Sunday, September 13, 2015

Week 42: The chill life of thoracic surgery and my little man Ali!

That was easier than I thought it would be.

The past week was less stressful than I expected it to be. Not because I'm some sort of natural at being a doctor but rather because the work load I had anticipated didn't exist. 
The chief, the attending and I did almost everything together. Sure, I got to change the bandages and remove chest tubes and suture at the end of surgery, but this wasn't anything I hadn't really done before. The only difference really was that I wrote a few release notes and my computer access was upgraded to full access of a doctor instead of my limited intern access. A lot of time was spent in the chief's office drinking coffee and eating snacks.

It was fun being back in the surgery department for a week. I all of a sudden saw a lot more of my surgical colleagues than before (the internal medicine department is on a different level of the building so at most I would see the surgeons in the hallway or at lunch but due to politics, you ate with your department). My time in internal medicine did shine a bit through while writing the first release letter. 

Surgical release letters are quite straight forward and to the point with little story telling involved. Patient had this. We did that. He left in a good condition.

Internal medicine release letters are some what of a novel about the patients life. It includes a long history of the patient, all the ailments he has, all the medications they are on, all the diagnostic tests that were run and the interpretation of them, how the treatment will go on from here.....they are easily 5-7 pages long compared to the usual 2 in surgery. 

So when I was working on the first release letter for my thoracic surgery patient, I started with a good thorough history of all the doctors the patient had already been to and had lead them to us. Continued with all the x-rays we had done and the interpretation of each. And filled the rest of the slots with ample information. When the attending came to look over the letter with me, he deleted about 2/3 of the text. From that letter on, my letters were short and to the point. 

We operated Tuesday through Thursday and had 4 operations. Removed a segment of a lung, a small part of a lung, took samples of a lung with a lot of adhesions and removed a lipoma on a mans chest. Most of them went as planned and only took 2-3 hours. The one that really got me was the patient with the adhesions. 

It was on Wednesday that we had two operations. The first one wasn't a problem and even finished a smidge earlier than expected. The second one was only supposed to be taking a sample from the pleura (the tissue covering the inside of the chest and the lung) since it looked thick in the CT scan and the patient had a history of working with asbestos (needed to see if that was a mesothelioma (I'm sure you've heard the commercials on TV about asbestos and mesothelioma and how you should hire their lawyer to get money)). The operation was expected to take 1.5 hours. It was already hard enough gaining access to the inside of the chest due to the adhesions but once we had an opening, we saw just how stuck together everything was. The surgeon just sighed and said this would take a bit longer. I sighed in my head because that day was technically a day I could go home an hour early and I had a massive to-do list I needed to get stuff worked off of). About an hour after that realization the anesthesiologist asked how long we anticipated the surgery to last and the surgeon replied, "easily 2-3 more hours". Great. We luckily all requested chairs to sit on because my back was already making itself noticed an hour into the surgery. I waited until 2.5 hours into it to ask for a chair though. Luckily the staff was friendly and we chatted a bit during the operation because all I did was hold hooks and was hardly to actually see anything in the chest. Not the most exciting thing to do. Chief came in the OR and told me he was going to go do the seminar with the interns and then come back in time so that I could catch the 5:25PM train with the other interns. He said he wanted to be in the OR by 4:40 since I had to leave the hospital by 5 if I wanted to catch the train. He didn't show up until 4:55 and we were basically done just doing the last suture. I hurried off to get changed and grab my stuff and left to catch my train. 

The week was fun and relaxed and the chief is still trying to convince me to start in the department. If I really did, I know it would be a rather relaxed job. The surgeries might kill my back but all in all, it would be a chill work environment. To bad my dream isn't becoming a thoracic surgeon.

Remember Ali? The little boy from Azerbaijan I told you about? He had his check up ultrasound this week and everything looks good! I started a little donation collection to help the family out. Below is the letter I sent out to family and friends asking for even just a little support to help this little family out. If you have $5 or however much to spare, I'd greatly appreciate it if you participated and I know the family will be so thankful as well!


Dear  Friends & Family,    

I’ll  try  to  keep  this  short  since  I  know  you  are  all  busy  people.  A  few  months ago,  I  was  introduced  to  little  2.5  year  old  Ali  from  Azerbaijan.  His  father worked  really  hard  to  get  a  scholarship  to  study  in  Germany.  One  of  his  biggest motivations  was  to  get  better  medical  care  for  his  son.  Ali  was  diagnosed  with hydronephrosis  in  his  home  country.  This  refers  to  distension  and  dilation  of  the kidney  pelvis  and  if  left  untreated  could  lead  to  kidney  failure.  For  Ali,  this  meant many  painful  days  of  kidney  pain  and  for  his  parents  a  lot  of  frustration  not being  able  to  help  him.  
Through  many  fortunate  coincidences,  I  was  introduced  to  him  and  his  family while  working  in  the  urology  department  for  my  internship  year.  The  doctors  took a  look  at  him  and  his  files  and  referred  me  to  the  pediatric  surgeon.  This  surgeon was  nice  enough  to  meet  with  me  and  explain  possible  treatment  options  for  Ali. We  were  perhaps  looking  at  a  $13,000  operation  bill  that  I  would  have  started fundraising  for.  I  organized  for  Ali  to  have  an  examination  done  that  would determine  if  he  needed  surgery  or  not  and  covered  the  costs  for  the  family  with some  help  from  my  grandma.  Although  his  hydronephrosis  was  rather  advanced,  as if  by  a  miracle,  he  had  grown  out  of  it!  That  isn’t  unheard  of  but  we  weren’t expecting  it  due  to  how  advanced  it  was  a  few  months  ago.  So  yay!  No  surgery needed!  The  surgeon  offered  to  give  Ali  a  check  up  before  returning  home  to Azerbaijan  in  September  2015.  

In  the  end,  it  couldn’t  have  turned  out  better  and  Ali  looks  much  healthier  than he did  when  I  first  met  him.  However,  the  family  went  through  great  trouble  to  get him  better  medical  help.  They  took  up  credits  in  Azerbaijan  to  pay  for  the  flight to  Germany  and  had  many  other  expenses  to  make  the  trip  happen.  They  came  to Germany  not  speaking  a  word  of  German  and  into  a  culture  completely  different than  their  own  in  order  to  get  the  best  help  they  could  for  Ali.  They’ve  been nothing  but  kind,  welcoming  and  modest.  I  would  like  to  help  the  family  pay  off some  of  their  debt.  This  is  where  I  need  your  help.  I’m  asking  you  to  donate what  you’d  like  (I’d  be  thrilled  even  if  its  $5)  to  help  this  great  little  family.  

I  tried  to  think  of  ways  to  make  it  easiest  for  you  to  donate.  Below  you  can  find my  paypal  account  and  bank  account.  If  you  are  so  kind  and  donate,  please  put Ali  as  the  subject.  September  18th,  I  will  draw  all  the  money  donated  from  the accounts  and  give  it  to  the  family.        

We  often  take  our  good  life  circumstances  for  granted  and  its  
situations  like  these  that  make  me  grateful  for  what  I  have  and  motivate  me  to help  others  less  fortunate.  I  thank  you  in  advance  for  your  humanity  and donations!  

Stay  healthy,    

Bank  Account: ApoBank     Viktoria  Hasselhof   
IBAN:  DE87  3006  0601  0008  8322  85 


Thank you to everyone who helps out!

Next week I'm back in Gastroenterology for a week. So it's back to long rounds and even longer release letters!

Stay healthy!


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