Week 32: "Don't go breaking my heart." "I couldn't if I tried....ok, I probably could but I'm trying really hard not too!"

Oh lordy its hot! Summer has finally arrived in Germany. Its about time but it also sort of came out of the blue and our circulatory systems had no time to prepare.  Speaking of circulatory system, I finished my first week in cardiology!

We received our rotation schedule on Monday. I'll be in cardiology then haematology/oncology then gastroenterology/general medicine and in the end pneumology. Each for 4 weeks. 

I was told to go to the ward and that a doctor would be there waiting for me. My doctor is actually a general surgeon but since he wants to start working in a practice, he needs to do 1.5 years of internal medicine. He has only been in the department for a few weeks. I think its actually pretty cool that I'm working with him because he also has to look up things and can explain the basics really well since he just recently reviewed them. He is also interested in me learning something while I'm there so he asks good questions during rounds that get me thinking. The other residents are also very nice and if they have an interesting ECG or patient case, they'll ask me to take a look. 

The big differences to being in internal medicine and not surgery anymore have so far been:

-I've used my stethoscope more times in the last 5 days than I have in the last 32 weeks. It is hangs out around my neck more than it does in my lab coat pocket.

-Rounds take FOREVER! Every morning is easily spent exclusively on rounds. Three to four hour rounds are the norm. My back and feet were not used to that the first few days. 

-Patients go on forever with their stories. We had the odd talker as a patient in surgery as well but most issues in surgery were rather clear on how they would be handled and usually surgery was the cure. There weren't a lot of followup questions there. In internal medicine, each person's story is long, their list of complaints many and the treatment is often with medications that take their time to start working and are taken for a life time. Many of the internal medicine patients, if not almost all of them, are multimorbid. This meaning they don't just have one chronic illness but a combination of many. This of course makes treating patients more difficult and requires a good sense of pharmacology since one drug used to treat illness A might not react well with a drug to treat illness B. 

-The average age of patients seems to lie in their 70/80's.

The department meeting starts at 12:15 and goes on for about 20 minutes. Afterwards, we all head to the cafeteria for lunch.

After lunch, the doctors are usually busy writing release letters and I take to my 3 medical text books and read up on cardiology. There is way more potential for learning in internal medicine than there is in surgery. I also really want to learn as much as possible while I'm in my internal rotation. So I'll read a section about heart murmurs for example and then go to the patient that I know has an aortic valve stenosis and listen to it. There are also various tests happening with patients after lunch like stress tests, so I go look at those in between.

Wednesday, an elective student started in the department. It's his first elective. He'll be starting his 7th semester soon. It is like having a living/walking/talking/breathing-reality check hanging out with you. He hasn't had cardiology in school yet so when he asks questions, we all have to remember that he hasn't heard the things we assume he already knows and we can add on to. Its really convenient for me because I get to explain things as if I was in my practical exam and had to explain something to the professor. I have to understand what I'm saying before I can teach it to someone else. It also gives me feed back on how much I've learned over the years.

I sat down with him and explained different heart murmurs, how they develop and where on the chest they are heard best. He told me he had never placed a line. I showed him how its done on one patient and then he got to try it out on me. (During med school, I was the genuine pig for my friends and had 7 puncture marks on my arms at once.) I supervised a few of his attempts on patients. He also came and got me to help him with patients where he was having trouble drawing blood. I loved being a TA in med school and teaching students so I enjoy being able to be one of the first people to explain things to him and then take him to patients so that he can hear things we discussed earlier. 

I really like the residents I work with. Three guys and all rather funny. The hobby-internist (my doctor) really is a surgeon at heart. Surgeons sense of humor is just more similar to mine. Three of the four attendings are women. I think that is great for women and shows an active movement towards more women in higher positions. For me personally, they all don't really seem like people I would become friends with. I think our personalities are too different. Obviously I am not in the hospital to become friends with the attendings but I feel it sets the atmosphere at work differently when you get along with attendings on a personality level.

I already had a good 1st week where I tried to learn as much as possible and hope to add on to that the next few weeks.

I left the hospital early twice this past week because either the lecture was done early or the doctors let me leave but not in time for me to catch the next train. I finally used the opportunity to look at some other parts of Hildesheim. If you leave the straight shot path from the train station to the hospital, you can see beautiful things. People have often told me that Hildesheim is beautiful but I couldn't really confirm that notion from my usually walking path. Now I am totally convinced as well. I'm sure there is a lot more to see and I will try to explore more if time allows!

The rose bush on the back building is the famous 1000-year old rose bush of Hildesheim

This weekend was so hot I could hardly function. I was in the lab Friday night until 9:30pm and was still sweating. I decided I would probably melt away if I went to the lab Saturday morning, so instead, I went to the library that has AC and sorted the pictures I have taken so far for my doctoral thesis. After the library session, I headed to the pool with two girl friends and attempted to lower our body temperature.

Happy 4th of July to all my American friends! 

Stay healthy!

V