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

Week 31: I guess no more standing elbow deep in someone's abdomen for awhile for me. Surgery rotation completed.

Another week and another rotation over.

That was it for surgery and that was it for the ER for now. I'm a bit sad about it actually. My doctor and I were a pretty good team. 

Monday was spent in Milan with a UW-Madison college friend of mine. I showed him around Milan a bit and we visited the World Expo 2015 taking place there. One of the coolest stops of the day was checking out the Chiesa di San Bernardino alle Ossa. There is a room decorated with hundreds if not thousands of human bones from a former cemetarty. I, the med student thought it was so cool. My rocket scientist friend (he's an actual rocket scientist), thought it was gruesome but then again cool at the same time.

Il Duomo, Milano, Italia

Chiesa di San Bernardino Alle Ossa, Milano, Italia

I am excited to see how internal medicine will be starting Monday. I expect to learn a lot and this expectation scares me a bit too. I don't want to end up sitting around all day again. If that does happen, I'll be right back in the ER.

I examined a man with an abdominal aorta aneurysm this past week. That was nifty. You could really feel a softball sized tumor in this mans stomach pulsating.

Thursday was weird. We might admit 1 or 2 patients a day on average in trauma surgery. This day, out of the 10 patients we saw until the afternoon meeting, 2 were kids and the parents opted to take the home rather than have them admitted, 6 were already admitted and the last two were ones we were working on. It was absolutely crazy and most of the time was spent with paper work. 

I had one patient I was primarily working on. I really tried hard to take care of his case in a timely manner but it just wasn't possible. Either I was waiting for one of the doctors to see him, waiting for the x ray or the lab results. He had pain in the hip region about 4 months after a hip surgery. When I examined him, the pain didn't appear to be coming from the hip. My thought was that he might have a hernia. The physical examination wasn't very typical for one but it's usually the small ones that cause the most pain. 

The surgeon on duty (vascular surgeon) took a look. She called the general surgery attending to come take a look. He said he'd bet his mother-in-law that it isn't a hernia. So I threw that theory out. My main objective was to exclude all the bad things it could be. Even checked his foot pluse with Doppler sonography. All good. In the end, we agreed that he had a tendinose. Since he was doing so well after the operation and in recovery and only started experiencing pain a few weeks ago, it correlates with the time he started to use his new hip more. This caused muscles to work differently than before the operation and which created the soreness at the location he was experiencing it. I apologized multiple times that everything took so long and that I was always bound to waiting on someone or something. He was very sweet though and wished me all the best in my career. Very sweet and understanding man.

Friday was busy but not crazy. At least we had patients that twisted their ankle or cut their finger instead of hip fractures and pain patients we had to admit the day before. I conveniently forgot my key at home and couldn't access my locker. I ran around in only blue scrubs, a pen and my phone all day. I was called nurse a few times. Interestingly, a lot of the patients born in the 1920's/'30's often call the other female doctors and I nurses. In their heads, women aren't doctors. We just go along with it. Sometimes they will be seen by three female doctors during the week who have all introduced themselves as such and when a male attending does rounds and they'll exclaim they are so happy to see a doctor......mhmm ok. 

We had two older ladies that were rather entertaining. To say they had slight dementia would be an understatement. One was incredibly adorable, the other one called us stupid and told us to take down the cross from the wall because we were not worthy of it. While the one waited to be picked up from the ward and the other on the transporter back home, the lobby was filled with yelling from both ladies.

I left work on time because I still had to pick up some relatives and drive to Hamburg for my grandmas 85th birthday. We went out to the Reeperbahn Friday night with a huge gang of family members. It was hilarious to say the least. 

After getting up after just 3 hours of sleep to take care of the munchkins, I had my sweet revenge when I made them wake up "the monster" aka my dad.

On our way to the bakery!

Monday morning it's back to the hospital and diving into a new department. Hope my expectations get somewhat fulfilled. 

Stay healthy!

V

Week 30: "Have you changed a nephrostomy tube before?" "No." "Well, you gon' learn today!"

Well, it's 6:30 on a Sunday morning.....thanks internal clock for not letting me have the experience of sleeping in on a Sunday. I'm awake and not tired but still....there is just something about waking up after 9AM on a Sunday that has a feel of luxury to it. Oh well, early bird catches......you know.

This past week flew by again! And once again I have a hard time trying to keep the days apart. So I can't really describes my individual days but rather my individual patients.

I was allowed to suture every case that came in and needed stitches. There was the guy at work that cut the back side of his finger with a saw, the old man that fell and rather deeply cut the side of his hand (it bled so much and his hands were drenched in blood and it looked like he had killed something with is bare hands), the old man that fell and hit his head and had a small wound and then there was the woman suffering from borderline disease who cut herself to relieve pressure.

Suturing in the ER is more fun for me than in the OR. I worked in plastic surgery for a month and learned the importance of aesthetics suturing. We weren't doing aesthetic surgery but rather reconstructive. Of course, if you are operating on a patient that needs reconstructive surgery, you will try really hard to make it look nice....its a big reason for why the operation is being done.  Most other departments don't see the closing of the patient as an aesthetic issue. Often times, patients will have staples placed instead of sutures because it's quicker. I think, if you had to go through a big abdominal operation, your scare isn't your biggest issue but the thing that constantly reminds you that you had to have surgery and might as well look nice. In the ER, the patients are wide awake and usually watching you as you suture (since the local anesthesia had time to work by then). A few do mention that we should try hard to make it look nice (especially when its in the face) but I also have expectations for myself to make it look good. So far, everyone has been really pleased with my work.

On my way up!

I was called up to the privately insured ward twice. Both times to place a line. You never know how a patient is until you meet him/her but I'm always more concerned about how a patient is when I'm on the privately insured ward. The privately insured often have higher expectations and straight up make you feel like you are a servant in a luxury hotel sometimes with the requests they have. I'm just not a fan of that mentality and sometimes have to refrain from commenting. The second day I was called up, it was the first thing I did that day. When I arrived, the nurses just smiled and said the patient was a rather complicated patient. Greeeeeeeeat. Just what I want to hear first thing in the morning and then having to place a line. In the end, this lady wasn't complicated at all. She was frustrated and exhausted. Her operation kept getting rescheduled due to her blood lab values. There is construction happening near her room and she is afraid to have another operation. All those factors together just made her exhausted and frustrated with the whole situation......but she wasn't complicated.

I definitely empathized with her. It bugged me a bit that she was described as complicated by the nurses. I've dealt with complicated patients before with absurd requests and expectations of the whole staff.  I'm sure even this patient rang for the nurses multiple times a day with questions about weather or not her operation is taking place. Keep in mind that the patient is not eating every day because there is a chance she might have her operation just to find out she isn't being operated in the afternoon. Please tell me you wouldn't be frustrated and exhausted if you were in the same situation.

Friday morning, trauma surgery was less than busy in the ER. Oddly enough, the urology department was receiving one patient after another. One of the first ones was a man from England. The nurse sitting at the reception desk just called over to the doctors room to inform me that I had a patient to see due to my English skills.

He was an urological patient which just made it all the much better for me. I stayed with the patient even after the urologist came. Once the urologist found out that I was planning on going into urology, his face lit up and for the next two hours, I was constantly by his side and doing procedures I hadn't done in the whole 16 weeks of my urology rotation. He would just ask me if I had changed a suprapubic catheter or nephrostomy tube before (my answer to both was no) and without further hesitation, I was changing the catheters with the help of his instructions.



Both things really aren't complicated but they were things I hadn't done before and that made it really exciting. We had a patient whos catheter was cut off by the nurse in the nursing home and the end part with the blocking-balloon was still in his bladder! We had to take him to the urology department because our plan was to perform a cystoscopy (looking into the bladder with an endoscope through the penis) and removing the catheter piece. The urologist again asked me if I had done that before and I again answered with no. He said I could do everything once we were in the bladder. This urologist was on a roll! Sadly, the passageway into the bladder was blocked due to a big prostate and adhesions that I didn't actually get to do anything. Nonetheless, the urologist explained how the endoscope worked (which was a question I had had for a while but people were always so stressed in the urology department I was in to take the time and explain it to me). This urologist was under stress too due to being responsible for the ER patients and the outpatient procedures but he made it work. He asked me when I would start working and that I should apply in their department. Very sweet but I had to break it to him that I am attempting to do residency in the States. After a few more things, I returned to my doctor in the ER. It was still rather empty.

That of course changed quickly. The second half of Friday was packed with patients. To top it all off, we also had a polytrauma. While my doctor had to work on the polytrauma, I did as much as I could to finish up the other 7 cases we had. I left an hour later than I had expected. I was so drained by the time I got home. I decided to take a 25 minute nap.....which I then repeated.....and once more. I made myself get up again to finish some errands before eventually dropping back into bed.

I have one week left in trauma surgery. It'll only be a three day week because I'm gone Monday and Tuesday. My doctor repeatedly told me that she was going to miss having me around when I leave for the internal medicine department. I'll miss her too and the work we do together. But I won't be far away considering I'm only two floors above her. So if I end up being bored somewhere.....you can most likely find me in the ER suturing up a wound!

Stay healthy!

V

Week 29: Sir, your wife's knee pain she has had for 2 years....isn't an EMERGENCY. So shush!

I often can't decide if a week went by fast or if it seemed forever long. Usually working in the ER, I'd say the week went by really fast. Monday was especially stressful for my doctor and when she was telling a colleague about it on Thursday, I could have sworn it happened the week before.

So lets dive into Monday. The place was already crazy at around 8:30AM. The patients just kept coming in. At some point, I just started writing patient release notes as soon as I heard their story so that we could discharge them promptly after my doctor treated them. 

Trauma surgery was definitely the busiest that day but the other departments weren't sitting around sipping coffee and watching us run around like chickens with our head cut off....they were running around just like us. The chief of the ER was hyperventilating at one point (not literally but pretty dang close). He wanted us to see patients in the waiting room to decide if they can immediately be sent to radiology instead of being examined in an examination room.

In theory, this might be an elegant way of avoiding the transfer of the patient from the waiting room to the examination room but it also has the potential to create a lot of problems. And it definitely did. We walked out with the next three patient clipboards to see what could be sent to get x-rayed. The first patient had knee pain. We had to exam him properly to see if he even needed an x-ray. So he had to wait until a room was open. The next patient was described on her chart as having a problem with her finger. This really was her smallest problem though. When we asked her what had happened, she paused, looked a bit scared and asked if she really needed to talk about this in public. Of course she didn't have to and we were about to say that it can wait until we have a room (the doctor and I both have a heart and already didn't like the idea of talking in public to the patients), but the patient was quicker and proceeded to tell us that she was badly beaten up by her boyfriend. She proceeded to break down and cry. Understandably and the doctor and I stood there mad at the chief for having made us do what we did. The third patient fit the theory quite nicely, hurt his wrist while playing soccer. Quick examination of the wrist (which is possible without an examination room obviously) and immediately sent him to get it x-rayed. 

The load of patients just didn't stop. One patient, who came with her husband due to knee pain she has had for 2 years(!!!!!!!!!), was examined by us and we needed one of the attendings to lend us a hand with figuring out what she might have. (I remind you that we work in the Emergency Room, this was not an emergency and we aren't there to do lengthy investigations, we are there to treat acute problems.) 

After her examination, a poly-trauma came in and we were all busy with that. So this couple ended up having to wait a while. When we finally did get to telling them that they need to see an orthopedic surgeon for further evaluation, the husband was not pleased. He quite sternly and not nicely told my doctor that this was absurd and that its an abomination that we simply "petted" his wife's knee and made them wait three hours to be told they had to go see an orthopedic surgeon. At some point, it was too much for my doctor and she started to cry and excused herself. (For people who regularly read this blog might remember my similar situation in urology. Although I didn't cry in front of anyone I was very empathetic for my doctor). I was not as emotionally involved in the situation and still stood there with the couple. I tried to calmly explain to the man that due to the poly-trauma which was an actual emergency, we couldn't finish up his wife's case any quicker and that I understand that waiting is annoying but that it was an emergency room and his wife's issue was flat out not an emergency. I also mentioned that as doctors, we are trained to gather a lot of information from simply observing the patient and "petting" their knee. 

He kept going on about how his wife's heart is bad and how despicable it is that we made them wait. Honestly, would your wife be doing much else at home than sit if her heart is so bad? I realized there is no point in arguing with crazy so I asked him to wait a moment and had an attending step in. He didn't have any more luck than I did and he made the chief have a talk with the man. In the end, the man came and apologized to my doctor for having been harsh. It obviously wasn't only this man's actions that brought my doctor to tears but rather the whole day. 

Patients need to learn to realize which doctors truly care about them and do their best to treat them and which doctors really don't care if you wait three hours. The doctors that care (and I'll include myself) really put themselves under a lot of stress to help patients as best and as quickly and comfortably for the patient as we can. We aren't sitting at our desks twiddling our thumbs. 

I ended up sewing a finger that day of a lady who almost cut off the bottom side of her finger with a knife.

The rest of the week was better than Monday but still had times a patient congestion. The other doctors in the department were really supportive of my doctor. On Monday, two came down to help us and that gave her a chance to collect herself. The chief said that she should go eat something and that the other two could finish up the last hour of her shift. The attendings offered her to stay out of the ER the next two days. They were all really great but my doctor is a lot like I am when it comes to these episodes of frustration. It gets to a point, we break and then we move on. She didn't need the next days off from the ER, she just needed a few minutes to breathe. Nonetheless, I think its great that she had so much support from her colleagues. I think almost every doctor (that cares) has these moments. 

I sewed up a few more patient during the week. 

Thursday was definitely a little kids day. About 80% of the patients were kids. I ended up just carrying around Berni the Teddy Bear in my scrubs pocket all day. Each kid that comes into the ER and looks like they would enjoy having a teddy bear gets one to take home.

Friday was another fairly busy day. Since it was, I was allowed to take care of a patient almost all by myself. He had cut his lower arm while moving material at work. It was deep enough to sew up and that is what I did. I prepared everything, sewed up, bandaged and wrote the release note all by myself. The only thing I didn't do was the local anesthesia. (That is something I still would like to do the next two weeks.)

I also sewed up a wound on a older man's head after he fell. The options were staples or sutures. I was happy we collectively decided to suture. I personally think the wounds look better with fewer scares and I have something to do. 

The whole week, I was spending my time after work preparing my friends bridal shower. I had planned on a nice picnic by the lake. I had even picked out the tree the week before. The weather forecast predicted rain. Only on Saturday. Not on Friday or Sunday. Just on the one day in the year I plan a picnic. I ended up transforming my itsy-bitsy apartment into an indoor picnic. Everyone was happy and had a good time so I see it as a success! 

Sunday I spent my day at the flea market trying to make some money and reduce the size of my baggage. Always thinking prospectively. In a few months, I have to decide what goes back to the states with me!

Stay healthy!

V