Week 38: Live. Laugh. Love.

It was a bit of a crazy week last week. 

At work: I spent a lot of my time taking care of patients by myself this week. I don't remember having any longer periods of time were I wasn't actively doing something. My work involved doing the admission work for new patients. I'd take their history, physically exam them and then usually proceed with a list of things: accessing the port, drawing blood cultures, drawing routine labs and starting fluids or antibiotics. I also tried to fill out the orders as much as I could by myself. Much of Thursday afternoon and Friday morning were spent writing release letters.

Monday, I was assigned a patient and had to do the whole run down, including a bone marrow puncture! I was a bit nervous considering how the last time went. After successfully accessing the port, I felt a bit more confident. The elective student came and watched me do the puncture. So not only did I have to prove myself to my doctor that looked on but also had to perform well for the student. It...went....fabulously! It was so perfect. We got what we needed, no complications and I did a happy dance in my head! My doctor was rather relieved too. 
 

The face you make when EVERYTHING on your to do list works....including bone marrow puncture!

I felt like I bonded more with my colleagues over the past week. I was not a happy camper Thursday...not at all actually. The night before, I met up with some of the urologists for a scrumdelicious dinner and wine. I really only wanted to drink a glass of wine but the three guys kept pouring more....I was already hard core babysitting my drink but it wasn't doing much for my cause. The boys had their fun teasing me....seems to be a common theme of our meetings. I can handle it though and have my fun with it too. Before we all knew it, it as almost midnight! My brother was hitch hiking from Prague to my town. He didn't have a cell phone, so I couldn't call him and didn't know exactly when he would arrive. The doorbell finally rang around 2A.M. I had enough energy to let him in, give him a towel so that he could shower and told him he could make himself breakfast in the morning before heading out again. I was back in bed and my alarm clock went off 4 hours later.

Usually I do alright with sleep deprivation (I've had quite a bit of training with my night shifts) and this time I also wasn't really tired all day but I was in a terrible mood! I had reflux due to the wine. Everything and anything annoyed me. When I get agitated, I become really quite because I don't want to snap on anyone. At work, I was really quite and went about my business. When I was assigned writing release letters, I had to stop myself from complaining about such a normal task. For some reason, my colleagues at work decided to continue with the teasing my urology friends had done the night before. I took it in more or less silence and tried not to snap. It was a rough day at work for me but I managed to keep it together. After work, I wanted nothing more than to be in my bed. When I got to the train station and found out my train had a 50 minute delay, I really was on the verge of punching a wall and screaming.....I decided not to do that though because I was afraid they'd admit me into psych. Instead, I went to the department store near by and cooled off, bought a bag of candy and browsed clothes. It helped and I spent the last 20 minutes reading my book back at the train station. I was very happy to be in bed that night.

I took Tuesday off. My best friend from medical school got married yesterday. I made a stop in the lab Tuesday morning to get an introduction lesson for the new camera we got. It felt like Christmas! Much better quality! They also replaced the old, fat backed computers with a nice big flat screen one. I'm excited to get some work done with the new system. I just need to practice a bit more so things go quicker. 

Afterwards, my friend and I drove to pick up her wedding dress. She looked absolutely stunning in the last fitting. It got me really excited for the weekend. We headed to the church afterwards and rearranged the interior and raked leaves in front of the church. We proceeded to work off a bunch of things off of the to-do list. As her Maid of Honor, it as my top priority to do everything she needed done and to her liking. 

This past weekend, it was finally time for her to say "I do" in the church. It was such a fun weekend filled with great moments, laughs, tears of joy, dancing, eating, taking pictures, meeting family and friends and doing everything she needed me to do so that her wedding was exactly how she hoped it would be. I've known her since day one of med school. We weren't best friends immediately but always had the same circle of friends. In the second year of school is when we really found each other and have shared many experiences ever since. I was with her the day she met her husband, I was the one who went with her to an island to meet up with him and his friend which was a weekend that showed me that this thing was serious. I'm honored she chose me to be a part of her wedding as her maid of honor. Med school can be grueling and she and I really went through the good and the bad together. I'm so very happy for her that she found her partner for life a few months before ending med school and that I was around to witness it all!

Always have her back

The happy couple

My best and favorite med school girls!

Uh-oh, I caught the bouquet!

I have one more week of hematology and oncology left. That was quite shocking for my doctor to hear. When the attending asked me if I'd be around next week and I said it would be my last week in the department, the doctor stopped what he was doing, spun around in his chair and looked at us and said, "You're lying". I wasn't but his reaction made me feel good because he sounded disappointed which means it couldn't have been too horrible having me around. 

Stay healthy everyone!

V

Week 37: Cancer's many faces, Berlin's many masks and my many impressions

What an interesting week I had. I spent three days throughout the week shadowing the chief. 

After the morning meetings, I would go to the private ward with him and see the patients he was taking care of. At 10, we'd go over to the office building for consultations until about 1:30pm. 

It was interesting because I was able to experience patients in all the different stages of cancer that exist. Being in the room for the moment someone is told they have cancer is a weird feeling. Especially, if you know the person has cancer before they come into the room and you we waiting in anticipation for the doctor to tell them. Doctors have a difficult task of conveying the message appropriately. You need to use the right words, in the right order and on the level of the patients understanding so that they really come to understand what their diagnosis means. As soon as the patient hears the word cancer, everything after that is usually not being registered. It's also a tough task because not every cancer is the same. If patients haven't had contact to cancer patients, they usually assume the worst outcome. If they have had cases of cancer in their family or circle of friends, they only know that specific case. But cancer is so different and personal to each person. Breast cancer is treated completely different than colon cancer. The outcomes and prognoses are different. The journey through treatment is different. Even one type of cancer, breast cancer for instance, varies a lot between patients in respect to treatment, outcome and journey. Some are hormone or genetically sensitive to treatment, others aren't. It is important to give the patient a sense of were they stand. At the same time, statistics are statistics and don't really have a meaning for the individual. We can only say how long most patients live statistically, but in the case for a specific person, that really isn't relevant. Most patients want it to be though and ask about statistics. As a doctor, we walk a thin line between giving false hope and real hope. Even if we articulate an appropriate amount of hope, it is received and interpreted by patients differently so we have to see if that which we were trying to convey, was registered correctly. 

I few things I noticed over the week were:

A) Many patients try to attribute a certain life event to their cancer. "I fell a few weeks ago and hurt my shoulder, can that be the origin of my sarcoma?" (It can't.)

B) Patients that are married seem to handle it all better. (This was actually proven in a study.)

C) If the patient with cancer is the husband, the wife does most of the talking. "He's been taking these and these pills. He's been doing so and so with the treatment. His next appointment is then and then." Probably why point B stands.

D) A few couples would say "we" have this or that appointment coming up. "We've" handled the treatment this way. It really shows how much cancer doesn't just affect the person with it but also the loved ones going through it.

E) In general, patients with a worse prognosis seems to take everything a lot harder (understandable) but that isn't always the case and the attitude of the patient has a lot to do with their support system and their view of the rest of their life. Some are quite inspirational. 

F) Quite a few patients live with their cancer as though it is a chronic disease. I think that is still a fairly new concept for people. Medicine has gotten so good that even if we can't cure you completely of your cancer, we can, in some cases, push it back so far that your life expectancy is about the same as without cancer, it just involves taking a pill everyday. And as with any pill you take, you have the risk of side effects. 

Chief surprised us in the afternoon meeting with 3 scoops of ice cream for each person!

I think the chief really enjoyed having me around, explaining things to me and letting me do the ultra sounds before he did them to confirm my findings. I think he also appreciated that I know how to politely deal with people. I think there is just a certain way you have to act if you are working with the chief because the patients have certain expectations when they come to consultations with the chief and it can't hurt to be greeted and escorted to the room by a friendly student. (And I'm also friendly to all the other patients too so it isn't like I'm trying to be any different than usual which makes it easy for me.)

Back on the ward, I finally got to do a bone marrow aspiration! It didn't go as smoothly as I had hoped it would but no unexpected harm was done and we got the material we needed so all good in the end. I just wish for myself that it had gone better but it was my first time so I guess it went well. I didn't accidentally go through the other side and do a colon biopsy (which as funny as that may sound, was my greatest fear, even worse, puncture a big vessel.) 

A good idea of what I did.    Google Images.

I'd also like to tell you about a situation with a patient because I think it is a good example that just because medicine is capable with doing things, it mustn't always be done if discussed openly with the patient. 

The patient has cancer. He's gone through chemo and was taking pills as the last option of treatment. The pills statistically could make him live a couple of months longer. While taking the pills, he suffered from gastrointestinal side effects and they left him not enjoying food anymore. He just didn't feel good in general under the therapy with the pills. He decided to take a break from the pills knowing that would statistically lower his life expectancy. As we talked with him, his wife, daughter and two grandchildren were in the room. He looked as though he was a normal old man enjoying his time with his family but you wouldn't have been able to tell he has cancer. After openly discussing with him the statistical benefits weighed against the reality of how he felt taking them, we all agreed that it would be better to take a break from the pills for the time being. If need be, he could always start them again. In his situation, I would have done the exact same thing. He weighed being under treatment and feeling bad, not enjoying life with feeling good, being able to enjoy life and statistically maybe living a few months less. But isn't a life you enjoy living and your loved ones can enjoy with you worth more than being able to say you lived a few months longer but weren't able to enjoy that time? It is a highly personal decision a person has to make for themselves. I thought it was a nice conversation to have witnessed. The doctor didn't push the medicine because of statistics but rather treated the patient as a whole and not as a disease that needs to be cured.

Similar situations happened during consultations. There was one situation though, were I as the patient, would have decided differently. The woman has cancer. Due to a certain factor she "luckily" has positive in her type of cancer, there is a pill that works highly specific and targets the caner cells which gives her a significant statistical advantage for survival over not taking them. The common side effects are also easily manageable. She decided she was done with medicine and was not going to go through with the therapy. This was rather baffling to me (especially with her medical professional background) and the chief was also not for her decision. Seeing that Germany is a free country and we can't force anyone to do anything (and our mentality isn't such that we would) the chief explained the benefits to her multiple times in the hopes that she might see the benefit and change her mind. After repeated attempts, he told her that his suggestion for treatment stands and that he wasn't going to change his recommendation but that he had to respect her decision even if he doesn't agree. I can live with situations like this when the patient is an adult and has understood the consequences. I have issues when these situations happen with children and their parents are the decision makers. Many things, if need be, can be done with a court order. Other situations, such as vaccinations, are a different thing. A big reason why pediatric medicine, although lovely on so many fabulous levels, will probably not be the area I work in. 

That was my rather interesting week in Hem/Onc. Two more weeks to go. The chief is on vacation the next two weeks and starting Monday we have an elective student in the department. I'll take over mentoring her a bit to see where she stands with drawing blood, placing lines and such.

Now a little travel report for those that are interested. :)

I spent the last weekend showing my friend from Miami a bit of Germany. We met up in Hamburg on Friday. Took the train to Berlin Saturday morning and both left Berlin Sunday evening. 

Christopher Street Day was going on in Hamburg. There were booths with drinks, food, tightly dressed men, rainbows and loud music all around. We took a stroll through all the festivities. The big department store Alsterhaus and the town hall both had pride flags displayed. I thought it was an incredibly cool symbol from the city to show support for the event. Germany in general is a very accepting country. Many might not associate that with Germany right away due to its history but we have acknowledged our past and dealt/are dealing with it. Nowadays, I feel it is one of the most accepting countries I've been in.

East Side Gallery shenanigans. Berlin

If you are in Hamburg, are starving and can't decide what you want to eat but just want a good variety of food immediately without having to look for a restaurant first, I suggest going to the LeBuffet on the 6th floor of the Alsterhaus. It has a buffet with a wide variety of food at a good price and a view on the water!

If you are in Berlin and want some really delicious Arabic food, you must go to Casalot (Claire-Waldoff-Strasse 5)....SO delicious and the presentation of the food is also outstanding. The service is very friendly and the place offers a lot of outdoor seating.

Pretty gelato flowers from Amorino

A restaurant I wouldn't suggest going to is DIE EINS (Wilhelmstraße 67A, 10117 Berlin). I hate to give a bad review but this place can easily be a tourist trap. It has a very nice location right on the river, around the corner from the Brandenburger Gate and a hop, skip and a jump away from parliament. My friend and I were just so starving that we sat down. Before even ordering I had a feeling the place relied highly on its location and could therefore care less about the food or its presentation. I ordered something of the breakfast menu (seeing our breakfast to that point had been a felafel, coffee and half a KIND bar). Granola with milk, quark (its German, think of thick yogurt) with berries and honey, fruit salad and fresh squeezed orange juice. That sounded really good to me and I could think of multiple ways of presenting that nicely. In reality, I was served a bowl of cornflakes with a few walnuts of top (how fancy), the quark was basically runny yogurt with jam in it, the fruit salad contained many broken grapes and in general was not that appealing. The fresh squeezed orange juice was 100ml....didn't feel like much more than a shot. It was just bad. I easily could have made a better meal at home for far less. My friends omelet and salad didn't look or taste half as appealing as the menu made it out to be. So if you aren't starving, avoid this place and go down a few streets for something nicer. 

Some fun in a store that encourages taking pictures: maskworld.com Store Berlin

Saturday evening, we stumbled upon the Monbijou Theater Strand Bar dance event. Every day of the week, they have a different DJ playing music and a dance floor set up right next to the river. You can get drinks and order Pizza and it is just such a lovely atmosphere in a lovely part of town. We sat down for a good long while and watched the couples glide across the dance floor. I seriously need to take my grandma up on her offer to pay for dance lessons to learn the standard dances and then I have to get my booty out on that dance floor someday! 

We did a Free Walking Tour of Berlin on Sunday. It takes about 2.5 hours and its great! While back packing through Europe, my travel buddy and I would often partake in them. The tour guides have always been fun and were really enthusiastic about it. They don't give you boring facts and move on, the stuff they talk about is interesting and explained well. A great part about it, and their business model, is that it is absolutely free and the tour guides work on a tips basis only. This makes it easier for students who might not be able to afford as much to decide what the tour was worth to them. If I had the extra funds, I'd probably be giving them double what I do because I always enjoy the walk so much. Great way to see the important things in the city if you have limited time. 

That is all for now my friends! Stay healthy!

V

Week 35/36: I want to be a part of it! NY, NY!!

(If you only want medical info and want to skip the travel talk, scroll down to that)

TRAVEL:

Start spreading the news! I want to wake up in the city that never sleeps!

Some famous lines from the song "New York, New York". Also the song that I had playing while I boarded the plane from Frankfurt to New York City. I left thinking that this week would be much like last years week. I should have known better than to be so naive. It is New York City after all. 

I woke up at 5am in Germany although my train to Frankfurt didn't leave until 8:17. I figured it would make me a bit tired and I could get a nap in on the plane. The great in flight entertainment system Delta provided didn't leave me much opportunity. I watched Get Hard (funny movie, especially if you are a fan of Kevin Hart and Will Ferrel), The Second Best Exotic Marigold Hotel (I loved the first one and the second one did not disappoint) and finally, as a way of getting into the right mood, I watched Breakfast at Tiffany's. I've always liked that movie and often saw certain aspects of Holly Golightly in myself. Quotes from the movie also ended up being the title to most of my Instagram shots (@svikkivmh ; in case you don't follow me yet and would like to). 

I was in the city for a convention to assist my agent/boss/one of my dearest friends. She wasn't arriving until the next day however. Being chronically broke and always looking for a good deal, I booked a bed in a hostel out in New Jersesy's Union City. It took me a good 1.5 hours to get there. I had made arrangements to go out on the town with DJ Spade (a friend of friends of mine). Before hand, I walked to the Best Buy a mile away to charge my SIM card for my phone. I honestly felt less comfortable walking the streets of Jersey in the dusk than I have walking the streets of other places. I don't know why that is. I'm sure they are all lovely people there. I just wasn't really sure how safe or unsafe the neighborhood was. I generally believe in the goodness in people and know that the houses are filled with hard working loving families. I passed a few graduation parties with loud Spanish music playing. I was tempted to go congratulate the grad and see if I could get some yummy food. I thought it best to not interrupt however and continued on my way. I made it to Best Buy and back just before it was completely dark out. I wasn't sure what time I'd need to be back in the city so I just got ready and waited. Eventually I made my way back into the city and hung out in Time Square people watching until DJ Spade picked me up and we left for the club. You can really have a quite entertaining time watching people in time square. Revlon has an ad playing that included a camera zooming into the crowd and taking a snapshot. Of course, everyone tried to be in the focus of the shot. What made me laugh was that they ALL had their camera phones in front of their faces, so really, all you saw was the phones. It amazed me that they didn't catch on to just have the picture taken of their faces and then take a picture of the giant screen displaying the picture for about 15 seconds. Seriously people, learn to enjoy a moment and don't constantly document every second of your life. 

The night out was fun, the way home showed me just about how cheap I am and was a funny learning experience. I won't go into as much depth on the other days (this is a medical blog after all and it would be way too long and I don't think any one actually cares to hear it all) but the story of how I got home is one to learn from. 

When I booked my hostel for the night, I made sure to see if the buses would be running throughout the night. I picked a random time around 3am and saw that a bus did in fact run. I stupidly just assumed that meant they ran all night long. Unfortunately, I had just coincidentally looked up the last bus of the night. I also assumed the New York crowd partied until 5am as they do in Miami (at least that's when the clubs close....and then you proceed to 24 hour clubs like E11even). However, the lights went on at 4AM in the club we were at. My phone was at about 20% battery. I looked up the next bus and found no specific suggestions leaving Port Authority at 6AM. I wasn't about to make anyone drive me over to Jersey. I hung outside the club with DJ and his friends for a bit. Then DJ and I went back to Time Square to take some pictures. 

The place was basically empty. Total contrast to a few hours before. That all only went on until about 5:15. Port Authority wasn't opening its doors until 6. I decided 45 minutes wasn't a terrible wait. I had DJ drop me off in front of the station. I quickly decided the crowd might not be the best to hang around at that time of the day. Across the street was a 24 hour Duane Read store. I decided to get some band aids for my blistered feet and some coconut water. I'm a people person (most of the time), and figured I could use that to help me have a safe haven while I waited for the bus station to open. I just simply chatted up the cashier who didn't seem to mind. Another employee joined in on the conversation. For a second I thought the security guy was going to ask me to leave, but he just joined the conversation as well. It's fun to see what happens at a Duane Reade at 5:30 in the morning in NYC. I even helped a customer find mentos (might as well put me to work if I'm staying). At the end of the 45 minute conversation, I shook everyone's hand, thanked them for their hospitality and walked over to the bus station. At this point I had left the club about 2 hours ago and my phone only had 3% left.

I've had the great opportunity to have traveled quite a bit in my life so far. Nowhere, in the places I've been, has a public transportation location bin as horrific in navigating as Port Authority New York City has been. The gates are different than the buses, their isn't a proper way of searching for connections, sure they have huge electronic interactive screens supposedly their to help but if my 25-year-old rather tech savvy self can't figure it out, how should anyone from an older generation have any luck. I had just enough juice on my phone to look up the next connection but with no gate number. The next bus wasn't leaving until 6:40AM and it held a half a mile from my hostel. The one that would've been closer left 20 minutes later. I wasn't about to wait even longer, especially when I can walk that half a mile within those 20 min. I found the gate by looking at various posters since the larger than life iPad they had standing there wasn't doing the trick. I waited in the line until the bus came. 

Once I got to Jersey, it was bright out, the streets were empty and the side walks looked clean enough for me to take my shoes off and walk to my hostel. I did precisely that. I arrived at my hostel at 7:10AM, left the club 3 hours and 10 minutes prior, had 1% left on my phone and really only saved $8 in the process compared to the cheapest hotel in Manhattan. So yea, I learned from that. I never got angry along the way. I knew I'd eventually make it and didn't have an appointment until 12 o'clock check out the next day. 

I only slept 2 hours before getting my stuff packed up and heading back to Manhattan. I met up with a friend of mine for a well needed brunch at Tick-Tock. I met Bob as a 15 year old on my trip to NYC 10 years prior and we have always stayed in touch. Afterwards, I met up with my friend who had made it to NYC. The rest of the day was spent getting some work done and a little cocktail party that night. By the time I made it to bed, I was up for almost 48 hours with only about 4 hours of sleep in between. Needless to say, I slept like a rock.

The rest of the week was filled with so many endless wonderful conversations with people we've known and a few new ones. Work was fun and I absolutely loved every minute of the week. People can be such great creatures. Especially when they are generous and kind and expect nothing in return but your presence and conversation. I didn't see much of the city itself because we spent a lot of time in the hotel for work. We made it down to the new World Trade Center and walked up through TriBeCa and SoHo one day. 

I spent Saturday morning with someone I met at the beginning of the week, taking pictures and visiting the zoo. 

I also met up with a friend from my home town. She was a senior in high school when I was a freshman. We just bonded over the years and would always meet up when I was in New York. She is a very kind soul and I'm glad I got to see her again. 

Needless to say, after the high of happiness I was on throughout the whole week, it was not easy getting on that flight back to Germany. But it had to be done. 

Some of my favorite spots in NYC when I did actually leave the hotel were:

Pazza Notte (1375 6th Ave, New York, NY 10019): Italian restaurant a block away from the Hilton Midtown we were at. Delicious food, the funghi risotto is to die for! And the prices are not insane for New York midtown standards. My coworkers also really enjoyed the all-the-time 2-for-1 martinis and 2-for-1 wine happy hour. 

Ray's Pizza (multiple throughout the city): a New York classic and my late night stop before heading to time square.

Tao Downtown (92 Ninth Ave, New York, NY 10011): we went here with a bunch of people for a fabulous dinner. It's not the cheapest place but a pretty cool one! The restaurant is ginormous and the interior design is great! The sushi looked fantastic and even vegetarians had plenty to eat :) 

Names&Faces (159 W 54th St, New York, NY 10019): a bar that is a regular hang out spot for all that attend the convention. It has some really neat artwork of famous actors hanging on the walls. Might not be as poppin as it is every week like the week the convention happens but it seems that during this week, I can always find at least one familiar face in this place. 

Tick Tock Diner NY (481 8th Ave, New York, NY 10001): fun colorful interior design and a yummy brunch menu!

New York, I can not wait to return!

Quick update on my dog Toby: he is back to being his old self. Seems as though he may have eaten something rotten and combined with the extreme heat, deteriorated quickly. Thank you a million times over to my parents for rescuing him! 

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MEDICAL:

So now to my first week in hematology and oncology. 

I think I've mentioned this before, but I always feel that the first day in a new department is a little awkward. I get along with people so quickly and feel so comfortable quicker than most that I get impatient for the people to get to know me enough to feel comfortable enough to joke around with me. It took about three days until the doctors started to feel comfortable to make jokes. In the mean time, I felt a bit out of place the first day. A) I was still adjusting from my high from New York B) Monday's are usually the most hectic were everyone is running around organizing things and not really keen on having a new person to deal with and C) I was tired still trying to catch up on sleep from my rather sleepless last week. Neither of the doctors felt completely responsible for teaching me. I just looked for productive things to do. There was supposedly a shortage in nursing staff so they left the blood drawing to us students. I was not too amused but I figured it was a good way of getting to know the patients and I might as well be doing something rather than standing around. The doctor promised that I would be allowed to perform a bone marrow aspiration while I was there. I assisted a few throughout the week. 

The bags under my eyes are Chanel.

I spent the first three days on the ward helping out the doctors with blood draws, admission examinations and random things. On day two, the doctors were sharing their chocolate with me (always a good sign in my book) and by day three, they were cracking jokes and calling me Viky. I think that's fairly good progress and we should be just fine the coming three weeks. 

Today, I went on rounds with the chief to see the privately insured patients. Afterwards, we spent the rest of the day with consultations. It was an interesting day for me. I was able to see various types of cancers in various progressions and witness different stages of the process of going through cancer, from the moment the patient is informed they have cancer, to the start, middle and end of treatment and the end stage were the patient will die in the foreseeable future. It was interesting to see how every person dealt differently with the situation. Most however, were understandably worried and frightened and looked for a reason for their cancer. Many cancers can be explained by someone smoking or drinking alcohol or work exposure, others however, and those are the ones that are really unfair, are the ones that happen to people that lived a healthy life, were never seriously ill and then out of the blue develop cancer. Due to our ever aging population, cancer is a disease of old age and in many cases a chronic illnesses for patients. Due to medical advancements, patients are living longer and sometimes have two, three or even four different cancers simultaneously. It's sometimes hard to explain to a patient that although we can't cure them of their cancer, we can treat it to an extend that it is like having a chronic illness that needs to be treated for the rest of their life but only somewhat limits their normal life. This is sadly not always the case and some cancers have better prognoses than others. Then again, there are some cancers that can in fact be completely cured. Cancer is an ugly thing but it is to some extend the price we pay for living longer or in some cases the price we pay for certain life choices. You only have one life and one body, decide wisely what you do to it and if you are willing to live with the consequences. 

I'll be in the department for a total of four weeks. My main goal is to perform a few bone marrow aspirations and biopsies myself. According to the doctor, this is a doable goal. I'll believe it once I've done it. 

Stay tuned and stay healthy!

V

Week 34: I'm going to start riding a camel to work.

This week has proven that certain transportation modes and I just don't work together very well.

Monday after work, at a time that I was already tired anyways, I crashed with my bike. 

Over the last few years, I've really had mixed feelings about my bikes. On the one hand, they got me where I needed to go and that was their greatest asset. I never spent a lot of money on any kind of nice bike. If it had been made out of wood with wood wheels but got me to where I needed to go, I would've taken it! For some reason, my tires on average are more flat than the tires of my friends. I even invested in what was supposed to be un-flatable tires. It only took a few weeks before that statement proved to be false. If it is the front tire, I'll change it myself before paying 20€ to have a repair shop do it. If its the back tire, I'm at a loss due to lack of tools. 

So one of he two bikes I currently have is out of business due to the very well flat "un-flatable" tire. The other issue that I often have is the dang chain popping off. I live in Europe. Europe has a LOT of cobble stone streets. My main campus grounds is covered in small, irregular blocks of stone. Riding over them gives you a whole body massage. Since I now always ride my bike to and from the train station, I have found a route with the least amount of bumps to prevent the chain from jumping off. 

Monday however, I had to stop by the financial bureau to drop off a letter and took an alternative route (still rather bumpless). While turning around the corner, my chain came off, I lost balance and fell half onto the road and half onto the side walk. While I was going down, I had flash backs of times when I was a kid and would fall on gravel and completely damage my hands. Luckily, that wasn't the case. I did hit my elbow pretty hard and now also have 3 lovely big bruises on my legs. The next day at work, I just strapped an ice bag around my elbow and continued on as always. 

This picture doesn't capture all the shades of blue actually going on here

The German train system has also been getting on my nerves. Besides all their strikes that they've done in the time Ive needed to take the train on a daily basis, this week they annoyed me in particular. Tuesdays and Fridays are the two days in the week that I could potentially be home earlier than 6pm. On both days this week, the trains were delayed by 1 hour for different reasons. So in the end, I still got home late and sat around the train station for an hour.

In conclusion, I've decided a camel might be the better transportation method for me. 

On a more medical note, this past week I spent some time evaluating EKGs. I can at least recognize the more common disorders. My doctor even let me analyze a 24 hour EKG on my own. The rest of the time was spent doing rounds and helping the elective student draw blood. He has improved a lot in the last week. Thursday, he didn't even come to get me for help with the 13 or so patients he had to draw blood from. Friday, he came and got me on special request from one of the male patients. I'm happy for the student that he has gotten so good so quickly. It also gives me a great feeling when I am able to help him with patients he is having trouble with and I draw blood fairly easy. Not because it makes me feel superior to him, but because it shows that the experiences I've gathered over the years I've studied more than him have obviously been beneficial. 

Other than that, the week flew by rather quickly again. My after work hours were filled with visiting family, helping family and packing. 

Yesterday after work was no joke. I received a message from my mom that my dog (13 year old golden retriever) wasn't doing well. Toby is a family member who has been a part of half of my life. He was extremely weak. While my mom was telling me this, I was stuck waiting at the train station on the dang late running train, my phone was almost empty and I had no good Internet connection to FaceTime my mom. It was all very frustrating and as soon as I was back in my town, I sped home with my bike (the chain popped off when I arrived on my parking lot but I didn't care to put it back on). My mom took him to the vet to get some fluids in him. He stayed a few hours before my mom picked him up and brought him home. 

Living on the other side of the world from your immediate family can be tough. I chose it so in the end, you could say its my fault. Although, had I stayed in the states, I could still easily be 10 hours travel time away. The point is, that its hard sometimes. Due to FaceTime, skype, whatsapp and all the other things, I am in frequent contact with my parents and siblings. The one family member I have missed most over the years has been my dog Toby. He doesn't understand Skype. It confuses him to hear my voice but not smell me. Every time I come home, its a ritual for my mom or sister to pull out their cameras and record what ensues when he realizes that I'm home. He makes a really excited whiney noise and it melts my heart every time. So sitting in Germany and not being able to hold him when he is feeling so bad or taking him to the vet myself is hard. He couldn't be in better care than with my mom though. I'm so happy that I have great people around him. 

My sister wasn't feeling so great this week either. Again, a case were I would have liked to be there in person but managed via various channels of communication. 

Its hard, but I make it work as best as I can. On the bright side, having lived in Germany the past 6 years has given me the opportunity to see a whole lot more of my relatives and experience great memories with them. I will miss them all very much when I move back to the states at the end of the year.

I'm aware this post wasn't very medical. But this week, my main focus wasn't on my job, it was on my family. Most of my brain power (when not being used to do my job) was spent on my family and how I can help them. 

I fly to the states for a week today (not to my family sadly but to a place to see friends and work) . I'll report on that next week!

Stay healthy (Because health is one of the most important things in life)

V

Week 33: No, I'm not a junkie, I'm a medical student.

No, I'm not a junkie. Yes, I know my arms look like I might be. 

It was another fast week in the hospital. This was mostly due to me cramming my days full with things to do after work.

At work, I sacrificed my beautiful veins for the greater good of our elective student's education again. This time he successfully placed a line on my right arm, tried drawing blood from my right hand but the vein busted and then successfully drew blood from my left elbow. A few days later, a couple of nursing students were being told how to theoretically draw blood with their supervisor until I interrupted and motivated a few men to let them practice drawing blood on their veins and mine. Medicine is a team sport. It's way less nerve wrecking to draw blood from someone with good veins and who offers and can handle you drawing blood slowly than going to an elderly patient with terrible veins and being expected to make it work on the first try. The chief found out about my little event and was rather impressed/amazed by the whole thing. 

The elective student started drawing the blood instead of the nurses so that he could practice. Often, he would come get me to come help him out. In all cases but one, I was able to help him. There was one patient we spent quite some time with. The student came and got me and upon entering the patients room, introduced me as the expert. The male patient turned around, looked at me and exclaimed, "and a beautiful expert at that!" Lol. Elderly men are so uncensored. I kindly smiled and proceeded to try to draw blood. Apparently, looks are no measure for blood drawing skills. The student had already tried one of the patient's best veins so I didn't have that one to use. Multiple attempts with all my tricks in the bag weren't successful (I refrained from asking the patient to take off his shoes so I could try from his feet.....although it wouldn't have been the first time for me). The nurse that is usually responsible for drawing blood came and was successful. 

Other than drawing blood and having blood drawn, we did our usual rounds. I did the admission history taking and physical examinations for our new patients. The rest of the time was spent reading up on cardiology. 

I went to my friends bridal dress fitting with her on Wednesday. She looks amazing and I am so excited for the wedding next month! 

So many dresses!

I spent Thursday evening in the lab. We are getting a new camera installed next week. Supposedly it'll have 4x the resolution. Exciting! .....no seriously, that really excites me. I'm a nerd. I know. 

Friday, I left work and took the train to Hamburg. One of my colleagues from the urology department invited me to his alma mater's graduation ball. Saturday morning, I met up with a friend for brunch before exploring Hamburg a bit with the urologist and then attending the ball at night. It was so much fun! I knew no one except the guy I went with and two of his friends. I ended up meeting some really fun people and had great conversations. Sunday, I stopped by my grandma's for a few hours.

5k run along the Elbe in Hamburg

Ready for the ball!

Flowers & Bubbly

One more week of cardiology ahead of me and then it's a week of vacation! 

Stay healthy!

V

Week 32: "Don't go breaking my heart." "I couldn't if I tried....ok, I probably could but I'm trying really hard not too!"

Oh lordy its hot! Summer has finally arrived in Germany. Its about time but it also sort of came out of the blue and our circulatory systems had no time to prepare.  Speaking of circulatory system, I finished my first week in cardiology!

We received our rotation schedule on Monday. I'll be in cardiology then haematology/oncology then gastroenterology/general medicine and in the end pneumology. Each for 4 weeks. 

I was told to go to the ward and that a doctor would be there waiting for me. My doctor is actually a general surgeon but since he wants to start working in a practice, he needs to do 1.5 years of internal medicine. He has only been in the department for a few weeks. I think its actually pretty cool that I'm working with him because he also has to look up things and can explain the basics really well since he just recently reviewed them. He is also interested in me learning something while I'm there so he asks good questions during rounds that get me thinking. The other residents are also very nice and if they have an interesting ECG or patient case, they'll ask me to take a look. 

The big differences to being in internal medicine and not surgery anymore have so far been:

-I've used my stethoscope more times in the last 5 days than I have in the last 32 weeks. It is hangs out around my neck more than it does in my lab coat pocket.

-Rounds take FOREVER! Every morning is easily spent exclusively on rounds. Three to four hour rounds are the norm. My back and feet were not used to that the first few days. 

-Patients go on forever with their stories. We had the odd talker as a patient in surgery as well but most issues in surgery were rather clear on how they would be handled and usually surgery was the cure. There weren't a lot of followup questions there. In internal medicine, each person's story is long, their list of complaints many and the treatment is often with medications that take their time to start working and are taken for a life time. Many of the internal medicine patients, if not almost all of them, are multimorbid. This meaning they don't just have one chronic illness but a combination of many. This of course makes treating patients more difficult and requires a good sense of pharmacology since one drug used to treat illness A might not react well with a drug to treat illness B. 

-The average age of patients seems to lie in their 70/80's.

The department meeting starts at 12:15 and goes on for about 20 minutes. Afterwards, we all head to the cafeteria for lunch.

After lunch, the doctors are usually busy writing release letters and I take to my 3 medical text books and read up on cardiology. There is way more potential for learning in internal medicine than there is in surgery. I also really want to learn as much as possible while I'm in my internal rotation. So I'll read a section about heart murmurs for example and then go to the patient that I know has an aortic valve stenosis and listen to it. There are also various tests happening with patients after lunch like stress tests, so I go look at those in between.

Wednesday, an elective student started in the department. It's his first elective. He'll be starting his 7th semester soon. It is like having a living/walking/talking/breathing-reality check hanging out with you. He hasn't had cardiology in school yet so when he asks questions, we all have to remember that he hasn't heard the things we assume he already knows and we can add on to. Its really convenient for me because I get to explain things as if I was in my practical exam and had to explain something to the professor. I have to understand what I'm saying before I can teach it to someone else. It also gives me feed back on how much I've learned over the years.

I sat down with him and explained different heart murmurs, how they develop and where on the chest they are heard best. He told me he had never placed a line. I showed him how its done on one patient and then he got to try it out on me. (During med school, I was the genuine pig for my friends and had 7 puncture marks on my arms at once.) I supervised a few of his attempts on patients. He also came and got me to help him with patients where he was having trouble drawing blood. I loved being a TA in med school and teaching students so I enjoy being able to be one of the first people to explain things to him and then take him to patients so that he can hear things we discussed earlier. 

I really like the residents I work with. Three guys and all rather funny. The hobby-internist (my doctor) really is a surgeon at heart. Surgeons sense of humor is just more similar to mine. Three of the four attendings are women. I think that is great for women and shows an active movement towards more women in higher positions. For me personally, they all don't really seem like people I would become friends with. I think our personalities are too different. Obviously I am not in the hospital to become friends with the attendings but I feel it sets the atmosphere at work differently when you get along with attendings on a personality level.

I already had a good 1st week where I tried to learn as much as possible and hope to add on to that the next few weeks.

I left the hospital early twice this past week because either the lecture was done early or the doctors let me leave but not in time for me to catch the next train. I finally used the opportunity to look at some other parts of Hildesheim. If you leave the straight shot path from the train station to the hospital, you can see beautiful things. People have often told me that Hildesheim is beautiful but I couldn't really confirm that notion from my usually walking path. Now I am totally convinced as well. I'm sure there is a lot more to see and I will try to explore more if time allows!

The rose bush on the back building is the famous 1000-year old rose bush of Hildesheim

This weekend was so hot I could hardly function. I was in the lab Friday night until 9:30pm and was still sweating. I decided I would probably melt away if I went to the lab Saturday morning, so instead, I went to the library that has AC and sorted the pictures I have taken so far for my doctoral thesis. After the library session, I headed to the pool with two girl friends and attempted to lower our body temperature.

Happy 4th of July to all my American friends! 

Stay healthy!

V