Sunday, October 11, 2015

Week 45-46: A little bit of work here and there

Kalimera everyone! (That's good morning in Greek)

Although you can't see me while reading this, take whatever image you have of me in your head and make my skin multiple shades darker. 

This obviously is not a tan from the OR lights but rather from a truly wonderful week long trip to Santorini, Greece with my family.

But first the work related topics.

Two weeks ago, I once again found myself not working in the pneumology department as originally planned but rather back with the thoracic surgeons! The chief was still on vacation and the attending and resident needed my help since the resident's left hand was still in a cast. 


I did all the bandage changes and pulled all of the chest tubes on rounds. On Tuesday, I assisted the two operations of the day; a biopsy had to be taken from a patients pleura (the inside lining of the chest) because it looked weird on the CT-scan and a tracheotomy. 

The first operation was really interesting to see. We performed the procedure thoracoscopically This means we made two small incisions, one for the camera and one for the instrument. My jaw dropped once the camera was in the chest and I saw what was there. I can't explain it better than: it looked like a bubble gum/bouncy ball pink wonderland you'd see in a Dr.Seuss book. It actually looked pretty although completely out of place considering we were in a patients chest and horrific knowing that the cause of such a landscape was cancer. What type of cancer is still unclear (at least at this point unclear to me since I'm not in the department anymore but I'm positive they have the results back by now).  Pleural carcinomatosis can have its origin from different types of cancer or it can even be a cancer originating from the pleura itself. It really was fascinating to see what the body is capable of producing, even if it is a terrible thing.

The second operation went fairly quick since we only had to perform a surgical tracheotomy. The patient was suffering from pneumonia and had been ventilated for a while and now had to be switched over to tracheotomy. 

This past week, I finally had my day in the pneumology department! Although there once again was another intern, I wasn't going to not be there for the last few days of my internship year. We spent the first part of the morning watching the chief perform bronchoscopies. They were all pretty quick.

The rest of the morning, before lunch, was spent on rounds with the resident. It seemed to take a while for the few patients we had but we spent a good amount of time with each of them. One patient was being trained to use a "cough-assist"-machine. Its a device that helps mobilize the secretions in the lungs when the patient isn't able to do it themselves. 

Our patient is an older man that has reoccurring pneumonia. The training session was rather entertaining. He went from not wanting the machine at all and having to talk to his wife about it first (since they don't make any decisions without having discussed it. How cute.) and asking how many Deutsche Mark (the German currency before the Euro was introduced back in 2000) he'd have to pay for the machine. We had to explain to him multiple times that his health insurance would be covering the costs. 

The training isn't a comfortable procedure. The patient has to do about 4-6 breath cycles with the mask held over the nose and mouth. A positive pressure is applied during inspiration and a negative pressure is applied during expiration. So when you breathe in, air is being forced into your lungs with a certain pressure (not much different than scuba diving I imagine albeit more powerful) and then the machine basically sucks the air out of you. In those two seconds, you feel like you can't breathe. What that does though is pull up the secretions from the bottom of the lung. In fact, the patient was able to cough up more after just a few cycles. At first he didn't like it at all, by the end of the training session, he hardly wanted to stop. He admitted that he understood why it helps and that he can, in fact, cough better but that he still needed to talk to his wife before buying such an expensive machine. We kindly informed him once again that he wasn't paying a cent and that after training with it over the weekend and talking to his wife that we would reevaluate the situation. 

I had to place another line on one patient which worked great. Afterwards the other intern told me that the patient he was supposed to draw blood from not only was known for her bad veins but also only let him try to draw blood once and was now refusing to let him try again. So it was up to me. 

I've drawn quite a bit of blood over the years and there are just some patients that need you to be more of a psychologist during the procedure than others. This patient was scared, frustrated and unhappy. She was always afraid of having her blood drawn because she knew she had bad veins and she frequently needed blood drawn. The vein that her general practitioner usually uses had a i.v. line in it. She is the type of patient you can't just walk into the room to, say your going to draw her blood and get it over with. I went in, told her why I was there, shared with her that I was aware that her veins weren't the easiest to work with and that all I wanted to do first was have a look at her veins to assess the situation for myself. Her first statement was that she was over it and wasn't letting anyone poke her again. This is were the psychologist comes into play. I told her that all I wanted to do was look and then reevaluate if I felt confident enough to try to draw blood. I also just chatted with her while doing so. Some patients have a huge urge to just talk about their problem and if you let them and you listen, they are much more open to you doing things. I genuinely want them to feel better too, I'm not just letting them talk so I can get my work done quicker. I even had to try twice before being successful but she said she didn't even feel the first try. Having the patients talk can nicely distract them from concentrating on the poke of the needle. By the end of all of it, I had the blood I needed and the patient seemed relieved that it worked but also that she had someone listening to her problems. I know for a fact that her resident wasn't sitting there listening to her woes. 

This coming week is my last week of my internship year. I've noticed that somewhere in my counting of weeks in my blog posts, something went wrong because I'm off by a week. The internship year is 48 weeks altogether and I'm only at 47 for next weeks post. Oh well. 

I'll be in the pneumology department for a couple of days before saying me last good-byes to all the departments on Wednesday. 

I've been busy sorting through my things at home like a mad man. I move out of my apartment in a week. If I were just moving into a new one, it would be easy. I, however, have to decide what I want to keep, what goes to America with me right away, what can stay in storage for a year, what am I donating and what am I throwing out. And since I'm in Germany, throwing out isn't just throwing everything into a big trash bin, it all has to be sorted accordingly. This all is making the process slower but I'm seeing less and less in my apartment each day so I know its working.

My tan works well with the white lab coat

I haven't downloaded the Santorini pictures onto my computer yet. I will do a separate post about Santornini here in a few days. I will leave you with this: if you have a travel bucket list, Santorini NEEDS to be on it. It is as beautiful as you would imagine it to be. The people are nice, the food delicious and the views on the Caldera breathtaking. Hopefully I can convey some of those feelings in the post. 

I wish you all a lovely rest of your Sunday!

Stay healthy

V

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