"Turn your head and cough, please!" Day 13

1.5 hours is not enough for beauty sleep. Fact.

My night shift was rather uneventful except for being called mother Mary and then the patient referred to me as her mother and wanted a bottle. It is sad and amazing how dementia effects people at night. The people can be almost normal during the day and then completely spiral at night. I'd be interested why there is a difference in their state according to the time of day and why almost all of them regress to a childish state and ask for their moms. 

I often have to remind myself that I am not in a horror movie. When I am sitting in a dark room on my computer next to the patients bed and they are illuminated merely by the glare of the computer screen and I look over and the old patients are just staring at me or groaning or half up in bed just looking at me, it can seem really creepy. When I go over to ask what the patient needs I often just get a blank stare and moan for a few minutes. Creepy. That is why I can't watch scary movies (I made it through all the paranormal activities with moral support....a lot of support and a side of making fun of me because I hid behind my pillow the first two movies (the third and fourth in the series, don't know why we watched them backwards))

After just 1.5 hours of sleep at home (and a whacked up dream) it was off to where I had seemingly just come from. I skipped breakfast to sleep a few more minutes. I was dead tired during the morning discussion and the first thing I did when that was done was buy a coffee. One of the good ones...the expensive 1.70€ kind. I also wanted a croissant but the worker bagged a sweet bread and I didn't notice it until outside and didn't have the energy to go back and switch. So I just ate what I had.

I was afraid I was going to fall over during the operations but luckily the four procedures I watched all only required one surgeon and I got to sit on a chair next to him while he worked (also seated...so it's all good). 

TUR-P:

Trans urethral resection of the prostate. So basically a device is inserted through the penis and then what looks like a lemon slicer (the kind that makes the fancy swirls for cocktails) is used to peel away tissue (it has an electric current which actually cuts the tissue).

TUR-B:

Transurethral resection of the bladder. The patient has a bladder tumor that had to be removed. Same concept as above but in the bladder.

Botox: 

Botox can be injected into the bladder muscles to relax them. For instance when the nerves aren't wired quite right and send a signal that you have to pee by very low urine volumes or when the muscle spasms itself and causes the urge to pee. This is a quick procedure.

Prostate biopsy: 

The prostate is looked at with a transrectal ultrasound and little punches of tissue are removed for further investigation to see if there might be a tumor present. Also quickly done.

I was relieved to be able to sit through all of them and got out of the hospital by 1:30pm. I planned on taking a long nap but had to pack for Hannover. So long turned into 20 minutes and I am now finally (at 2:30AM) going to sleep after only having about 2.5 hours of sleep since 6:50AM two days ago.

Good night

Baci, V

"Turn your head and cough, please!" Day 12 - Do you mind?!

Before even coming to work today I knew that another DaVinci operation was happening. As exciting as the operation is, I was not looking forward to the back breaking standing around. And to be honest, if you aren't operating yourself, you've seen one and that is enough for a while.

Do you mind?
So when the attendings and assistants were discussing how much work had to be done in the outpatient department and admissions I offered my help. The attending was pleased and said he was about to ask me if I'd be willing to skip the operation anyways. Booyah! I beat him to it though and now I was the nice student who offered her help without having to be asked. :D

This was probably the day that went by the fastest. I was doing something almost non-stop.

Welcome to the circus!
Dr.K was in charge of admissions and outpatients. He said that admissions where now my thing and that I should do as much as I could and was allowed to and then he would do the things that needed a doctor (such as patient consent for operations). He really let me be very independent. It was great!

In general, I would look through the patients files and gather the info I needed to get a picture of why the patient was even coming. Then I'd get my admission papers collected and go see the patient.

"Hello there, I'm Miss Hasselhof and I'm in charge of admissions today"
First up was taking the patient's history. Usually the nurses will then draw blood and get a urine sample. Since the place really was a circus with all the work that needed to be done I decided to do the job to help them out. This also made me even more independent. If necessary, I would do ultrasounds of the kidneys and bladder, print the pictures and write down my findings. Then I would get everything ready for Dr.K so all he had to do was come in, do the patient consent form and the patient was good to go. Yay teamwork!

My 8 patients probably could have been taken care of a lot quicker than they were if 3 other doctors weren't using the rooms parallel to me to get stuff done. Nonetheless I was always busy.

Job description: where do I begin?
I felt like in addition to playing doctor, I was call center worker (that phone was ringing non-stop), office manager (I had the general overview of all the patients present and was sending doctors in their respective rooms) and nurse (I helped out with their activities since I saw how much they had to do as well).

It was a fun day.  :)

I headed home at 3:30PM to get some sleep in before my night shift. So here I am again in the hospital because its just so lovely ;)

I'll see how I do with one hour of sleep tomorrow....

Baci, V

"Turn your head and cough. please!" Day 11

This morning I felt like I was a very unfit 90 year old lady. It took a few minutes of walking around before I could actually move my back.

We had two procedures today.

Circumcision: Sadly it wasn't the right Dr.H doing the operation otherwise I'd probably get to sew again. I got to assist though and felt pretty confident in that role ;)

Cystectomy: Bladder removal. Normally, if the patient doesn't have a lot of other problems or a complicated anatomy, this procedure takes only a few hours. This patient had both and it took 6 hours!!!

The bladder was encased in fibrous tissue and the intestines were stuck together. The process of removing the bladder took the most time because of all of this. Since the patient had a few other medical issues a general surgeon came and operated later on.

I was second assistant because two attendings were operating. There wasn't much for me to do other than occasionally hold a few hooks. I woke up pretty tired this morning and really fought to focus and pay attention during the operation. To be honest, I was bored just standing there and hardly being able to see anything. If this had been my first operation ever, every little move the people make would be interesting but since this wasn't, it is kind of as if I was just standing in one place for hours on end. You'd be bored too.



If I was operating myself I'm sure I'd feel differently and be so focused on what I was doing that I wouldn't have time to feel my back pain. Luckily after about three hours, the general surgeon showed up to operate with the other two. Since there wasn't any more room at the table I was told to go have a coffee break.

I did for about 20 minutes and then returned to watch some more. Once the general surgeon finally left I got washed up and joined the surgeons again to hold a few more hooks.

What made it all fun though was the team. It's a great mix of people that joke with each other. Makes operating a lot more enjoyable than grumpy, serious and quiet people.

After 6 hours we had the patient cleaned up and out of there. And I was right behind him.

Got this little message from a friend and had to share!

"When I was young, I decided to go to medical school. At the entrance exam, we were asked to rearrange the alphabets:

P N E I S

and form the name of an important human body part which is most useful when erect.

Those who answered SPINE are doctors today, while the rest are on Facebook."

Now I beg to differ if you end up in Urology ;)

Baci, V
 

"Turn your head and cough, please!" Day 10

My poor back. I think once I am in any position to say something and make decisions, especially in my OR, it will be that things are done more back friendly.

There were only two procedures today but the first was 4 hours long and spectacular (except for the at times extreme back pain from standing).

Today I witnessed the first ever DaVinci operation in the Medical School Hospital of Göttingen. My chief was operating. He had apparently gotten a lot of hours of training in a different hospital and conferences because he performed the operation without any major problems. So what exactly is DaVinci? It's this beast:

How does it work?

-Five people are essential for the operation to work.

• Operating surgeon
• assisting  surgeon
• OR nurse
• OR runner (get supplies for the OR nurse who is sterile and can't touch unsterile things)
• and the anethesiologist

-The patient is prepped as though he was having a laproscopic operation done. So instead of cutting the patient open, five holes are made where various instruments are inserted and the inside is made visible with a camera.

-The difference in the DaVinci procedure is that the operating surgeon isn't standing by the patient with his two instruments inserted in two of the holes but rather the DaVinci device is attached to two of the holes while the surgeon sits in a sort of console and operates the DaVinci machine from there.

-So the assistant is still standing at the table and inserting various instruments to essentially help the robot arms (inserting needles, removing tissue, sucking away the blood).

Why my back killed.

Most of the operation, this chair was right next to me:

My back was killing me from the standing so I tried all different kinds of subtle stretches to ease the pain and even thought about inventing OR-Yoga to help others. I was happy to see one of the assistant doctors (not operating but observing like me) was also stretching his back or had his thigh on the above pictured chair but he also never sat down.

At some point the older nurse (the oldest person in the room) momentarily sat down on the chair. I feel that was legit.

But why didn't Dr.M or I ever sit down in those 4 hours? I thinks its a hierarchy thing. Every one in that room knows that standing around for 4 hours in one spot will hurt your back. The chief was the only one (except for the anesthesiologist) sitting during the procedure. The assistant surgeon (who happened to be the attending) had to stand.

So if he had to stand the 4 hours and not move, what gave us the right as merely observers to be more comfortable than him? It would have looked really bad had I, as the little medical student, made myself comfortable on the chair while everyone else got to stand in pain. So it's a combination of hierarchy and solidarity I guess. Or at least it is in my head. So there I stood thinking up the next big fitness wave called OR-Yoga while watching the operation.

So what was done?
The patient's prostate was removed. It was crazy how the surgeon at the console was controlling the machine to actually sew things and cut and navigate through the set holes and the filled-with-gas stomach of the patient. Check out the doctor at work:

Luckily for me a representative of the DaVinici system was there to help. This was only practical for me because reps are known to bring food along for the OR-team and that is exactly what he had done. I was starving, cold and aching by the end of the operation so the three brötchen (German bread with something on it) and candy where a life saver (and I didn't have to buy food...I'm on a low student budget after all).

The other operation was an open kidney biopsy. Dr.H, Dr.M and I where done with that in less than an hour. Go team!

I debated going to the lab after all the work was done but then decided to enjoy the good weather a bit and hit up the basketball court with a good friend. Sometimes you just gotta live a bit...

Baci, V

"Turn your head and cough, please!" Day 9- off with his head! (Wellsorta....at least his hat)

Snip, snip, snip!

It's finally my operation week!

Get 'er done!

I watched four procedures.

-A cystoscopy (looking at the bladder with a camera) was done before a 

-colonoscopy (looking at the large intestine with a camera) on the same patient

-a nephrectomie, due to a tumor the whole kidney had to be removed. I got to hold hooks but not much more because another assistant was there as well.

-a circumcision on a grown man.....and I got to help! The doctor did the snipin and I did the stitchin! I love that Dr.H let's me sew up in his surgeries. 

All of these things with set up and take down lasted from 8AM to 1:30PM. 

After that I headed into the lab and worked with my attending professor for a few hours on the fluorescence microscope.

Tomorrow is supposed to be a packed schedule including the DaVinci system! So basically the doctor plays a video game on a console while a robot operates. I'm excited to see it happen. Full report tomorrow!

Baci, V

"Turn your head and cough, please!" Day 8 - just keep swimming

Well it was another successful day of sitting around and waiting for something to happen. If anything, I did more office work and management than anything else the first half of the day.

Dr.H working the outpatient department today seemed to always be a step away from a heart attack. I didn't really want to bother him and ask him to show me things in his state. So I sat around and looked for work to do. 

What I do to waste time...

Dr.K gave me a huge pile of patient files that he had received during the morning meeting that needed the diagnoses coded with the DRG system. That was actually kind of fun because I had to look through the files and see what the patient had and then find the code and coolest of all, I had to sign the papers. It gave me a little feeling of power that I had made this decision and it was going to be used. Silly, I know.

At some point Dr.H wanted Dr.W to come down and help out. He showed up temporarily and decided there was nothing for him to do there. The nurses, Dr.H and I preceded the next two hours looking for Dr.W. we paged him, we called all the wards, we asked everyone we saw, I even texted the elective working with him for the day. Nothing. Eventually we found out he was in the OR (odd for him since he doesn't like it there) and thus could not be reached.

I almost gave up on the day and wanted to go home but then the only female doctor in the department at the time came to help out and started taking me to see the patients. She had me be very hands on. I did a testicle ultrasound on two different patients. I drew blood. I did the routine ultrasounds. 

I was excited that she was so active but kept fighting with the thought of wanting to go home and get some sleep before my night shift. We proceeded to go back to the ward and do afternoon rounds before heading back to the urology management department for the afternoon meeting. The other electives were long gone of course. We looked for the attending and found him with the other attending and chief. They were all sitting around and drinking coffee. Do they not have lives? Anyways, at some point the chief asked if they didn't want to let the young colleague, aka me, go home. I told him he didn't have to tell me that twice. See ya!

On the way to my locker I saw that I had a call from my night shift office. I called back to find out that they were giving me the night off because there weren't enough patients that needed us and since I had enough overtime I got the night off.

I quickly went to the grocery store and bought a pizza to eat since I hadn't had a meal since 6:30 that morning and it was already 4PM. It was kind of a little insight into how my residency will someday be. living off of whatever is quick and easy becaue I haven't eaten all day. I also quickly organized a ride to Berlin for my god child's birthday. So now I am sitting on the couch with my cousin and chilling. A nice alternative to 8 more hours hospital. 

I'd like to give a shout out to my big sis Fran for starting med school in Erie Pennsylvania today! I'm happy you get to persue your dream. It's a great one but its also one that at times will break you down, push you to your limits and make you question your decision. Just keep swimming (Dory vocals here). The best of luck! (Everyone can check out her blog www.franish.blogspot.com)

Alright everyone, have a great weekend! See you Monday!

Baci, V

"Turn your head and cough, please!" Day 7

Well, it was another day of looking for things to look at and do. Nothing as shocking as penis piercings today. But I did find a Playboy booklet with the best 500 playboy jokes. The other elective was reading it but I will grab it tomorrow and see what I can find ;)

The morning meeting was brief and after the doctors' "lung therapy" I was upstairs in outpatient care again.

Destroy it!
A pretty cool thing I did see today was a PCNL aka percutaneous nephrolithotomy. Basically the patient has a kidney stone that is too big or to risky to pull out through the ureter. If you YouTube pcnl you'll find a video with some dramatic music showing the process. (Someone actually sat down and put that music to that video footage. Cracks me up.) Once you have access to the kidney, the stone gets crushed with ultrasound waves. I imagine it being more fun to do than to watch. Someday.

"Oh I'm sorry for wanting to get something done around here......NOT!"
Other than that I helped out with the outpatient appointments. I even got a bit of an attitude from one of the nurses because I decided on my own to go in and take the patient's history for Dr.W. I came out of the room looking for him and the nurse just gave me a bitchy look and told me I was the cause of confusion because they thought another doctor was working with me since Dr.W. didn't know why I was in the room. I instantly felt bad because honestly, I am rightfully a little afraid of nurses with bad attitudes. Instantly I apologized to Dr.W. for the confusion and explained that I was merely doing him a favor in taking the history. He didn't really seem to care that I had done so and had taken a smoking break. So sassy miss nurse decided to spread a bad energy just for the heck of it.

Writing doctory
I ended up being asked to write the doctor's letter for the patient again. I told Dr.W off the bat that he better give me more than 10 minutes to get it written and proof read. I know it sounds silly, especially when you hear me speak German but German grammar is extremely difficult. Even the other elective that looked at my letter had some issues. In the end Dr.W was actually quite pleased with the contents of the letter but changed a lot to sound more "doctory".

After all the regular patients were seen I headed into the lab to get some work done.

Tomorrow is a pretty busy OR day so I might hop in here and there depending on what is happening in outpatient. :)

Baci, V