Egypt! A Report: Part 1

Well that was a lot of fun! One of my dreams came true this past week and it involves Moses. I'll explain later.

I arrived in Alexandria late Saturday night/ early Sunday morning. I found the little money exchange/Visa window my friend told me about and bought my visa. I packed 20€ for the visa but they told me it costs $25. I didn't have dollars on me though so I convinced them to take 24€ and give me the sticker.

I had been warned that they might ask me questions as to the nature of my visit and might want to check my luggage but I got through all the stations so quickly that I was outside the airport waiting for my friends before they arrived 10 minutes later. They were both shocked to already see me waiting outside. Only passengers with tickets are allowed to enter the airport. So anyone arriving will meet their people outside and anyone leaving has to say their goodbyes before entering the airport. 

My friend Amira from Germany and her boyfriend picked me up. We drove about a half an hour to arrive at his family's beach house on the Mediterranean coast. We spent the night there and made a quick stop on the beach the next morning so I could get an idea of what awaited us a week later.

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Our first day was spent in Alexandria with one of Amira's best friends. In Egypt, the weekend is on Friday and Saturday and everyone is usually back at work on Sunday. Gina took the day off to spend the day with us as they showed me some great spots in Alexandria.

Montazah Palace Gardens: the palace and the surrounding gardens were built by Khedive Abbas Hilmy (1892-1914) as his summer retreat from the hot Cairo. The palace itself is off limits but the palm tree filled gardens surrounding the place are full of courting couples. Being a couple in Egypt is quite different than being a couple in Europe. Public Displays of Affection are a big no-no. Most parents don't know that the person their child is dating exists until the engagement is announced (or they know but it's not really talked about). The grounds of this palace also has little bungalows along the water that can be rented. These and the parks are places for couples to escape to to have a bit of privacy and sit close to eachother without feeling judged. Gina told us that Hilmy had deer put on the huge property exclusively to hunt them. (Sounds a bit like my dad getting Scottish highlander cows for the sole purpose of seeing cows in the front yard upon returning from work. Men mustn't always be understood).

Bibliotheca Alexandrina: Oh, every nerds dream! Friends of ours organized a private tour of the library for us. In all reality it was mainly for me. I, being the huge nerd that I am, had a great time listening to every single fact the tour guide told me while Gina and Amira (both of whom have been to the library multiple times), seemed beyond bored with the whole thing. Oh to be in college again and have the opportunity to study for hours in the largest reading room of the world! Some fun facts (for the nerds)

- the granite exterior wall is covered in letters, pictogram, hieroglyphs and symbols from over 120 human scripts

- the reading room can accommodate 8 million books and 2500 readers

- the windows flood the room with natural light but don't actually let the rays enter the room

- the windows are meant to look like eyes while the metal in front of them are supposed to remind you of eyelashes

- the reading room contains Egypt's first printing press

-there are multiple art exhibits within the library

-the complex consists of the library which is meant to look like the rising sun, the planetarium which is positioned to look like the earth revolving around the sun (library) and the conference center which integrates ancient and modern Egyptian architecture.

Fort Qaitbey: built in 1480 by the Mamluk sultan Quitbey, this fairytale like fort sits on the peninsula where the famous Pharos lighthouse used to stand. The lighthouse (one of the seven ancient wonders of the world), was destroyed by an earth quake and laid as ruins for over a hundred years before the Fort was built using materials from the fallen lighthouse. I didn't enter the fort due to many visits to various forts in my life and the grumbling of my stomach to get some food. 

Greek Club: as the name might suggest, it's a club for Greeks. But even without a membership because you aren't Greek, there is a great restaurant at the top and one level below that with a great view of the harbor and yummy Greek food for a fairly descent price. The top level is more expensive than the lower but the lower level has a lovely terrace overlooking the harbor as well. 

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The next morning, Amira and I were picked up by a driver who drove us to Cairo (450E£). The drive takes about 2.5-3.5 hours depending on traffic. We both slept most of the way after sever sleep deprivation the last few nights. The first stop was a childhood dream come true for me! As a child, ancient Egyptian culture and mythology fascinated me! Ancient Egypt was one of the first countries we learned about besides the repetition of the short history of the U.S. in school. Many, many years later, I was finally standing in front of the pyramids!

One of my main wishes was to ride on a camel around the pyramids. Our driver told us that he had a friend who was a tour guide there. It seems every Egyptian has a friend working somewhere you plan to visit. Of course, they are helping each other out by bringing tourists to each other for business. We weren't even asked, the tour guide just showed up and told us to follow him. We were fully aware of what was going on and slightly annoyed that we weren't asked. Ever since the revolution in Egypt, the country has been hit hard with a fall back in tourist numbers and this atmosphere was clearly felt. We weren't hounded by many because we already had our driver and tour guide with us. It seems as though everyone is trying to make a dollar (ok, Egyptian pound) by showing you the way or telling you some fact about a structure although you didn't ask. Amira and I didn't let them fool us though. We clearly stated that we didn't want a full blown tour and that we were just looking to take in the environment and ride a camel. Karim, our tour guide, introduced us to two camels. The two men wrapped our scarfs around our heads and told us to jump on the camel. It all happened so quickly that I totally forgot to ask what all of this would cost. If there is one thing that I learned before coming to Egypt was that you always have to bargain. Thus, I wasn't to worried about the current situation. I was riding on Bebsi and Amira sat on Moses. Moses and I became good friend really quickly. He would always nudge my leg, nibble on my purse and enjoy me petting him. Bebsi on the other hand was a full on drama queen. She was basically dragged along by Karim most of the way.

After about 15 minutes of riding and a few photo ops, the camel owner showed up and wanted to negotiate prices for various tours. They started off wanting 400E£ ($53) per person for the big tour. We bargained back and forth and I finally got them down to 100E£ ($13) p.P. for the big tour. Karim jumped on Bebsi with me and we went on our tour. Moses was being absolutely adorable for the photo ops. If my face was near him, he'd nudge the side of my face with his nose and tickle me with his whiskers. The tour took us to a spot in the dessert that gave us the "9 pyramid view". Sounds more spectacular, and is advertised by the guides as a must see, than it actually is but I guess if we are there, we might as well see it. I didn't go into the pyramid because I am saving that for my next trip when I can spend as much time as I want there. 

Cairo is huge. And it's always growing. It took us quite a while to get from the pyramids to our hotel. The hotel owner is a close friend of Amira's dad and put us up in a room for the two nights we were there. We were pretty tired from the early morning, long drive and pyramid shenanigans that we grabbed something to eat and relaxed a bit in the hotel.

The next morning, we were picked up by a different driver that we hired for the day (350E£). 

Coptic Cairo: confined in the walls of a former Roman fortress, this is a collection of ancient and modern churches with cute little alley ways and impressive patterns. The most impressive patterns were found in the Hanging Church (named so because it is suspended over the Water Gate of Roman Babylon). Make sure you cover your shoulders and knees if you visit this area (but also generally a good idea when you are in Egyptian cities). 

Egyptian Museum: A pink building of about 15,000 sq m packed to the brim with more than 100,000 objects. The building seems a bit overwhelmed with the masses of artifacts. Each little nook and cranny is used to display something. At times, it feels like walking through a museum warehouse. Sarcophagi even stand outside exposed to the weather and environment. I did a quick 1.5 hour walk around, avoiding the offers of personal tour guides and getting an impression of everything and keeping a look out for patterns. Students pay 35E£ to get in, regular price is 65E£. Cameras are technically supposed to be checked at the entrance but I still saw people walking around with their big cameras. I snuck a picture here and there with my iPhone when I saw a cool pattern. The must see is definitely Tutankhamun's Sarcophagi and all his treasures!

Khan al-Khalili: Built in the 14th century, this market can easily become a tourist trap but can also supply you with hours of shopping and bargaining fun! Amira's boyfriend gave me two pieces of advice before coming here. 

1. ALWAYS bargain. If he says it costs 20E£, it should cost 5E£. Have fun bargaining and settle on a price you are comfortable with. "Eh! If I wasn't a woman or our (non-existing) Egyptian husbands were with us, we wouldn't be paying that much! It is far to high of a price my friend!"

2. ALWAYS ask for a present! "Oh, you don't want to give me a present? The nice sellers in Luxor always gave me a present. But I guess its okay, I'll just tell my friends back home that they should shop in Luxor.".....worked every time.

Amira and I spent 3.5 hours in the market, shopping, making friends, bargaining our butts off and being rewarded with some great buys and little presents. I stopped for some Turkish coffee and Amira for Shisha in between. 

Al-Azhar Park: This green oasis sits on land that used to be a huge landfill that collected trash over centuries. Thanks to funds from the Aga Khan Trust for Culture, the area is now a beloved get away from all the noise and craziness of the city that surrounds the place. The air seems a tad less smoggy than in the rest of the city as well. You can climb to the top of the hill for a 360º view of the city. You can even see the Pyramids in the background if the smog isn't too bad. 
A group of Egyptian boys were on top of the hill and started talking about us in Arabic when we arrived. Little did they know that one of "those Germans" understood enough Arabic to call them out on it. That, of course, was Amira. The boys wanted to have their picture taken with me. I said it would be okay but it would cost them 100E£. They didn't take me up on that offer and didn't even really bargain. The little sister of one of the boys came to talk to me while I was taking pictures of the view. She had such piercing beautiful eyes. With a lot of language barriers, she told me she also wanted to become a doctor. I told her not to let the boys bother her and work hard if she really wants to pursue her dream of becoming a doctor. The hard work pays off.

New Cairo: We drove out to a couple's place in New Cairo. New Cairo is basically its own city adjacent to Cairo. The roads are packed with one huge house after another! I don't know where all the people are supposed to be coming from to move into them. There are so many! We went and had dinner at Festival City. Its a ginormous mall build on what used to be desert. Its insane. It really, really is. We ate at Leila, a very delicious Lebanese restaurant. 

We didn't get back to the hotel until really late that night. After breakfast the next morning, we headed back to Alexandria. 

The next few days were spent hanging out with friends, attending a 4-year-old's birthday party and then heading out to the summer place Thursday night. 

The summer place has not Internet but a TV. The next 3 days were spent sleeping, eating, watching movies, drawing, talking, sun bathing and going to the beach. It was relaxing to be off the grid and spend time watching movies you haven't seen in years (for example, Clueless! As if!)

The week was an absolute treat! Not to completely overload on information (although I already did), I will post another post the coming days talking about travel tips in Egypt and give you a lesson on all the yummy food I ate! 

Tomorrow, it's back to the hospital and the start of my trauma surgery rotation.

Stay healthy!

Viktoria (فيكتوريا)

Week 25: On the plus side, we have great conversations......

I'm really trying to find something to write about for this past week. In a nutshell: train strikes, rounds, talk, eat, prepare patient presentation, present, attend lecture, get home later than usual.

The German train conductors went on strike for a whole week. This meant that almost all fast trains and many regional trains were cancelled. As you can imagine (if you yourself aren't in Germany and already dealing with it anyways), this caused quite a few problems for anyone trying to go anywhere. For me, it meant leaving the train station 5 minutes later but arriving in Hildesheim 40 minutes later than usual. I usually wasn't changed and ready to go on the ward until 8:50. Getting home was the same situation. It wasn't terrible but it also wasn't as fun as just hopping on one train and being there in half an hour. 

The surgery schedule was fuller than it was last week and the nurse who's job it is to hold hooks during the operation was there so us interns were a bit jobless. I spent the majority of the week just chatting about everything and anything with the doctor, my friend started her general surgery rotation week this past week so we were always a gang of three women. 

We went on rounds everyday with either an attending or the chief on Tuesday. Since we had to prepare to present the patients for the next days operation this week, I felt like I knew so much more about the patients than in the past few weeks. 

 the city I work in turns 1200 years old this year

I helped clean a few wounds and renew the bandages. I successfully placed a few more lines. It's becoming less and less of a big deal to place them. 

Beyond that and eating long lunches......I didn't really do much. I even brought a text book with me on Friday so I could at least look at examining patients in theory. 

The doctor said that she'd love to have more tasks for us but that they just didn't exist.

We definitely learned a thing or two about department politics this week considering there was enough time for the doctors to rant about others. 

Sorry I couldn't make that post more interesting. As a compensation, I will post about the exiting things I'm up to this coming week next week! So it'll be a little excurse into a travel post and not medical post but hopefully I'll have fun stuff to tell. And real doctors go on vacation too......so I guess it fits somewhat. I'm currently at the airport in Frankfurt and will be enroute to EGYPT in about two hours! I've wanted to visit Egypt since my childhood. I was fascinated by the ancient Egyptian mythology and the ancient Egyptian culture. I'm so fortunate to have people there waiting to show me their country. Next week, I'll share with you! Have a great week everyone and stay healthy!

V

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!