Update

It's been a while.

A lot has happened. A lot has changed.

I left Poland not knowing what was going to happen next. I was excited and scared. I thought I'd go to Ireland for my intern year but alas that did not happen. Instead to my great dissapointment I went home.

I went home and held my grandmothers hand as she took her last breath. I lost the woman who made me who I am today. It was the worst year I have ever had.

And yet it was a year of learning. I took all of the board exams back to back (I don't exactly recommend doing it that way). I worked 6 days a week, primarilly at night as a medical scribe and made sure to pay attention every second. I didn't have the best experience in the ER on my US rotation, but I learned so much as a scribe. I learned how to write notes and talk to patients. After a year of preparation I applied for the match expecting to start the following June.

I became very close with the ER physicians I worked for. They helped me so much- I can never repay them for everything they did for me. Several of them teamed up to help me get an observership with the internal medicine residency at one of our sister hospitals. I did the observership and at the end was called in to meet with the director of the program. They offered me a spot!!! Instead of waiting a year I would only wait one month.  I had at that point gotten around four interviews- it was strange to rescind all of my applications after all that work! But boy was I thankful for it!!!

Not your typical route to residency, but then again going to Poland isn't exactly your typical route to medical school either!

I miss Poland every day from the people I experienced it with to my apartment, to silly little things like the box of ginger snap cookies I could get for 5 złoty. But for now I'm okay with being back in the US. I will get top notch training and then maybe if I ever do learn Polish I'll go back. Or maybe I'll go somewhere else.

Only time will tell!  

Flashback: Coming to Poland

I had just gotten a phone call. It was the type of phone call that could change my future.

"I'm sorry to inform you that our school no longer accepts US government loans."

That's the only part of the conversation that I heard.

I sat in my parents office crying for thirty minutes after that. I had two weeks left until I was supposed to come to Poland, I had already bought the plane tickets, made plans, and then this. TWO WEEKS before I was supposed to come.

I had no idea how I was going to pay for school or what I was going to do. I was totally lost.

I probably should have seen the last minute notice as a sign of things to come. But, me being me I completely ignored it (probably a good thing too!). After I finished crying, my step dad coaxed me out to the living room where we had a good chat. A week later after making some inquiries and after some long hard contemplation I decided that I was going to find a way to make this happen. I was going to go to Poland, I was going to go to medical school.

Thank goodness for Sallie Mae.

I got the money I needed. And two weeks later my father and I landed in Poland for the first time. My Dad being the pioneer that he is opted to take the bus to the hotel versus a taxi like a normal person. We had no idea how to speak the language and no idea where we were going. Luckily some old woman adopted us. She bought us tickets and showed us which stop to get off.

My first thoughts about Poland were, "wow these buildings are really run down." And looking back I was only half right- the outside might be disastrously run down but the inside of most of the buildings are actually quite nice. (Maybe that's a good metaphor for the country?)

After we arrived and got the hotel stuff sorted out we went for what would be the first of many Polish meals. KFC! 

Okay, I know what you're thinking typical Americans! I had just been on an airplane for 13 hours I can eat whatever I want. Plus, KFC in Poland isn't quite the same as in the US, it definitely has more of a fast food vibe here.

My dad stayed for about four days and helped me move into the dormitory. My roommate arrived as we were organizing all the newly purchased items from ikea. Her first words to me were, "If you see any needles I'm diabetic, not a drug addict."

I had no clue how to respond to that so I just said, "I have asthma. My inhaler is in the drawer."

Clearly we both need to work on our introductions.

So something you should know about Polish dorms. They're not the cushy rooms that North American Students are used to. No personal space here. The rooms are small. Very Small. When we laid down in bed at night our feet pretty much touched each other. But, there was something quaint about our room. Yes it was small, but it was about to become home.

Would You Want to Know?

A group of us sat huddled around a table in the local gas station at one in the morning. We were sipping cokes eating sandwiches and laughing at silly jokes.

It's amazing how conversations that are lighthearted can quickly turn into deep discussions about the very core of our existence. We sat there laughing and then all of a sudden someone asked the question: "If you had a terminal disease that cannot be treated, would you want to know?"

We were all quiet for a moment, thinking, wondering.

At this point we've seen people who are dying, we've spoken to them, we've helped them into bed, we've put our hands over their chests to pump the blood through their body, we've seen them take their last breath and die. But, would we want to know if that was what was coming soon for us?

"Yes, of course," were my friends answers. Their reasoning, "Because I would want to make sure that I live life to the fullest."

I thought for a second longer before speaking and ironically my answer was the opposite of theirs, but for exactly the same reason.

If there's nothing I can do about it for myself or future children I would not want to know. I want to live my life to the fullest, I don't want my imminent demise hanging over my head anymore than it already is.

You see I believe you should always live life to the fullest, regardless of when or how you're going to die- why should having a terminal disease change the way I live? I live or I don't.

The truth is terminal diseases aside, anyone of us could die tomorrow in a freak accident or from some undetected health problem. I hate to say it like this, but if I do happen to go, I'm okay with that.

My friend gave me an "I'm concerned" look after I explained my reasoning so I continued to explain.

I've explored the world, I've done crazy things, I've loved and been loved, and most importantly I'm happy.

I'm not saying that I want to die or anything like that. Just that, I think we should all strive to live like we're going to die tomorrow. We should enjoy each sunset, each kiss, each moment of laughter like it's our last.

If that makes me sound crazy, then okay.

I'm enjoying life.

Packing

I don't have much time left here. 

It feels surreal. 

How is it over? How has four years of hard work and classes ended just like that? 

Today I began the process of packing my suitcases. There probably aren't too many people that can fit their entire life into two suitcases. 

I feel like I've lived an entire lifetime here.

I can't even begin to explain how much it hurts me to have to leave. I don't remember ever being as happy anywhere as I am here right now. 

I've been running to my favorite parts of the city more, thinking that it might be the last time I ever see these places. Even if I do come back to visit, it will never be the same. 

I know that it will be the last time I ever feel like I'm home for a long time. I'm sure wherever I'm at next will slowly become what this place has been to me. But it will take time. 

I know people will say, "look at all the other great places you will go" "change is good." 

Those people have never dropped everything and left their entire life behind. I have done this more times than I can count. 

I hate it. 

I just want to go home. But I don't know where that is.  

Flashback: The Interview

Deciding to come to Poland was one of the hardest and easiest decisions I've ever made.

I knew that I wanted to come here from the moment I first saw the website my sophomore year of college. Of course I knew it would be easier to go to school in the US, but I kept Poland in consideration.

The time to apply to medical schools came around and I had my applications in the first week they were open. I was so excited and nervous. Mostly excited. There was nothing else in this world that I wanted to do.

I got interviews at a few places. But, my first interview was for my school in Poland. It was one of their first interview days in November. My mother and I drove out to New York City where the interviews were being held. It was my first time in a city of that size.

My mom helped me pick out my business suit and shirt. She helped me do my hair (because anyone who knows me, knows that I can't get it under control). We sat around for a while at the hotel and I nervously looked up possible interview questions. I had an answer rehearsed and ready to go for almost any question they would give me.

The time finally came for us to drive to the interview. We packed everything in the car and headed off. We had driven ten minutes when I realized that I had forgotten my folder with my passport copies, my research, and everything else I'd need for the interview. We made it back to the hotel in 2 minutes.

After that little mishap we made it to my interview. My mom decided to stay in the car where she could look at the hudson river and I walked- well hobbled to the building where the interview was being held. As it happens, heels have never been a strong suit for me. Why I decided to try them out the day of my interview I'll never know! Luckily they wouldn't see me walk.

I came into the building and was immediately beckoned into a room with a large oval table with 8 people sitting at it. They placed me at the head and thus the interview started. At first it was just basic, why do you want to be a doctor? why Poland? What do you do to relieve stress?... And then the question that I blanked on: Name three attributes that would make you a good doctor?

I got two. And then I totally blanked. My palms began to sweat, my hands began to shake. For the life of my I couldn't think of a third attribute.

I tried in earnest to think of something and then hastily apologized. "I'm sorry, I'm so nervous." I explained. They nodded and smiled.

Luckily, the remainder of the interview was science questions that I knew the answers to. The hardest part was deciphering what the interviewers were asking me. Many had Polish accents which I wasn't yet accustomed to, but one particular older professor spoke so deeply and with such a strong accent that I kept looking to the other interviewers to decipher what he was telling me.

After they were done with their questions they were quiet for a moment. And then the one who must have been in charge at the end of the table said, "Congratulations, we would love to accept you."

My heart literally jumped into my throat.

I was so happy.

I stood up and they each shook my hand. One of the older women gave me a big hug. I'm sure I looked like I needed it.

They gave me pens and a book on the school. They asked me if my mother was in the waiting area so they could congratulate her as well. Unfortunately, she was outside. They still loaded me down with pens and notebooks to give her as well.

I thanked them and walked calmly out of the building. And then I RAN to the car to tell my mother. If I hadn't been wearing the heels I probably would have done a heel click too.

We celebrated by going to see downtown NYC.

I was going to be a medical student.

Athens

Spring break was a few weeks ago and a friend of mine had always wanted to go to Athens. Despite my visa issues I decided that I wanted to go too. So I got a blessing from the visa office and two days before break started we booked a hotel and bought tickets on Ryanair to Athens.

Day 1: We traveled all day. The city where I live does not have direct flights to Athens so we ended up taking a bus to Warsaw. The bus left at around 10am and it got there at around 2pm. From the bus station we decided to take a taxi out to the Modlin airport.

We got in the cab drove for thirty seconds to a red light and the bus that was driving in front of us decided that it was going to back up on top of us. It all happened in slow motion, luckily we were stopped, and no one was hurt. It ended up taking out one of the lights and the front bumper. My friend and I just sat in the taxi awkwardly unsure of what to do. The cabbie did call another taxi for us and we did eventually make it to the airport which was around 30 minutes away.

Interestingly that is the second time I've been hit by a vehicle that's decided to back up without any warning. The first time I was on my bike. Talk about bad luck.

Our flight left Warsaw at around 7pm and we got to Athens at nearly 11 o'clock their time. It's hard to believe it's only around a three hour flight.

Day 2:  We woke up early the next day excited to see the area! The place we were staying was in a pretty run down area but there were plenty of people around so we walked to our first destination- the Acropolis!

Apparently if you have an EU student ID card you can get into most everything for FREE. It was a definite bonus!

We stayed at the Acropolis for at least an hour if not more. I loved reading about what all the old ruins were and trying to imagine what it looked like back in the day. It's amazing that things like that were able to be built when they didn't have tools that we have now. We saw the theater of Dionysus, climbed the hill to see the Parthenon which was undergoing renovations, viewed the temple of Athena, and checked out the view of Athens from the top. You can see pretty much everything from up there- including the sea!

Next we headed to what was my favorite part of the trip, the Panathenaic Stadium. The site of the first modern olympic games and where the marathon ended. This one we had to pay for, but we still got a discount with our student cards. We walked around on the track and checked out the statues and I did a lap for completeness sake. We walked into what we thought was a cave but turned out to be a tunnel to where a museum is set up. They had all of the old torches from olympic games past as well as more history on the stadium and of course the marathon.

Nearby the stadium is the Temple of Zeus, which unfortunately isn't as cool as it sounds. It's mostly just old pillars on a nice little plot of grass. We did a loop around it, took some pictures, and then headed to the Plaka.

The Plaka is one of the main shopping districts in Athens. There is your typical tourist trap area with souvenir shops which we spent some time perusing. If you walk far enough from their there's also a typical sort of market with less touristy stuff. We ran into the Roman Agora and the Temple of Hephaestus we walked so far.

Day 3: We had decided pretty early on in our trip planning that we wanted to do some kind of cruise tour. As we walked around we discovered that there were signs everywhere for this one day tour of three islands for 100 euro. We signed up not knowing what to expect.

They came and picked us up at our hotel at 7am and took us to the dock where our boat awaited. We were still pretty sleepy from the day before and it was chilly out so we sat at a table inside for the first hour or so. There was music and then they told us more about the islands that we'd be visiting as well as the events on the boat. At one point on the way to the islands I walked into the bathroom to find an elderly woman being violently seasick, I ended up hunting down a seasick tablet for her and helping her hold her head over the sink- my first med school moment of the day (the second was when my friend and I "consulted" a boy who had split his chin and needed stitches).

I think it took two hours to get to our first island which was Hydra at which point it was very windy and rainy! It was a small little place with only donkey's for transportation (though we did see a small truck!) We walked up the hill to check out some of the houses which were typical of the Greek architecture and then we walked down one of the costal trails which was amazing. It's too bad the weather was miserable, I think we both would have liked to spend some time swimming there!

We got back on the boat and they had a buffet prepared for us. I had three huge plates- I was starving! Others didn't eat so much though, the water had gotten significantly more rocky after we left port. People were puking left and right. They even started handing out barf bags. Meanwhile I was stuffing my face.

By the time we had reached the next island, Poros the rain had stopped and the sun was starting to peak through. We were only there for 40 minutes I can't say too much about it.

Our final island was Aegina where we went and saw the temple of Aegina and bought some pecans which are apparently their main crop. I liked the temple of Aegina more than the ruins in Athens, it seemed more put together and there were less tourists around so it was more personal.

As we headed back to Athens that day there was traditional Greek dancing! And of course I joined in!

The cruise was hands down one of the best parts of our trip! We had a blast!!!

Day 4: We slept in and went to the Archeological Museum for a few hours. It was chilly and a bit rainy out again so being inside was nice. After we went to the Plaka to explore again and to pick up last minute souvenirs. We also found a great restaurant where we hung out for a few hours. Heads up, if you're ever in Athens- get a spinach pie.

Day 5: Once again we spent all day traveling. This time we went from an airplane, to a bus, to a tram, to a train, to a cab. We didn't get back to our city until 3am!

Neurology

Since I've finished neurology I suppose I should tell you a little bit about it.

Really, there isn't much to say except I really enjoyed the course and learned a lot. It was the best course I've taken in medical school so far, except for maybe my electives. If anything the course actually made me consider neurology as a possible career course.

Scary I know.

My group was fortunate to have one of the younger doctors who was more hands on. The first thing we learned was how to do a neuro exam, which is easier said than done. There's a lot more to it than just hitting a person with a hammer. You have to know why you're hitting the person with the hammer, what to look for when hitting them, and where the abnormality is if you hit them and something weird happens.

We practiced on each other first because it's easier and faster to do in English than to figure out how to say it in Polish, especially when you're a mediocre at both (though I think by the end I could almost do the exam in Polish- almost). We quickly moved on to real patients which were a bit trickier since there were abnormalities in the exam.

The section of the department we were placed in had an overwhelming number of MS patients. So we got really good with all things MS. Because of this however, the variety of patients we saw was limited. For example, I don't think we saw any Parkinson's patients except maybe the one I spotted in the waiting room (the tremor really is a give away).

The ward next to us was a critical care section for more severe patients, we got to visit this area several times. They didn't have anyone on respirators but they had patients with encephalopathy and strokes which were stable. It's here that we did our first neurological exam on a semi-comatose patient. It was strange. We kept being very gentle with them in fear that we would hurt them, our doctor had to remind us to be more aggressive. Actually, now that I think about it (and after being the victim of it) the neurologists are kind of scary with their hammers.


We got to see a good number of spinal taps as well, which is something none of us had seen before. Our doctors made it look so easy! The only time I saw a patient moan in pain was when one of the professors did it (there is serious irony in this...) Unfortunately, the didn't let us try, but I can completely understand why.

Somewhere during the middle of this month long course there was a party downtown which I attended. Around 11pm I turned towards the dance floor to see two of my classmates doing a choreographed neurological exam.

Needless to say, it was a great course.

The Visa Game

If you've ever lived for a prolonged time in a country that is not your own you probably know what a hassle it is to apply for a visa or residence permit. There is nothing worse than feeling helpless in a system that seems doomed for you to fail.

I can't say much about the U.S. immigration system as I'm lucky enough to hold a U.S. passport, but I am thankful most days to have that piece of cardboard. I say most days because there are days like today when I would kill for an EU passport. Life would be so much easier.

My first two years in Poland I went through the US embassy in Washington DC to apply for a student visa. I went in submitted my forms and three days later picked it up. No problem, easy peasy, simple.

My third year I didn't return back to the US so I was forced to apply for what is known as a temporary stay card as you can't apply for student visas inside of Poland (you also can't apply for temporary stay cards outside of Poland. Which makes no sense.) So I did what I was supposed to do, I applied within the 90 day period, I collected the letter from my school, proved that I had enough money in my bank account, got health insurance from ZUS, officially registered my residence with the town hall, was visited by the Police, and managed to navigate my way through the Polish immigration system (mostly in Polish, a miracle even then).

Generally speaking it was the nightmare you're probably imagining. But it was nothing compared to what some students have gone through to get their temporary stay cards. So I was happy to have conquered the system and in the end I was rewarded with a shiny new temporary stay card. Proof that I live in Poland.

Let's fast forward a year. The card expired when I was back in the US last fall. I was going to apply for a student visa in Washington, but my school never sent me a letter of enrollment to prove I was a student (after I repeatedly called and asked). I finally got an e-mail from them asking if I still needed it a week before I was supposed to return to Europe. Too late.

I got back in December but wasn't able to apply for my temporary stay card right away because unlike the student visa I also had to prove that I had funds to stay in Poland. Which I didn't as we don't get our loans until the end of January. So I had to wait. Which totally wasn't a problem. I had time.

Around the first of February I had everything I needed to apply for my visa. So I did. The next weekend I flew to Ireland again which "reset" my 90 days in Poland, but not in the rest of the shengen zone- something that wouldn't be a problem once I get my visa. (Oh and I have the 90 day rule recorded from the horses mouth. Because I couldn't find that law written anywhere.).

I waited and waited. No letter, no confirmation of my application. No nothing.

I went to the visa office. "It's no problem, don't worry" they said.

I visited them 5 times in the past 2 months and waited two hours in line or more each time. And every time they said the same thing.

Today I visited again and this is what I was told. "You aren't eligible for a visa because you're leaving in June."

I just want a visa! Is that too much to ask?!? 

If I get deported before I graduate, I'm not going to be a happy camper. 

Tell the Truth

A few weeks ago I had a patient that kind of surprised me. 

I was in oncology and an older patient who had presented with neurological symptoms was diagnosed with lymphoma in the brain. If you know anything about this terrible disease, you also know that it's usually related to HIV/AIDS. But, upon taking the patients history the only disease she admitted to having was fifteen years ago when she was treated for syphilis. 

So as she lay in critical care the doctors performed the routine tests including normal blood work and an ELIZA for HIV/AIDS. Her CD4+ count was 3. She had AIDS. 

Two weeks later she was doing much better all things considered. But, still had not been told of her diagnosis. Some classmates and I asked the doctors why she hadn't been told yet and they told us that they were concerned for her mental well-being and her current health state. Both genuine concerns. We were under strict instructions NOT to mention the diagnosis in front of the patient.  

As we sat in the doctors lounge one day near the end of the rotation one of my classmates asked if she had been told. The doctor said that he was going to tell her today. But, he said something that made me think long and hard about this patient.

"I think she already knows. I think she was probably diagnosed when she was diagnosed with syphilis, or at some other point. Most people don't have a CD4+ count that low and not show some preliminary symptoms of some type." 

They took her to a private room to tell her the diagnosis later that day. 

She already knew she had AIDS.  The doctor was right. 

But, why had she not told them? What made her think that it wasn't important enough to share? Was it fear of the stigmatism that HIV has in Poland? Or was it genuine lack of knowledge about the disease itself? 

Universal precautions are always used, but knowing the diagnosis would have made it more important and would have led those who treated her to be just a bit more careful. Knowing the final diagnosis would have also meant that her current diagnosis of brain lymphoma would have been recognized and treated sooner, which would have been better for her. She could have been started on HAART sooner and had radiation sooner, she might have lied and wasted the chance to save her own life. 

No one cared that she had AIDS. The doctors were upset because they had been lied to. They were upset because, she might very well have died had they of not caught it. 

Please, never lie or fail to mention health conditions to your doctors. It might not seem important to you, but to your healthcare provider it might be the minor difference between medications used to treat you or the difference between knowing the diagnosis and not.

It's your life, doctors are just trying to help you save it. Don't lie to them.  


Photo Credits to: http://www.med.uc.edu/neurorad/webpage/gua.html

  

A Month

Almost a month has passed since classes started and it's hard to believe that we'll be completely finished in 3 months.

Even so it's been a LONG month.

We've had otolaryngology (ear, nose, and throat), and then dermatology, and then after that infectious disease, and finally we're in neurology.

All of the classes have been pretty good. Though after doing electives in the US I feel like I'm a little kid again who everyone thinks needs her hand held. I've returned to the land of not letting students do anything.

Luckily, otolaryngology let us practice albeit on each other. Even if it was with equipment from the dark ages I think we all enjoyed the practice. It was a tad hilarious though because we used one of those old head mirrors and had to reflect light into the persons ear, nose or throat. The doctors here do use battery powered head lamps though so that was some consolation. I never did see or use an actual otoscope during the whole class though, which would be a tad annoying if I hadn't of used one virtually everyday on my electives back in the US. The fact that this was the first time they decided to teach us anything about the ear or doing an ear exam is doubly annoying, luckily I had a great mentor back in the States who helped me figure it out. Ears are kind of important!

The other classes were pretty much on par with what I've come to expect from my school. Hands off and very didactic. Which I appreciate, but at this point I think we're past the basics that they keep repeating. (I know the difference between a macule and a papule, thank you very much).

Neurology might be the one exception. Since we've just started it's hard to judge, but the teachers really seem like they want to teach and we have seen actual patients and have had time to practice examinations (which would have been nice to know during my time in the ER a few months ago!!!) Granted our best practice comes from practicing on each other. It's easier to get the order and flow down in English before trying to either have someone translate it or trying to translate it yourself.

That's all here. Not too much excitement going on which is why I haven't written.

And finally I leave you with something profound that one of the otolaryngologists told us as he prepared to show us how to examine someones nose.

"Be professional, dress nicely, sit up straight, keep your speech appropriate. From the minute they see you and know that you're their doctor, they're watching. You will be judged. Never forget it."

The 16th Move

Today I realized how much I don't want to leave.

I can't bear the thought of being gone from this place.

It's funny that a place that has caused me so much misery is also the place that has become my safe haven. I know this place, I've grown to be the person I am now in this place, I'm happy here, it's become my home.

Everyone keeps saying that things change, that you have to move on.

I'm sick of moving on. 

Just once I want to stay.  

It doesn't matter how I feel. In 5 months I'll pack my bags and board a plane. Where it will take me I have no idea.

But, I do know that this place will never be my home again and that is something I regret.

The Indeks

In Poland we have something that I guarantee most North Americans have no idea about. In fact they might even find it kind of funny and sort of "old school." (Because it is). It's called an indeks. 

An indeks is basically a little green book that has all of our information and all of our scores from every class we've ever taken. Pretty normal right?  Well no, not really.

Once we complete a class the indeks has to be taken to the head of the department and signed and (more importantly) stamped in order for us to get credit. Nothing in Poland happens without a stamp.

Most departments take three or four days to sign an indeks, some like to hold them hostage for weeks. I've been in offices that have piles of the things waiting to be signed. But, you have to wait as long as it takes, because unless the indeks is signed and submitted to the deans office at the end of the year, technically you have not completed the course. Never mind the fact that the department sends all of the course results directly to the deans office via this new fangled thing called a computer. So  the school has all of our results within days after the course is completed.

But, like I said no indeks, no credit.

http://ed.mug.edu.pl/4434.html the only place I could find a good photo.

And heaven forbid you or a department LOOSE the indeks.

If it's lost one must hunt down every professor for every class ever taken and get it signed AGAIN. It doesn't matter how long has elapsed between loosing it and it getting signed, the indeks must have ALL of the classes in it; even if the dean has seen it signed and reported it as being signed for previous academic years.

So say for example you loose your indeks in your final year. You must find ALL of the teachers from your 1st, 2nd, 3rd, and 4th years and get them to sign it otherwise you will not be permitted to graduate. That's right, despite the fact that the school has all of your results, if you don't have it in the indeks you will not get a diploma.

What's even better is that there is also a single standard sized piece of loose leaf paper which must also be signed and stamped with the indeks and then submitted with it at the end of the year. The piece of paper is placed in the indeks and one hopes that it does not fall out or is not lost in the process of signing- as the same rules apply to the piece of paper as to the indeks. The only exception being that the piece of paper is only for one academic year and it's replaced before starting in the fall.

And you know how in North America they have those fancy white coat ceremonies to mark the beginning of med school. Do you know what type of ceremony we have?
An indeks giving ceremony.

So there you have it. Our report card system. The indeks!

If mine makes it through this final year without being lost or misplaced I haven't decided if I'm going to frame it or burn it- right after I submit it to the graduation overlords to get my diploma.

(I should probably add that despite the tone of this post, it's actually a really interesting system. It's just so different from what I'm used to. The US also has loads of traditions that might seem odd to outsiders.)

And On the First Day

I was asleep for the daytime part of the first day of the new year.

Too much partying. Only it wasn't me that was partying, it was the rest of the city.

The fun started on New Years Eve at around 9am when I trudged off to the ER where I stayed until around 4pm. That morning was arm morning, everyone who came in pretty much had a broken arm of some sort (it's amazing how they come in groups like that, the last shift had been head injuries).

After 7 hours in the ER, I left and headed to an internal med ward where I was from around 5pm until about 7:30pm, the doctor took me around and we talked to the patients mostly and looked at some x-rays.

I stopped by my room on the way back from internal med to have a quick dinner and wish my parents a Happy New Year. At around 9pm I headed back across town to the ER where I stayed until 8am.

What a night. After the head doctor found out I can suture (which I can do pretty darn well at this point thanks to a few great people- you know who you are) he put me to work. I sewed up around eight people; one of which took around 2 hours because I had to pick plastic shrapnel from his hand and put in around 63 sutures (a new personal record). Guess what! Holding on to a firework as it explodes, not a great idea. I also got to use a nerve block technique that I learned when I was out west, because I was pretty much left to my own devices- firework guy really appreciated it.

http://drsimonmorris.com.au/

I think they kept purposely giving me the annoying, talkative, drunk, patients though. I can understand a lot of what's being said depending on the person and the conversation. But, because I have a tendency to miss key parts of conversations, the people who talk a lot don't annoy me nearly as much. On top of that my speaking Polish is kind of terrible. Conversations in a medical context are pretty much limited, to "sit down," "lie down," "Okay," "Do you have pain?" and "finished." If anything the patients were probably wondering why in the world I wasn't saying anything.

By the time I left in the morning, there were no patients. I think we did pretty good!

I was feeling pretty good until I had to take the bus home from the hospital and discovered that my route wasn't running this morning. It ended up taking two buses and an hour and a half to get home.

I didn't sleep for well over 24 hours, but it was the best New Years/ Sylwester that I think I've ever had!!!

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.

http://www.biziel.pl

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.

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.

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.

http://www.spzoz-dzialdowo.pl

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.

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.

http://www.wolski.med.pl

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.

Response

Recently someone anonymously wrote to me on my other blog saying, "I live in Poland and I can't believe you chose to study here. Education sucks here." and another also anonymous person pretty much chewed me out for "being lazy" and "throwing your school under the bus" (haha this person obviously doesn't know me and throwing my school under the bus is kind of hard to do since I don't ever mention where I go to school, I change the identities and specialties of all my professors, and the pictures I post from inside Poland are other cities and events I have visited... so even if you think you know where I am, trust me you don't-unless you know me personally.)

Anyways, I'm getting off topic. I wanted to share my response to the first comment because I think it best sums up how I feel about my school and my education as a whole. Something that I have obviously not made clear enough on this blog.

My response:

"I have very mixed feelings about saying that any type of education sucks. You take out of everything what you put into it. 

It all really depends on the person in question. Are certain parts of my education better than others? Well yeah. I’d be lying if I said everything was hunky dory. I think my blog is evidence of that.    

People have different styles of learning and Poland’s primary strategy of medical education is you teach yourself or you don’t learn it. Despite this, certain parts of my education have been really great. 

Some teachers have really gone above and beyond to make sure that myself and my classmates get the information we need. I think for the most part (there’s always an exception) most of the Doctors want to help us learn and they do a great job at it. 

If anything the faults in the system have made me a better student. I have to work twice as hard to be as good as my US counterparts. I’ve had to teach myself, which makes learning more difficult but also keeps me on my toes. I can safely say I’m eager to learn, I want to learn new things, yes I get annoyed when people who are supposed to help me learn don’t. But, I can deal with that. I can learn on my own if I have to.    

There have been amazing and world renowned doctors who have come from my school. Doctors who have been pioneers in their specialty, so to say that the education sucks would be a falsehood. I have learned so many wonderful things from my teachers. 

The point of an education is to learn, and I’m learning everyday not only about medicine which is important, but also about the world and about the plethora of different cultures that populate it. I’m learning how to work with others who are not the same as me, how to communicate effectively, and most importantly I’m learning about myself and my ability to overcome life’s hurdles.  

So no the education does not suck."