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

Week 31: I guess no more standing elbow deep in someone's abdomen for awhile for me. Surgery rotation completed.

Another week and another rotation over.

That was it for surgery and that was it for the ER for now. I'm a bit sad about it actually. My doctor and I were a pretty good team. 

Monday was spent in Milan with a UW-Madison college friend of mine. I showed him around Milan a bit and we visited the World Expo 2015 taking place there. One of the coolest stops of the day was checking out the Chiesa di San Bernardino alle Ossa. There is a room decorated with hundreds if not thousands of human bones from a former cemetarty. I, the med student thought it was so cool. My rocket scientist friend (he's an actual rocket scientist), thought it was gruesome but then again cool at the same time.

Il Duomo, Milano, Italia

Chiesa di San Bernardino Alle Ossa, Milano, Italia

I am excited to see how internal medicine will be starting Monday. I expect to learn a lot and this expectation scares me a bit too. I don't want to end up sitting around all day again. If that does happen, I'll be right back in the ER.

I examined a man with an abdominal aorta aneurysm this past week. That was nifty. You could really feel a softball sized tumor in this mans stomach pulsating.

Thursday was weird. We might admit 1 or 2 patients a day on average in trauma surgery. This day, out of the 10 patients we saw until the afternoon meeting, 2 were kids and the parents opted to take the home rather than have them admitted, 6 were already admitted and the last two were ones we were working on. It was absolutely crazy and most of the time was spent with paper work. 

I had one patient I was primarily working on. I really tried hard to take care of his case in a timely manner but it just wasn't possible. Either I was waiting for one of the doctors to see him, waiting for the x ray or the lab results. He had pain in the hip region about 4 months after a hip surgery. When I examined him, the pain didn't appear to be coming from the hip. My thought was that he might have a hernia. The physical examination wasn't very typical for one but it's usually the small ones that cause the most pain. 

The surgeon on duty (vascular surgeon) took a look. She called the general surgery attending to come take a look. He said he'd bet his mother-in-law that it isn't a hernia. So I threw that theory out. My main objective was to exclude all the bad things it could be. Even checked his foot pluse with Doppler sonography. All good. In the end, we agreed that he had a tendinose. Since he was doing so well after the operation and in recovery and only started experiencing pain a few weeks ago, it correlates with the time he started to use his new hip more. This caused muscles to work differently than before the operation and which created the soreness at the location he was experiencing it. I apologized multiple times that everything took so long and that I was always bound to waiting on someone or something. He was very sweet though and wished me all the best in my career. Very sweet and understanding man.

Friday was busy but not crazy. At least we had patients that twisted their ankle or cut their finger instead of hip fractures and pain patients we had to admit the day before. I conveniently forgot my key at home and couldn't access my locker. I ran around in only blue scrubs, a pen and my phone all day. I was called nurse a few times. Interestingly, a lot of the patients born in the 1920's/'30's often call the other female doctors and I nurses. In their heads, women aren't doctors. We just go along with it. Sometimes they will be seen by three female doctors during the week who have all introduced themselves as such and when a male attending does rounds and they'll exclaim they are so happy to see a doctor......mhmm ok. 

We had two older ladies that were rather entertaining. To say they had slight dementia would be an understatement. One was incredibly adorable, the other one called us stupid and told us to take down the cross from the wall because we were not worthy of it. While the one waited to be picked up from the ward and the other on the transporter back home, the lobby was filled with yelling from both ladies.

I left work on time because I still had to pick up some relatives and drive to Hamburg for my grandmas 85th birthday. We went out to the Reeperbahn Friday night with a huge gang of family members. It was hilarious to say the least. 

After getting up after just 3 hours of sleep to take care of the munchkins, I had my sweet revenge when I made them wake up "the monster" aka my dad.

On our way to the bakery!

Monday morning it's back to the hospital and diving into a new department. Hope my expectations get somewhat fulfilled. 

Stay healthy!

V

Week 30: "Have you changed a nephrostomy tube before?" "No." "Well, you gon' learn today!"

Well, it's 6:30 on a Sunday morning.....thanks internal clock for not letting me have the experience of sleeping in on a Sunday. I'm awake and not tired but still....there is just something about waking up after 9AM on a Sunday that has a feel of luxury to it. Oh well, early bird catches......you know.

This past week flew by again! And once again I have a hard time trying to keep the days apart. So I can't really describes my individual days but rather my individual patients.

I was allowed to suture every case that came in and needed stitches. There was the guy at work that cut the back side of his finger with a saw, the old man that fell and rather deeply cut the side of his hand (it bled so much and his hands were drenched in blood and it looked like he had killed something with is bare hands), the old man that fell and hit his head and had a small wound and then there was the woman suffering from borderline disease who cut herself to relieve pressure.

Suturing in the ER is more fun for me than in the OR. I worked in plastic surgery for a month and learned the importance of aesthetics suturing. We weren't doing aesthetic surgery but rather reconstructive. Of course, if you are operating on a patient that needs reconstructive surgery, you will try really hard to make it look nice....its a big reason for why the operation is being done.  Most other departments don't see the closing of the patient as an aesthetic issue. Often times, patients will have staples placed instead of sutures because it's quicker. I think, if you had to go through a big abdominal operation, your scare isn't your biggest issue but the thing that constantly reminds you that you had to have surgery and might as well look nice. In the ER, the patients are wide awake and usually watching you as you suture (since the local anesthesia had time to work by then). A few do mention that we should try hard to make it look nice (especially when its in the face) but I also have expectations for myself to make it look good. So far, everyone has been really pleased with my work.

On my way up!

I was called up to the privately insured ward twice. Both times to place a line. You never know how a patient is until you meet him/her but I'm always more concerned about how a patient is when I'm on the privately insured ward. The privately insured often have higher expectations and straight up make you feel like you are a servant in a luxury hotel sometimes with the requests they have. I'm just not a fan of that mentality and sometimes have to refrain from commenting. The second day I was called up, it was the first thing I did that day. When I arrived, the nurses just smiled and said the patient was a rather complicated patient. Greeeeeeeeat. Just what I want to hear first thing in the morning and then having to place a line. In the end, this lady wasn't complicated at all. She was frustrated and exhausted. Her operation kept getting rescheduled due to her blood lab values. There is construction happening near her room and she is afraid to have another operation. All those factors together just made her exhausted and frustrated with the whole situation......but she wasn't complicated.

I definitely empathized with her. It bugged me a bit that she was described as complicated by the nurses. I've dealt with complicated patients before with absurd requests and expectations of the whole staff.  I'm sure even this patient rang for the nurses multiple times a day with questions about weather or not her operation is taking place. Keep in mind that the patient is not eating every day because there is a chance she might have her operation just to find out she isn't being operated in the afternoon. Please tell me you wouldn't be frustrated and exhausted if you were in the same situation.

Friday morning, trauma surgery was less than busy in the ER. Oddly enough, the urology department was receiving one patient after another. One of the first ones was a man from England. The nurse sitting at the reception desk just called over to the doctors room to inform me that I had a patient to see due to my English skills.

He was an urological patient which just made it all the much better for me. I stayed with the patient even after the urologist came. Once the urologist found out that I was planning on going into urology, his face lit up and for the next two hours, I was constantly by his side and doing procedures I hadn't done in the whole 16 weeks of my urology rotation. He would just ask me if I had changed a suprapubic catheter or nephrostomy tube before (my answer to both was no) and without further hesitation, I was changing the catheters with the help of his instructions.



Both things really aren't complicated but they were things I hadn't done before and that made it really exciting. We had a patient whos catheter was cut off by the nurse in the nursing home and the end part with the blocking-balloon was still in his bladder! We had to take him to the urology department because our plan was to perform a cystoscopy (looking into the bladder with an endoscope through the penis) and removing the catheter piece. The urologist again asked me if I had done that before and I again answered with no. He said I could do everything once we were in the bladder. This urologist was on a roll! Sadly, the passageway into the bladder was blocked due to a big prostate and adhesions that I didn't actually get to do anything. Nonetheless, the urologist explained how the endoscope worked (which was a question I had had for a while but people were always so stressed in the urology department I was in to take the time and explain it to me). This urologist was under stress too due to being responsible for the ER patients and the outpatient procedures but he made it work. He asked me when I would start working and that I should apply in their department. Very sweet but I had to break it to him that I am attempting to do residency in the States. After a few more things, I returned to my doctor in the ER. It was still rather empty.

That of course changed quickly. The second half of Friday was packed with patients. To top it all off, we also had a polytrauma. While my doctor had to work on the polytrauma, I did as much as I could to finish up the other 7 cases we had. I left an hour later than I had expected. I was so drained by the time I got home. I decided to take a 25 minute nap.....which I then repeated.....and once more. I made myself get up again to finish some errands before eventually dropping back into bed.

I have one week left in trauma surgery. It'll only be a three day week because I'm gone Monday and Tuesday. My doctor repeatedly told me that she was going to miss having me around when I leave for the internal medicine department. I'll miss her too and the work we do together. But I won't be far away considering I'm only two floors above her. So if I end up being bored somewhere.....you can most likely find me in the ER suturing up a wound!

Stay healthy!

V

Week 29: Sir, your wife's knee pain she has had for 2 years....isn't an EMERGENCY. So shush!

I often can't decide if a week went by fast or if it seemed forever long. Usually working in the ER, I'd say the week went by really fast. Monday was especially stressful for my doctor and when she was telling a colleague about it on Thursday, I could have sworn it happened the week before.

So lets dive into Monday. The place was already crazy at around 8:30AM. The patients just kept coming in. At some point, I just started writing patient release notes as soon as I heard their story so that we could discharge them promptly after my doctor treated them. 

Trauma surgery was definitely the busiest that day but the other departments weren't sitting around sipping coffee and watching us run around like chickens with our head cut off....they were running around just like us. The chief of the ER was hyperventilating at one point (not literally but pretty dang close). He wanted us to see patients in the waiting room to decide if they can immediately be sent to radiology instead of being examined in an examination room.

In theory, this might be an elegant way of avoiding the transfer of the patient from the waiting room to the examination room but it also has the potential to create a lot of problems. And it definitely did. We walked out with the next three patient clipboards to see what could be sent to get x-rayed. The first patient had knee pain. We had to exam him properly to see if he even needed an x-ray. So he had to wait until a room was open. The next patient was described on her chart as having a problem with her finger. This really was her smallest problem though. When we asked her what had happened, she paused, looked a bit scared and asked if she really needed to talk about this in public. Of course she didn't have to and we were about to say that it can wait until we have a room (the doctor and I both have a heart and already didn't like the idea of talking in public to the patients), but the patient was quicker and proceeded to tell us that she was badly beaten up by her boyfriend. She proceeded to break down and cry. Understandably and the doctor and I stood there mad at the chief for having made us do what we did. The third patient fit the theory quite nicely, hurt his wrist while playing soccer. Quick examination of the wrist (which is possible without an examination room obviously) and immediately sent him to get it x-rayed. 

The load of patients just didn't stop. One patient, who came with her husband due to knee pain she has had for 2 years(!!!!!!!!!), was examined by us and we needed one of the attendings to lend us a hand with figuring out what she might have. (I remind you that we work in the Emergency Room, this was not an emergency and we aren't there to do lengthy investigations, we are there to treat acute problems.) 

After her examination, a poly-trauma came in and we were all busy with that. So this couple ended up having to wait a while. When we finally did get to telling them that they need to see an orthopedic surgeon for further evaluation, the husband was not pleased. He quite sternly and not nicely told my doctor that this was absurd and that its an abomination that we simply "petted" his wife's knee and made them wait three hours to be told they had to go see an orthopedic surgeon. At some point, it was too much for my doctor and she started to cry and excused herself. (For people who regularly read this blog might remember my similar situation in urology. Although I didn't cry in front of anyone I was very empathetic for my doctor). I was not as emotionally involved in the situation and still stood there with the couple. I tried to calmly explain to the man that due to the poly-trauma which was an actual emergency, we couldn't finish up his wife's case any quicker and that I understand that waiting is annoying but that it was an emergency room and his wife's issue was flat out not an emergency. I also mentioned that as doctors, we are trained to gather a lot of information from simply observing the patient and "petting" their knee. 

He kept going on about how his wife's heart is bad and how despicable it is that we made them wait. Honestly, would your wife be doing much else at home than sit if her heart is so bad? I realized there is no point in arguing with crazy so I asked him to wait a moment and had an attending step in. He didn't have any more luck than I did and he made the chief have a talk with the man. In the end, the man came and apologized to my doctor for having been harsh. It obviously wasn't only this man's actions that brought my doctor to tears but rather the whole day. 

Patients need to learn to realize which doctors truly care about them and do their best to treat them and which doctors really don't care if you wait three hours. The doctors that care (and I'll include myself) really put themselves under a lot of stress to help patients as best and as quickly and comfortably for the patient as we can. We aren't sitting at our desks twiddling our thumbs. 

I ended up sewing a finger that day of a lady who almost cut off the bottom side of her finger with a knife.

The rest of the week was better than Monday but still had times a patient congestion. The other doctors in the department were really supportive of my doctor. On Monday, two came down to help us and that gave her a chance to collect herself. The chief said that she should go eat something and that the other two could finish up the last hour of her shift. The attendings offered her to stay out of the ER the next two days. They were all really great but my doctor is a lot like I am when it comes to these episodes of frustration. It gets to a point, we break and then we move on. She didn't need the next days off from the ER, she just needed a few minutes to breathe. Nonetheless, I think its great that she had so much support from her colleagues. I think almost every doctor (that cares) has these moments. 

I sewed up a few more patient during the week. 

Thursday was definitely a little kids day. About 80% of the patients were kids. I ended up just carrying around Berni the Teddy Bear in my scrubs pocket all day. Each kid that comes into the ER and looks like they would enjoy having a teddy bear gets one to take home.

Friday was another fairly busy day. Since it was, I was allowed to take care of a patient almost all by myself. He had cut his lower arm while moving material at work. It was deep enough to sew up and that is what I did. I prepared everything, sewed up, bandaged and wrote the release note all by myself. The only thing I didn't do was the local anesthesia. (That is something I still would like to do the next two weeks.)

I also sewed up a wound on a older man's head after he fell. The options were staples or sutures. I was happy we collectively decided to suture. I personally think the wounds look better with fewer scares and I have something to do. 

The whole week, I was spending my time after work preparing my friends bridal shower. I had planned on a nice picnic by the lake. I had even picked out the tree the week before. The weather forecast predicted rain. Only on Saturday. Not on Friday or Sunday. Just on the one day in the year I plan a picnic. I ended up transforming my itsy-bitsy apartment into an indoor picnic. Everyone was happy and had a good time so I see it as a success! 

Sunday I spent my day at the flea market trying to make some money and reduce the size of my baggage. Always thinking prospectively. In a few months, I have to decide what goes back to the states with me!

Stay healthy!

V

Week 25: On the plus side, we have great conversations......

I'm really trying to find something to write about for this past week. In a nutshell: train strikes, rounds, talk, eat, prepare patient presentation, present, attend lecture, get home later than usual.

The German train conductors went on strike for a whole week. This meant that almost all fast trains and many regional trains were cancelled. As you can imagine (if you yourself aren't in Germany and already dealing with it anyways), this caused quite a few problems for anyone trying to go anywhere. For me, it meant leaving the train station 5 minutes later but arriving in Hildesheim 40 minutes later than usual. I usually wasn't changed and ready to go on the ward until 8:50. Getting home was the same situation. It wasn't terrible but it also wasn't as fun as just hopping on one train and being there in half an hour. 

The surgery schedule was fuller than it was last week and the nurse who's job it is to hold hooks during the operation was there so us interns were a bit jobless. I spent the majority of the week just chatting about everything and anything with the doctor, my friend started her general surgery rotation week this past week so we were always a gang of three women. 

We went on rounds everyday with either an attending or the chief on Tuesday. Since we had to prepare to present the patients for the next days operation this week, I felt like I knew so much more about the patients than in the past few weeks. 

 the city I work in turns 1200 years old this year

I helped clean a few wounds and renew the bandages. I successfully placed a few more lines. It's becoming less and less of a big deal to place them. 

Beyond that and eating long lunches......I didn't really do much. I even brought a text book with me on Friday so I could at least look at examining patients in theory. 

The doctor said that she'd love to have more tasks for us but that they just didn't exist.

We definitely learned a thing or two about department politics this week considering there was enough time for the doctors to rant about others. 

Sorry I couldn't make that post more interesting. As a compensation, I will post about the exiting things I'm up to this coming week next week! So it'll be a little excurse into a travel post and not medical post but hopefully I'll have fun stuff to tell. And real doctors go on vacation too......so I guess it fits somewhat. I'm currently at the airport in Frankfurt and will be enroute to EGYPT in about two hours! I've wanted to visit Egypt since my childhood. I was fascinated by the ancient Egyptian mythology and the ancient Egyptian culture. I'm so fortunate to have people there waiting to show me their country. Next week, I'll share with you! Have a great week everyone and stay healthy!

V

Week 19/20: Circumcisions, lots of circumcisions...Pediatric surgery

As I had predicted, I wasn't at all in the state of mind to write a post last Saturday. But lets get caught up real quick.

I spent the last two weeks in pediatric surgery. I absolutely loved it! The department again consisted of 3 people. I almost exclusively spent the week working with the chief. He is such a nice man and explained quite a lot. He also is a book full of stories from his residency and fellowships and can recite poems like almost none other that I know! He is the old school breed of surgeons. He prefers open surgery to just about any laproscopic or minimal invasive procedure, the takes his time for his operations (for example with circumcisions, not just pull and snip, rather a lot of clamps and exact precision), and hails from a time where a lot of doctors still thought it was okay to throw surgical instruments around the OR like a 3 year old if something didn't go exactly their way (he did not agree with these antics and there are a few people who still do that today). We had so many things to talk about that didn't pertain to medicine too. He had spent some time in Africa, a few weeks in America as a young adult and so on. There was hardly ever silence between the two of us.

Most of the time was spent in the OR. He made for a nice relaxed environment and explained a lot about the procedures. Since the school kids were on Easter break, most of the operations we were doing were circumcisions due to phimosis (too tight foreskin). Circumcision isn't necessarily "in fashion" the way it is in the USA so we had parents (mostly the dads) who were really fighting for the little boys to keep their foreskin and seemed devastated when we told them it had to be cut off. We had to explain to them that the boys could still lead perfectly normal lives and would grow up being just fine. (Shows how different cultures can be when it comes to foreskin and its value). There were also a lot of testicle operations on kids who's testicles hadn't fully descended yet. The OR staff was really nice too. They gladly assisted me when I needed help. I probably had to tell the story of my life on a daily basis in the past two weeks. So many people were fascinated about the duality of my life in Germany and America.

The first week, I was pretty much all over the place emotionally due to the USMLE being the following Monday. On the Friday before, the doctor let me go a bit earlier and the whole OR staff and doctors wished me luck!

I drove to Frankfurt on Sunday to spend the night in a hotel before heading to the testing center the next morning. I ordered sushi and watched An American in Paris in my hotel room. I wasn't at all nervous before the exam. Not because I felt confident that I knew everything (not at the least) as I did for most of my life with exams but rather because I was just SO sick of the whole thing. I spent more than 6 months day in and day out studying. Using almost all my free time out of work. I know that there are people out there that would like to at least have 95% right so they lock themselves up for months on end, never seeing another human soul and in the end maybe even achieving that goal, but for me it was more important that I actually learned something and reviewed important information. This exam doesn't show how good you will be as a doctor. It shows that you are good at memorizing and making connections with a huge amount of information. Medicine is ever changing and a lot of the questions asked about procedures...patient so and so comes with so and so  and what would be your immediate next step? Well that seems rather vague in a lot of examples. One hospital might have standard procedures than others. Different countries have different procedures. Is it a university hospital were no expenses are spared or a small hospital were working economically is key. What I'm trying to say is that with a lot of the questions, I can see multiple answers being an option. I don't really see the point in just learning procedures for an exam like this if you can't think about why you might do it one way or anther, make it depend on the patient and the situation. I know standardized exams are needed for the process but I don't allow this exam to predict my qualification of being a good doctors. There are a lot of human skills you need for that to be true and those can't easily be tested. Nonetheless, good for the people who reach the goal they set for themselves, especially if they are trying to get into prestigious programs if thats what they want. Its a tough exam (more so if you didn't study in America and weren't basically trained for the exam). I went out of that exam not really having a positive or negative feeling towards my work. It can really go either way. There were few questions were I really was confident to know the right answer and many were "well you could do that but this option would also work". At this point all I want is to have passed. I'm not looking to get into Harvard and Urology seems like a stretch at the moment anyways (considering its one of the most desirable specialties and only 60% of applicants got a spot last year). But I hope my resumé as a whole gets me a spot in Family Medicine or so. Once I'm in the system, it'll be easier to switch if I decide I want to do that.

I was actually more emotional after the exam than I was the week and night before. Once the tension of the last few months started wearing off, I just wanted to cry for no specific reason. The day after, I was still all over the place with my emotions and still not really ready for the normal daily life again. After the exam, I bought myself 3 dunkin donuts and an InStyle magazine, I tried to be as unmedical and unhealthy as possible. The next day in the hospital I was fairly quiet and indifferent to a lot of things. A good OR day was exactly what I needed on Wednesday to get out of my funk a bit and enjoy my freedom.

I was rather sad on my last day in the department. We had a day of clinic with ultrasound appointments. There was a lot of variety in the cases presented and I loved getting to interact with the kids while they are awake. We were done fairly early, so I chatted with the secretary for a really long time before heading into town to take care of some errands before our afternoon lectures.

Millennium Park Chicago 

That night, I took a train to Berlin to fly out the next morning to Chicago. I am spending about 9 days back in the states and am so excited to be driving home tomorrow after a fun weekend in Chicago with friends. Last night, Wisconsin Badgers beat the Kentucky Wildcats in the final four game of March Madness basketball and I was beyond excited. We watched in a bar and I had some fellow Wisconsinites to cheer with. This was a pretty personal game for me and after last years loss in the same constellation (last year I was on the beach in Ghana without access to the game) I couldn't stop smiling after that amazing game. So congratulations Bo Ryan and the boys. You made this little Badger really happy last night (and I don't think I was the only one).

Quick fabulous update to my little kid Ali! He had his diagnostic test two weeks ago on Tuesday. He seems to (as if by miracle, because we really weren't expecting it) have grown out of his hydronephrosis and doesn't need surgery! The doctor offered to do a follow up ultrasound before the family leaves to go home in September but doesn't expect there to be anything pathological.

This upcoming week I'll be home in Wisconsin and after that, I'll start working in vascular surgery. I've heard that the department is nice so we shall see if that's true and hopefully I'll have someone there to explain a lot to me.

Now I wish you all a very Happy Easter, stay healthy and ON WISCONSIN!

Week 17/18: you are not here to work, you're here to learn!

Sorry for the delay everyone! I took off this past week to stay out of the hospital and study for the usmle step 2 coming up really soon (March 30th). The week before this one was my first week in the new hospital.

My mornings are quite different now. I still get up around 5:30am but then take the bus at 6:24 to the train station, take the train at 7:03 and arrive in Hildesheim around 7:33, walk about 15 minutes to the hospital and start work around 8. On Mondays, Wednesdays, and Thursdays we have lectures until 5pm which doesn't get me back to my apartment until about 6:30. Due to the over hours we accumulate with the lectures, we get off Tuesday or Friday every other week. 

I'm currently in my surgical rotation. On the first day, we spent most of the time running around the hospital getting our lab coats, having lockers assigned to us, picking up our I.d. and chip cards. One of the surgeons sat down with us to divide us up in the departments. The first week I was in thoracic surgery. Then it'll be as follows for varying amounts of time: pediatric surgery, vascular surgery, general surgery and lastly trauma surgery.

I have a few vacations planned in between as well. 

My first week in a new hospital and new department went well. I spent everyday in the OR. I'd never really been in contact with thoracic surgery before and in the few days there I assisted in removing a lung, taking lung samples, cleaning out an infected pleural space, thoracoscopy and tracheotomy placement. It was cool to feel a breathing lung and touch a beating heart. 

The department is way smaller compared to what I'm used to. Thoracic surgery in this hospital consists of three people: chief, attendant and resident. Huge contrast to what I'm used to. But the whole hospital is a smaller scale than the university setting I've been working in. It's seems much more small town-y. People will open the doors for you, ask if you'd like some coffee, have a conversation with you. The chief himself sat down with me and discussed x-ray pictures with me. He made sure that I saw a lot and helped where I could. He also said that I'd be much better off being a thoracic surgeon than God forbid an urologist! It's so funny, the last few months I've lived in my urology world and thought it was the most normal thing in the world to want to be a urologist, work in that setting and treat those patients. Ever since I've come to the new hospital, everyone is amazed at my decision, shocked almost and tries to convince me to do something else and teases me about wanting to be a urologist. The urologists in the hospital are all supposedly really nice though and seem to have a lot to do. The other doctors like the urologists, they just can't wrap their mind around the idea of me becoming one.

One of the first things that the doctor that greeted us told us was that we are not there to work but rather to learn. We are supposed to get insight into the different departments and be as hands on as possible. That is great news for us! I really do look forward to learning a lot. I'll even be more excited once this board exam is over so I can actually relax and enjoy the time in the hospital. If the other departments are anything like the thoracic surgeons, I will be learning a lot!

Monday I start in pediatric urology, super excited! There is one surgeon who does pediatric urology. I'll try to work with him as much as possible. This upcoming week will be quite stressful since it's the week before my exam and I'll try to focus on that as much as possible. I apologize in advance if there is another week delay on the next post. I'll try to fit it in in one of my study breaks but no promises. Who knows what state I'll be in two days before the exam. 

Quick update on my meeting with the pediatric surgeons. In a nutshell, I was introduced to a little boy with a urological condition who comes from Azerbaijan. His family is in Germany on a scholarship and came in the hopes of receiving better care for their son. Unfortunately the insurance doesn't cover preexisting conditions. I've presented his case to the pediatric surgeons and urologist and have asked administration to let me know what the diagnostic test and most likely surgery will cost since the money will have to be fundraised. My fundraising goal is now set at about $13,000. I've been meeting with some people and getting the ball rolling on things and as of right now, if everyone pulls through, it seems promising. Up first is the diagnostic test to see how extensive the condidition is and what the best treatment option would be. In the upcoming posts I'll share a little more about this little boys story and also share information on how you can help me help him and his family if you want! 

Stay healthy everyone!

V