Sunday, January 25, 2015

Week 10: "Well, you don't place tracheotomy tubes, now do you?" rude! Get over YOUR fear of the penis Sir.

This week seemed incredibly long. This was mostly due to my numerous little naps in between. I am really able to fall asleep almost anywhere and sometimes I'm refreshed after just sleeping a few minutes.

Monday through Friday I got up at 4:30am, studied for the USLME until 6:10am, slept until 6:30am and went to work. Consequently, I went to bed around 9:30pm to at least get 7 hours of continuous sleep. Studying and answering questions in the morning significantly increased the amount I was getting right. It's still not where I want it in the end but I still have until the end of March to get there. I looked through the questions and worked on flash cards after work.

I attended a lecture Monday night held by Prof. Dr. Harald Lesch. He is a German physicist, astronomer, natural philosopher, author, television presenter, professor of physics at the Ludwig Maximilian University of Munich and professor of natural philosophy at the Munich University of Philosophy. He held a lecture about the smallest and the largest components of the universe and how they fit together. It was really interesting and refreshing to learn something different and new!

Wednesday, I was called into the OR to assist with a hydrocele operation. The patients ascites (excess water in the abdomen) was so extensive that it had reopened the processus vaginalis (connection between abdomen and scrotal sac) that usually closes in early development. Basically, he had excessive amounts of fluid in his scrotal sack....and since there was a lot of pressure from the fluid in his abdomen, it was like turning on the water faucet once we opened the membrane in the scrotal sack.
Cucumber, Apple, Basil, Lime Juice for the OR

Wednesday was a long day. The day involved ward work, operation, pathological conference lecture, evening meeting which was then still followed by a short educational lecture by one of the attendings. Luckily I had my back turned towards everyone to face the screen.....because I totally fell asleep for a minute or so....good thing I didn't snore. I was just so tired!

Friday looked like a busy day from the get go. One of the three interns wasn't there and the other didn't show up. We had two huge operations and two wards that needed to be tended to by interns.....and there I stood! My ward doctor was afraid I wouldn't be around to draw all the blood and his fear came true. Directly after the morning meeting I was sent into the OR immediately. I grabbed a coca cola and a biscuit and hurried off to the OR. I usually don't drink Coke, I did while in Ghana because coffee or tea wasn't very accessible and I needed caffeine. Now I do sometimes when a big operation gets sprung on me unexpectedly and I wasn't able to have breakfast yet. Caffeine and sugar to keep me from passing out while standing for 5 hours. Luckily the other intern had just overslept and was able to assist in the other huge operation.
Sometimes I just have to...
I was operating with the chief and he is tall. Although it was a 5 hour operation, my back didn't hurt nearly as much as it does when I operate with shorter surgeons. It was really nice operating with chief because he kept asking me questions. Sometimes anatomical, sometimes surgical or just logical to get me to think like a surgeon. He is an examiner for the board exams so it felt like a mini board exam.

Saturday I decided to tag along for an 24 hour on call. We started Saturday morning at 8am and I went home this morning at 8:30am. I slept for 2 hours and then again for 3. During the day we had quite a bit to do. The wards had to be tended to, the emergency room would call every now and again and we'd go there to check out the patients. We had some postoperative patients that weren't very stable and had to be transferred to intensive care. I hardly sat throughout the day.

We were called by the ENT-ward because they had a patient that hadn't peed in a day and a half. We asked them if they had placed a trans-urethral catheter. The doctor retorted that we (urologists) didn't place tracheotomy tubes so why should they place a trans-urethral catheter......Um....because every nurse should know how to!!! The genital area seems to be a big Tabu for many of the other departments and some doctors don't even take the time to look at the patient when it comes to urogenital tract problems and proceed to just call the urologist on call. Get over it people! Look under the blanket! Its only a penis!
Middle of the night, glazy eyes.

Late evening we were informed that a patient was being brought to the hospital with horrific labs. The patient was placed on acute dialysis when they arrived and desperately needed the kidneys drained. We couldn't do that until the acute dialysis was over though....which was around 1:30am. The doctor and I slept for two hours before being called to the CT to check out the patient's pictures and get the attending and nursing staff on call to come to the hospital and coordinate the anesthesiologists for the procedure. We were back in bed by 4am and slept uninterrupted until 7am. It was a long on call but also really interesting and the doctor and I get along great so that was nice too.
Outta there and walking home in the snow!
I get three days off in the week for being on call over the weekend. I am taking Wednesday-Friday off. Thursday I turn a quarter century old...  (0_0) ...... I'm heading to Heidelberg for the Semi-Live Urology Conference during my free days.

Hope everyone had a lovely week! Stay healthy!



Sunday, January 18, 2015

Week 9: Study, work, little sleep, repeat.

To sum up my last week: work, study, little sleep, drinks, science, boots.

I can't really keep my days straight. Nothing extraordinarily exciting happened patient wise. I spent my evenings studying and when I was fed up that the results were not that great after a 10 hour work day, I went to bed at 10 pm and got up at 4 am on Thursday to study before going to work. 

Tuesday was such a lovely day outside! There was real, full on sun! We didn't have any coffee pads left on the ward for our coffee machine in the doctors office and I had all my immediate tasks completed, so I told the doctors I would be more than happy to walk to the nearby grocery store and buy some. Thank you coffee addiction! The doctors gave me some cash and I was able to enjoy a few minutes in the full on sun! In a t-shirt! The other pedestrians looked at me a bit weird but that temperature and weather is great weather for Wisconsin standards. 

Saturday wasn't much different for the first half. Library from 8am till 3pm. Afterwards, I met a friend for coffee and then attended the Night of Knowledge. This night takes place in many big german cities and it was the second year in my city. The while city is involved. My main visitation sites where the hospital (go figure) and the northern campus (chemistry, physics, astrophysics, Max Planck Institute for Solar System Research). The urology department and a few others had a stand with two models of the DaVinci robot for interested future surgeons and video game enthusiasts alike. The bulk of my time was spent on the north campus though.

I heard a lecture from Jens Frahm (important in the development of the MRI) about the newest developments in MRI technology. He showed us some cool videos of real time images. I've had a real time MRI done of my heart (I really need to get those images). Afterwards, I listened to a lecture about astronomy in South Africa. I really love astronomy and could listen to lectures about the topic all day. My aunt and uncle met up with me and went back to the hospital. I helped the visitors use the DaVinci. Although it wasn't planed that I even help out, I stayed until 12:45am taking everything apart.

This morning (Sunday), my friend and I left early in the morning to drive to Düsseldorf. After a quick stop at Starbucks (something we don't have in our small town, so every time we are in a larger town we tend to make a stop), we went to a restaurant called Mongo's. It's a Mongolian restaurant where you can put together your own dishes. We ended up eating for three hours. It was so delicious! And since it was mostly vegetables and fruit, I was full but not the completely uncomfortable full you feel after carb binge eating. 

We then headed to our actual reason for being in Düsselfdorf. The boot exhibition. It's a HUGE exhibition that deals with anything body of water related. We spent our time in the scuba divining and yacht exhibition halls. Thought I'd take the biggest yacht (7,000,000€) home with me.... 

Tomorrow it's up and early it continues......

P.S. Recipe: I am always tying new ways to use what is available on the ward to make something delicious. Especially when it's cold outside, I like to make a cup of hot lemon with honey. So this recipe is no rocket science:

Lemon juice (quantity depending on level of preferred tartness)
Honey (quantity dependent on level of preferred sweetness)
Hot water

So simple and yet so very delicious!

Sunday, January 11, 2015

Week 8: Tulips, Talkative patients, Test preparation & Thai massages


[bawr-ing, bohr-] 
1. causing or marked by boredom
Origin: 1835-45

Boring is not an adjective I would use to describe the first full week back at work.

Monday started the week off with a bang. I was in the hospital until almost 6pm. The day started out with only half of the ward filled with patients and then BAM....the whole ward full from one minute to the next. We also had an oddly over proportionate amount of female patients. Three of them consumed quite a bit of my time which consequently lead to me being in the hospital so long.

Up dark and a good full moon

The first, (understandably frustrated with her progression and constant fall backs in therapy) started to cry while we three doctors were leaving the room. The men left, I stayed, held her hand and comforted her until she had stopped crying.

The second, I merely wanted to take a brief history and fill out the admissions form. In extremely quick twist and turns, the patient brought the topic of conversation to geology, the definition of one's mother language, bilingualism and how she sees the world. There was no stopping it! I tried to redirect the conversation back to the topic at hand thrice....she didn't seem to get the point or at least just didn't care. I was saved by one of the doctors who had to get her informed consent for a procedure. I should note that the male nurse student was in the room before me to fill out the nurses admission form (a normally quick thing) and I waited about 15 minutes for him to be done.

The third was a charm, she's known to the department. A dependent personality. The first time in the room, I had to place a line and she explained her whole medical history to me. She told me others usually have problems placing lines but that she liked my calm and friendly aura and believed that I would be successful. I placed it on the first try. This promoted me to her new personal favorite status. Uh-oh.  That was in the morning. A few minuted before I was ready to pack and leave for the day, the nurse informed me that the patient needed a new line placed since the one from that morning gave up. Greeeeeeeeeat. I spent the next half an hour trying to place a line. I was actively doing something those 30 minutes (had to poke her 4 times before it worked) and she used that time and told me her whole personal history. I couldn't have escaped that even if I wanted to. The line needed to be placed.

By the end of that I was drained. The others had gone to the afternoon meeting without letting me know (they thought I had already left). When I caught up, they were all shocked to see I was still there.  I left the hospital and bought myself tulips as a reward for the day.

We have a new resident and a new intern in the department. The resident was also on my ward. This allowed me to work on some other things during the week. I translated a release letter into English for one doctor, proof read an English paper for another doctor and was able to help the doctor doing admissions with those.

I was treated to a Thai massage on Wednesday!

Best Moment : I was visited by Pat. X this week. He had his follow up meeting with the general surgeon and he is tumor free! I was so happy to hear that. We talked for a bit before I was asked by one of the doctors to do something else. (It was a task on the ward I wasn't really responsible for so it kind of irked me that the task wasn't given to the responsible intern and rather to me just because I was at the wrong place at the wrong time. I obviously didn't say that and completed the task.)

Made it out of the hospital in time for the sunset. Score!

Friday, the other intern didn't come at all! I was in a really bad mood already (I'll explain below) and planned on getting my work done and leaving as early as possible to go to the library. Now I was hopping from one ward to the next. Its extremely annoying when a doctor doesn't have a clear plan for the day and rather just throws tasks your way that easily could have been collected at the beginning of the day. I didn't sit down once until lunch. I also didn't leave the ward for the library until 4:30pm.

Wanting to draw blood, can't find clean equipment & then find this in the closet. Not ok. Guess who cleaned up.
Worst moment: I was in such a bad mood because the night before, I had worked on two blocks of questions for the USMLE and it was the worst result I've had yet! I had been steadily increasing my score over the last few weeks so this turn really shocked and upset me. This USMLE business is tough. Its not fun. It consumes almost every free minute I have. Not to mention the constant pressure I feel regardless of what I'm doing. I would much rather spend my nights after work and my weekends doing something else or relaxing but instead I'm spending hours with the USMLE prep. Someone once asked me if I was doing the USMLE on the side....I had the urge to punch him. I'm schduled to take the exam March 30th. So until then, I will still constantly feel pressure, continue to lose hair, continue to have stomach aches, continue to have psoriasis outbreaks  and continue to spend the largest amount of my free time with this stuff.

I spent most of Saturday in the library and have to work on doctor thesis stuff today (my doctor thesis professor sent me an email requesting I put together a presentation of results....perfect timing.......)

I wish you all a lovely Sunday and hope its much more relaxing than mine :)

Stay healthy!


P.S. Recipe: I very often make myself a smoothie in the morning to take to work. The first few weeks I drank a lot of kale smoothies (since it was the beginning kale season) but have now switched to pure fruit smoothies for a while. So delicious and fairly quick to make. Especially with the NutriBullet I have. This week:

Lemon didn't make the cut for the picture.

1 Banana
3 fresh squeezed oranges
1/2 fresh squeezed lemon
1 chunk of papaya


Sunday, January 4, 2015

Doesn't get much shorter than this....week 7

I really don't have much to say. I went to work on Monday and the doctors from the New Years Rotation were shocked to see me there. One of the doctors wanted to send me home almost immediately. Since I was already there and had gotten up at 6 a.m., I stayed.

The day was a busy one. I was sent from one task to another, one blood draw after another (some patients twice), one phone call after another.....

The doctors had all agreed to get the work that had to be done, done in a timely fashion. This meant that I was out of the hospital around 2 and was told not to show up for the rest of the week. (I would have came Tuesday and Friday but I'm also not going to beg them for that....I can handle a few days off of work. Gives me the opportunity to study.)

New Years was rather relaxed. I had dinner and watched a movie with two friends and watched the fireworks at midnight being lit on the streets.

I also booked my first vacation in the mean time. Stay tuned to find out where it is I am heading in February for 9 days.

When my dad heard I had booked my vacation, he insinuated that interns now a days have a much more relaxed life style.

I won't argue with him that getting paid nowadays is a fabulous improvement opposed to back then. I also really can't complain about my work environment which might allow me to leave work earlier (I usually end up staying anyways). However, I still work a 40+ week for minimal pay (its pitiful when calculated on the hour). Also, its really all about optimizing the time and money you do have. I don't fly direct because layovers are cheaper and I spend a lot of time looking for the right flight that incorporates weekends or holidays so I don't lose vacation days.

Over the many years of looking for and booking flights (in the meantime not just my own but have become somewhat of a personal travel agent for family members) I've developed my system of finding just the right flight.

I'll be working the weekend shift before I leave which gives me Monday-Wednesday off.....3 less vacation days used!

I hope everyone had a good holiday season and had fun over New Years. Now its back to the real world tomorrow!

Stay healthy!