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 44: Ultrasounds, chocolate and happiness

I spent the first part of Monday organizing where I'd even be the rest of the week. 

Originally planned was that I would start in the pneumology department. This is a rather small department to start with and they still had an intern planned to be there for the next two weeks. One intern is almost an overdose, so two would have been overkill. I ran between various secretary offices and making calls to the chief of the department. I saw on the official plan that the gastroeneterology department I had been in the last few weeks and which is the biggest of the four internal medicine departments, didn't have an assigned intern. The chief of the department was ecstatic and told me I was more than welcome to stay in the department another week. After talking it over with the pneumology chief and having it noted by the secretary, I was back in the gastro-department. 

The set up of doctors was a bit different this week. I spent a lot of the time placing i.v. lines and drawing blood again but I also spent a lot of time on rounds with the doctors. The two doctors I went with were great! They asked me a bunch of questions. Some I could answer really well, others not so much but they were great at explaining the answer to me and helping me understand why things are as they are. I had some mind blowing moments there. Little things that I just learned during my studies but never really understood why were explained to me. 

Smaller wasn't an option?

I quite enjoy rounds where I'm asked a lot. I don't expect myself to know everything but it gets my brain working and is practice for my exam. The annoying this is when the brain doesn't work. I was asked by which system liver cirrhosis is classified. I definitely knew I knew the answer but all type of other scores started popping into my head and blocking my thought of the right answer. After a few moments I had it but that just felt annoying because I don't want that happening during my exam.

I went on grand rounds as well. Since I had had an informative day of rounds the day before, I was hoping I could shine because the chief would ask about the same questions. Oh how naive Ms. H. (Miss H Dot is what chief calls me, although he actually knows my name). He ended up asking questions that luckily the resident couldn't answer in it entirety either. Its just how chief is. He asserts his superiority with it. That's fine because I end up learning something as well. 

The one doctor took me along to do ultrasound this past week. Instead of him doing it and telling me something, he immediately had me sit down and do it. I'm rather good at finding the kidneys and bladder due to my urology rotation but for the rest of the abdomen, I didn't have a clear system. It ended up being a lot easier than I had imagined it would be. He showed me how to find all the things I needed to look at. Of course, each patient is different and some are easier to examine than others but I definitely feel more confident in examining many parts of the abdomen. 

I watched a few colonoscopies throughout the week. It really is a super important exam everyone over 50 should have. If you fall into that group and haven't had one. Go get it done. Its not a big deal and you're thinking about way to much in your head and worrying about things.....its not a big deal. But it can be a big deal if it helps find something that can be removed.

There were so many sweets on the ward this week. I really tried to hold back most of the time but sometimes it took so long for everyone to be ready for lunch that I just had to chow down a bit. I need to make sure to take more healthy snacks with me in the future so that I'm not as tempted. 

Tuesday evening, I went to see Ali and his family and give them the money I was able to collect. Thank you from the very bottom of my heart to every single person that donated. I can't express how happy it makes me feel inside that there are such nice, helpful people out there. Being able to help Ali and his family is one of my proudest accomplishments and those who donated or donated their time to help me are a part of that happiness. So thank you!

This coming week, I'm only at work for 2 days before heading to Santorini with some members of my family! WOOHOO! I can NOT wait! I've wanted to go to Santorini for the longest time. I hope to have a relaxing week that will get me ready to get down and dirty and study for my practical exam!

Have a good week! Stay healthy!

V

Week 43: Oh the redundancy......

I'm coming off of couple of very sleep deprived days.....for a change, this time medical school was not the culprit.

The work week was rather redundant. I spent most of the days drawing blood and placing a series of i.v. lines every day. It has gotten to the point were I almost enjoy placing i.v. lines. I've been so successful that I see every new line as an opportunity to keep my stats up and take on challenges to push my abilities. 

"Hey Viktoria, want to place another i.v. line for me?" my facial response. Pure excitement

There were so many to do though that I didn't even attend rounds the first few days! Except Tuesday for grand rounds. Chief asked a lot of questions again and I was more graceful with my answers than last week. I even low key impressed him when I answered a question. He told me that most gastroenterologists didn't even know that answer....which again surprised me because you could easily answer it if you knew the blood vessel anatomy of the stomach and spleen (which I guess I assumed most doctors did). 

I admitted another patient. She was an elderly lady and the conversation went much longer than it needed to be. We ventured off into none medical topics as well. I think the two years I spent living with my grandparents and spending so much time with my grandma and her friends really influenced me. The idea of a big round of older ladies, coffee and cake sounds great to me....I'm guessing that's not the case for most 25-year-olds. 

Giving your intern ample amounts of chocolate for her help is most definitely appropriate

Since it was my last week in the gastroenterology department, I really wanted to make sure I get to see some endoscopy procedures. 

I watched an ESD (endoscopic submucosal dissection). It is a procedure in which, for example, neoplasms (new formation of tissue that shouldn't be there and could possibly be cancerous) in the colon are removed. Older procedures would use a type of electrical sling to remove that growth but the reappearance rate is high. With the ESD, the layer between the mucous membrane and the muscle layer is cut apart and if done correctly, practically  diminishes the recurrence of new formations at that location. This procedure can take anywhere from 2-10 hours according to the chief. Its basically an operation an internist performs. 

Oh hey there BFF Coffee......what a surprise to see you here!

I also was shown an ERCP (endoscopic retrograd cholangiopancreatography). Essentially, you go through the mouth, through the oesophagus into the stomach and on to the small intestine. There you'll find the opening from which the pancreas and gallbladder excrete their fluids. The passage ways of the bile and pancreas can be displayed using contrast medium. This is good to see where strictures or obstructions in the passage ways might be. The doctor also performed a 360° ultrasound of the upper gastrointestinal tract which was interesting to see and not so easy to interpret.

Besides that, I spent my time with the patients and their terrible veins. 

Thursday, I left for Berlin after work to meet up with friends that were on tour in Germany and hung out with them for a few days, watched the shows and just had a great time getting away from it all.
 

The Badder

DJ Premier and the Badder

Posers. Practice. Preemo.

Tomorrow, snap back to reality, Oh there goes gravity.......ok I'll stop there ;)

Stay healthy my friends!

V

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!

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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,    
_________________________________________________
Paypal:     viky_oddball@hotmail.com    

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


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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!

V

Week 41: And the award for best supporting beverage goes to..........COFFEE!

If I ever win an award, I will be sure to thank caffeine for existing. This past week, caffeine was my superhero. 

Award for best supporting beverage: Coffee

Caffeine, aside from the one or other fine wine or Hennessy will be the most extreme I will ever get with any type of drug. I try to ween myself off of coffee and for very long periods of time, I don't need a coffee during the day. I even sometimes have phases were I can't drink coffee because the thought alone disgusts me. Other times, and the phase I'm currently in, is that I enjoy drinking a coffee in the morning and sometimes during the day. 

This past week, it kept me alive.

After getting home late Sunday night from visiting my grandma in the hospital again, I went to work Monday. Since it was a usually Monday, a coffee was needed just for that. After the morning rounds, I spent the rest of my day dealing with blood draws and placing about 8 lines. I lost track at some point. When a patient needs a new line, the nurses don't tell me, they simple place a bandage that is used to keep the lines in place on the counter. This inefficient method requires me to look into the supply room every now and then to see if there is something for me to get done. It started off with 3 bandages. When I was done successfully placing those, I walked into the supply room in order to put away the things I had used only to find 3 more bandages waiting on me. Once those were through, I found two more. The residents even felt bad for me and told me to just leave some for the others if need be. I can't live with leaving things behind for others to pick up, especially when it is more or less technically my task to complete. After all of those, I went to the tumor board conference. I had warned the doctors that I wouldn't be coming the next day because I had to go to my grandmas again. I had originally planned to take Friday off but now had to switch that for Tuesday.

Monday Night: Straight Outta Compton

Tuesday morning, I hopped on multiple trains and arrived at my grandmas 3.5 hours later. After a bit of a fiasco on the weekend where the nurses didn't want to give me information about my grandmas treatment although they were actually legally obliged to do so, I finally had a nice talk with one of the doctors there. I'll tell you a pretty stupid position to be in: being an almost doctor with a grandma in the hospital and your relatives all wanting you to bud into the doctors business.......it's not my place and makes me feel rather uncomfortable. It's not like I'm going to know more than the attending. The nurses and some doctors definitely didn't act right in regards to the situation but I still tried to be respectful of their positions whilst also accomplishing some of my relatives requests. 

Tuesday night, I attended a concert in Hamburg. It was a great time. I hung out with some friends and only got 1.5 hours of sleep before catching my train at 4:50AM back to the hospital in time for work. I got about an hour of terrible sleep on the train. So, with that amount of sleep in me, I looked and probably acted like a zombie all day. I pumped three cups of coffee in me (I'm aware this is still little compared to the hard core addicts). Nonetheless, it just barely got me by. It was another day of placing lines and drawing blood. It was almost the end of the day and time for me to leave for two rounds of seminars when I was asked to admit a privately insured patient. I pushed myself to read through the old release letters before heading to the patient. He was a very nice gentleman and I don't think he perceived me as such a zombie. Afterwards, I quickly headed to the seminars with my third cup of coffee in hand. 

DJ Premier and his live Band in the Mojo Club Hamburg

Where did my drums go??

Breakfast of champions: yogurt and tortilla chips

Once I arrived at the train station to catch the train home, I was beyond excited to be in my bed soon. Unfortunately, I realized when I was on the train (before the train left) that I forgot to buy my monthly ticket. I quickly jumped out of the train again. I went and bought my new ticket and ended up having to wait an hour until the next train came.........greeeeaaaattt. I was too tired to even be mad. I slept like a rock that night.

The eight hours weren't enough however and I needed two coffees on Thursday and Friday to get through the day. Thursday was grand rounds. I was still tired and the chief caught me off guard and I sort of bombed the first round of questions regarding the anatomy of the stomach (something I actually know really well). Luckily, throughout the grand rounds, I redeemed myself nicely and also asked a lot of questions which made him feel good because he could explain things to me. The rest of the day was spent.......you guessed it, with difficult blood draws and line placing. We had our seminar with the chief that day and I rocked it. The topic was colorectal cancer and for some reason I was a roll. I was answering questions to completion where he could only nod and say that was correct (which is odd for that particular chief).

Friday was much the same like the rest of the other days. During lunch, the chief of thoracic surgery called me and asked if I wanted to drain a pleural effusion. When I asked him "when?" and he said, "now", I quickly ate three more bits and hurried to him. I had drained one pleural effusion before with a bit of help, this time, he let me do everything. 

The patient I had admitted Wednesday, became my patient. This meant I checked on him, looked to make sure his examinations were requested in the computer and wrote his release letter. It was a fairly simple case but a good start to get used to what is in store this coming week. 

Starting Monday, I'll be in the thoracic surgery department for a week as a pseudo-resident. Should be a good and challenging week. 

I spent the weekend in Stuttgart visiting family. I arrived Friday night to a yard filled with 5 screaming kids (under the age of 5). They all thought it would be fun to chase me around. You'd think that would be the last thing I wanted to deal with after the week I had but, I loved it. The rest of the weekend was also relaxing in a crazy family and nature kind of way.

A few of my favorite people

I'm captured.

Out and about near Stuttgart

Let see how many pounds I gain or lose depending on how much I prep myself for operating and how long the operations actually go where I'm not eating most of the day.  

Stay healthy!

V

Week 39: That didn't go as planned...... at all!

Well that didn't go as planned.

This past week went everything but how I had thought it would. Monday was the most normal day out of all of them.

I came back to the hospital after the great wedding weekend motivated to work. Especially considering it was my last week in hematology and oncology and I had finally gotten to the point where I really, really liked working with my two colleagues.

Monday was a bit crazy as always. I spent the afternoon admitting patients and completing the usual long lists of examinations with them. The last patient of the day was a lady I had seen with the chief two weeks earlier in consultations. Since the chief is on vacation, I was the only one in the department who had an idea who this woman was. She has end stage pancreas cancer and let's just say her and her husband either don't want to accept the disease and acknowledge the scope of it or they really don't understand. She couldn't have the next round of chemo right away since she had elevated infection lab values. In their mind, once she gets the next chemo, the cancer will be stopped and she can live her life as it was before the cancer. The doctor and I tried to clarify some of the circumstances surrounding the disease but the two just kept being fixated on the chemo and that it'll be the cure. It isn't easy talking with them. I have no idea how I would be if I was in their position and every person is different and deals with such situations differently but the doctor and I just feel like we can't really help them grasp the scope of what is coming up for them.

During the Monday tumor board conference, I was flagged over by the chief of thoracic surgery. With a lot of brown nosing, he asked if I would be willing to assist in operations the next two days. I was sitting right next to my hem/onc doctor, he wasn't amused about giving me up for the days but sort of had to agree due to hierarchy.

The next morning, I got up earlier in order to make myself an omelet for breakfast. Not having been in an OR for a few months, I wasn't going to risk fainting. Since I had no idea when the operation would start (and not having access to the OR schedule since I'm in the internal medicine department), I snacked in between tasks and drank two cups of coffee being prepared for whenever the call came. It came at 10:30. I chugged a high energy drink and went to get scrubbed in. I most likely took in way more calories than necessary, had an overdose of caffeine and water in me but I wasn't taking any chances. (It proved to be a good amount of everything because I didn't feel fainty at any point during the 3.5 hour operation). I wasn't binge eating/caffeine drinking during my surgery rotation but my system was trained for long days in the OR. Not having operated in a while, I had to make sure I wouldn't feel sleepy or have low blood pressure (caffeine), wouldn't be hungry (high caloric drink, breakfast, KIND bar, chocolate bar) or thirsty (a liter of water) and made sure to empty my bladder just before entering the OR area. 

 

I think I ate about 11 of these throughout the week

I assisted in a partial removal of the right lung. It was a fun operation. Aside from the technical aspect of it all, the conversations we had while working were fun. The chief told that he didn't like the idea of me going back to the States. He offered me a job in his department. He proceeded to offer me a husband and house as well! He told me that his wife's brother is a really great guy, tall, good looking, works in media/broadcasting at a major German television station and would be moving to Hannover in October. The chief said he'd make sure I got a house in a nice part of town. He assured me the guy liked traveling and would love kids. In theory, it all sounded great. I threatened the chief with the prospect of having to deal with me a lot more if that all happened. He said he wouldn't mind. Oh man. This is just one of many situations I've had the last few months as my departure from Germany comes closer. Relatives are making me offers in hopes of keeping me around; “Vik, I have two private practices you could work in, the doctors there will be retiring in a few years and it can be yours!” I truly appreciate the love and effort and if I could live parallel lives, I would. If the States would accept my German residency I'd even consider it all. But the circumstances don't allow it if I ever want to work in the states and not redo my residency. I approach my return to the states with big time mixed feelings.

Wednesday, I took the elective student with me into the ER because she had never been and was supposed to assist the second operation. This time, we were supposed to go to the ER first thing in the morning. Again, I made eggs for breakfast, snacked along the way, chugged a coffee and a high caloric drink before entering the OR. Again, we took out a part of a lung. I was allowed to do a bit more this time around. Parallel, we all helped the elective student adapt to the new environment. She was lucky to have had such a great team as her first. It can sometimes be pretty ugly in the OR. Especially when everyone is stressed and gets snappy. That wasn't the case in the thoracic surgery OR however.

So after a quick rendevous with surgery, I thought the rest of the week would go as planned. That wishful bubble quickly burst when I woke up to a text message from my uncle (who at the time was on vacation in Italy) that my grandma had fallen the night before and was in the hospital. I called him, although it was 6AM. He told me that my grandma had fallen about 5 feet down. The miracle of the whole thing is that she supposedly didn't break a single bone. I called the hospital at 7AM, very well knowing that I wouldn't be able to talk to a doctor. The nurses told me that she had gotten through the night just fine and that nothing was broken but that they couldn't tell me more than that (something I totally understood due to confidentiality). They said it would be good if I stopped by to bring her some things. I partly laughed and told them that “stopping by” wasn't quite as easily done as said. It would take me 4 hours by train to even get there, not to mention I still had to go to work.

I had packed most of my things for my planned Munich weekend the night before, I threw in a few missing things (still missing things in the process as I noticed later) and took the train to work as usual. When I got there, I told my doctors what had happened and that I wanted to leave work as soon as possible and would be taking a vacation day for Friday. Nonetheless, I wanted to complete the intern tasks and not bother anyone else with them. I participated in rounds which seemed to drag on before leaving. I was bummed. I had looked forward to two fun days with the guys and those had to be cut way short. Obviously, fallen grandma trumps fun at work. I'm in the fortunate position as an intern to just take a vacation day without much notice (notice is appreciated but not mandatory).

I had to take the train to my home town first to drop off some things I had planned to drop off after work but had to be taken care of that day (otherwise I would have taken a train immediately to my grandma and not take the detour back to my hometown). I felt under extreme stress the whole first half of the day with all the running around and catching trains. Once I got to my grandma's town, it was a series of taxi rides to get to and fro from the house and get the key for my grandma's car from her at the hospital.

She is doing alright. Her back and ribs hurt understandably. Again, it is a miracle that my 85 year old grandma didn't break a single bone in that fall/tumble/stop. I was there too late to talk to a doctor. I already knew they'd be done for the day and the on call doctor wouldn't have been much help.

It is weird being so close to being a doctor myself and then having to be the patient's relative. I walked a fine line between doctor and relative, not trying to step on anyones toes but also fulfilling the tasks my uncle and dad had given me. I was especially considerate of the nurses knowing how annoying it can be to have a patient's relative constantly wanting to know something and even better, try to change something about the course of treatment.

This morning, I finally got to talk to the doctor. Again, I took steps to assure that I wasn't trying to hijack my grandma's treatment plan and that I respect and trust their work but that I had to be the messenger for a few of my dad's and uncle's questions/requests. I tried to avoid all the annoying things I've come to experience over the years of working in the hospital. I think I did an ok job and none of them dislike me....or at least I hope.

So although nothing this week really went as planned, one thing didn't change, the fact that I will be spending some days in Munich visiting friends and family. I might head back a day early and back up to Grandma if need be but otherwise I'll be back up in that corner of the country next weekend anyways.

Without further ado, I hope you all have a healthy and fun weekend!

V

Week 38: Live. Laugh. Love.

It was a bit of a crazy week last week. 

At work: I spent a lot of my time taking care of patients by myself this week. I don't remember having any longer periods of time were I wasn't actively doing something. My work involved doing the admission work for new patients. I'd take their history, physically exam them and then usually proceed with a list of things: accessing the port, drawing blood cultures, drawing routine labs and starting fluids or antibiotics. I also tried to fill out the orders as much as I could by myself. Much of Thursday afternoon and Friday morning were spent writing release letters.

Monday, I was assigned a patient and had to do the whole run down, including a bone marrow puncture! I was a bit nervous considering how the last time went. After successfully accessing the port, I felt a bit more confident. The elective student came and watched me do the puncture. So not only did I have to prove myself to my doctor that looked on but also had to perform well for the student. It...went....fabulously! It was so perfect. We got what we needed, no complications and I did a happy dance in my head! My doctor was rather relieved too. 
 

The face you make when EVERYTHING on your to do list works....including bone marrow puncture!

I felt like I bonded more with my colleagues over the past week. I was not a happy camper Thursday...not at all actually. The night before, I met up with some of the urologists for a scrumdelicious dinner and wine. I really only wanted to drink a glass of wine but the three guys kept pouring more....I was already hard core babysitting my drink but it wasn't doing much for my cause. The boys had their fun teasing me....seems to be a common theme of our meetings. I can handle it though and have my fun with it too. Before we all knew it, it as almost midnight! My brother was hitch hiking from Prague to my town. He didn't have a cell phone, so I couldn't call him and didn't know exactly when he would arrive. The doorbell finally rang around 2A.M. I had enough energy to let him in, give him a towel so that he could shower and told him he could make himself breakfast in the morning before heading out again. I was back in bed and my alarm clock went off 4 hours later.

Usually I do alright with sleep deprivation (I've had quite a bit of training with my night shifts) and this time I also wasn't really tired all day but I was in a terrible mood! I had reflux due to the wine. Everything and anything annoyed me. When I get agitated, I become really quite because I don't want to snap on anyone. At work, I was really quite and went about my business. When I was assigned writing release letters, I had to stop myself from complaining about such a normal task. For some reason, my colleagues at work decided to continue with the teasing my urology friends had done the night before. I took it in more or less silence and tried not to snap. It was a rough day at work for me but I managed to keep it together. After work, I wanted nothing more than to be in my bed. When I got to the train station and found out my train had a 50 minute delay, I really was on the verge of punching a wall and screaming.....I decided not to do that though because I was afraid they'd admit me into psych. Instead, I went to the department store near by and cooled off, bought a bag of candy and browsed clothes. It helped and I spent the last 20 minutes reading my book back at the train station. I was very happy to be in bed that night.

I took Tuesday off. My best friend from medical school got married yesterday. I made a stop in the lab Tuesday morning to get an introduction lesson for the new camera we got. It felt like Christmas! Much better quality! They also replaced the old, fat backed computers with a nice big flat screen one. I'm excited to get some work done with the new system. I just need to practice a bit more so things go quicker. 

Afterwards, my friend and I drove to pick up her wedding dress. She looked absolutely stunning in the last fitting. It got me really excited for the weekend. We headed to the church afterwards and rearranged the interior and raked leaves in front of the church. We proceeded to work off a bunch of things off of the to-do list. As her Maid of Honor, it as my top priority to do everything she needed done and to her liking. 

This past weekend, it was finally time for her to say "I do" in the church. It was such a fun weekend filled with great moments, laughs, tears of joy, dancing, eating, taking pictures, meeting family and friends and doing everything she needed me to do so that her wedding was exactly how she hoped it would be. I've known her since day one of med school. We weren't best friends immediately but always had the same circle of friends. In the second year of school is when we really found each other and have shared many experiences ever since. I was with her the day she met her husband, I was the one who went with her to an island to meet up with him and his friend which was a weekend that showed me that this thing was serious. I'm honored she chose me to be a part of her wedding as her maid of honor. Med school can be grueling and she and I really went through the good and the bad together. I'm so very happy for her that she found her partner for life a few months before ending med school and that I was around to witness it all!

Always have her back

The happy couple

My best and favorite med school girls!

Uh-oh, I caught the bouquet!

I have one more week of hematology and oncology left. That was quite shocking for my doctor to hear. When the attending asked me if I'd be around next week and I said it would be my last week in the department, the doctor stopped what he was doing, spun around in his chair and looked at us and said, "You're lying". I wasn't but his reaction made me feel good because he sounded disappointed which means it couldn't have been too horrible having me around. 

Stay healthy everyone!

V

Week 37: Cancer's many faces, Berlin's many masks and my many impressions

What an interesting week I had. I spent three days throughout the week shadowing the chief. 

After the morning meetings, I would go to the private ward with him and see the patients he was taking care of. At 10, we'd go over to the office building for consultations until about 1:30pm. 

It was interesting because I was able to experience patients in all the different stages of cancer that exist. Being in the room for the moment someone is told they have cancer is a weird feeling. Especially, if you know the person has cancer before they come into the room and you we waiting in anticipation for the doctor to tell them. Doctors have a difficult task of conveying the message appropriately. You need to use the right words, in the right order and on the level of the patients understanding so that they really come to understand what their diagnosis means. As soon as the patient hears the word cancer, everything after that is usually not being registered. It's also a tough task because not every cancer is the same. If patients haven't had contact to cancer patients, they usually assume the worst outcome. If they have had cases of cancer in their family or circle of friends, they only know that specific case. But cancer is so different and personal to each person. Breast cancer is treated completely different than colon cancer. The outcomes and prognoses are different. The journey through treatment is different. Even one type of cancer, breast cancer for instance, varies a lot between patients in respect to treatment, outcome and journey. Some are hormone or genetically sensitive to treatment, others aren't. It is important to give the patient a sense of were they stand. At the same time, statistics are statistics and don't really have a meaning for the individual. We can only say how long most patients live statistically, but in the case for a specific person, that really isn't relevant. Most patients want it to be though and ask about statistics. As a doctor, we walk a thin line between giving false hope and real hope. Even if we articulate an appropriate amount of hope, it is received and interpreted by patients differently so we have to see if that which we were trying to convey, was registered correctly. 

I few things I noticed over the week were:

A) Many patients try to attribute a certain life event to their cancer. "I fell a few weeks ago and hurt my shoulder, can that be the origin of my sarcoma?" (It can't.)

B) Patients that are married seem to handle it all better. (This was actually proven in a study.)

C) If the patient with cancer is the husband, the wife does most of the talking. "He's been taking these and these pills. He's been doing so and so with the treatment. His next appointment is then and then." Probably why point B stands.

D) A few couples would say "we" have this or that appointment coming up. "We've" handled the treatment this way. It really shows how much cancer doesn't just affect the person with it but also the loved ones going through it.

E) In general, patients with a worse prognosis seems to take everything a lot harder (understandable) but that isn't always the case and the attitude of the patient has a lot to do with their support system and their view of the rest of their life. Some are quite inspirational. 

F) Quite a few patients live with their cancer as though it is a chronic disease. I think that is still a fairly new concept for people. Medicine has gotten so good that even if we can't cure you completely of your cancer, we can, in some cases, push it back so far that your life expectancy is about the same as without cancer, it just involves taking a pill everyday. And as with any pill you take, you have the risk of side effects. 

Chief surprised us in the afternoon meeting with 3 scoops of ice cream for each person!

I think the chief really enjoyed having me around, explaining things to me and letting me do the ultra sounds before he did them to confirm my findings. I think he also appreciated that I know how to politely deal with people. I think there is just a certain way you have to act if you are working with the chief because the patients have certain expectations when they come to consultations with the chief and it can't hurt to be greeted and escorted to the room by a friendly student. (And I'm also friendly to all the other patients too so it isn't like I'm trying to be any different than usual which makes it easy for me.)

Back on the ward, I finally got to do a bone marrow aspiration! It didn't go as smoothly as I had hoped it would but no unexpected harm was done and we got the material we needed so all good in the end. I just wish for myself that it had gone better but it was my first time so I guess it went well. I didn't accidentally go through the other side and do a colon biopsy (which as funny as that may sound, was my greatest fear, even worse, puncture a big vessel.) 

A good idea of what I did.    Google Images.

I'd also like to tell you about a situation with a patient because I think it is a good example that just because medicine is capable with doing things, it mustn't always be done if discussed openly with the patient. 

The patient has cancer. He's gone through chemo and was taking pills as the last option of treatment. The pills statistically could make him live a couple of months longer. While taking the pills, he suffered from gastrointestinal side effects and they left him not enjoying food anymore. He just didn't feel good in general under the therapy with the pills. He decided to take a break from the pills knowing that would statistically lower his life expectancy. As we talked with him, his wife, daughter and two grandchildren were in the room. He looked as though he was a normal old man enjoying his time with his family but you wouldn't have been able to tell he has cancer. After openly discussing with him the statistical benefits weighed against the reality of how he felt taking them, we all agreed that it would be better to take a break from the pills for the time being. If need be, he could always start them again. In his situation, I would have done the exact same thing. He weighed being under treatment and feeling bad, not enjoying life with feeling good, being able to enjoy life and statistically maybe living a few months less. But isn't a life you enjoy living and your loved ones can enjoy with you worth more than being able to say you lived a few months longer but weren't able to enjoy that time? It is a highly personal decision a person has to make for themselves. I thought it was a nice conversation to have witnessed. The doctor didn't push the medicine because of statistics but rather treated the patient as a whole and not as a disease that needs to be cured.

Similar situations happened during consultations. There was one situation though, were I as the patient, would have decided differently. The woman has cancer. Due to a certain factor she "luckily" has positive in her type of cancer, there is a pill that works highly specific and targets the caner cells which gives her a significant statistical advantage for survival over not taking them. The common side effects are also easily manageable. She decided she was done with medicine and was not going to go through with the therapy. This was rather baffling to me (especially with her medical professional background) and the chief was also not for her decision. Seeing that Germany is a free country and we can't force anyone to do anything (and our mentality isn't such that we would) the chief explained the benefits to her multiple times in the hopes that she might see the benefit and change her mind. After repeated attempts, he told her that his suggestion for treatment stands and that he wasn't going to change his recommendation but that he had to respect her decision even if he doesn't agree. I can live with situations like this when the patient is an adult and has understood the consequences. I have issues when these situations happen with children and their parents are the decision makers. Many things, if need be, can be done with a court order. Other situations, such as vaccinations, are a different thing. A big reason why pediatric medicine, although lovely on so many fabulous levels, will probably not be the area I work in. 

That was my rather interesting week in Hem/Onc. Two more weeks to go. The chief is on vacation the next two weeks and starting Monday we have an elective student in the department. I'll take over mentoring her a bit to see where she stands with drawing blood, placing lines and such.

Now a little travel report for those that are interested. :)

I spent the last weekend showing my friend from Miami a bit of Germany. We met up in Hamburg on Friday. Took the train to Berlin Saturday morning and both left Berlin Sunday evening. 

Christopher Street Day was going on in Hamburg. There were booths with drinks, food, tightly dressed men, rainbows and loud music all around. We took a stroll through all the festivities. The big department store Alsterhaus and the town hall both had pride flags displayed. I thought it was an incredibly cool symbol from the city to show support for the event. Germany in general is a very accepting country. Many might not associate that with Germany right away due to its history but we have acknowledged our past and dealt/are dealing with it. Nowadays, I feel it is one of the most accepting countries I've been in.

East Side Gallery shenanigans. Berlin

If you are in Hamburg, are starving and can't decide what you want to eat but just want a good variety of food immediately without having to look for a restaurant first, I suggest going to the LeBuffet on the 6th floor of the Alsterhaus. It has a buffet with a wide variety of food at a good price and a view on the water!

If you are in Berlin and want some really delicious Arabic food, you must go to Casalot (Claire-Waldoff-Strasse 5)....SO delicious and the presentation of the food is also outstanding. The service is very friendly and the place offers a lot of outdoor seating.

Pretty gelato flowers from Amorino

A restaurant I wouldn't suggest going to is DIE EINS (Wilhelmstraße 67A, 10117 Berlin). I hate to give a bad review but this place can easily be a tourist trap. It has a very nice location right on the river, around the corner from the Brandenburger Gate and a hop, skip and a jump away from parliament. My friend and I were just so starving that we sat down. Before even ordering I had a feeling the place relied highly on its location and could therefore care less about the food or its presentation. I ordered something of the breakfast menu (seeing our breakfast to that point had been a felafel, coffee and half a KIND bar). Granola with milk, quark (its German, think of thick yogurt) with berries and honey, fruit salad and fresh squeezed orange juice. That sounded really good to me and I could think of multiple ways of presenting that nicely. In reality, I was served a bowl of cornflakes with a few walnuts of top (how fancy), the quark was basically runny yogurt with jam in it, the fruit salad contained many broken grapes and in general was not that appealing. The fresh squeezed orange juice was 100ml....didn't feel like much more than a shot. It was just bad. I easily could have made a better meal at home for far less. My friends omelet and salad didn't look or taste half as appealing as the menu made it out to be. So if you aren't starving, avoid this place and go down a few streets for something nicer. 

Some fun in a store that encourages taking pictures: maskworld.com Store Berlin

Saturday evening, we stumbled upon the Monbijou Theater Strand Bar dance event. Every day of the week, they have a different DJ playing music and a dance floor set up right next to the river. You can get drinks and order Pizza and it is just such a lovely atmosphere in a lovely part of town. We sat down for a good long while and watched the couples glide across the dance floor. I seriously need to take my grandma up on her offer to pay for dance lessons to learn the standard dances and then I have to get my booty out on that dance floor someday! 

We did a Free Walking Tour of Berlin on Sunday. It takes about 2.5 hours and its great! While back packing through Europe, my travel buddy and I would often partake in them. The tour guides have always been fun and were really enthusiastic about it. They don't give you boring facts and move on, the stuff they talk about is interesting and explained well. A great part about it, and their business model, is that it is absolutely free and the tour guides work on a tips basis only. This makes it easier for students who might not be able to afford as much to decide what the tour was worth to them. If I had the extra funds, I'd probably be giving them double what I do because I always enjoy the walk so much. Great way to see the important things in the city if you have limited time. 

That is all for now my friends! Stay healthy!

V