Sunday, April 26, 2015

Week 23: Bäm I've got your appendix! (Well, not really because they won't let me)

This week it was time for some general surgery. Monday morning, the chief of the department talked to me about the department, the colleagues and the different function is could look at during my three week stay in the department.  I spent the first part of the day familiarizing myself with the current patients. I was told that the first operation of the day was a fistula removal. A fistula is a connection between A and B that normally doesn't anatomically exist. They can come about after operations. So in the case of our patient, the fistulas developed after an abdominal operation and there were multiple connections between the small intestines and the skin. As you can imagine, you wouldn't want the contents of your small intestines to exit through the skin of your stomach. I couldn't exactly imagine how these fistulas are removed so I thought I'd check it out. The other doctors told me the operation could take anywhere from a half an hour to 4 hours.
My main source of nutrition seems to be KIND bars

I didn't have a very big breakfast but figured that the operation might take 2 hours or so. It was 5.......5 hours of holding hooks. No lunch. And I was the tallest at the table. I didn't get to actively do all too much (I don't consider holding hooks as actively doing something). My back started hurting at about 3 hours. Luckily, I was offered a stool at 4 hours. I don't actively ask for one if I can manage somehow because I'm the lowest ranked doctor at the table. At the same time, I still have the longest time of work ahead of me and have to protect my back. I gladly accepted the offer when it was made. 

Once the operation was done, I quickly grabbed lunch and then went to our tumor board conference.

The other 3 days were spent looking for something useful to do. Tuesday we had chief rounds. I wanted to attend the clinic visits but they seemed so sporadic that I didn't catch one. In general, there wasn't really a lot happening. The doctors told me that it's usually not this calm but sometimes there are just holes at certain times during the year. Well great. Did it have to be while I'm in the department? And apparently the OR schedule is still looking pretty empty for next week. Boooooo.

I spent quite a bit of time reading in the general surgery text book because I didn't want to be playing Two Dots on my phone and kill my battery all the time.
Greetings from Ice Mountain in Two Dots

Thursday, I helped (holding hooks) with a laparoscopic operation. I'd never assisted in a laparoscopic operations so in theory,  it was exciting. In reality, I stood there, holding a hook and hoping the images on the screen were interesting enough to keep me from falling asleep. It didn't necessarily help that everyone worked in more or less silence. 

The lectures we had during the week weren't bad. We were told about the emergency medicine program in the hospital and what vehicles belonged to the fleet of rescue vehicles. We were also offered to ride along one day. This is an offer I will be taking them up on.  Another lecture was held by the chief of internal medicine. Technically, it was supposed to be a class about examining. No active examining was done. He did however talk to us about examining patients and asked us a lot of interesting questions. They were things that seemed so logical until you were asked to actually say things out loud. Sometimes you just have images in your head of how things work without putting them into words, now we had to use our words. It was a lot of fun for me though and really got us thinking about how our oral exams at the end of the year might be like. 

This upcoming week shall be interesting, and by that I mean I hope it's not spent killing time. If the OR schedule is still as vacant as it was Friday, I'll look if I can just help in the clinic and always have extra reading material with me. One thing I definitely won't do is hang out on the ward. It's almost as though the nurses can smell your boredom. Some of them then throw some of their duties your way or will just give you something to do that is actually meant for another intern. I usually really don't mind because A) I need the practice in placing lines and B) it's better than sitting around. 

I had one incident where I was 10 feet away from the ward doors on my way out when the nurse came out of the patients room and told me that two men in the room needed a line placed but that they didn't want the other intern to do it. These patients didn't want their arms "unnecessarily poked with needles" and the other intern had apparently done that the day before while drawing blood. Well great, so now these patients except me to place a line and do it better than someone who just had to draw blood. No pressure. Of course, the patient reminded me multiple times of how nice it would be if I didn't have to poke him multiple times. I wasn't successful on my first try but I had told the patient from the get go that trying to place the new line in the same vein as the last one might not work so well. But he insisted. While I was preparing to try again, the other intern entered and tried to place a line on the other patient. The patient was less than enthused that the intern was the one doing it but he was more polite than my patient and didn't say anything. From the corner of my eye I could already tell that his first try wasn't going to be successful. I think the intern just wanted to get out of that room because even though the patient said the spot hurt and the tissue was swelling up, he insisted it still might work. That's when I cut into the conversation and said that the line was most likely not placed right and that he would have to try again. He opted to go tell a colleague to do it instead. I'm not sure the colleague ever came. I however, did get the line placed on my second try and my patient called me an angle. He also said that now I would have bragging rights. I told him I didn't want the bragging rights and obviously would have wished that my intern colleague would have been successful on his first try and I also would have wanted that for the patient receiving the line. Seriously, does everything have to be a competition and about bragging rights? 

I took Friday off to head to Berlin with my good friend. We visited a friend of mine in Berlin and I was so excited since I haven't hung out with him in a while. He had to leave Saturday morning and let my friend and I stay at his place until Sunday. I appreciate my friends so much for their constant hospitality around the world. I really, really hope I end up somewhere fun so I can have a guest room for all my fabulous friends to come stay in when they visit my city.
East Side Gallery in Berlin, Germany

Russell James Exhibition at Camera Works in Berlin, Germany

Brandenburger Tor in Berlin, Germany

Memorial to the Murdered Jews of Europe in Berlin, Germany

It's back to work tomorrow with hopefully something to do!

Stay healthy!


Saturday, April 18, 2015

Week 21/22: From Wisconsin cheese and family to rotting wounds and maggots.....

This little two week rhythm that's been going on the last few weeks should be over for the next 4 weeks at least.

I spent a week home in Wisconsin and it. was. heavenly. I loved being home after almost a year, spending time with friends and family and MY DOG (!) and getting to see so many people who were a part of my life growing up and are a part of my life still today. I also probably exceeded the recommended limit on deep fried cheese curds in that week.

Pirate Puppy Toby

What a goof ball....but I love her.
My Wisconsin Badgers boys basketball team sadly lost in the final game of March Madness but first they kicked Kentucky's butt (Boo-yah!). The team did a great job and I really fell in love with some of those boys....have you seen the interview with Nigel Hayes where he is caught saying the stenographer is so gorgeous? And the double face palm after?!

Immediately fell in love with him. Anyways,.....home was great. I wish I could have stayed longer. I got to see my little sister for a day which was really fun! Wasn't able to see my older sister due to the fact that she is off in medical school in Erie, Pennsylvania.

All good things must come to an end though and so I had to fly back to Germany on Sunday.

This past week was spent in vascular surgery. The people in the department were lovely. The wounds the patients had were quiet the contrary. I think vascular surgery might have some of the least aesthetically pleasing wounds. I'm talking amputations, ulcers that won't heal, necrotic (dead or dying) skin, wounds being cleaned with maggots, patients with no toes or fingers because they killed those with smoking.....seriously....these wounds could be straight out of a scary movie.

The doctors however, really fun and nice people. The doctor I helped on the ward seemed to like me too since he went ahead and claimed me when a urologist walked by and had apparently looked at me. Haha, very flattering Sir, but I'm not really a thing that can be claimed.

I was asked to represent the hospital at the intern fair in our university hospital on Wednesday. This entailed me talking to potential applicants for an internship spot in the hospital along with the chief of internal medicine. We stood at our booth for a few hours just chatting away and telling the potential interns what a great program we have (which really is true and not just a bunch of bull, the hospital was even one of two of the first hospitals to pass the quality check for internship programs in the country!)

I spent all day Thursday and Friday in the OR. I got to see a few operations I hadn't seen before and had always wanted to. For instance, stripping varicose veins. I couldn't imagine that it was possible to just pull veins out of the body. Like....isn't there connective tissue holding them in place? Guess not as tightly as I had thought. They use a wire for the long ones but small varicose veins are removed by making a little incision and pulling them out with a hook. At least that is one way to do it, the doctor told me that there are multiple ways of performing the operation and that in the states a lot of varicose veins get removed by "laser". 

The same doctor also told me a bunch of medical history facts about vascular surgery. He had a rather strong accent so I really only understood about 75% of what he was saying at any given time.

I also assisted in removing a big toe. I thought I would get a bit squeamish because I think amputations are such a weird operation (can you imagine being handed a leg?). I think that is a thousand times more weird than being handed a kidney. So I assisted in this toe removal and I was actually doing way better than I thought I would. Nonetheless, just going right at it with the scalpel and then saw has a horrific aspect to it.

The days always ended with an afternoon meeting. The doctors were interested to know if I would be back the next week. Since my trip home was rather spontaneous and my first week of vascular surgery had been planned for that time, I am in the midst of rescheduling a week during the time I'm in trauma surgery. I'm scheduled for 6 weeks of that. I don't need six weeks. I've already seen a lot of trauma surgery and can spare a week to see some more vascular surgeries I haven't seen yet.

Starting next week, I'll be in general surgery. Since it is such a small hospital, I already know a few of the doctors in that department. I've been most afraid of this part of rotation because general surgery operations can take a really long time and I'm afraid that we interns will be used to only hold hooks. My brain and my back would not be too fond of this situation. If it is that way, I guess it is what it is and I'll survive that too. Excited to see some operations I haven't before though. Appendectomy seems like such a standard thing but I've actually never seen one done (except while removing other organs and just taking that out as well). I'd like to see a classic case.

I hope everyone had a great Easter and enjoyed some good chocolate eggs!

Stay healthy!


Sunday, April 5, 2015

Week 19/20: Circumcisions, lots of circumcisions...Pediatric surgery

As I had predicted, I wasn't at all in the state of mind to write a post last Saturday. But lets get caught up real quick.

I spent the last two weeks in pediatric surgery. I absolutely loved it! The department again consisted of 3 people. I almost exclusively spent the week working with the chief. He is such a nice man and explained quite a lot. He also is a book full of stories from his residency and fellowships and can recite poems like almost none other that I know! He is the old school breed of surgeons. He prefers open surgery to just about any laproscopic or minimal invasive procedure, the takes his time for his operations (for example with circumcisions, not just pull and snip, rather a lot of clamps and exact precision), and hails from a time where a lot of doctors still thought it was okay to throw surgical instruments around the OR like a 3 year old if something didn't go exactly their way (he did not agree with these antics and there are a few people who still do that today). We had so many things to talk about that didn't pertain to medicine too. He had spent some time in Africa, a few weeks in America as a young adult and so on. There was hardly ever silence between the two of us.

Most of the time was spent in the OR. He made for a nice relaxed environment and explained a lot about the procedures. Since the school kids were on Easter break, most of the operations we were doing were circumcisions due to phimosis (too tight foreskin). Circumcision isn't necessarily "in fashion" the way it is in the USA so we had parents (mostly the dads) who were really fighting for the little boys to keep their foreskin and seemed devastated when we told them it had to be cut off. We had to explain to them that the boys could still lead perfectly normal lives and would grow up being just fine. (Shows how different cultures can be when it comes to foreskin and its value). There were also a lot of testicle operations on kids who's testicles hadn't fully descended yet. The OR staff was really nice too. They gladly assisted me when I needed help. I probably had to tell the story of my life on a daily basis in the past two weeks. So many people were fascinated about the duality of my life in Germany and America.

The first week, I was pretty much all over the place emotionally due to the USMLE being the following Monday. On the Friday before, the doctor let me go a bit earlier and the whole OR staff and doctors wished me luck!

I drove to Frankfurt on Sunday to spend the night in a hotel before heading to the testing center the next morning. I ordered sushi and watched An American in Paris in my hotel room. I wasn't at all nervous before the exam. Not because I felt confident that I knew everything (not at the least) as I did for most of my life with exams but rather because I was just SO sick of the whole thing. I spent more than 6 months day in and day out studying. Using almost all my free time out of work. I know that there are people out there that would like to at least have 95% right so they lock themselves up for months on end, never seeing another human soul and in the end maybe even achieving that goal, but for me it was more important that I actually learned something and reviewed important information. This exam doesn't show how good you will be as a doctor. It shows that you are good at memorizing and making connections with a huge amount of information. Medicine is ever changing and a lot of the questions asked about procedures...patient so and so comes with so and so  and what would be your immediate next step? Well that seems rather vague in a lot of examples. One hospital might have standard procedures than others. Different countries have different procedures. Is it a university hospital were no expenses are spared or a small hospital were working economically is key. What I'm trying to say is that with a lot of the questions, I can see multiple answers being an option. I don't really see the point in just learning procedures for an exam like this if you can't think about why you might do it one way or anther, make it depend on the patient and the situation. I know standardized exams are needed for the process but I don't allow this exam to predict my qualification of being a good doctors. There are a lot of human skills you need for that to be true and those can't easily be tested. Nonetheless, good for the people who reach the goal they set for themselves, especially if they are trying to get into prestigious programs if thats what they want. Its a tough exam (more so if you didn't study in America and weren't basically trained for the exam). I went out of that exam not really having a positive or negative feeling towards my work. It can really go either way. There were few questions were I really was confident to know the right answer and many were "well you could do that but this option would also work". At this point all I want is to have passed. I'm not looking to get into Harvard and Urology seems like a stretch at the moment anyways (considering its one of the most desirable specialties and only 60% of applicants got a spot last year). But I hope my resumé as a whole gets me a spot in Family Medicine or so. Once I'm in the system, it'll be easier to switch if I decide I want to do that.

I was actually more emotional after the exam than I was the week and night before. Once the tension of the last few months started wearing off, I just wanted to cry for no specific reason. The day after, I was still all over the place with my emotions and still not really ready for the normal daily life again. After the exam, I bought myself 3 dunkin donuts and an InStyle magazine, I tried to be as unmedical and unhealthy as possible. The next day in the hospital I was fairly quiet and indifferent to a lot of things. A good OR day was exactly what I needed on Wednesday to get out of my funk a bit and enjoy my freedom.

I was rather sad on my last day in the department. We had a day of clinic with ultrasound appointments. There was a lot of variety in the cases presented and I loved getting to interact with the kids while they are awake. We were done fairly early, so I chatted with the secretary for a really long time before heading into town to take care of some errands before our afternoon lectures.

Millennium Park Chicago 
That night, I took a train to Berlin to fly out the next morning to Chicago. I am spending about 9 days back in the states and am so excited to be driving home tomorrow after a fun weekend in Chicago with friends. Last night, Wisconsin Badgers beat the Kentucky Wildcats in the final four game of March Madness basketball and I was beyond excited. We watched in a bar and I had some fellow Wisconsinites to cheer with. This was a pretty personal game for me and after last years loss in the same constellation (last year I was on the beach in Ghana without access to the game) I couldn't stop smiling after that amazing game. So congratulations Bo Ryan and the boys. You made this little Badger really happy last night (and I don't think I was the only one).

Quick fabulous update to my little kid Ali! He had his diagnostic test two weeks ago on Tuesday. He seems to (as if by miracle, because we really weren't expecting it) have grown out of his hydronephrosis and doesn't need surgery! The doctor offered to do a follow up ultrasound before the family leaves to go home in September but doesn't expect there to be anything pathological.

This upcoming week I'll be home in Wisconsin and after that, I'll start working in vascular surgery. I've heard that the department is nice so we shall see if that's true and hopefully I'll have someone there to explain a lot to me.

Now I wish you all a very Happy Easter, stay healthy and ON WISCONSIN!