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!


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