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 life....in 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!

V

Week 12: Bitter tears and 24 hour shifts.....but now it'S VK time!

Hey y'all!

Just got out of my 24 hour on call shift and thought I'd update everyone quick before I head off!

I started working in the outpatient clinic this week. Depending on the doctor working the clinic on any given day, there is more or less for me to do with patients. Luckily, the consultants had their consultation hours running parallel.

Urology can now also be found on Level 02

We also had two new girls doing electives this week. I played mom a bit for one of them making sure she saw as much as possible while she was in our department for one week. My days were spent between jumping in on some consultations, showing the girl around and doing some translation work.

Wednesday was a bit of a tough day. I'm still getting up before work every morning to study. And while this isn't effecting my mood substantially and I am surprised at how happy I am in general, I am still constantly under a certain level of stress making me a bit more prone to decompensating. I went in with the doctor to see a patient. He talked to the man and his daughter, gave the man the shot he came for and then left to let me do the ultrasound (rather standard procedure). Well, then the daughter started asking me about what dimensions a kidney should have. When I tried to explain to her that we don't generally concern ourselves with the exact dimensions of the kidney but rather look at the kidney's structure, she interrupted telling me she was from the medical field and that she would know that already.....well then why the heck did you ask?! So she became increasing difficult and then sprung the question on me if her dad was getting his prostate checked. Now, I have no issue with checking prostates but I usually ask when it was last done because there are more or less intervals in which it should be done. Her basically deaf father and she talked concurrently about how the prostate should be checked and this doctor said this and that doctor said that. When I told her I didn't know her fathers complete history and that the intervals are a bit dependent of the patients history, she yelled at me that I should know her dad's complete history since its all in the files (You are absolutely right, for your fathers outpatient appointment for a shot, I certainly intensely reviewed his 20 year urological appointment history in our department. Would you like to know his blood pressure from March 10th 1986?). She continued to yell at me that every doctor said something else and that we should know what we are talking about...blah blah blah! At some point I interrupted her and told her that it was not feasible to fulfill her vision of knowledge and even less considering I've been in INTERN in the department for merely a few WEEKS and the she could use a substantially nicer tone! And then I walked out. I told the doctor about the situation and then went to the bathroom. I just made it in time to the last stall to bawl my eyes out. I couldn't believe how mean she was to me. I was just there to help and would have discussed everything in a calm manner had she approached me in such a way but to just let out all her frustration with life on me was too much. I stayed in the stall for about 15 minutes until I couldn't cry anymore and tried to freshen up and hide the evidence. I was paged and asked where I was since there was a patient for me to see. I washed my face with cold water, put on some lip gloss and headed back to the outpatient department. The rest of the day was fine but this lady's inhumane treatment really irked me for a few more hours.

Urologist also have our own exit (and apparently use too much Viagra)

My friend wasn't feeling well and came to the hospital. After getting her all worked up and checked, I left the hospital after 12 hours.

Nothing all to exciting happened Thursday and Friday.

Yesterday (Saturday), I started my 24 hour shift. We had quite a bit to do. There were patients on the ward that needed us, the emergency room called almost every hour with a different case for us (mostly renal colic or infections). We also had to place renal fistulas as an emergency again (luckily this time it wasn't in the middle of the night). I did get 5 hours of sleep in all though. It was busy but interesting.

Today I leave to Frankfurt so that I can fly away tomorrow morning! Where to? Cape Town, South Africa!!!!!!!! I haven't really had it sink in yet since I've been so extremely busy with other stuff but since a few hours, I've been getting more and more excited! Of course I'll report a bit about my time there next week!

And as a last little thing for you all to try out (because its yummy!). I've been making this ginger-lemon-honey drink daily the past week. I wasn't going to risk getting sick! And like I said, its delicious!

-cut slices of ginger and pour over with hot water and let it stand over night
-1 fresh pressed lemon
-1 tablespoon honey
-some mint or lemon balm leaves for color
-mix it all together and enjoy while your colleagues think you brought a mojito to work ;)

Enjoy and stay healthy!

V

Week 11: Urology congress in Heidelberg= the only place the mens restroom has a line and the womens doesn't!

Well, I'm officially a quarter of a century old! 1/4 of my minimum goal reached!

The week started off with two rather unspectacular work days.

Wednesday I had to present some of my research data to the lab. I thought it would take about 10 minutest to click through my pictures and then they would tell me how little I've found and that I am a complete failure as a doctorate student. Okay, I didn't actually think it was going to be that bad but I had no idea what to expect. I had nothing definitive to show them. I composed some of the electron microscopy pictures I had taken and wanted to discuss these with the group of histology and anatomy professors and researchers. And in reality, that is what happened. The whole thing took 1.5 hours because each slide was discussed to great lengths with everyone there. I got some great input and some more direction as to what it is I am looking for. The conclusion is also that my endless hours in front of the electron microscope are long from over.

Wednesday night, I drove out to my aunt and uncles place to celebrate into my birthday. I facetimed my parents and opened my package of presents they had sent me. So happy! Amongst other things, I got a lot of material on Stephen Hawking. I'm excited to read his "A Brief History of Time" book on vacation. My friend got me travel guides for two of my destinations this year!

The next morning, my aunt and I took the train to Heidelberg. Most people know Heidelberg. Its a rather famous city also in respect to its medical history. I'd never been and have always wanted to go. Having won the tickets to the Urology Semi-Live Congress there, I finally had a reason to. My aunt and I ran around the city (sadly with not so great weather) but it truly is a gorgeous city.

The funniest thing happened in the candy store. There is a candy store that isn't very big but packed from top to bottom with candy from Germany and around the world. Even crazier than the collection of candy was the guy working there! Crazy beard and hair-do and thick leopard print nerd glasses. He spent about 10 minutes with each costumer at the register. So, don't go if you are in a rush. If you complain, he'll kick you out. What a cool way of working. Once we were up, my aunt told him it was my birthday. Before I knew it, he brought a stool in front of the register, told me to stand on it, made my "mom" hold my hand, gathered all the customers in the store around me, turned the light and radio off and announced to everyone that it was my birthday and that deserved a celebration, lit up a sparkler and made everyone sing Happy Birthday to me! It was fabulous and I couldn't stop smiling! He makes everyone at the register roll dice and play a little game and then you'll get more candy as a present. Super fun experience! I recommend it to anyone who visits. The store is called "Heidelberger Zuckerladen", has been around since 1986 and is located at Plöck 52 in Heidelberg.

At night, my uncle came and joined us. We had dinner at Moghul Tandoori, an Indian restaurant (Brückenkopfstraße 1, 69120 Heidelberg, Germany). I can also recommend this place.

Earlier in the day we had coffee at Coffee Nerd (Rohrbacher Straße 9, 69115 Heidelberg, Germany) (recommendation from the candy store guy and TOTALLY worth it). The coffee is ridiculously good.

I spent Friday and Saturday at the Semi-Live Urology Congress. The concept was that every half an hour, a different surgeon who is exceptional at the procedure, presents important information and techniques. Each was followed by a question and discussion road. In between there would be lunch and coffee breaks.

A little DaVinci practice never hurts

Right off the bat I met a student from Heidelberg and we ended up spending most of the time at the congress together. The presentations were more or less all really good. With about 300 participants present....there were only about 8 women. This meant this was the only place were the men's bathroom has a line and the women's doesn't!

I saw some operations I had never seen before let alone knew were a possibility. Friday night, there was a big dinner at a really old restaurant in Heidelberg. There was no lack of food.....it was so much food.....

Early morning walk to the congress

I made a connection with an Egyptian urologist and was invited to check out the facilities. The chief of urology in Heidelberg told me to apply for his department next year. The only people I didn't get a chance to talk to and wanted to were the two speakers from the States. I'll get in contact with them though. Over all it was a lot of information but really cool.

Heidelberg at night

Today I had a birthday brunch with some of my girlfriends.

Over my birthday weekend I didn't allow myself to study.....not that that made my guilty feelings go away any.....Its back to it tomorrow morning!

Hope you all had a great week!

Stay healthy!

V

Week 10: "Well, you don't place tracheotomy tubes, now do you?"......how rude! Get over YOUR fear of the penis Sir.

This week seemed incredibly long. This was mostly due to my numerous little naps in between. I am really able to fall asleep almost anywhere and sometimes I'm refreshed after just sleeping a few minutes.

Monday through Friday I got up at 4:30am, studied for the USLME until 6:10am, slept until 6:30am and went to work. Consequently, I went to bed around 9:30pm to at least get 7 hours of continuous sleep. Studying and answering questions in the morning significantly increased the amount I was getting right. It's still not where I want it in the end but I still have until the end of March to get there. I looked through the questions and worked on flash cards after work.

I attended a lecture Monday night held by Prof. Dr. Harald Lesch. He is a German physicist, astronomer, natural philosopher, author, television presenter, professor of physics at the Ludwig Maximilian University of Munich and professor of natural philosophy at the Munich University of Philosophy. He held a lecture about the smallest and the largest components of the universe and how they fit together. It was really interesting and refreshing to learn something different and new!

Wednesday, I was called into the OR to assist with a hydrocele operation. The patients ascites (excess water in the abdomen) was so extensive that it had reopened the processus vaginalis (connection between abdomen and scrotal sac) that usually closes in early development. Basically, he had excessive amounts of fluid in his scrotal sack....and since there was a lot of pressure from the fluid in his abdomen, it was like turning on the water faucet once we opened the membrane in the scrotal sack.

Cucumber, Apple, Basil, Lime Juice for the OR

Wednesday was a long day. The day involved ward work, operation, pathological conference lecture, evening meeting which was then still followed by a short educational lecture by one of the attendings. Luckily I had my back turned towards everyone to face the screen.....because I totally fell asleep for a minute or so....good thing I didn't snore. I was just so tired!

Friday looked like a busy day from the get go. One of the three interns wasn't there and the other didn't show up. We had two huge operations and two wards that needed to be tended to by interns.....and there I stood! My ward doctor was afraid I wouldn't be around to draw all the blood and his fear came true. Directly after the morning meeting I was sent into the OR immediately. I grabbed a coca cola and a biscuit and hurried off to the OR. I usually don't drink Coke, I did while in Ghana because coffee or tea wasn't very accessible and I needed caffeine. Now I do sometimes when a big operation gets sprung on me unexpectedly and I wasn't able to have breakfast yet. Caffeine and sugar to keep me from passing out while standing for 5 hours. Luckily the other intern had just overslept and was able to assist in the other huge operation.

Sometimes I just have to...

I was operating with the chief and he is tall. Although it was a 5 hour operation, my back didn't hurt nearly as much as it does when I operate with shorter surgeons. It was really nice operating with chief because he kept asking me questions. Sometimes anatomical, sometimes surgical or just logical to get me to think like a surgeon. He is an examiner for the board exams so it felt like a mini board exam.

Saturday I decided to tag along for an 24 hour on call. We started Saturday morning at 8am and I went home this morning at 8:30am. I slept for 2 hours and then again for 3. During the day we had quite a bit to do. The wards had to be tended to, the emergency room would call every now and again and we'd go there to check out the patients. We had some postoperative patients that weren't very stable and had to be transferred to intensive care. I hardly sat throughout the day.

We were called by the ENT-ward because they had a patient that hadn't peed in a day and a half. We asked them if they had placed a trans-urethral catheter. The doctor retorted that we (urologists) didn't place tracheotomy tubes so why should they place a trans-urethral catheter......Um....because every nurse should know how to!!! The genital area seems to be a big Tabu for many of the other departments and some doctors don't even take the time to look at the patient when it comes to urogenital tract problems and proceed to just call the urologist on call. Get over it people! Look under the blanket! Its only a penis!
 

Middle of the night, glazy eyes.

Late evening we were informed that a patient was being brought to the hospital with horrific labs. The patient was placed on acute dialysis when they arrived and desperately needed the kidneys drained. We couldn't do that until the acute dialysis was over though....which was around 1:30am. The doctor and I slept for two hours before being called to the CT to check out the patient's pictures and get the attending and nursing staff on call to come to the hospital and coordinate the anesthesiologists for the procedure. We were back in bed by 4am and slept uninterrupted until 7am. It was a long on call but also really interesting and the doctor and I get along great so that was nice too.

Outta there and walking home in the snow!

I get three days off in the week for being on call over the weekend. I am taking Wednesday-Friday off. Thursday I turn a quarter century old...  (0_0) ...... I'm heading to Heidelberg for the Semi-Live Urology Conference during my free days.

Hope everyone had a lovely week! Stay healthy!

Baci

V

Week 9: Study, work, little sleep, repeat.

To sum up my last week: work, study, little sleep, drinks, science, boots.

I can't really keep my days straight. Nothing extraordinarily exciting happened patient wise. I spent my evenings studying and when I was fed up that the results were not that great after a 10 hour work day, I went to bed at 10 pm and got up at 4 am on Thursday to study before going to work. 

Tuesday was such a lovely day outside! There was real, full on sun! We didn't have any coffee pads left on the ward for our coffee machine in the doctors office and I had all my immediate tasks completed, so I told the doctors I would be more than happy to walk to the nearby grocery store and buy some. Thank you coffee addiction! The doctors gave me some cash and I was able to enjoy a few minutes in the full on sun! In a t-shirt! The other pedestrians looked at me a bit weird but that temperature and weather is great weather for Wisconsin standards. 

Saturday wasn't much different for the first half. Library from 8am till 3pm. Afterwards, I met a friend for coffee and then attended the Night of Knowledge. This night takes place in many big german cities and it was the second year in my city. The while city is involved. My main visitation sites where the hospital (go figure) and the northern campus (chemistry, physics, astrophysics, Max Planck Institute for Solar System Research). The urology department and a few others had a stand with two models of the DaVinci robot for interested future surgeons and video game enthusiasts alike. The bulk of my time was spent on the north campus though.

I heard a lecture from Jens Frahm (important in the development of the MRI) about the newest developments in MRI technology. He showed us some cool videos of real time images. I've had a real time MRI done of my heart (I really need to get those images). Afterwards, I listened to a lecture about astronomy in South Africa. I really love astronomy and could listen to lectures about the topic all day. My aunt and uncle met up with me and went back to the hospital. I helped the visitors use the DaVinci. Although it wasn't planed that I even help out, I stayed until 12:45am taking everything apart.

This morning (Sunday), my friend and I left early in the morning to drive to Düsseldorf. After a quick stop at Starbucks (something we don't have in our small town, so every time we are in a larger town we tend to make a stop), we went to a restaurant called Mongo's. It's a Mongolian restaurant where you can put together your own dishes. We ended up eating for three hours. It was so delicious! And since it was mostly vegetables and fruit, I was full but not the completely uncomfortable full you feel after carb binge eating. 

We then headed to our actual reason for being in Düsselfdorf. The boot exhibition. It's a HUGE exhibition that deals with anything body of water related. We spent our time in the scuba divining and yacht exhibition halls. Thought I'd take the biggest yacht (7,000,000€) home with me.... 

Tomorrow it's up and early again......so it continues......

P.S. Recipe: I am always tying new ways to use what is available on the ward to make something delicious. Especially when it's cold outside, I like to make a cup of hot lemon with honey. So this recipe is no rocket science:

Lemon juice (quantity depending on level of preferred tartness)

Honey (quantity dependent on level of preferred sweetness)

Hot water

So simple and yet so very delicious!