Saturday, March 21, 2015

Week 17/18: you are not here to work, you're here to learn!

Sorry for the delay everyone! I took off this past week to stay out of the hospital and study for the usmle step 2 coming up really soon (March 30th). The week before this one was my first week in the new hospital.

My mornings are quite different now. I still get up around 5:30am but then take the bus at 6:24 to the train station, take the train at 7:03 and arrive in Hildesheim around 7:33, walk about 15 minutes to the hospital and start work around 8. On Mondays, Wednesdays, and Thursdays we have lectures until 5pm which doesn't get me back to my apartment until about 6:30. Due to the over hours we accumulate with the lectures, we get off Tuesday or Friday every other week. 

I'm currently in my surgical rotation. On the first day, we spent most of the time running around the hospital getting our lab coats, having lockers assigned to us, picking up our I.d. and chip cards. One of the surgeons sat down with us to divide us up in the departments. The first week I was in thoracic surgery. Then it'll be as follows for varying amounts of time: pediatric surgery, vascular surgery, general surgery and lastly trauma surgery.

I have a few vacations planned in between as well. 

My first week in a new hospital and new department went well. I spent everyday in the OR. I'd never really been in contact with thoracic surgery before and in the few days there I assisted in removing a lung, taking lung samples, cleaning out an infected pleural space, thoracoscopy and tracheotomy placement. It was cool to feel a breathing lung and touch a beating heart. 

The department is way smaller compared to what I'm used to. Thoracic surgery in this hospital consists of three people: chief, attendant and resident. Huge contrast to what I'm used to. But the whole hospital is a smaller scale than the university setting I've been working in. It's seems much more small town-y. People will open the doors for you, ask if you'd like some coffee, have a conversation with you. The chief himself sat down with me and discussed x-ray pictures with me. He made sure that I saw a lot and helped where I could. He also said that I'd be much better off being a thoracic surgeon than God forbid an urologist! It's so funny, the last few months I've lived in my urology world and thought it was the most normal thing in the world to want to be a urologist, work in that setting and treat those patients. Ever since I've come to the new hospital, everyone is amazed at my decision, shocked almost and tries to convince me to do something else and teases me about wanting to be a urologist. The urologists in the hospital are all supposedly really nice though and seem to have a lot to do. The other doctors like the urologists, they just can't wrap their mind around the idea of me becoming one.

One of the first things that the doctor that greeted us told us was that we are not there to work but rather to learn. We are supposed to get insight into the different departments and be as hands on as possible. That is great news for us! I really do look forward to learning a lot. I'll even be more excited once this board exam is over so I can actually relax and enjoy the time in the hospital. If the other departments are anything like the thoracic surgeons, I will be learning a lot!

Monday I start in pediatric urology, super excited! There is one surgeon who does pediatric urology. I'll try to work with him as much as possible. This upcoming week will be quite stressful since it's the week before my exam and I'll try to focus on that as much as possible. I apologize in advance if there is another week delay on the next post. I'll try to fit it in in one of my study breaks but no promises. Who knows what state I'll be in two days before the exam. 

Quick update on my meeting with the pediatric surgeons. In a nutshell, I was introduced to a little boy with a urological condition who comes from Azerbaijan. His family is in Germany on a scholarship and came in the hopes of receiving better care for their son. Unfortunately the insurance doesn't cover preexisting conditions. I've presented his case to the pediatric surgeons and urologist and have asked administration to let me know what the diagnostic test and most likely surgery will cost since the money will have to be fundraised. My fundraising goal is now set at about $13,000. I've been meeting with some people and getting the ball rolling on things and as of right now, if everyone pulls through, it seems promising. Up first is the diagnostic test to see how extensive the condidition is and what the best treatment option would be. In the upcoming posts I'll share a little more about this little boys story and also share information on how you can help me help him and his family if you want! 

Stay healthy everyone!


Sunday, March 8, 2015

Week 16: My last week in Urology for a while

The past 16 weeks seem to have flown by so quickly! I assume this is mostly do to the old saying "time flies when you're having fun" but also due to the fact that almost all my free time before and after work was spent studying.

I spent most of my last week trying to complete my internship log book and get all the signatures I needed from multiple doctors. I was called into the OR to hold hooks in a cystectomy (bladder removal). Typically one of the longest operations urologist preform and I spent 4.5 hours holding hooks in my last week in the department. Only seemed fitting to end this way (because if I remember correctly, a cystectomy was the first urological operation I saw a year and a half ago when I did an elective in the department).

I baked 60 banana bread muffins and a "Kalter Hund" (German dessert consisting mainly of coconut fat, cocoa and graham crackers) Thursday night to take to work with me on Friday. I am genuinely sad that I won't be going to work in that department on Monday. The department consists of some pretty great people. The work atmosphere is the best I've been in and it really is more of a family than a group of doctors. I am thankful to the whole staff (doctors, nurses, secretaries, etc.) who helped me out during the last few months and didn't make me feel like an idiot if I asked a question. 

I also genuinely think that they are a bit sad that I won't be around anymore either.

My highlight while in the department was probably the whole situation with patient X. But I also have to thank all the patients who were kind to me. They were all a crucial part in my training and I thank them for having faith in me. 

Tomorrow it's off to Hildesheim every weekday until mid October. I'm not the biggest fan of the transistion periods. I've never been to this hospital, let alone have I ever traveled there. I don't know a single soul that works there. I've heard good things but it's always so overwhelming the first few days trying to figure out your orientation in a new hospital, observe and understand the dynamic of the people working there and getting to know the basic procederes (do you have to call for a consultation, or send a fax, or is it on the computer?). It'll be an overwehlming few days. Luckily, I have a little break from work starting Friday and all of next week to concentrate on the USMLE primarily since that is right around the corner as well (March 30th).

Since I'll be in a smaller hospital, I hope to be way more hands on than I have been. We will be rotating through different departments so little transistion periods will always be taking place. I'll be doing my surgical rotation so I assume I'll see the likes of trauma surgery, general surgery, maybe anesthesia. I'll know more tomorrow. 

Still can't say much about my appointment with the pediatric surgeons but I hope to be able to by next week. 

I hope you all had a great week and stay healthy in this crazy world!


Sunday, March 1, 2015

Week 15: Falling out of love with medicine.

I've always joked that I am in a long term relationship with med school. With everything going on in my life...any potential real boyfriend would leave me due to lack of attention. So my guy med-school and I are having a bit of a rough patch. We've had rough patches before but this one seems to be going on a while.

View from the ward
I haven't fallen out of love with medicine itself, just the process I'm stuck in right now. I spend my early mornings before work studying, spend my evening studying, spend my Saturday and Sunday mornings studying....all for this dang USMLE. At work, I feel rather useless. We are so many "extras" and new residents that I don't actually get to do anything beyond questioning patients and doing an ultrasound. I fell my time is being wasted. I could be using the time to study (instead of getting up at 5) or use it painting, traveling, being crafty, baking, etc. But I'm stuck in the hospital trying to find something to do! Luckily, some of the consultants have gotten a hint that I am rather underwhelmed and will find new things for me to do. Even if it is setting up appointments or entering research data. At least then I'm not sitting around trying to look like I'm doing something when I'd rather be studying.

Since I had so much to do...didn't waste any nutella.

Its so frustrating because I hate sitting around! So the whole thing just seems tedious and annoying. I question why anyone willingly dedicates so much time and effort into this job when all you hear from most colleges is that if they could do it over....they wouldn't. How encouraging. Why sign up for a life of night shifts, on calls, weekend work, high stress level and 6 years of basic education before entering years on end of further training where you are used like an animal? You can't tell me its because of the money. There are easier, funner and quicker ways to make the same amount of money in this world. So in the core, it must be a love for the field. And that is the case for me. Just hard to see that sometimes with so many distraction around.

24 hours....Ready to get you!
Luckily, I decided to be on call on Wednesday after the doctor on call asked if I would join him. He is also one of those colleagues that suggest not doing medicine but at the same time, he is one of the best in the department (IMO). His patients love him, he works in favor of the patient, he keeps it real and is a pretty cool dude. Since this was my first on call during the week, it didn't seem as long as the ones where you come Saturday at 7AM and leave Sunday at 7AM and were you are the only two urologist in the house. On Wednesday, it was a normal work day until about 4:30PM and then it was the two of us. I had told him about how I feel about my current situation and all the fabulous things I see myself doing and he took that and told me I'd be doing most of the work for this on call.

This meant, I interviewed the patients primarily and did the diagnostic tests. There was even a pregnant woman with urinary problems and I had to do an ultrasound and obviously looked at the bladder so that I could also see the little foreign object sucking on its thumb! So cute! The doctor just rolled his eyes and said, "Women." I couldn't help myself.

Around midnight, we were able to go to bed. Not for long though. I was paged at 3:15AM and told a patient was coming in who thought he might have testicular torsion! I hopped out of bed and met the doctor and the patient in the out patient department. The patient's history and presentation were very classic for testicular torsion. We called the consultant to come in for the operation. I scrubbed in and assisted in alleviating the torsion on the one side. As a standard practice, the other side needs to be fixated as well. I got to do that and the consultant assisted! That meant I did the cut, the fixations and the sutures!! It was very exciting for me! Finally, hands on!

After finishing up a few things and letting the colleagues know what happened through the night, I went home around 7:30AM. I didn't sleep though, I had a meeting with my doctor thesis professor, had to take care of paperwork and had a meeting with the pediatric surgeons. Hopefully I'll be able to share some information from this meeting with you soon.

That on-call was what I needed to fall a bit in love with medicine again.

I know that once these exams are done and I can use the little free time I do have for other things, I will be more enthusiastic. Residency will be no walk in the park either but at least I'll be working.

I also participated in a pretty fun thing this past week. A guy I went to High School with, Zac Ziebarth, started an organization called SmartRoots Global. Their mission:

To create a generation of innovative problems and critical thinkers who are equipped to solve the biggest challenges in their community and world

Well Howdy Texas!
He has been working with students in Texas on the human systems and the health care system. He asked me if I'd be interested in skyping with some of the classes and talk about my medical journey and medical school in general. This came directly in the time that I was most demotivated on that subjected. But since I know its not my true feeling of the situation as a whole, I had a great time with the kids! They asked questions like, "What was your hardest operation?" "Have you seen a heart operation?" "What materials do you use in the hospital?". It was great to hear that about 10 students in each class are thinking about going into the medical field. Sure, they might just be 7th graders, but I knew what I wanted to be when I was in 7th grade and I'm in the midst of completing the first major part of that.

And as a last note, another yummy shake recipe:
-1 avocado
-1 banana
-2 fresh squeezed oranges
-1 cup coconut milk
-half a squeezed lemon or lime
-pinch of salt
Mix it up and enjoy the tropical breakfast smoothie!

Stay healthy!


Screen grab from the interview, click the link below to see the whole thing!

P.S. Found this (German) interview from the Urology Congress I went to in Heidelberg :)