighed in my head because that day was technically a day I could go home an hour early and I had a massive to-do list I needed to get stuff worked off of). About an hour after that realization the anesthesiologist asked how long we anticipated the surgery to last and the surgeon replied, "easily 2-3 more hours". Great. We luckily all requested chairs to sit on because my back was already making itself noticed an hour into the surgery. I waited until 2.5 hours into it to ask for a chair though. Luckily the staff was friendly and we chatted a bit during the operation because all I did was hold hooks and was hardly to actually see anything in the chest. Not the most exciting thing to do. Chief came in the OR and told me he was going to go do the seminar with the interns and then come back in time so that I could catch the 5:25PM train with the other interns. He said he wanted to be in the OR by 4:40 since I had to leave the hospital by 5 if I wanted to catch the train. He didn't show up until 4:55 and we were basically done just doing the last suture. I hurried off to get changed and grab my stuff and left to catch my train. 

The week was fun and relaxed and the chief is still trying to convince me to start in the department. If I really did, I know it would be a rather relaxed job. The surgeries might kill my back but all in all, it would be a chill work environment. To bad my dream isn't becoming a thoracic surgeon.

Remember Ali? The little boy from Azerbaijan I told you about? He had his check up ultrasound this week and everything looks good! I started a little donation collection to help the family out. Below is the letter I sent out to family and friends asking for even just a little support to help this little family out. If you have $5 or however much to spare, I'd greatly appreciate it if you participated and I know the family will be so thankful as well!

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Dear  Friends & Family,    

I’ll  try  to  keep  this  short  since  I  know  you  are  all  busy  people.  A  few  months ago,  I  was  introduced  to  little  2.5  year  old  Ali  from  Azerbaijan.  His  father worked  really  hard  to  get  a  scholarship  to  study  in  Germany.  One  of  his  biggest motivations  was  to  get  better  medical  care  for  his  son.  Ali  was  diagnosed  with hydronephrosis  in  his  home  country.  This  refers  to  distension  and  dilation  of  the kidney  pelvis  and  if  left  untreated  could  lead  to  kidney  failure.  For  Ali,  this  meant many  painful  days  of  kidney  pain  and  for  his  parents  a  lot  of  frustration  not being  able  to  help  him.  
  
Through  many  fortunate  coincidences,  I  was  introduced  to  him  and  his  family while  working  in  the  urology  department  for  my  internship  year.  The  doctors  took a  look  at  him  and  his  files  and  referred  me  to  the  pediatric  surgeon.  This  surgeon was  nice  enough  to  meet  with  me  and  explain  possible  treatment  options  for  Ali. We  were  perhaps  looking  at  a  $13,000  operation  bill  that  I  would  have  started fundraising  for.  I  organized  for  Ali  to  have  an  examination  done  that  would determine  if  he  needed  surgery  or  not  and  covered  the  costs  for  the  family  with some  help  from  my  grandma.  Although  his  hydronephrosis  was  rather  advanced,  as if  by  a  miracle,  he  had  grown  out  of  it!  That  isn’t  unheard  of  but  we  weren’t expecting  it  due  to  how  advanced  it  was  a  few  months  ago.  So  yay!  No  surgery needed!  The  surgeon  offered  to  give  Ali  a  check  up  before  returning  home  to Azerbaijan  in  September  2015.  

In  the  end,  it  couldn’t  have  turned  out  better  and  Ali  looks  much  healthier  than he did  when  I  first  met  him.  However,  the  family  went  through  great  trouble  to  get him  better  medical  help.  They  took  up  credits  in  Azerbaijan  to  pay  for  the  flight to  Germany  and  had  many  other  expenses  to  make  the  trip  happen.  They  came  to Germany  not  speaking  a  word  of  German  and  into  a  culture  completely  different than  their  own  in  order  to  get  the  best  help  they  could  for  Ali.  They’ve  been nothing  but  kind,  welcoming  and  modest.  I  would  like  to  help  the  family  pay  off some  of  their  debt.  This  is  where  I  need  your  help.  I’m  asking  you  to  donate what  you’d  like  (I’d  be  thrilled  even  if  its  $5)  to  help  this  great  little  family.  

I  tried  to  think  of  ways  to  make  it  easiest  for  you  to  donate.  Below  you  can  find my  paypal  account  and  bank  account.  If  you  are  so  kind  and  donate,  please  put Ali  as  the  subject.  September  18th,  I  will  draw  all  the  money  donated  from  the accounts  and  give  it  to  the  family.        

We  often  take  our  good  life  circumstances  for  granted  and  its  
situations  like  these  that  make  me  grateful  for  what  I  have  and  motivate  me  to help  others  less  fortunate.  I  thank  you  in  advance  for  your  humanity  and donations!  

Stay  healthy,    
_________________________________________________
Paypal:     viky_oddball@hotmail.com    

Bank  Account: ApoBank     Viktoria  Hasselhof   
IBAN:  DE87  3006  0601  0008  8322  85 


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Thank you to everyone who helps out!

Next week I'm back in Gastroenterology for a week. So it's back to long rounds and even longer release letters!

Stay healthy!

V

Week 41: And the award for best supporting beverage goes to..........COFFEE!

If I ever win an award, I will be sure to thank caffeine for existing. This past week, caffeine was my superhero. 

Award for best supporting beverage: Coffee

Caffeine, aside from the one or other fine wine or Hennessy will be the most extreme I will ever get with any type of drug. I try to ween myself off of coffee and for very long periods of time, I don't need a coffee during the day. I even sometimes have phases were I can't drink coffee because the thought alone disgusts me. Other times, and the phase I'm currently in, is that I enjoy drinking a coffee in the morning and sometimes during the day. 

This past week, it kept me alive.

After getting home late Sunday night from visiting my grandma in the hospital again, I went to work Monday. Since it was a usually Monday, a coffee was needed just for that. After the morning rounds, I spent the rest of my day dealing with blood draws and placing about 8 lines. I lost track at some point. When a patient needs a new line, the nurses don't tell me, they simple place a bandage that is used to keep the lines in place on the counter. This inefficient method requires me to look into the supply room every now and then to see if there is something for me to get done. It started off with 3 bandages. When I was done successfully placing those, I walked into the supply room in order to put away the things I had used only to find 3 more bandages waiting on me. Once those were through, I found two more. The residents even felt bad for me and told me to just leave some for the others if need be. I can't live with leaving things behind for others to pick up, especially when it is more or less technically my task to complete. After all of those, I went to the tumor board conference. I had warned the doctors that I wouldn't be coming the next day because I had to go to my grandmas again. I had originally planned to take Friday off but now had to switch that for Tuesday.

Monday Night: Straight Outta Compton

Tuesday morning, I hopped on multiple trains and arrived at my grandmas 3.5 hours later. After a bit of a fiasco on the weekend where the nurses didn't want to give me information about my grandmas treatment although they were actually legally obliged to do so, I finally had a nice talk with one of the doctors there. I'll tell you a pretty stupid position to be in: being an almost doctor with a grandma in the hospital and your relatives all wanting you to bud into the doctors business.......it's not my place and makes me feel rather uncomfortable. It's not like I'm going to know more than the attending. The nurses and some doctors definitely didn't act right in regards to the situation but I still tried to be respectful of their positions whilst also accomplishing some of my relatives requests. 

Tuesday night, I attended a concert in Hamburg. It was a great time. I hung out with some friends and only got 1.5 hours of sleep before catching my train at 4:50AM back to the hospital in time for work. I got about an hour of terrible sleep on the train. So, with that amount of sleep in me, I looked and probably acted like a zombie all day. I pumped three cups of coffee in me (I'm aware this is still little compared to the hard core addicts). Nonetheless, it just barely got me by. It was another day of placing lines and drawing blood. It was almost the end of the day and time for me to leave for two rounds of seminars when I was asked to admit a privately insured patient. I pushed myself to read through the old release letters before heading to the patient. He was a very nice gentleman and I don't think he perceived me as such a zombie. Afterwards, I quickly headed to the seminars with my third cup of coffee in hand. 

DJ Premier and his live Band in the Mojo Club Hamburg

Where did my drums go??

Breakfast of champions: yogurt and tortilla chips

Once I arrived at the train station to catch the train home, I was beyond excited to be in my bed soon. Unfortunately, I realized when I was on the train (before the train left) that I forgot to buy my monthly ticket. I quickly jumped out of the train again. I went and bought my new ticket and ended up having to wait an hour until the next train came.........greeeeaaaattt. I was too tired to even be mad. I slept like a rock that night.

The eight hours weren't enough however and I needed two coffees on Thursday and Friday to get through the day. Thursday was grand rounds. I was still tired and the chief caught me off guard and I sort of bombed the first round of questions regarding the anatomy of the stomach (something I actually know really well). Luckily, throughout the grand rounds, I redeemed myself nicely and also asked a lot of questions which made him feel good because he could explain things to me. The rest of the day was spent.......you guessed it, with difficult blood draws and line placing. We had our seminar with the chief that day and I rocked it. The topic was colorectal cancer and for some reason I was a roll. I was answering questions to completion where he could only nod and say that was correct (which is odd for that particular chief).

Friday was much the same like the rest of the other days. During lunch, the chief of thoracic surgery called me and asked if I wanted to drain a pleural effusion. When I asked him "when?" and he said, "now", I quickly ate three more bits and hurried to him. I had drained one pleural effusion before with a bit of help, this time, he let me do everything. 

The patient I had admitted Wednesday, became my patient. This meant I checked on him, looked to make sure his examinations were requested in the computer and wrote his release letter. It was a fairly simple case but a good start to get used to what is in store this coming week. 

Starting Monday, I'll be in the thoracic surgery department for a week as a pseudo-resident. Should be a good and challenging week. 

I spent the weekend in Stuttgart visiting family. I arrived Friday night to a yard filled with 5 screaming kids (under the age of 5). They all thought it would be fun to chase me around. You'd think that would be the last thing I wanted to deal with after the week I had but, I loved it. The rest of the weekend was also relaxing in a crazy family and nature kind of way.

A few of my favorite people

I'm captured.

Out and about near Stuttgart

Let see how many pounds I gain or lose depending on how much I prep myself for operating and how long the operations actually go where I'm not eating most of the day.  

Stay healthy!

V

Week 40: Rent-an-Intern

For the lack of a better intro for this post, lets just get down to it, shall we?

After a few great days in Munich visiting friends and family, it was back to the hospital for a quick two days. Again, I was rotating to a different department and I had my reservations about it. Much like I did rotating into hematology/oncology thinking it wouldn’t go nearly as great as the cardiology rotation had gone, I was afraid my experience in gastroenterology wouldn’t mount to the same level of fun as hem/onc had offered.

I was also worried about how the interaction with the chief would be. During his seminars, he had a way of letting you know just how knowledgeable he was and how, in comparison, uninformed you were. Not that his seminars weren’t extremely informative, they just left you feeling a bit unworthy. My fear was going on grand rounds with him and being asked where every little factor or enzyme was produced (like one instance in a seminar of his). Due to the usual train delay in the morning, I was running a few minutes late. In Hem/Onc, the morning meeting didn’t start until 8:15AM. I had no idea where I had to be or what time the morning meeting started in Gastro. Luckily, another intern crossed my path that had been in the department before. He informed me that the meeting had already started (8:00AM) and where I had to go. Great. I was prepared for some remark on my tardiness.    

My green essentials

I arrived at the room and snuck in. Although my arrival was noticed, the meeting went on and it wasn’t until the end that the chief kindly introduced me to the staff and welcomed me to the department and offered me the opportunity to see anything I wanted to see. Gee,……why thanks!

From there, it went directly into the grand round. Uh-oh. I braced myself for a storm of complicated questions that I would only be able to answer with limited knowledge. It’s not that I doubt the amount of knowledge I have. I know there is a lot of information in my head, its just that for years on end, we were trained to answer multiple choice questions. So, if I see a question and you give me 5 answers to choose from, I’ll most likely be fine. If you ask me to answer an open end question……there are bits and pieces of information that pop up in my head but managing to put them in an acceptable spoken answer is a whole other thing. I approach questions in grand rounds openly however since that is how my practical exam will be. Might as well start practicing!

A nice surprise for me was that the questions that were asked were rather fair. Nothing totally out there. The chief also really likes to explain things. He probably even expects me to ask question just so he can explain some more. Sure, if I don’t know an answer I feel somewhat unworthy. 

Oh look, sun out there!

Often, tid-bits of information or random words will immediately come to mind when I’m asked a question. The annoying thing is that I can’t immediately explain why that might be the right answer and don’t always say the first thing that comes to mind. Even more annoying is that often, the first thing that pops into my mind is the right answer! I’m just not compulsive and think ahead knowing that the person asking the question doesn’t just want an answer but also the explanation. „I don’t know why its the right answer, it just is.“ doesn’t seem like an acceptable explanation. If you give me time to think it through, I can usually tell you why it is the way it is. But the chief ain’t got time for that! ;) Luckily there are still enough things I can explain just beautifully to make up for the answers I can’t.

The residents in the department are all super nice. They might be the internal medicine department were the comfort level of communication was almost instantaneously were as in other internal medicine departments it took a few days for them to really warm up to me.

I spent the rest of Thursday helping a resident with her patients, drawing blood from the patients that the nurses weren’t successful in drawing blood from, placing lines, etc.

I stopped by the thoracic surgery chief’s office because I was told he had been looking for me the last few days. Of all the chiefs in the hospital, he and I are totally on buddy level. He is the one who tried to convince me to stay in Germany by offering me a husband and house and a job! He informed me that the department was still suffering from a lack of doctors due to injury and vacations and asked if I would be willing to come work a week for him in two weeks. I’d basically play the role of a resident. Take care of the patients, do rounds, write release letters, be first assistant in operations……basically do that which a full blown doctor does…..just without the full accountability. I told him he’d have to talk to my current chief. He called him up right away, offered him a cup of coffee and asked him he could borrow me for a week. My chief said he’d have to ask me if that would be okay with me. His reaction nicely surprised me once again (maybe I need to change my perception of the chief). It wasn’t unheard of that chiefs would absolutely NOT give up their intern to another department. Rather, it was an exception that the chief would allow it.

After the morning meeting on Friday, chief stopped to ask me if I’d be willing to go work in thoracic surgery in two weeks for a week. He said that he wasn’t going to place stones in my way if I wanted to do it but that it was my internship year and I should be able to decide. If I wanted to learn internal medicine, I should be able to. Haha, the backhanded guilt trip. I told him that I was rather interested in learning as much as possible in internal medicine but that I understand that the thoracic surgery department is in a situation of need and that I should be so kind and help them out.

After I had my work on the ward completed Thursday and before the afternoon seminar, I found myself back in the thoracic surgery chief’s office with their current intern (pseudo-resident) and the chief of Pneumology. We talked about how theoretically fun it would be if the other intern started to work for the pneumology department and I for the thoracic surgery department. The men proceeded to joke about my arranged marriage with the chief’s brother-in-law and how crazy fun the wedding would be with all sorts of celebrities in attendance. We really threw the wildest ideas out there and the secretaries in the room next door were able to follow every word. If they have a sense of humor, they thought it was funny. If they don't, they probably thought we were the cockiest, most stuck up and narcissistic people on earth. I love when people can get over the hierarchy of a work place and just have fun with one another.  

After a bit of stress, the natural nerve-calmer

Friday, I was once again a few minutes late to the morning meeting but that didn’t seem to bother anyone. I went on rounds with my resident. We did an ultrasound on a patient with the help of an attending. Its pretty nifty what a good ultrasound machine can show you. We finished up rounds and I finished up the blood draws before getting started on some release letters. Since all the computers were being used on our ward, I wondered to the surgery ward and hung out there to write some letters. I stayed comparatively late because the right moment didn’t present itself to ask if I could leave. I’m always bound to the train schedule so I have to think about the likelihood of me being able to leave ahead of time to have enough time to change and make it to the train station. If the right moment is missed, I have an hour to wait for the next train. I missed my opportunity to ask twice because my resident and I were so involved in the care of a patient with the attending that I didn’t feel it was appropriate to ask if I could leave. After missing both of the trains I had planned on taking, the resident finally said I could leave and could have left two hours earlier, she just hadn’t thought of telling me. Oh well, I’d rather stay longer and miss the train I planned on taking than looking like I’m trying to leave early and am not interested. Its just a constant battle of right timing.

This weekend, I am back in northern Germany to visit my grandma in the hospital and to babysit my godchild since her parents are celebrating their 2nd wedding anniversary. If all goes according to plan, she and I will go visit the Hagenbeck Tierpark, a huge Zoo in Hamburg.

And as a little treat, here are some of my pictures from the last weekend in Munich! 

Chiemsee

A moment of relaxation

Where to?

Looking for a new Dirndl

Pretty Bavaria