Tuesday, December 30, 2014

It Happens

I think I mentioned before that I'm doing an emergency medicine elective right now. Well I got to talking to one of the trauma surgeons and they invited me over to their department for a few surgeries. I've gotten to see some pretty cool stuff and I REALLY enjoy surgery.

Fast forward to this morning after a sleepless night (2 hours to be exact- yay insomnia!) I woke up and realized that I was running late to get out to the hospital in time for morning rounds. So I hurried up got dressed and pretty much ran out the door. Who am I kidding I do this every day! I usually eat breakfast around 10am, so no worries there- I can eat at the hospital.

I made it just in time for the beginning of morning rounds at 6:30 am and got to witness THE PROFESSOR in action. AKA I got to watch everyone follow around an old dude in a white coat while he interrogated them about their patients. One of the nurses wasn't able to get morning lab results for a particular patient due to bad veins and he pretty much chewed her out in front of the entire department and about 4 patients, including the patient in question. The patient started apologizing to the Professor for not being a good stick. People had to leave the room they were laughing so hard. The Professor was NOT happy.

After that, one of the doctors arranged for me to assist with an abdominal surgery with another Professor so I skipped off to the operating theater. I met up with the doctor actually performing the surgery and then with the Professor who I don't think spoke much English. Almost everyone in this department is so nice and dare I say, normal. It's totally ruining the image I have of most surgeons (though I might have just gotten lucky- I have met some crazy surgeons before).

So the operation starts, there are three of us standing around the patient. First the scalpel, then the cauterizer, then more cutting. I have the traditional medical student duty of holding traction while squeezed in between the doctor and the patients arm requiring me to stand sideways while bending in an odd yoga-like position. Finally the doctor and the professor get where we need to and they accidentally sever a vessel. Blood pulsates everywhere. They quickly repair it and continue on their intended mission, I'm still holding traction like a champ. And then finally, the main part of the surgery is complete. They prepare to sew the patient up.

I realize that for the last few minutes I've been in la-la-land. I try to tighten my grip on the traction devices, I can't. I notice that I've started loosing hearing in my ears and that my arms still holding traction feel strange. I take a deep breath, but the mask tied tightly around my face means that my breath makes little difference. I try again. My cognition feels slow, I wait for this feeling to pass. When the vision in my eyes starts to go foggy around the edges, I realize what is going on.

I try to say something to the doctors, I think I said "przepraszam"- but it might have only been in my head.  My hand must have relaxed the grip on the traction because someone said, "Are you okay."
"Nie," why is it that when I'm fainting Polish is the first language to come to mind?

My vision is gone. Someone grabs the back of my scrubs and pulls me backwards away from the operation. They push a stool underneath me. I don't know what happens next.

The anesthesiologist's hand is keeping me in the chair as I revisit the world. She helps me out of my surgical gown and gloves and walks me to the hallway. "Are you alright?"

"Yeah, I'm fine. Just had a moment I guess." A moment- haha right, how about quite possibly the most embarrassing episode of my life. "Sorry," I say.

"Don't worry. It happens."

An hour and one sugary cup of coffee with breakfast later I'm able to walk out of the surgical ward. I'm still shaky, but I don't tell them that when they ask. It takes a few hours for the feeling to completely disappear.

By noon the entire department has heard. News travels fast in this place. On top of that, this entire department like most surgery departments in Poland is all men. I just fulfilled the swooning girl stereotype and I'm sure I'll be reminded of it every time I scrub in.

I know that people faint in operations, it's one of those things, but did it really have to happen to me?

As a side note, I don't think it was the operation itself (the worst parts were over and yesterday I saw someone get their leg amputated- so really?). I think maybe it was lack of sleep combined with not eating breakfast.

What a day!

I guess, "It happens."

Let's just hope it doesn't happen again.

Tuesday, December 23, 2014

The Holidays Again

It's that time of year again.

I've been fortunate the past few years to be able to enjoy the holiday season with my family. But, alas it was bound to happen eventually and this year marks the first year that I will be without them. Instead I'll be sitting in my dormitory binge watching movies. Somehow, it just doesn't seem the same. It's like there isn't any holiday happening at all. I didn't even realize that tomorrow was Christmas Eve and the final day of Hanukkah until someone else pointed it out.

I suppose it will hit me more in the coming days- as unlike in the U.S. EVERYTHING in Poland is set to close down. I went shopping today and I think I have enough food to make it through!

Last weekend I went to Berlin to get some things sorted out and I got to visit a few of their Christmas markets. They're all so festive and beautiful! I wish my family could have been there to share it. I feel like I rushed past things or walked through quicker than I would have if someone had been there with me. I was going to buy a few things, but my enjoyment was interrupted by a sudden thunderstorm. Yeah, you read that right- a thunderstorm in the  middle of December.

Unfortunately, I was pretty soaking wet after this. And on top of that I pretty much had no place to go to dry off or get warm since I had already checked out of my hotel and my train wasn't set to leave for another 6 hours. So I made my way back to the Haufbahnhof (main train station), went to the food court area, got a coffee, and attempted to study.

Three hours later my eyes started to droop so I bought another coffee, but I couldn't resist the urge anymore and I put my head down on my textbook to try and rest for a minute. What I was not expecting was to have two very (excuse my language) bitchy workers come and wake me up and tell me off after only around two minutes after I did this. Yes, I know sleeping in public areas, not a great thing to do. But, seriously? I'm sitting here with my coffee and snack that I just bought, with my bags, and my medical textbook book- do I really look like I'm homeless? And even if I were, I would hope that you'd treat someone with a bit more respect!

I eventually hopped on my train back to Poland. The train in question was headed to Moscow. Everyone on it was jabbering away in Russian the conductor didn't speak German, or English, or even Polish for that matter (though the languages are similar enough- I just had no idea what he was saying). Luckily the woman in my compartment was able to translate and we talked almost the whole way back to Poland. We exchanged e-mail addresses and hopefully we'll stay in touch. She made what would have been a miserable 5 hour trip very nice and seem short (unfortunately for her the trip to Moscow from Berlin is about 20+ hours).

Anyways, that's pretty much it as far as what I've been up to- besides working in the hospital (which I love by the way).

Oh and it's not going to be a white Christmas here...it's hovering around 50 degrees fahrenheit (10 degrees celsius) and it hasn't stopped raining for the past 2 weeks.

Tuesday, December 16, 2014

A Strangers Face

Today started like any other day. I got up, almost missed the bus, got to the hospital, put my white coat on, hung the stethoscope around my neck. Pretty run of the mill. I've been working in the Emergency Room in Poland since I got back a few weeks ago.

These are not patients from my hospital, the photo is from a newspaper.
It's one of the few North American type emergency rooms in my city. They usually get a trauma and severe medical issues. It's very different and yet very similar to the ED in the US. First off, it's organized different. They have a triage system, but I don't think they've quite got it down pat just yet. Second, the ED itself is small. I don't mean that to be rude or anything- it's a fact.  There are 8 beds jammed into a small room with a desk in the middle where the doctors take turns writing notes. Meanwhile there are at least 30 people waiting in the hallway to be seen (a HUGE difference from my last experience). The place just can't hold this many people and on top of that, there aren't enough staff.

But, just working in the emergency room was not the most defining part of my day. This was:

I was leaving the exam room after interviewing a patient with suspected MI and I noticed a man sitting in the hall waiting to be seen next. He was probably middle aged and he was quite skinny. I pointed him out to one of my classmates and I said, "There's a good example of the tripod position if you've never seen it." My classmate looked at him and remarked, "It looks like COPD."

We went to our next patient who was in the main room with all the beds and the desk. We started talking to our next patient and just as we were finishing up the history and exam one of the paramedics, the head doctor, and two of the nurses wheeled on a man on a gurney into the area right next to our patient. The doctor called us over.

He was blue. Proper blue. I think I realized at that moment that he wasn't going to make it. "Put on dee gloves!" our doctor yelled to us. (This was much louder than codes in the US). I put the gloves on. "You" he pointed to me, "Take over compressions after this cycle." I nodded and walked as confidently over to the side of the bed trying not to bump into the patient who I had just finished interviewing- there was a curtain, but it wasn't closed completely and curtains don't stop noise or increase space.

Two minutes was up, they checked the pulse, still none, they checked the rhythm, still a systole. "Continue compressions." I placed my hands on the mans bare chest like I'd been taught and began to press. It was easier than it had been on the mannequins, but that was most likely due to his small size. I got into a rhythm and then I made a huge mistake. I looked at his face.

It was as if the world stopped. All at once I felt faint and shaky. It was the man who I had pointed out to my classmate only moments before who had been sitting in the tripod position. His light brown eyes were still open, but his face was a shade of purple. I kept pressing.

Another 2 minutes passed. Still in asystole, still no pulse. Someone switched off with me. "How do you say 1,2,3 in Greek?" the head doctor asked on of my classmates standing nearby. We looked at him incredulously. A patient was dying and he wanted a Greek lesson? Other jokes were made which I couldn't understand- but laughter is a universal language.

Another 2 minutes. Still in a systole, still no pulse. I began compressions again. "Is it similar to a mannequin?" the doctor asked. "NO," I replied between compressions. "The mannequin doesn't look at me."

Another 2 minutes. Still in asystole, still no pulse, switch. Another 2 minutes, still in asystole, still no pulse, my turn again. I continued my compressions just as vigorously as before. A minute in I felt and heard a deafening snap as I broke at least two of his ribs. I stopped compressions for half a second, startled by the sensation.

 2 minutes, asystole,  no pulse, switch. 20 minutes passed like this. 2 minutes, asystole, no pulse, switch. 2 minutes, asystole.....

"Time of death: 20:58"

The other patients watched as they slowly began to disconnect him from the machines. They finally closed the curtain as they placed his body on another gurney and covered him with a sheet. The gurney with his body was taken out through the waiting room to the morgue. His right arm was still visible as they wheeled him away.

Once he was in cardiac arrest there probably wasn't much we could do. But, the fact that he was alive, sitting there, just 10 minutes before I began compressions on him... It's mind boggling. And even had he of been seen sooner, would we have realized quickly enough what was causing it before he went into asystole? Probably not.

All I know is, a man is dead and I will never forget his face.

Today started like any other day.

Monday, December 1, 2014

Love Hate Relationship

I try and share a little bit about each class as it comes and each experience as I have it. But, given that I rarely have enough time to even sleep these days I often have to skip over certain events. So beginning with this post every now and then I will share a story about a certain scenario or details about my schooling over here.

Today we're going to talk about psychiatry. I think I shared a little bit about my experience with psychiatry in another post. But, I don't think I shared this particular story.

Please be aware that there is some obscene language in the below post. 

Nearly half way through our time in the psychiatry hospital we were buzzed into a ward we had never been to before. Patients of all types male and female sat in the hallways and gazed out at us from their rooms. A nurses station was visible from the end of the corridor so myself and my 3 classmates made our way down to it in hopes of finding the days assigned doctor- we rarely know who our doctor is going to be until we get to the wards. One nurse sat at the station, she was about as helpful as a rock.
Photo by: Ewa Furtak, http://info.wyborcza.pl

Knowing that once again our doctor must be late (which is not uncommon) we continued to stand in front of the desk waiting. We had only been there for a few minutes when an older, well dressed woman approached us and said in English, "Hello!"

We smiled and greeted her in return. She began to shake our hands and asked us our names. Assuming  she was our doctor we reciprocated and each shook her hand and told her our names. The final person to shake her hand was a very dark skinned Nigerian man. When she reached him she shook his hand a bit longer, smiled sweetly and asked, "Where are you from." He told her.

She continued smiling. And then without warning pursed her lips and planted a huge wet kiss on his cheek.

My entire group looked shocked- particularly my Nigerian friend. Why would our doctor KISS a student. There was only one explanation. This was NOT our doctor, this was a patient!!!

Around this time our real doctor arrived and seeing that we had already met this patient asked her if she would like to be interviewed by us. She graciously accepted and seated in a small gathering room with glass windows and large sofas we learned her story.

15 minutes later when we had finished the doctor had to make a phone call and dismissed the patient who said very nicely and calmly. "Thank you, it was nice to meet you," and then walked away.

We returned to the room after a 5 minute coffee break to find her in the room waiting for us, our doctor was nowhere in sight.

"F*** you. Go to H***" she shouted at us in English before beginning in Polish.

My friend who speaks fluent Polish was unfortunately absent that day, but I didn't need her to know what she was saying. We sat down and let her continue yelling obscenities until she got into the face of my Nigerian classmate and said in Polish, "You deserve to die, I'm going to kill you."

At this point I turned to a classmate closest to the door, who besides sensing her rage had no idea what she had just said. "Go find the doctor," I told her. "Quick."

A minute later our doctor and two other companions were there to order her out of the room. But they didn't take her anywhere, or give her anything to calm her down, they simply escorted her to the hallway. A new patient was brought in for us to interview and as we spoke to him she continued shouting obscenities through the class, making faces at us, flipping us off, and banging on the thick shatterproof window.

Our doctor sat there calmly throughout as though nothing was going on.
I suppose after a while, nothing phases the experienced psychiatrist. But, as students we were certainly taken back.

That was the first time I ever saw a rapidly cycling bipolar patient.