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!

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