Week 28: "I've been looking for fractures, I've been looking so long!"

Well, David Hasselhoff and the reference to his song is quite fitting for the past week. No, we didn't single-handedly bring down the Berlin Wall with our angelic voices, but we did have a reason to feel like we accomplished an equally challenging task after Thursday's shift.  Secondly, there was once again no lack in the most-asked-question-of-my-life. And we did look for a lot of fractures on x-rays.

Each day of this past week was completely different from the next. I love that. I can't even keep the days and the cases straight anymore because for the most part we were working off one case after another. Sometimes more relaxing than others.

I got quite a bit of flesh sewing in this week. There was the glass-cut-open-my-hand case, the I-tripped-in-the-yard-and-busted-up-my-lip case, the I-was-moving-junk-and-slit-open-my-forearm case and I believe a few more that I can't remember.

We had another load of kids throughout the week as well as the numerous cases of elderly folks falling down.

One of the cases that falls into the age gap was a mid 40 year old that hurt her fingers while at the gym. Unfortunately, it happened the night before and she didn't remove her wedding ring. I tried as much as I could to massage the edema out of the finger in the hopes of saving the ring. Try as I may though, the swelling around the capsule was so strong that I couldn't get it over the joint. We had no other option but to cut it off. The patient was understanding and even joked that this would be a good excuse for her husband to buy her a new one. So as a good thing to remember, if you ever hurt your hand....REMOVE ANY JEWELERY ON YOUR ARM! We don't enjoy cutting off wedding rings but we will if it means saving your finger!

Many cases we had this week were not cases for the emergency room. Dear citizens of the world, if you have had back pain for 6 weeks, make an appointment with a practice (I am aware you can't get those quickly sometimes but make it very clear to the receptionist that you need an appointment) and get treated. An emergency room (and it baffles me that we have to tell people this) is for EMERGENCIES! It's not a free for all to get to see a doctor right away when you don't have a new acute problem! Just because your binge watching of TV shows can't continue because you have seen all the seasons and you happen to have a moment of time in your schedule, it is not the time to fill it with a visit to your local emergency room (preferably at 3:30AM) to complain about your shoulder that has been bugging you for the past week. (That specific case didn't happen in my current hospital, but people. it happens). Use common sense, us doctors (and soon to be doctors) don't want to (and can't) turn you away but our job in the emergency room is to treat emergencies. Rant end.

Thursday was crazy. We had enough cases to work on at 9:30 and the files in our slot just kept coming. The other departments started to fill up as well and by 11AM we had patients/nurses/EMTs/doctors packing the ER. I went from seeing people with the doctor to immediately writing the start of the release note and leaving to see the next patient again. The doctor would finish the release letter and I would get it in an envelope, to the patient and discharging them. At some point, while both our computers were being used by doctors, I took all their money cards, went to the cafeteria, called the doctors and told them what was available and carried multiple meals back to the ER so that we could eat in between writing letters and looking at x-rays. It was a crazy but absolutely fun day.

Friday was the COMPLETE opposite! We had 5 patients in the whole day I was there! We thought it might even get crazier than it was Thursday because the weather was absolutely beautiful and 30 degrees Fahrenheit out that we figured everyone was coming out of hibernation (I know it's June but it was still rather icky and cold until Friday) and since they haven't been out in the world, would fall on their face after the third step and show up in the ER. Surprisingly, that was not the case. The internal medicine department had a few more cases because people forgot to drink plenty of water. But all in all, it was a really calm day. It made the day drag on and on though. After work, I bought a container of really lovely looking yummy strawberries and dropped them off in the ER because they let me go an hour early!

My doctor has told me several times that she doesn't know what she'll do without me. She will be just fine without me, I can tell you that much. I do try really hard to make the lives of people around me easier though. I'm like the born personal assistant (although I could use my own). While in Urology, I made sure the doctors were eating and if they didn't stop to have breakfast, I'd make them something and make them eat it. If I heard a sniffle or saw a runny nose, I'd make them ginger-honey-lemon tea and even brought it back to the hospital after my work day if they had a night shift. I was usually one step ahead of them when it came to office work. I'm the same in the ER. I know when something is about to be printed and already have the letter in the envelope with a work release note filled out so that the doctor only has to sign it. I don't like sitting around doing nothing so I'd rather fill my time with those kinds of things or reading up in a book than just staring at the wall.

I'm excited to return to work on Monday. My body is pretty set on it too I guess. I forgot to set an alarm on Friday but woke up on my own only 7 minutes after what should have been my alarm. Today, although it's Saturday, I was up and started my day at 6:45. As long as I'm not tired I don't mind an early start to a day.

I shall see if my internal alarm clock takes off on Sundays ;-)

Stay healthy!

Week 27: Trauma surgery-- broken bones, sewn up wounds and death.

I finally got my hands dirty this week! My first of six weeks of trauma surgery and I'm in the emergency room. I plan on staying there too seeing that I have already observed enough knee and hip replacements to last me a life time.

I'm working with a fairly new doctor. There is almost always something going on which is great. The four days flew by.

I loved going to work with my dad in the emergency room and I still enjoy it now. I like that you don't know what is coming and what needs to be done that day from the get go. You take care of the patients and then move on to the next. It's just not predictable and I like that.

Most of the time I would follow the doctor around and see patients with her. I sewed up three patients during the week. We had a lot of people come in that fell on their way to work or at school. There were only small broken bones: fingers and toes, nothing big.

We did have an interesting case. An older lady comes in because she supposedly fell and hurt her knee. She couldn't really tell us when we asked her but mentioned pain while we examined her joints. Her son had said that she seemed to become more confused over time. We did multiple x-Rays of the areas she had pain but found no fractures. Due to some really high lab values, we had a CT scan of her head done. It showed us a big structure in her brain that was thought to be either a meningoma or a calcified aneurysm. She was transferred to the Neurologie department so I'm not quite sure what it ended up being.

I spent most of my Friday with one of the first patients to come into the ER. Again, an older lady fell. She had a big open wound on the side of her head from the fall. By the time she made it to us, she could hear what we were saying but wasn't reacting appropriately, we immediately had a Ct scan of her head done and it sadly showed a huge bleed. Even sadder was that it was a kind of bleed that can't be operated on. She was basically going to bleed to death while slowly becoming more and more unconscious of the world around her while her body reacts to the rising pressure in her head. Her son told us that she had contemplated attending college seminars the day before. She was just a few years shy of 100. It really made me sad that a person who was more or less absolutely fine the day before could so easily be given the prognosis of dying in the next few hours just because of a fall. Her son left the ER to take a walk. The nurses and doctors all moved on to work. I was the last one left in the room and sure wasn't going to leave this lady to die alone. I cleaned her up a bit and helped when the rising pressure in her head made her vomit. Other than that, I just sat there and held her hand. When she was transferred to the ward, I went along. I asked a nurse to help me clean the patient up a bit, put a new night gown on and I cleaned the blood out of her hair from the wound we stapled. I sat there for another 2 hours holding her hand waiting for the son to come back. At this point, I was pretty sure she wasn't registering the outside world consciously anymore and I had to get back to the ER. I asked the nurses to keep a close eye on her because I didn't want the relative returning to find her covered in vomit. I was disappointed that the son was gone for so long. I understand it being hard for a child to be with their parent in that situation as well but I would want to be there as a child. I'm sure she didn't have many more hours to live.

This weekend I'm spending some time in Paris. Monday is a national holiday in Germany so I don't have to go to work and I'm taking Tuesday off as my study day. So it'll be a short 3 day week but I'm hoping to learn some cool things and help some more people. 

Stay healthy! 

Week 26: "Oh no, now he has to ask his mom to help him in the bathroom!"

It's astounding how many people trip and fall everyday and end up in the emergency room because of it.

We are also only one of 3 hospitals in the not so large town, so I can only imagine how many other people head to the ER with their cuts/bruises/broken bones on a daily basis.

Growing up with an ER doctor dad, I never had to go to the hospital. I was a fairly wild kid. I've been bucked off of horses, run over by three horses, fallen from things.....but I always managed never to hurt myself so bad that I needed stitches or broke a bone. (The thought of breaking a bone is so scary to me.)

Even if I had needed stitches, they would have probably been done on our kitchen counter. Any ache we had was treated with Ibuprofen. Really anything. My dad is a very experienced doctor and had he seen any severe issues, I'm sure even he would have brought me to the hospital. I managed to get through life with Ibuprofen.

The one time I twisted my ankle while at the gym, I proceeded to walk on it and even rode my bike home. My roommate at the time called three upperclassman to tell them to call me and talk some sense into me. I didn't see the need to go to the emergency room. I wouldn't have had I been in America. So I elevated my foot, put some ice on it and took some Ibuprofen (of course). After the third call, I gave in and said I would go if someone drove me (since my ankle was the size of my calf at this point). And so, for the first time in my life, I was an actual patient.

Having experienced the patient side of being in the ER, I try to see to it that the patients get seen and tended to (as much as is possible with my non-existing amount of power in that place).

We had quite a few broken bones and falls this week. I felt like a high percentage of patients were kids or teenagers. I guess that makes sense, since they are the ones falling off of things and getting hurt in recess. The other larger portion of patients were many senior citizens that fell. Some fell so unfortunately, that they had a big open wound on the middle of their forehead.

The little ones that came in to the ER mostly had little open wounds on their face from falling. The teenagers were usually the ones that hurt themselves in recess....mostly because they were playing soccer.

One guy really took the crown in not getting injured half ass. He was playing soccer during recess and was running really fast and tried to stop himself before hitting the wall. He did so holding his hands in front of him ready to slow his impact. Well, by doing so, he managed to break both of his wrists! He was in such pain and the wrists were visibly deformed. One of my first thoughts was, "Oh no, now he has to ask his mom to help him in the bathroom!" One wrist broken: yea, I'll feel a bit sorry for you but you'll get over it. Both wrists broken: I can't stop feeling bad for you (until those casts come off, then I have to feel bad for someone else. You're good now.)

The ER is always an unpredictable place; which is one of the things I love about it. We had periods of times this week where we had so much to do and the clipboards with new patients overflowed our slot and at other times we had absolutely no patient to tend too. I definitely prefer the busier times. Unfortunately, I can't really do much to lighten the load of patients when it gets that busy because a doctor will always have to look at the patient as well and then its almost double the work. I do as much as I can (write release notes, print them and put them in envelopes, run papers around the ER so the doctor can continue working).

I was told to go in and see one patient on my own. The clipboard said it was a patient with tingling sensations in his knee. After talking to the patient and physically examining him, I was pretty sure his femoral artery or maybe even higher was basically shut. His foot was cold and pale compared to the other and I couldn't feel his foot pulses. I informed the doctor of my findings and she came and tried to find the pulses using Doppler sonography. No luck. So we called the vascular surgeons to take a look and treat the patient. It was fun going into the patients room on my own and seeing what I could find out and how much I could find on my own through physical examination without a bunch of fancy machines. In the end, my prediction was right and that felt pretty good too.

I'm really enjoying my time in the ER. Luckily, multiple doctors asked me if I wanted to go into the OR as well or stay in the ER. I told them I was very happy working in the ER. I've really seen enough knee and hip replacements.

Four more weeks of ER for me!

Stay healthy!

V

If you are looking to work on that Type 2 Diabetes......here is how. So...much...sugar!

If you have a sweet tooth, you will love all the sweets in Egypt! Most consist of milk or cream with a load of sugar and either rice, couscous or pastry. Oh, and can't forget to top it all off with a combination of nuts! (I guess for the added protein?)

So lets start off your culinary trip with the main meals before we move on to cavity-creating-nation.

I'm a vegetarian and I have yet to starve. I've been in the deepest corners of southern Germany and still survived off of potatoes and sauerkraut. I've been to Ghana and survived off of fried plantains and rice. And I even survived Egypt and probably consumed that most calories doing so. All of my friends seemed to have contemplated together to get as much sugar down my throat as possible.

The funniest question that I frequently was asked when the people found out I was vegetarian was, "So, you don't eat chicken?"........No. It's sort of in the definition. The Egyptians I was around seemed to differentiate between meat and chicken. While at dinner, our friend asked Amira if she felt like eating meat or chicken. I think we need to review the definition of meat with our friends.

Anyways, here are some yummy traditional things I just had to try.

Kushari: noodles, rice, black lentils, chickpeas, fried onions and tomatoes. A bit basic tasting but good for the westerner's palate since there aren't any out of the ordinary spices involved.

Molokhiyya: its an oddly sticky soup made up of a leafy green (that isn't spinach). I really don't know why its oddly slimy and was honestly too afraid to ask.

Ful: Flava beans with lemon and tahini and oil and spices. Really yummy and mostly had as breakfast with....

Egyptian bread: there were two kinds we ate most of the time
 -- A'aish baladi: its like a pocket of bread. Its made of wholemeal and plain flour and leavens to form a pocket with a soft crust. You can see them being baked on an open flame in the streets.
-- A'aish shammy is kind of like the Egyptians version of a tortilla but made with plain flour and the two layers can be separated.

And now for the sugar overload:

Couscous with milk: This was served in a dish filled to the brim with couscous, topped with a bunch of sugar and served with a bag full of hot milk that you had to manage to open and pour on the couscous in the already full dish without making a complete mess in your new friend's car. I succeeded and it was sweat success....literally. Pretty delicious!

Zalabya covered in white chocolate: Tiny fried dough balls covered in white chocolate. Need I say more.

Peanut butter and chocolate drink made with a sugar milk mix they drink during Ramadan. It was so think and so sweet and really was an overkill for that particular day of eating.

Omm Ali: My favorite of all! Layers of fiteer pastry with nuts and raisins, soaked in cream and milk, and baked in the oven. SO. GOOD. I had three in the time I was there. Two in one day. I'm sure each had 8000 calories.

Number one.

Number two for one day.

I brought home a bunch of Egyptian treats that included kunafa and baklava.

Our coffee at the summer place was a packet mixed with coffee, sugar and milk powder....it was already ridiculously sweet and Amira's boyfriend still always added a few spoons of sugar......


Apparently the Egyptians also really love their meat. Amira's boyfriend would have barbecued every night for me if that had been something I wanted.

All in all, I'm sure all those yummy things are working their way into my thighs and hips.....and it was totally worth it!

I had a pretty fun time at work this past week. I'll post about it tomorrow!

Stay healthy! (That seems rather hypocritical after this post)

V

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.

...........................................

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. 

...........................................

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