Sunday, May 3, 2015

Week 24: Half time baby!

Half time! 24 of the 48 weeks of my internship year are over.

Sadly, my fear from last week sort of came true and there wasn't much to do. The operations performed were 3 laparoscopic gallbladder removals, 1 hernia repair, 1 perforated stomach repair and 1 liver cyst removal done laparoscopically......during the whole week. That list could easily be an intinerary for just one day.

Tuesday, I participated in chief rounds again. Wednesday, one of the attendings let me do the examinations in the clinic for 4 patients with gallbladder issues. Thursday, was the only day I was actually scrubbed in for the stomach perforation operation. Other than that, I spent a lot of time chatting with the doctors, drawing blood, placing lines and watching laparoscopic operations. My two main guide times of the day were 11:30 lunch and 2:30pm afternoon meeting. After that, I had lectures on Monday, Wednesday and Thursday again. Friday was a national holiday and thus we had off (benefit of being a student).

I can't really say I learned all to much this week. The time in the clinic with the attending was probably the most useful.

On Thursday, there was a little incident that I'll share. The planned OR programm for the day was:

1. the liver cyst
2. the hernia

The perforated stomach was added on as an "emergency" operation.

From the very beginning of my OR career, I quickly learned through experience and instructions to introduce yourself when you come into a new OR setting because A) its polite B) the people in the OR should know who you are and C) the only things that help you recognize someone in the OR is their body shape and height, voice and the portion of their face between the forehead and just below their eyes. I'm sure if I showed up in the OR without my glasses, everyone would think I'm somebody new.

I also learned through experience (and some really unfriendly OR nurses) that you are really better off not trying to help out without being explicitly asked to do so. Many OR nurses are very particular and you are almost always standing in the wrong spot or just seconds away from making the whole OR blow up (obviously not, but they react as though). I'm usually a person who loves to help out and will do a lot of things to help without being asked in daily the OR....I know better.

Knowing all of this, the following happened on Thursday.

I've been in the OR in this hospital for 8 weeks now. Although I might not know everyone's name (because there are a lot of people), I was pretty sure I knew just about everyone's face and had said hello to almost everyone personally or had at least been in the same OR room as almost everyone on the staff at some point in time. Since I had been in the OR periodically this past week as well and hadn't reintroduced myself because I knew the people, I also didn't reintroduce myself on Thursday because walking into the room, I was sure I knew all the "faces" (forehead to below the eyes). They were getting the patient ready for the operation and didn't seem to need my help, so I took a stool and sat myself in the one spot I seemed to be most out of everyone's way, not blocking any supplies and still having a few of the TV screen showing the operation.

The anesthesiologist was having a conversation with the OR nurse about BMI and the cut off values for overweight and obesity. The nurse said she had a BMI of 19 or 20. The anesthesiologist exclaimed that was FAR to little and that she needed to gain weight. Somewhere in my head, the information that 18.5 was the cut off for normal weight and below that was underweight, popped up. Instead of correcting the anesthesiologist and interrupting their conversation, I looked it up on my iPhone real quick.

At this point, I have to say that different ORs react differently in respect to people using their cell phones. In some ORs, you better not look at your phone unless you want to be yelled at and in others, such as this one, everyone who isn't scrubbed in usually has their phone out most of the time when they aren't actively working. So I didn't hesitate and looked the information up real quick.

After the first operation, a group of about 5 people left the OR at the same time. One of the nurses mumbled something about helping move the patient to the recovery room. Since I had never done that, had never been asked to and no name of the person addressed was used, I did not feel that that statement was directed towards me. I really had to pee, so I continued on in the direction of the bathroom. I have a bad back (standing long hours in the OR doesn't help) so I often walk with my arms crossed because it feels better on my back (I'm aware that in the science of body language, that is interpreted as not interested or closed off). One of the nurses called out a name (that very clearly was not Viktoria) and I turned around out of habit (as I think many people do when someone yells out loudly). The second I turn around, I see that the one nurse imitates my crossed arms and says some snarky remark to the other nurse that is waving me over. So I go and help move the patient from the OR bed to the recovery bed and ignore the snarky nurse's behavior.
The look I give snarky nurses that bug me.

Back in the OR, the second patient is ready to go and the anesthesiologist asks if the operating doctors had been called to come. The snarky nurse just gives me a dirty look and says "no, but that could have already been done". I sure hope she didn't mean that I was supposed to have called them since that isn't my job, I wasn't asked and I honestly can't read minds. I was getting really excited for the second operation to be done so that I could leave Mrs. Evil and go back to the ward. Unfortunately, the "emergency" operation was scheduled. I asked the doctor if they needed me and he said I could scrub in to get a better look. It was already 11:10am though and I had plans for lunch in 20 mins (obviously I don't insist on this exact time, but I just wanted to get away from Mrs. Evil).

Before the emergency operation, I was standing outside of the OR looking out of the window when the attending approached me. He told me that Mrs. Evil had complained to her fellow nurses that I hadn't introduced myself at the beginning of the day. He told me that its better to introduce yourself one time too many than not to since some nurses take that very seriously (his toned indicated that he too thought their behavior was ridiculous). A few minutes later, Mrs. Evil exited the OR and I stopped her. I introduced myself and explained that I thought we had already made acquaintances. She just snarkly replied that we had not and that she had very well noticed that. (Ok, take a chill pill lady) She continued to lecture me that it is not a good image for a student if they "just sit around with their arms crossed, playing on their phones and don't help". I took a deep breath mentally and quickly decided that explaining my back problems and the fact that I was researching medical literature on my phone probably wouldn't really help the situation and I just had to accept my losses in that respect but I wasn't about to let someone tell me I was lazy and didn't feel like helping. I told her that I do not interfere with OR procedures unless explicitly asked to do so by someone from the staff because I have learned over the years that the processes happening all go quite smoothly when no one else intervenes and that more times than not, students have been yelled at for wanting to help on their own initiative. I also explained that I am more than willing to help at anytime with anything if asked but that I respect their work environment and do not want to impose. All she had to do was ask and I'd help. She didn't really have a snarky reply for my calm remarks and just mumbled something under her breath and went back into the OR.

I much rather would have told her off. Who does she think she is that she acts like a complete witch just because I didn't personally introduce myself to her? Last time I checked, she doesn't run the place. And really, she must have self confidence issues or something if the mere fact that an insignificant little student such as myself not introducing myself can put her into such a terrible mood and really ruin her day for herself? Besides all that, she easily could have also came to me, introduced herself and asked who I was. I wouldn't have expected her too, I also wouldn't have been mad had she not introduced herself because I just quite frankly don't care that much.

In the end, I just wanted to share that story to show the importance of some little tricks while in the OR (or any other) setting. Little things like that can help you avoid certain stressful situations (not all, don't worry, you'll stand in the wrong place or breathe somebodies air sure enough and get yelled at for that). Even if you feel people take themselves too seriously and they try to make it seem like they reign over the OR, just smile, introduce yourself and make them feel important so that you can avoid the snarkiness and go on with your own wonderful day.

I'd like to give a shout out to all the wonderful OR nurses out there that do an amazing job at what they do and are helpful to students! I really appreciate a kind, helpful nurse and I know that doctors wouldn't trade you for the world if you are good at what you do! There are some really great nurses out there. I just wanted to mention that before you guys think I generally have something against nurses. 

This weekend, I drove to Hamburg and Stade to visit family and bake some yummy cake. Said cake will be eaten in about 2 hours once the Hamburg relatives arrive! Afterwards, its back to G-town and back to a 5 day work week tomorrow.
soccer with my god daughter

church in Stade

love the architecture in the "old land" Altes Land

Fisch Markt Stade

In love with the details

Rhubarb cake ready to be eaten!

Stay healthy!


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