"Turn your head and cough, please!" Day 20....only one day left :(

Well, slowly there is an end in sight. I am split on my emotions. On the one side, I am happy I won't have to get up early every morning and have time to do what I want (well that is only half true, I don't really have any free time since I start traveling right after my night shift tomorrow night....it'll be a great vacation but not exactly relaxing) and on the other, I am so used to being around the same people all day long, seeing patients and operating that I will definitely miss all of that.

But we aren't there yet.

Today I was back in the OR.

Our first operation was a kidney removal. Chief was operating. It was finally an operation that went smoothly and we actually only needed half of the time that was planned! I talked to chief in the break room and asked him about his connections in the US. Turns out he has never been in the USA but rather Dr.H....guess I'll be talking to him then tomorrow.

The second operation was another testes opening, pathology check and in the end removal like yesterday. Since I was operating with Dr. S again and we had just done the same operation yesterday he let me do even more! He was my first assistant and I basically did everything with him telling me what to do! Too bad tomorrow is my last day. I am sure I would do the whole thing the next time or at least do as much but with less direction. :)

The difference with today's patient was that he was also circumcised by us. That was quickly done and we were done for the day!

It was a lot of fun with the team today. In the break room, a harmless conversation started about a pen ended with all of our heads in the gutter real quick.

In the OR, the male nurse and I had a lot of fun while operating because we kept making jokes about how I am at the bottom of the hierarchy and actually have nothing to say and so on....you had to be there. There were of course also sexual jokes....I mean, this is urology after all. For example, while operating on the testes, I handed the surgical instruments back to him and mentioned that I used to play with them at home as a kid (our scissors were often medical scissors or clips that totally drove me insane because I kept thinking the handles belonged to scissors). The male nurse just looked at me and asked, "With which one?" referring to the instruments or the testes we were operating on. Ha.... I've said it before and I'll say it again, great team to work with.

I went and had dinner at my friend's house. Of course our conversations often involve what I am currently doing in my elective (for some reason people really like talking about penises). Her husband then asked me if I knew "Puppetry of the Penis". I did not. He showed us a YouTube video....and now I know. These two Australian guys originally started it. The ancient art of genital origami. Many have copied the original and it is hilarious. These two guys are butt ass naked and make different things out of their penises. Crazy. There are snails, hamburgers, Loch Ness, pelicans, Eiffel Tower....just YouTube "Puppetry of the Penis" and check it out for yourself. You'll be amazed.

I've been busy packing for my trip and baking apple pie as a thank you for tomorrow.

One more day of urology left.... :( / :) ?!?!

Baci, V

"Turn your head and cough, please!" Day 19....I'm so confused on what day it is

I apologize in advance for the shortness of this post but in the last 26 hours, I have only had one hour of sleep.

I worked the night shift on Saturday and Sunday using most of my time during the day to sleep. After my shift on Saturday I went for a nice morning run (go get it) before falling into bed. 

Both shifts where good because I didn't have a patient per se but rather was a nurse's help on the wards. This meant work to do for about two hours and then time to work on my own things. 

I know we med students like to claim things such as we save lives everyday, there actually are doctors who do that but for the most part we are making lives more enjoyable and helping keep people alive. In my Saturday night shift, I am convinced that the nurse working and I actually saved a man's life by being persistent and following our gut feeling.

After my night shift on Sunday, I took a one hour nap and headed back to the hospital for work.

During the morning meeting we were asked who would assist in the operations. The other electives didn't seem to hot to do it and I like working in the OR anyways so I said I would. I did mention that I only had one hour of sleep though. The senior attending asked why (probably thinking I was out partying) but I gladly informed him that I was working. He said that was the right thing to do ;)

The chief was really nice and told me that I could go home and sleep after the first operation if I wanted to. I told him I'd see how it goes but would try to stay and help. Totally worth it!

The first operation was a testes tumor. Dr.S and I operated. He let me do a lot in this operation. For the second half he basically was my first assistant while I did all the operating and he lead me through the steps. It was awesome!

I decided to stay for the other operation as well because it was only supposed to last two hours. I also knew he'd have a hard time getting one of the other electives in the OR and I didn't want a doctor to have to leave their work just because I was feeling tired. Honestly, I wasn't feeling too bad. It ended up taking longer than 2 hours though.

The second operation was a kidney viewing. The patient had tumors and cysts in the CT and we had to check it out. It took longer than expected due to the kidney's desire to keep bleeding. We were finished at 1:30PM and I went home. 

Instead of going to bed, I had a few errands to run downtown. I ended up at my friend's hair salon and did the whole shebang since I planned on doing that tomorrow after work but she has a day off tomorrow.

So now, I finally lay down to sleep.

Good night world

Baci, V

"Turn your head and cough, please!" Day 18- I'm a brain surgeon!

For some reason I thought this was going to be a chill Friday. Wrong.

I had one operation today. That might sound like nothing.....it was 7 hours long. I was the only one at the table that was there from beginning to end. Granted I was offered a break but I figured I still had an hour in me and would then take a break. We ended up being so busy, I would have felt like a jerk had I said I wanted to leave then. So I sucked it up and stayed.

The operation was an adrenal gland removal. The patient had been operated before though so all the intestines where stuck together and it took a long time to even just get them apart. The presented anatomy was so bad that we ended up having to remove several organs.

There are certain phases I go through when I have to stand for such a long time.

• I get to the table and my back starts to hurt but I ignore it and it is quickly gone again
• I start having circulatory issues (I didn't wear my socks today....probably would have helped but would have been very uncomfortable in the next phase) where my sight starts acting weird and I feel extremely weak
• I start getting really hot and sweaty. Especially under the face mask. Luckily it covers my mouth so no one can see me making funny faces to try to get more air into my mask :)
• I start yawning profusely...I think my body tries getting more air. I try not to let people notice so that they don't think I'm just bored
• after about 5 hours....I just don't care anymore and I can stand for probably another 5 hours. My body is used to what it's doing and nothing bothers me anymore (this stage is bliss)

Here is what you have to keep in mind about the 7 hours. I am scrubbed in and can't touch my face! So when my forehead is sweaty or my ear itches or my nose itches....I can't do anything about it! Except make funny faces under my mask hoping that will move muscles around and relieve the itch. If it really got terribly bad, I know I could ask someone in the room that isn't scrubbed in to rub my nose.

I also don't sit, eat, drink, pee or move around a lot in those 7 hours. Luckily, when I operate I usually forget about those necessary things. I am super thirsty once I'm done with the operation though and realize just how long I haven't had anything to drink.

So why was I the only one there for 7 hours straight? Well, the chief, Dr.S and I started the operation. Since we were dealing with so many other organs, Dr.C from general surgery came to help out. Once he did, Dr.S left the OR. (I secretly thought they might tell me to take a break instead.) About two hours before we were done, Chief left the OR and Dr.S came back. At about the same time the OR nurse switched with another one.

I couldn't decide if I liked Dr.C or not. He made some remarks to the nursing students that made me want to kick him. He just acted as if they needed to know every chief of the hospital and made stupid comments. I was not in the best mood for about half an hour and he happened to make these remarks in that time. I had about 5 scenarios played out in my head of how I would give him a piece of my mind if he made another comment (luckily it never came to that). So here he was making stupid remarks to the nursing students but then would turn to me and ask me if I needed a break or if holding the hooks was okay. I don't expect to be comfortable in the OR. I try to hold the hooks in such a fashion so that the surgeons can work easily. I told them I was fine and was only moving around a bit to move my back. I hope he wasn't being nice to me because I'm a med student and they are nursing students. I have a feeling that was the reason and I don't like when people are like that. Towards the end of the operation he was in a good mood though.

I didn't do much productive after I was done for that day. (Treated myself to the expensive coffee at the hospital though!)

I did however Skype with a good friend of mine and we were talking about gender differences and the problems they create. He said the problem was that men had two brains and one controls the body more than the other. That's when I told him, "I guess that makes me a brain surgeon!" Haha,...we both died laughing. So from now on, I will be telling people I'm going to be a men's brain surgeon :)

My whole weekend is filled with night shifts. This means sleeping all day (hopefully) and working all night before it's off to work again Monday morning.

Baci,V

"Turn your head and cough, please!" Day17- I'm so sorry I'm late....

Today was my longest day in the hospital and I did the least I ever did in a day. Go figure. I was in the hospital from 7:30AM-5:30PM.

We had two DaVinci operations. A guest professor was there to help out and watch. I sat around the...whole...time. I had to fight falling asleep. Luckily the guest professor mentioned he was tired too. :)

I did use my time to organize a few things. Chief asked me if I knew anybody who does video recording and editing. Luckily for me, I just met a guy who does that yesterday. What a cawinkydink. I hope my connections for him will be rewarded with connections he has in the states for me ;) 

I made a coffee date with a friend at 5:30PM. This planning took place at 2PM when I was beyond confident that I would make that appointment. By the time the second DaVinci was done it was 3:30. So still two hours to go...okay...I can make it. Then Dr.H and I started an operation that he said would take an hour. Ok good, I'll be out by 4:30 and still good to go.

Dr.H and I worked micro-surgically on a varicocele. This is a condition in which the veins of the testis dilate and feel heavy to the guy. Almost always on the left side due to the anatomy difference of the veins. I thought we would have to remove all the veins but in fact, you just sever the veins and coagulate them which breaks them done. Apparently that is enough. We used a standing microscope because Dr.H was not all too down for this variation (from what seemed to be from the 1980s or older):

Why Hellloooooo!

Reality hit. I didn't get out of the OR until 5:32PM. To make matters worse, my phone was dead so I had no way of contacting my friend. The only option I had was to ride my bike as fast as possible. Luckily my friend waited the 20 minutes I was late. I don't think this will be the last time I either am late for an appointment or miss an appointment due to my work. It's unpredictable. I apologize in advance if I ever have to cancel on you.

I sadly have nothing interesting to tell except for that. I thought about telling you all about how one of the OR nurses pissed me off but I figured I should get over it and I'm also sure it'll happen again and I'll want to vent ;)

Baci, V

"Turn your head and cough, please" Day 16- free stuff and genital warts(which in some cases is the same thing)

Well today was interesting.

I was asked by the senior attending to write an English letter for him for a patient traveling abroad and needing a letter for costumes explaining his medication. I was glad to help considering I could shine with my English skills in comparison to my German. He was so excited when I whipped that baby up in five minutes saying he could have never written it that nicely. You are welcome sir :)

Then I was off into the OR to help with a prostate removal. The removal never happened. The patient was obese. The layer of fatty tissue above the stomach muscles was wider than the width of my hand. Under the muscle was more fatty tissue. We couldn't even visualize the prostate. The chief decided that we would be putting the patient in more harm than doing him good if we tried operating blindly. We removed lymph nodes and closed up. That was even a task in itself because all the instruments and sutures were so slippery from all the fat. We weren't expecting to have such bad conditions to operate in so we found an alternative treatment plan for the patient. I can only say, if you need more motivation to get active and stay healthy besides the obvious reasons....think of your surgeons trying to help.

The next operation was fun. We lazered genital warts! The chief and I did this operation. Such a cool dude. We were cracking jokes the whole time. In the previous operation, we had talked about why I wanted to do urology and he agreed with my points.

I had to move some things around for my last operation and had the intern jump in because my friend had a doctor appointment and needed someone to watch her little baby girl.

Talking to the chief was just a great confirmation of my thoughts about this job. He said that he can't pinpoint why, but regardless in what urology department you are, it is filled with chill people who just get along. True.

Now, some more hospital lifestyle:

The required hand killer: they have come a long way with disinfectants. The formulas return the fat to your hands so they don't completely dry out like they used to. Still, my hands would be happier without.

The optional hand saver: this stuff is fatty and great. I try to use it between operations to take care of my skin. If I'm looking at decades of operating, I want to do what I can to keep my hands healthy.

I love freebies: some people might be opposed to them but I grew up on company freebies. And honestly, they didn't effect me. I don't remember the name on the pens, clipboards or clocks, I remember the products so I'm all up for anything I can get! Last week I got a sweet pen and today I got this USB card....baller!

P.S.: while babysitting and watching CNN, I briefly saw the DaVinci being presented :)

Baci, V

"Turn your head and cough, please!" Day 15- So, can I start?

Days just never go as planned...especially in medicine.

It is almost never ever a 9 to 5 job. I thought I'd be up and out of there by 2PM the latest to meet up with a friend to go to the pool. Boy was I wrong (I still made it to the pool but about 4 hours later than planned). Between longer surgeries and lost surgeons, everything took longer than planned today.

During the morning meeting I asked the chief where he would like me to work for the day (offering my help in the other departments since I knew there were less doctors). He asked me what I wanted to do. Well, if possible, I told him I wanted to jump between the different stations and just see where I could help out. He said that would be fine.

OR:
I started out in the OR. Since the DaVinci set up is not that exciting, I headed up to ward.

Ward:
All I could help with was drawing blood and clarifying a question the staff had been dealing with for days (I only knew the answer because I had helped with the operation. Who knows how long it would have taken them to find out had I not just happened to be standing there.)

Outpatient:
I headed to Outpatient to code some patient files for billing purposes and headed back to the OR.

OR:
The DaVinci was still going on. I was waiting for my operation to start. It was going to take place in the room next door. So first I had to wait for the OBGYN operation happening there end. Once it did, I checked the room about every 5 minutes to see if we could get started. It wasn't until about 5 checks later that someone informed me that the DaVinci anesthesiology team would also be doing my operation so we had to wait for the DaVinci operation to be done. great.

At this point, the surgeons had removed a part of the prostate and sent it to pathology to see if it had been removed with enough safety distance around the tumor. Since it was taking so long, chief and the attending went and had lunch.....while we sat in the OR room and waited.

About half an hour later we finally got the call. I was hoping they'd say we are good to go and we could close up and move on with the program. Wrong. The whole tissue was still filled with tumor so more had to be removed from the patient. This added an extra hour to an already overdrawn operation. great. While all of this was happening, I just saw my plans of pool and sun go down the drain.

Eventually the operation was done and I started setting up my operation with the nurses. We started paging Dr.H to join us since he was the first surgeon and I was first assistant. We couldn't reach him. great.

We called the wards, paged him about 6 times, called other doctors asking if they'd seen him. Nothing.

I got scrubbed in and started draping the patient (something I've never done and was happy to do). So there I was, scrubbed in at the table, ready to go with an OR nurse at my side. It was tempting to just take the scalpel in my hand and get this party started!

The other Dr.H came and we opened the patient while still waiting for Dr.H's arrival.

He eventually came (his pager supposedly didn't work) and took over from the other Dr.H.

Finally we were operating (removed a kidney) and I got to help quite a lot! I didn't even notice time pass because I had something to focus on!

As soon as we were done, we got the patient moved and I...was...outta....there! I hurried and went to hang out with my friends at the pool (on the way I took a ginormous detour. Story of my day...everything took longer than planned.)

While running all around the hospital and having to change my clothes for the different departments, I decided to present to you the hospital life style. With topics you would find in a magazine, here presented in a hospital theme.

The New Workout Plan:

Stairs, stairs, stairs = Good cardio!

Holding hooks and standing all day= good muscle conditioning!

The Makeover:

The wardrobe= green or blue or white all over

Shoes....OMG Shoes

The accessory wall (like in project runway...use it wisely)

The Manicure:

Short, not painted, boring but hygienic

 

The end result:

You can operate! Booyah!!

Baci, V

"Turn your head and cough, please!" Day 14- I feel nothing in that area

Another day at work breaking my back.

Since I didn't take any pics today and I love pictures in posts, thought I'd add a bit of the hilarious Kevin Hart to the mix for what might be a painful subject for some men.

I asked the other elective if she wanted to be in the OR this week but she said she was quite comfy on the wards.

There are multiple factors as to way my back hurt so much toady. The biggest factor is probably that of the 6 hour operation I was really only doing something 2.5 hours of it while the rest was spent standing there. Like I've said before, you could put in me in a room and make me stand there for 6 hours and it would be about the same (except for the sometimes humorous conversations that were had between the attending and male OR nurse).

If you had filmed me the 5 hours and then played it back in high speed, it would have looked like I was doing some crazy tribal dance. I tried stretching and moving my legs and back through out the whole operation to ease the pain.

Since I had nothing else to focus on I am sure my back hurt even more (or at least I noticed it more).

I'm just so dang tall! Dr.H already has to stand on a little step because he is shorter than Dr.S. But I'm about half a head taller than Dr.S. Of course the whole team isn't going to get up on steps just to equal out my height. This however makes everything worse on my lower back.

The attendings were stretching too but not as much (they were focused on operating). I'm just starting to get sick of this standing around and occasionally holding a hook (I am fully aware I have a lot more of these operations ahead of me.)

Weird, I feel nothing in that area.
So what did we operate for 6 hours?



The patient had bladder cancer and the bladder had to be removed along with the urethra.

Histology side note: Urothelium are the cells that make up the lining of the urine transporting surfaces. It is different from any other epithelium in the body. It starts in the kidneys and ends (by men) a bit before the urethra exits the body. (the yellow in my drawn pics further below) Since this patient's cancer was invasive the urothelium a saftey distance above and all below the tumor had to be removed.

The whole bladder is removed. The ureters (leading from the kidneys to the bladder) were cut and sent to pathology to make sure we were well above the tumor. The ureter ends were sewn to the outside of the stomach so that the urine could empty into bags.

I've seen a few bladders removed so far but the urethra wasn't removed in the ones I saw. This was the first one and it was kinda fun to watch (the male nurses in the room did not feel the same amusement and had sympathy with what the patient wasn't feeling due to anesthesia.)

I tried to think of the best way to explain the urethra removal to y'all but it's difficult in 2D but I decided to draw a sketch. Basically, the penis is turned inside out. Let me (try to) explain.

The stomach was cut open to get access to the ureters, bladder and the first part of the urethra. Once the urethra leaves the body through the penis out of the body you can't access it all the way through the end. So the exit of the penis gets exposed between the symphysis (part of the hip bones) and the skin. It is turned inside out and the urethra can be cut out and the penis can be turned right side out again. (The cringing of the male nurses at times was entertaining. I felt nothing haha)

So....The normal anatomy (very simplified from reality and obviously we aren't usually green on the inside and look like a pole with a penis in real life)

 The stomach is cut open and held open with hooks to get access to the bladder (and a lot of other slimy things)

Just for better visualization and not to indicate an erection during operation, the following drawing:

And now the inside-out maneuver:

The yellow in the picture can all be removed and the penis put back into place and the patient sewn back up and voila. (A LOT easier said than done)

Since there will be a lack of doctors tomorrow and another DaVinci is planned I assume I'll be helping out in outpatient or on the ward tomorrow. Hopefully a bit more back friendly :)

Baci, V