Week 24: Half time baby!

Half time! 24 of the 48 weeks of my internship year are over.

Sadly, my fear from last week sort of came true and there wasn't much to do. The operations performed were 3 laparoscopic gallbladder removals, 1 hernia repair, 1 perforated stomach repair and 1 liver cyst removal done laparoscopically......during the whole week. That list could easily be an intinerary for just one day.

Tuesday, I participated in chief rounds again. Wednesday, one of the attendings let me do the examinations in the clinic for 4 patients with gallbladder issues. Thursday, was the only day I was actually scrubbed in for the stomach perforation operation. Other than that, I spent a lot of time chatting with the doctors, drawing blood, placing lines and watching laparoscopic operations. My two main guide times of the day were 11:30 lunch and 2:30pm afternoon meeting. After that, I had lectures on Monday, Wednesday and Thursday again. Friday was a national holiday and thus we had off (benefit of being a student).

I can't really say I learned all to much this week. The time in the clinic with the attending was probably the most useful.

On Thursday, there was a little incident that I'll share. The planned OR programm for the day was:

1. the liver cyst
2. the hernia

The perforated stomach was added on as an "emergency" operation.

From the very beginning of my OR career, I quickly learned through experience and instructions to introduce yourself when you come into a new OR setting because A) its polite B) the people in the OR should know who you are and C) the only things that help you recognize someone in the OR is their body shape and height, voice and the portion of their face between the forehead and just below their eyes. I'm sure if I showed up in the OR without my glasses, everyone would think I'm somebody new.

I also learned through experience (and some really unfriendly OR nurses) that you are really better off not trying to help out without being explicitly asked to do so. Many OR nurses are very particular and you are almost always standing in the wrong spot or just seconds away from making the whole OR blow up (obviously not, but they react as though). I'm usually a person who loves to help out and will do a lot of things to help without being asked in daily life....in the OR....I know better.

Knowing all of this, the following happened on Thursday.

I've been in the OR in this hospital for 8 weeks now. Although I might not know everyone's name (because there are a lot of people), I was pretty sure I knew just about everyone's face and had said hello to almost everyone personally or had at least been in the same OR room as almost everyone on the staff at some point in time. Since I had been in the OR periodically this past week as well and hadn't reintroduced myself because I knew the people, I also didn't reintroduce myself on Thursday because walking into the room, I was sure I knew all the "faces" (forehead to below the eyes). They were getting the patient ready for the operation and didn't seem to need my help, so I took a stool and sat myself in the one spot I seemed to be most out of everyone's way, not blocking any supplies and still having a few of the TV screen showing the operation.

The anesthesiologist was having a conversation with the OR nurse about BMI and the cut off values for overweight and obesity. The nurse said she had a BMI of 19 or 20. The anesthesiologist exclaimed that was FAR to little and that she needed to gain weight. Somewhere in my head, the information that 18.5 was the cut off for normal weight and below that was underweight, popped up. Instead of correcting the anesthesiologist and interrupting their conversation, I looked it up on my iPhone real quick.

At this point, I have to say that different ORs react differently in respect to people using their cell phones. In some ORs, you better not look at your phone unless you want to be yelled at and in others, such as this one, everyone who isn't scrubbed in usually has their phone out most of the time when they aren't actively working. So I didn't hesitate and looked the information up real quick.

After the first operation, a group of about 5 people left the OR at the same time. One of the nurses mumbled something about helping move the patient to the recovery room. Since I had never done that, had never been asked to and no name of the person addressed was used, I did not feel that that statement was directed towards me. I really had to pee, so I continued on in the direction of the bathroom. I have a bad back (standing long hours in the OR doesn't help) so I often walk with my arms crossed because it feels better on my back (I'm aware that in the science of body language, that is interpreted as not interested or closed off). One of the nurses called out a name (that very clearly was not Viktoria) and I turned around out of habit (as I think many people do when someone yells out loudly). The second I turn around, I see that the one nurse imitates my crossed arms and says some snarky remark to the other nurse that is waving me over. So I go and help move the patient from the OR bed to the recovery bed and ignore the snarky nurse's behavior.

The look I give snarky nurses that bug me.

Back in the OR, the second patient is ready to go and the anesthesiologist asks if the operating doctors had been called to come. The snarky nurse just gives me a dirty look and says "no, but that could have already been done". I sure hope she didn't mean that I was supposed to have called them since that isn't my job, I wasn't asked and I honestly can't read minds. I was getting really excited for the second operation to be done so that I could leave Mrs. Evil and go back to the ward. Unfortunately, the "emergency" operation was scheduled. I asked the doctor if they needed me and he said I could scrub in to get a better look. It was already 11:10am though and I had plans for lunch in 20 mins (obviously I don't insist on this exact time, but I just wanted to get away from Mrs. Evil).

Before the emergency operation, I was standing outside of the OR looking out of the window when the attending approached me. He told me that Mrs. Evil had complained to her fellow nurses that I hadn't introduced myself at the beginning of the day. He told me that its better to introduce yourself one time too many than not to since some nurses take that very seriously (his toned indicated that he too thought their behavior was ridiculous). A few minutes later, Mrs. Evil exited the OR and I stopped her. I introduced myself and explained that I thought we had already made acquaintances. She just snarkly replied that we had not and that she had very well noticed that. (Ok, take a chill pill lady) She continued to lecture me that it is not a good image for a student if they "just sit around with their arms crossed, playing on their phones and don't help". I took a deep breath mentally and quickly decided that explaining my back problems and the fact that I was researching medical literature on my phone probably wouldn't really help the situation and I just had to accept my losses in that respect but I wasn't about to let someone tell me I was lazy and didn't feel like helping. I told her that I do not interfere with OR procedures unless explicitly asked to do so by someone from the staff because I have learned over the years that the processes happening all go quite smoothly when no one else intervenes and that more times than not, students have been yelled at for wanting to help on their own initiative. I also explained that I am more than willing to help at anytime with anything if asked but that I respect their work environment and do not want to impose. All she had to do was ask and I'd help. She didn't really have a snarky reply for my calm remarks and just mumbled something under her breath and went back into the OR.

I much rather would have told her off. Who does she think she is that she acts like a complete witch just because I didn't personally introduce myself to her? Last time I checked, she doesn't run the place. And really, she must have self confidence issues or something if the mere fact that an insignificant little student such as myself not introducing myself can put her into such a terrible mood and really ruin her day for herself? Besides all that, she easily could have also came to me, introduced herself and asked who I was. I wouldn't have expected her too, I also wouldn't have been mad had she not introduced herself because I just quite frankly don't care that much.

In the end, I just wanted to share that story to show the importance of some little tricks while in the OR (or any other) setting. Little things like that can help you avoid certain stressful situations (not all, don't worry, you'll stand in the wrong place or breathe somebodies air sure enough and get yelled at for that). Even if you feel people take themselves too seriously and they try to make it seem like they reign over the OR, just smile, introduce yourself and make them feel important so that you can avoid the snarkiness and go on with your own wonderful day.

I'd like to give a shout out to all the wonderful OR nurses out there that do an amazing job at what they do and are helpful to students! I really appreciate a kind, helpful nurse and I know that doctors wouldn't trade you for the world if you are good at what you do! There are some really great nurses out there. I just wanted to mention that before you guys think I generally have something against nurses. 

This weekend, I drove to Hamburg and Stade to visit family and bake some yummy cake. Said cake will be eaten in about 2 hours once the Hamburg relatives arrive! Afterwards, its back to G-town and back to a 5 day work week tomorrow.

soccer with my god daughter

church in Stade

love the architecture in the "old land" Altes Land

Fisch Markt Stade

In love with the details

Rhubarb cake ready to be eaten!

Stay healthy!

V

Week 23: Bäm I've got your appendix! (Well, not really because they won't let me)

This week it was time for some general surgery. Monday morning, the chief of the department talked to me about the department, the colleagues and the different function is could look at during my three week stay in the department.  I spent the first part of the day familiarizing myself with the current patients. I was told that the first operation of the day was a fistula removal. A fistula is a connection between A and B that normally doesn't anatomically exist. They can come about after operations. So in the case of our patient, the fistulas developed after an abdominal operation and there were multiple connections between the small intestines and the skin. As you can imagine, you wouldn't want the contents of your small intestines to exit through the skin of your stomach. I couldn't exactly imagine how these fistulas are removed so I thought I'd check it out. The other doctors told me the operation could take anywhere from a half an hour to 4 hours.

My main source of nutrition seems to be KIND bars

I didn't have a very big breakfast but figured that the operation might take 2 hours or so. It was 5.......5 hours of holding hooks. No lunch. And I was the tallest at the table. I didn't get to actively do all too much (I don't consider holding hooks as actively doing something). My back started hurting at about 3 hours. Luckily, I was offered a stool at 4 hours. I don't actively ask for one if I can manage somehow because I'm the lowest ranked doctor at the table. At the same time, I still have the longest time of work ahead of me and have to protect my back. I gladly accepted the offer when it was made. 

Once the operation was done, I quickly grabbed lunch and then went to our tumor board conference.

The other 3 days were spent looking for something useful to do. Tuesday we had chief rounds. I wanted to attend the clinic visits but they seemed so sporadic that I didn't catch one. In general, there wasn't really a lot happening. The doctors told me that it's usually not this calm but sometimes there are just holes at certain times during the year. Well great. Did it have to be while I'm in the department? And apparently the OR schedule is still looking pretty empty for next week. Boooooo.

I spent quite a bit of time reading in the general surgery text book because I didn't want to be playing Two Dots on my phone and kill my battery all the time.

Greetings from Ice Mountain in Two Dots

Thursday, I helped (holding hooks) with a laparoscopic operation. I'd never assisted in a laparoscopic operations so in theory,  it was exciting. In reality, I stood there, holding a hook and hoping the images on the screen were interesting enough to keep me from falling asleep. It didn't necessarily help that everyone worked in more or less silence. 

The lectures we had during the week weren't bad. We were told about the emergency medicine program in the hospital and what vehicles belonged to the fleet of rescue vehicles. We were also offered to ride along one day. This is an offer I will be taking them up on.  Another lecture was held by the chief of internal medicine. Technically, it was supposed to be a class about examining. No active examining was done. He did however talk to us about examining patients and asked us a lot of interesting questions. They were things that seemed so logical until you were asked to actually say things out loud. Sometimes you just have images in your head of how things work without putting them into words, now we had to use our words. It was a lot of fun for me though and really got us thinking about how our oral exams at the end of the year might be like. 

This upcoming week shall be interesting, and by that I mean I hope it's not spent killing time. If the OR schedule is still as vacant as it was Friday, I'll look if I can just help in the clinic and always have extra reading material with me. One thing I definitely won't do is hang out on the ward. It's almost as though the nurses can smell your boredom. Some of them then throw some of their duties your way or will just give you something to do that is actually meant for another intern. I usually really don't mind because A) I need the practice in placing lines and B) it's better than sitting around. 

I had one incident where I was 10 feet away from the ward doors on my way out when the nurse came out of the patients room and told me that two men in the room needed a line placed but that they didn't want the other intern to do it. These patients didn't want their arms "unnecessarily poked with needles" and the other intern had apparently done that the day before while drawing blood. Well great, so now these patients except me to place a line and do it better than someone who just had to draw blood. No pressure. Of course, the patient reminded me multiple times of how nice it would be if I didn't have to poke him multiple times. I wasn't successful on my first try but I had told the patient from the get go that trying to place the new line in the same vein as the last one might not work so well. But he insisted. While I was preparing to try again, the other intern entered and tried to place a line on the other patient. The patient was less than enthused that the intern was the one doing it but he was more polite than my patient and didn't say anything. From the corner of my eye I could already tell that his first try wasn't going to be successful. I think the intern just wanted to get out of that room because even though the patient said the spot hurt and the tissue was swelling up, he insisted it still might work. That's when I cut into the conversation and said that the line was most likely not placed right and that he would have to try again. He opted to go tell a colleague to do it instead. I'm not sure the colleague ever came. I however, did get the line placed on my second try and my patient called me an angle. He also said that now I would have bragging rights. I told him I didn't want the bragging rights and obviously would have wished that my intern colleague would have been successful on his first try and I also would have wanted that for the patient receiving the line. Seriously, does everything have to be a competition and about bragging rights? 

I took Friday off to head to Berlin with my good friend. We visited a friend of mine in Berlin and I was so excited since I haven't hung out with him in a while. He had to leave Saturday morning and let my friend and I stay at his place until Sunday. I appreciate my friends so much for their constant hospitality around the world. I really, really hope I end up somewhere fun so I can have a guest room for all my fabulous friends to come stay in when they visit my city.

East Side Gallery in Berlin, Germany

Russell James Exhibition at Camera Works in Berlin, Germany

Brandenburger Tor in Berlin, Germany

Memorial to the Murdered Jews of Europe in Berlin, Germany

It's back to work tomorrow with hopefully something to do!

Stay healthy!

V

Week 21/22: From Wisconsin cheese and family to rotting wounds and maggots.....

This little two week rhythm that's been going on the last few weeks should be over for the next 4 weeks at least.

I spent a week home in Wisconsin and it. was. heavenly. I loved being home after almost a year, spending time with friends and family and MY DOG (!) and getting to see so many people who were a part of my life growing up and are a part of my life still today. I also probably exceeded the recommended limit on deep fried cheese curds in that week.

Pirate Puppy Toby

What a goof ball....but I love her.

My Wisconsin Badgers boys basketball team sadly lost in the final game of March Madness but first they kicked Kentucky's butt (Boo-yah!). The team did a great job and I really fell in love with some of those boys....have you seen the interview with Nigel Hayes where he is caught saying the stenographer is so gorgeous? And the double face palm after?!

Immediately fell in love with him. Anyways,.....home was great. I wish I could have stayed longer. I got to see my little sister for a day which was really fun! Wasn't able to see my older sister due to the fact that she is off in medical school in Erie, Pennsylvania.

All good things must come to an end though and so I had to fly back to Germany on Sunday.

This past week was spent in vascular surgery. The people in the department were lovely. The wounds the patients had were quiet the contrary. I think vascular surgery might have some of the least aesthetically pleasing wounds. I'm talking amputations, ulcers that won't heal, necrotic (dead or dying) skin, wounds being cleaned with maggots, patients with no toes or fingers because they killed those with smoking.....seriously....these wounds could be straight out of a scary movie.

The doctors however, really fun and nice people. The doctor I helped on the ward seemed to like me too since he went ahead and claimed me when a urologist walked by and had apparently looked at me. Haha, very flattering Sir, but I'm not really a thing that can be claimed.

I was asked to represent the hospital at the intern fair in our university hospital on Wednesday. This entailed me talking to potential applicants for an internship spot in the hospital along with the chief of internal medicine. We stood at our booth for a few hours just chatting away and telling the potential interns what a great program we have (which really is true and not just a bunch of bull, the hospital was even one of two of the first hospitals to pass the quality check for internship programs in the country!)


I spent all day Thursday and Friday in the OR. I got to see a few operations I hadn't seen before and had always wanted to. For instance, stripping varicose veins. I couldn't imagine that it was possible to just pull veins out of the body. Like....isn't there connective tissue holding them in place? Guess not as tightly as I had thought. They use a wire for the long ones but small varicose veins are removed by making a little incision and pulling them out with a hook. At least that is one way to do it, the doctor told me that there are multiple ways of performing the operation and that in the states a lot of varicose veins get removed by "laser". 

The same doctor also told me a bunch of medical history facts about vascular surgery. He had a rather strong accent so I really only understood about 75% of what he was saying at any given time.

I also assisted in removing a big toe. I thought I would get a bit squeamish because I think amputations are such a weird operation (can you imagine being handed a leg?). I think that is a thousand times more weird than being handed a kidney. So I assisted in this toe removal and I was actually doing way better than I thought I would. Nonetheless, just going right at it with the scalpel and then saw has a horrific aspect to it.

The days always ended with an afternoon meeting. The doctors were interested to know if I would be back the next week. Since my trip home was rather spontaneous and my first week of vascular surgery had been planned for that time, I am in the midst of rescheduling a week during the time I'm in trauma surgery. I'm scheduled for 6 weeks of that. I don't need six weeks. I've already seen a lot of trauma surgery and can spare a week to see some more vascular surgeries I haven't seen yet.

Starting next week, I'll be in general surgery. Since it is such a small hospital, I already know a few of the doctors in that department. I've been most afraid of this part of rotation because general surgery operations can take a really long time and I'm afraid that we interns will be used to only hold hooks. My brain and my back would not be too fond of this situation. If it is that way, I guess it is what it is and I'll survive that too. Excited to see some operations I haven't before though. Appendectomy seems like such a standard thing but I've actually never seen one done (except while removing other organs and just taking that out as well). I'd like to see a classic case.

I hope everyone had a great Easter and enjoyed some good chocolate eggs!

Stay healthy!

V

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

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

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

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

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

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

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

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

Millennium Park Chicago 

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

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

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

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

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

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

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

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

I have a few vacations planned in between as well. 

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

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

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

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

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

Stay healthy everyone!

V

Week 16: My last week in Urology for a while

The past 16 weeks seem to have flown by so quickly! I assume this is mostly do to the old saying "time flies when you're having fun" but also due to the fact that almost all my free time before and after work was spent studying.

I spent most of my last week trying to complete my internship log book and get all the signatures I needed from multiple doctors. I was called into the OR to hold hooks in a cystectomy (bladder removal). Typically one of the longest operations urologist preform and I spent 4.5 hours holding hooks in my last week in the department. Only seemed fitting to end this way (because if I remember correctly, a cystectomy was the first urological operation I saw a year and a half ago when I did an elective in the department).

I baked 60 banana bread muffins and a "Kalter Hund" (German dessert consisting mainly of coconut fat, cocoa and graham crackers) Thursday night to take to work with me on Friday. I am genuinely sad that I won't be going to work in that department on Monday. The department consists of some pretty great people. The work atmosphere is the best I've been in and it really is more of a family than a group of doctors. I am thankful to the whole staff (doctors, nurses, secretaries, etc.) who helped me out during the last few months and didn't make me feel like an idiot if I asked a question. 

I also genuinely think that they are a bit sad that I won't be around anymore either.

My highlight while in the department was probably the whole situation with patient X. But I also have to thank all the patients who were kind to me. They were all a crucial part in my training and I thank them for having faith in me. 

Tomorrow it's off to Hildesheim every weekday until mid October. I'm not the biggest fan of the transistion periods. I've never been to this hospital, let alone have I ever traveled there. I don't know a single soul that works there. I've heard good things but it's always so overwhelming the first few days trying to figure out your orientation in a new hospital, observe and understand the dynamic of the people working there and getting to know the basic procederes (do you have to call for a consultation, or send a fax, or is it on the computer?). It'll be an overwehlming few days. Luckily, I have a little break from work starting Friday and all of next week to concentrate on the USMLE primarily since that is right around the corner as well (March 30th).

Since I'll be in a smaller hospital, I hope to be way more hands on than I have been. We will be rotating through different departments so little transistion periods will always be taking place. I'll be doing my surgical rotation so I assume I'll see the likes of trauma surgery, general surgery, maybe anesthesia. I'll know more tomorrow. 

Still can't say much about my appointment with the pediatric surgeons but I hope to be able to by next week. 

I hope you all had a great week and stay healthy in this crazy world!

V

Week 15: Falling out of love with medicine.

I've always joked that I am in a long term relationship with med school. With everything going on in my life...any potential real boyfriend would leave me due to lack of attention. So my guy med-school and I are having a bit of a rough patch. We've had rough patches before but this one seems to be going on a while.

View from the ward

I haven't fallen out of love with medicine itself, just the process I'm stuck in right now. I spend my early mornings before work studying, spend my evening studying, spend my Saturday and Sunday mornings studying....all for this dang USMLE. At work, I feel rather useless. We are so many "extras" and new residents that I don't actually get to do anything beyond questioning patients and doing an ultrasound. I fell my time is being wasted. I could be using the time to study (instead of getting up at 5) or use it painting, traveling, being crafty, baking, etc. But I'm stuck in the hospital trying to find something to do! Luckily, some of the consultants have gotten a hint that I am rather underwhelmed and will find new things for me to do. Even if it is setting up appointments or entering research data. At least then I'm not sitting around trying to look like I'm doing something when I'd rather be studying.

Since I had so much to do...didn't waste any nutella.

Its so frustrating because I hate sitting around! So the whole thing just seems tedious and annoying. I question why anyone willingly dedicates so much time and effort into this job when all you hear from most colleges is that if they could do it over....they wouldn't. How encouraging. Why sign up for a life of night shifts, on calls, weekend work, high stress level and 6 years of basic education before entering years on end of further training where you are used like an animal? You can't tell me its because of the money. There are easier, funner and quicker ways to make the same amount of money in this world. So in the core, it must be a love for the field. And that is the case for me. Just hard to see that sometimes with so many distraction around.

24 hours....Ready to get you!

Luckily, I decided to be on call on Wednesday after the doctor on call asked if I would join him. He is also one of those colleagues that suggest not doing medicine but at the same time, he is one of the best in the department (IMO). His patients love him, he works in favor of the patient, he keeps it real and is a pretty cool dude. Since this was my first on call during the week, it didn't seem as long as the ones where you come Saturday at 7AM and leave Sunday at 7AM and were you are the only two urologist in the house. On Wednesday, it was a normal work day until about 4:30PM and then it was the two of us. I had told him about how I feel about my current situation and all the fabulous things I see myself doing and he took that and told me I'd be doing most of the work for this on call.

This meant, I interviewed the patients primarily and did the diagnostic tests. There was even a pregnant woman with urinary problems and I had to do an ultrasound and obviously looked at the bladder so that I could also see the little foreign object sucking on its thumb! So cute! The doctor just rolled his eyes and said, "Women." I couldn't help myself.

Around midnight, we were able to go to bed. Not for long though. I was paged at 3:15AM and told a patient was coming in who thought he might have testicular torsion! I hopped out of bed and met the doctor and the patient in the out patient department. The patient's history and presentation were very classic for testicular torsion. We called the consultant to come in for the operation. I scrubbed in and assisted in alleviating the torsion on the one side. As a standard practice, the other side needs to be fixated as well. I got to do that and the consultant assisted! That meant I did the cut, the fixations and the sutures!! It was very exciting for me! Finally, hands on!

After finishing up a few things and letting the colleagues know what happened through the night, I went home around 7:30AM. I didn't sleep though, I had a meeting with my doctor thesis professor, had to take care of paperwork and had a meeting with the pediatric surgeons. Hopefully I'll be able to share some information from this meeting with you soon.

That on-call was what I needed to fall a bit in love with medicine again.

I know that once these exams are done and I can use the little free time I do have for other things, I will be more enthusiastic. Residency will be no walk in the park either but at least I'll be working.

I also participated in a pretty fun thing this past week. A guy I went to High School with, Zac Ziebarth, started an organization called SmartRoots Global. Their mission:

To create a generation of innovative problems and critical thinkers who are equipped to solve the biggest challenges in their community and world

 

Well Howdy Texas!

He has been working with students in Texas on the human systems and the health care system. He asked me if I'd be interested in skyping with some of the classes and talk about my medical journey and medical school in general. This came directly in the time that I was most demotivated on that subjected. But since I know its not my true feeling of the situation as a whole, I had a great time with the kids! They asked questions like, "What was your hardest operation?" "Have you seen a heart operation?" "What materials do you use in the hospital?". It was great to hear that about 10 students in each class are thinking about going into the medical field. Sure, they might just be 7th graders, but I knew what I wanted to be when I was in 7th grade and I'm in the midst of completing the first major part of that.


And as a last note, another yummy shake recipe:
-1 avocado
-1 banana
-2 fresh squeezed oranges
-1 cup coconut milk
-half a squeezed lemon or lime
-pinch of salt
Mix it up and enjoy the tropical breakfast smoothie!

Stay healthy!

V

Screen grab from the interview, click the link below to see the whole thing!

P.S. Found this (German) interview from the Urology Congress I went to in Heidelberg :)