"Turn your head and cough, please!" Day 3

Today was a busy day. I was so exhausted I had to take a 2 hour nap after work.

It's not even because I was so busy with patients per se but Dr.W and I are responsible for the patients on the half ward on the 5th floor and the urological patients on the 7th floor on the OBYGN/URO ward. Additionally we helped out in the clinic today (2nd floor and in the main building) and Dr.W is an avid smoker (tsk tsk tsk) which meant about 5 smoking breaks on the other side of the building on the main floor. We were constantly going from one place to the other. I should really wear a pedometer. I'm sure I got a lot of miles in today. In addition, my muscle soreness from Yoga yesterday started to kick in.

Anyways, as always up bright and early. Rounds were fine as was the morning meeting. Dr. W and I took care of business on the ward; blood drawn here, paper work done there, tried to get in touch with other doctors. It's amazing how much time is spent on not primarily medical procedures. We had to find an internal medicine doctor for one of your patients and it probably took half a day until the responsible one was found and actually showed up! Then it was a crazy mix of running all over the place and getting various things done. No lunch was had. I survived off of a granola bar and two chocolate milks that I grabbed off the ward and a little pack of gummi bears that the nurses gave me. Dr. W seemed fine with his coffee and cigarettes. Told him he was on a cliche model diet :)

Here some highlights of the day:

Honestly one of the best feelings in the world.
We were able to tell a patient who had a very large kidney mass (which in 90% of the cases is cancer) that she fell under these 10% and didn't have cancer. She immediately jumped up, hugged Dr. W and teared up. It was an indescribable feeling to know what joyful news you are about to give a patient. It's like waiting for someone to open a present because you know how happy they will be.

Would you like to talk to someone?
Obviously doctors don't have all the time in the world to constantly talk to patients. I think the average time a patient sees a doctor is about 3 mins. Nonetheless, a lot of doctors just aren't compassionate enough to care (which baffles me when they picked this job but apparently they still only see the disease and not the patient). One of our patients really had a lot happen to her. She has a feeding tube, can't keep anything in her system, came for one thing but there is always something that is keeping her from leaving. In addition, she has an infection which requires her to be alone in a room and for us to always come in with protective wear and face masks. I usually don't go into the isolation rooms during rounds to save on clothing but I did over hear her saying she wanted to talk to a therapist which the attending either decided to ignore or didn't understand that she meant a psychologist and not a normal doctor. When I went to draw blood she told me she felt like giving up. That is something you never want to hear from people. It just sad. So I talked to her a bit and realized A) how much she appreciated my time but also B) that I wasn't enough and also didn't have all day. I told her I would talk to the nurses and have them get a psychologist or even better a pastor or religious figure to come talk to her. She told me that would be so great because she just needed support in this hard time. So I did just that. Asked about 3 more times during the day if that person had finally shown up and finally the late shift nurse said that she would get on it. Next time I see a case like this again I will call the hospital pastor myself. I didn't want to overstep my position and go behind the nurses backs because as I said earlier, you want them to be your friends. Long story short, a little bit of my time can back a big difference in a patients life. A little compassion never hurts.

Coming to you live from the patients bladder!
We performed a cystoscopy (looking at the bladder) on one of our outpatient patients. It was very interesting to see the bladder live and in color. Usually men aren't a big fan of the exam because well,....a camera is inserted through the penis. I personally can not comment on the painfulness or unpleasantness of this procedure but welcome you men to imagine what that might be like. Don't worry, they get a numbing gel inserted first....we aren't that cruel ;)

You don't puncture the amniotic sack when the baby is coming!
Oh lordy lord. One of our outpatients was interesting and complicated to say the least. The whole time she told us things I just wanted to give her an anatomy book. Let's just say I don't think she was aware that there is a seperation of the the urethra and bladder to the vagina and uterus. Her theories were quite absurd as were her reasonings. Just as a little taste, we needed to get catheter urine from her and she told us she had to pee first since the bladder was full. When we told her that was good because we needed a urine sample (which btw she wanted to give us, we didn't really need it) she said that doesn't work because the urine is already on its way (I don't think she is aware that there is only a very small distance the urine can go from the bladder as a women, men have a few more cenimeters, so if its "on the way" its actually already out) and that you wouldn't puncture the amniotic sack if the baby is on its way. Yeah......no sense what so ever.

It was a full day but that's good. Saw a lot of patients got a lot done. Tomorrow I am hoping to help with a pretty interesting operation. Come back tomorrow to find out more :)

Baci, V

"Turn your head and cough, please!" Day 2

Today really was a day of standing around and waiting for something to happen.

Once again I started off on the ward at 7AM for rounds. This time we actually got through them on time. The morning meeting was a nice and relaxed atmosphere (I've sat in way worse). We were done by 8 and had a 15 minute break before we had to attend an hour long hygiene seminar.

I thought it was being held by a hygiene person from the hospital so I removed all my jewelery just in case. It turned out to be a seminar by one of the attendings responsible for hygiene in the department so I probably could have skipped taking out my nose ring. Oh well. (they are actually allowed, FYI, but I didn't know how picky the person might end up being).

Once again there wasn't much happening on the ward. I was however given the task of measuring the residual urine of one of our patients. This ultrasound is done after the patient pees to see how much urine stays in the bladder (large amounts of residual urine are the perfect growing grounds for bacteria and can lead to urinary tract infections which can be dangerous in men with all the anatomical structures hanging out around the bladder.) My patient was just fine though.

With no more tasks to perform on the ward I headed down to the clinic. The OR only had two operations happening. The varicocele operation unfortunately didn't take place. The other one was a one-man-job and the last was a renal gland removal and all the good spots where taken by residents :( Luckily, smaller operations where being performed in the outpatient department and I was able to watch a ureteric stent being inserted and a kidney stone removal. The stone was too big to pull out whole so the doctor had to break it up before removing it. It looked like a fun operation to perform. (breaking things for a good cause is always fun!) And here a sneak peak at the radiological version of a statement necklace:

There weren't very many patients for us electives to examine but any eligible patient had to deal with us first. I took a few histories and even did the kidney and bladder ultrasounds, printed out the pictures and discussed my findings with the doctor. I was quite proud of myself that the ultrasound pictures turned out so nice.

Since I hate standing around doing nothing (especially when I have a million and one other things that need to be done) I was constantly looking for work to do, reading files and even organized a room for us electives to practice ultrasound on each other. I present to you, my bladder:

After a few hours I headed back up to the ward to see if anything could be done. Sadly nothing. So I decided to go to the lab and at least get a bit of work done on my doctor thesis.

I am not giving up hope that it won't get more exciting the more I know. My plan is to be really aggressive with the doctors and force them to let me do things or explain things to me. I've got some papers to read packed for tomorrow just in case.

Hopefully I'll have better stories to tell tomorrow. Sorry :/

Baci, V

"Turn your head and cough, please" Dia uno

"Since when do you speak Spanish, Viktoria?" I really don't but we'll get to that.

6:15AM
Getting up at 6:15 is just a bit early for my liking. Thankfully its bright out by 4AM otherwise getting up would be so much worse. I just kept telling myself its actually around 10 and time to get to the hospital. My body was not ready for breakfast though. I did force myself to eat a not so fresh banana though and headed over.

6:45AM
I got my lab coat filled up with books, stethoscope, notepads, iPhone and gum and headed to the ward. I was a bit early so I took the time to introduce myself to the nurses. Note to any med student: They can be your best friends or worst enemies but its ALWAYS good to have them on your side so try real hard so that they like you ;) One after another the doctors started showing up. Mostly guys, no surprise (2 of the 3 female doctors are at home with their new babies). In addition to myself, there are two more girls doing an elective in the department and a female intern (where are all the future male urologists at?). I decided to stick on the ward the first day to see what patients we have currently in treatment.

7:05AM
Dr.W, Dr.H and I did rounds on the two wards not part of the main ward. Nothing exciting to tell from that really. Since Dr.W had been on vacation the last 7 weeks and Dr.H just recently came to the department and the department recently got a new chief, my two doctors weren't quite sure when the morning meeting was taking place. They guessed 8AM. We didn't get through rounds and to the room until 8:12. We thought we were really cool because we were the first ones there. After about 2 minutes the chief walks in and tells us how cute we are sitting there because the meeting ended at about 8AM.....because it starts at 7:45. Oops.

8:15AM
Dr.W, an elective and I headed back to the ward and we discussed our current patients, treatment options, complications and further planning. Since it was a Monday, there wasn't a lot that needed to be done. The elective and I headed to the clinic to see if we could help out there.

9:00AM-1:45PM
Dr.M was in charge of the admissions for the day. We were allowed to head in and chat with the patients and get their history before he would join us, look over everything, discuss the upcoming procedures, get consent and send the patients up to the ward. We were in charge of getting their blood drawn and getting urine samples.

The four patients I worked with already nicely showed the variation in patients that show up in urology. Our youngest patient (already on the ward) was in his late 20s while the oldest one admitted by us today was a 81 year old female.

The cases included testicular cancer, kidney stones, varicoceles, kidney cancer and obstructions. We even ended up doing ultrasounds on the patients. I saw a patient with double kidneys on both sides, kind of bizarre! So although I wasn't in the OR today, it was a relaxed and informative day.

I'm always happy when I can use my English speaking abilities to help out in Germany. So when they told me the next patient only spoke English and Spanish I was excited and so where the nurses and doctors that I was there. Gosh dang it, why didn't I learn more from Mr.Wannicke back in High School?! I quickly looked up some Spanish words in case I'd need them. The standard: el testiculo, la vena, la arteria, los cojones (which is actually vulgar and was obviously not used with the patient) and so on because I was basically working with: si claro!, una cerveza por favor and vamos a la playa (all irrelevant for my case). Luckily the patient spoke English well enough that we could stick with that. We got all the work up done and then Dr.M joined us. Out of no where Dr.M starts speaking Spanish with the patient! I was flabbergasted! It wasn't fluent but it was a heck of a lot more than I had expected to hear out of his mouth! So with English, Spanish, German and hands and feet we explained the upcoming procedure to him and answered his questions. I even understood their conversation which just shows you that any little amount of foreign language can help out in unexpected situations! Stay in school and pay attention kids ;-)

After that I had to accompany my friend PKay to the ophthalmologist in Hannover so I had to leave early.

The other electives and I decided to split up the departments clinic, ward and OR amongst ourselves during the weeks and rotate weekly or drop in and help if our respective department was running slow. I said I'd continue ward since I had started there this morning which unfortunately means being on ward every morning at 7 for rounds but since they are experiencing a bit of a summer break, I will try to get into the OR tomorrow as well.

On a side note: A thing I deal with basically every first day of an elective is my circulatory system. After months of just sitting in lecture to then sitting at my desk my body is not a fan of having to suddenly stand all day. Thus, the first few hours of my day are a roller coaster of feelings. Either I feel great or feel like I'm about to faint and no amount of water or pumping my muscles while standing can change it. I'll probably have the same phenomenon in the OR tomorrow with bright lights, multiple layers of clothing and face masks that make me think I'm getting less air.

It's an absolutely terrible few hours but after that I am good to go for the rest of the time. Basically I just want to make everyone aware of the fact that this is a completely normal thing! Most people are embarrassed by it and stand in the OR trying to keep it cool and the next second they are lying on the floor. No fun for anyone especially if there is a patient on the table because honestly that person is more important than your dumb ass that didn't just say you need to sit down a second. I've had doctors from all levels insure me that it is totally normal and nothing to be ashamed of. Just thought I'd share that with y'all :)

And now for your urological entertainment. Meet the waving Eskimo.

We discovered him in our second semester during anatomy and in all reality he is actually a penis with cut open scrotum....you are welcome.


I'm off to bed, I'm spent.

Baci, V

"Turn your head and cough, please!"

I'm back baby! In the mean time I have completed my fourth year of med school (craaaazzzy!). Tomorrow I start my month long elective in, wait for it......Urology! (thus the new title of this one month long adventure). Now most people's first reaction is, "Ewwww, WHY?!?!?". But I say, " Why not?!"

In theory, Urology might turn out to be the best specialty for me. This month will determine if that all holds in practice too. It's not just about testicular exams, prostate checks and incontinence. Those just seem to be the things most people associate urology with (all very important, nonetheless).

But seriously Viktoria, why? you might ask. Well here is why:

• It's a small surgical field.
• Surgery has always been my dream and goal but after a month of plastics, I just realized I don't exclusively want to be standing in the OR every hour, every day. I like the detective work of internal medicine as well and Urology combines both quite nicely.
• It has about 70% male, 30% female and children patients
• I really like OBGYN because of the deliveries and elegant operations but lez-be-honest people. I'm a tomboy on the inside. Grew up with a bunch of guy friends, need them, love them, can't live without them. So the thought of working in OBGYN were you exclusively have female patients (unless the baby being born is a boy), the nurses are mostly female and in today's day and age, the doctors are mostly female. TOO MUCH ESTROGEN! In Urology I will still see some woman and maybe even their babies if they have urological problems after delivery. I can also specialize even further into children's urology.
• No middle-of-the-night calls into the OR (well almost none)
• My Urology professor told us that there are only two emergencies in Urology, everything else can wait. I do plan on having kids one day and I really like my sleep so if this turns out to be the case, it works for me :)
• Death is not very present
• I know I could deal with the deaths of my patients but it is nice if you can help without death being a regular outcome. Of course fatal diseases exist in the field of urology but in comparison to other fields (Oncology, Cardiology, etc.) its not as present. The patients often have a lot of pain (have you ever had a UTI....no fun right?) but the treatment options are good and you can really help the people.
• I can be sassy
• I'm the type of girl that doesn't really care what you think and have a pretty tough skin (especially after having been in the modeling scene). Consequently, if a patient feels uncomfortable (Men really are the worst patients, such wussies ;) ) having a female doctor and feels the need to make a snipe remark, you better believe I've got a reply. So if they start complaining that a prostate exam might be uncomfortable, I've got the personal experience of a OBGYN examination and can tell them to calm down because in comparison to what we go through regularly, this ain't nothin!
• Best jokes at a party
• I will be dealing with penises almost all day....you KNOW there are going to be good jokes to tell at parties. The things people do sometimes. I will only say: vacuum cleaner accidents, auto-erotic accidents and fractured penises (although there is no bone, it can happen).
• I will help people to have a better sex life.
• 'Nuff said

So starting tomorrow at 7AM we will see if these points hold. If the next four weeks go well and I like it, this will most likely be my specialty. But let's convene at the end of it all and see where I stand.

My plan is to post throughout the whole experience, either at night or during breaks from my iPhone. Obviously I am fully aware of the patient confidentiality law which I fall under so you won't see names or any details that might reveal the identity of my patients but I will give you an insight into my day and will hopefully have fun stories and accomplishments to share.

So please enjoy!

Baci, V

Vorklinik is officially OVER!

Hey Everyone! Its over! Has been for about 2 weeks now. The end result was amazing. The last few weeks of MediLearn just started being daily life. I got so used to working all day. Once the whole thing was over and the day came to write the exam...I felt nothing! Absolutely no adrenaline. None. I went in there and just worked my way through the 160 questions. I didn't even really have a different feeling going out of it which kind of upset me. I had hoped that the adrenaline would have kicked in because I feel that this is a vital part of such an important exam. On the other hand, I had been studying my butt off the past few months and I had the feeling that I was prepared. Of course I didn't know everything but you can't study for every last protein or enzyme there is. We were able to put our results in on the internet and the results were compared to the answers of all the other students that added their results giving us an estimation of what our score could be. As the day went on, MediLearn posted their answers. For the first day I most likely have a 2 (equaling a B) which was what I wanted. The second day wasn't any different on the adrenaline level. However, I was done after about 1.5 hours and spent the rest of the time drawing. I could have left but then I would have had to give up my answer sheet and pick it up later again. Since I wanted to wait for my friend anyways and wasn't going to start studying anymore on that day I had nothing better to do. I went home after the exam and put my answers in the internet. Again, most likely a 2! I was so bored and didn't know what to do with myself and was very happy when a friend of mine asked if I wanted to go to the pool with him. It was nice laying in the sun for a while.

The next week consisted of studying for the oral exam giving each subject two days. The day of the oral my adrenaline gland finally decided to do something. We got our histology glass plates and got to look at it under the microscope for 15 minutes. The next 4 hours was just sitting there and waiting to be asked. Since I was the first one to be asked I always had an hour between the subjects. They usually were quick hours because I was waiting for the next subject but once I was all done I had to sit through another hour which took forever. End result....1..!!!! We were a bit shocked when they told us but overly happy. To be fair, they did ask some really tough questions (even admitting that themselves) but we also rocked it. 

The next day I was cleaning and packing and then the next day I was on my way to my grandmas house so I never had a minute to just breathe. The next morning I flew home with a friend and spent the last 10 days shoving America down her throat. Today was my first day since the monster that is Physikum is over. In the end it wasn't a big deal. If the rules that I have heard are true my final score will be a 1 (=A) which would be fabulous. Now I am going to sit back and relax for the next few weeks doing things I like to do :)

9 Days MediLearn In

 So I have to make a little correction to the last post. I only have the course for 5 weeks and 1 day. Not 7 weeks. 

Anyways. Today was our last physiology lecture day. This concludes the section for physiology and physics with a practice exam tomorrow morning with 80 questions. Since I have been answering 80 questions every night, it really shouldn't be a big deal. Through all the different mediums of exam questions, a lot were either very similar questions if not exactly the same so I am guessing my score kept getting better in part due to that.

I really don't have much else to say. The lecturers are all pretty good. In the end, it is mostly all review. I am hardly learning anything new. Its more of a better understanding of somethings after having had all the classes over the 2 years.

On my free day, I went grocery shopping with one of my girl friends and then went clothes shopping with a guy friend. His girlfriend came too. End result: I got a nice pair of jeans, 2 tops and a pair of shoes. He got a sweet pair of jeans and shoes.

Physikum isn't as scary as it was at the beginning of the last semester but I only have 9 of 36 days behind me. Who knows how much is going to still be stuck in my head by the time the real deal rolls.

MediLearn

Hi Friends!

So I finished the fourth semester succussfully. The last few weeks were spent almost exclusively in the library in my little study box. In between I had to teach English and still had my cadavers job. Once the biochemistry exam was written, I got to see my dad. He had been in Denmark for a week with relatives and was then in Gö to visit me and be there for my concert that night. A bunch of my friends showed up as well to watch me play. :) 

We had two weeks "off". I didn't really do any studying in the first week. Rather, I got things done that were always on my mind but things I just didn't have time for. My roommate was gone for 2 weeks. To show him that he shouldn't leave me like that, I took pictures with our skeletons doing things around the house such as baking, cleaning and decorating. I started studying a bit in the second week. 

Two days ago the MediLearn curse started. The first day was an introduction at 10am with tips and tricks. At 2pm we took an exam that took 4 hours to see where we stood. I did pretty well. Better than I thought I would. But a lot of details are missing in my brain somewhere.

Yesterday we had 5 hours of physics. The curse goes for 7 weeks non-stop except for 3 days "off" in between there somewhere. The daily plan looks as follows:

8:30-13:00 Lecture

Daily Exam containing 20 questions to the day's topic

Study and review daily scripts 

Night exam with 80 questions 

If time is left over (haha hardly) there are 100 extra questions to answer.

And that every day unless we have a practice test of a block of lectures.

In the end it should be helpful to make this Physikum thing work. It doesn't scare me as much as it did at the beginning of the semester.

An go!