More Adventures in Internal Med

Classes have been going pretty good lately. Over the past two weeks we've had a few different classes all part of internal med. Namely: rheumatology, family med, and diabetology (yes, apparently that is a real specialty-I'd never heard of it before either).

Of all of them the rheumatology and family medicine rotation were probably the best of the three. The doctors in rheumatology spoke amazing English and were very helpful. And family med was good just because we were actually allowed to do things for a change. I got to give my first shot, we took blood glucose levels for all the patients who needed it, did physical exams, and all that sort of fun stuff. It was nice to be trusted and taught actual skills.

Even though we got to do a lot, the patients for the most part seemed like a bunch of (forgive this adjective) wimps. There were a few people who were legitimately ill, but for the most part it was "I woke up with a stuffy nose this morning and need a note for work." Seriously!?!? I've come to class with bronchitis both in med school and in undergrad because I'm not allowed to miss classes, not even one even with an excuse. And they're telling me they can't go work a cash register with a stuffy nose?

Okay, I get it some people just can't handle being sick. But, it seemed like ALL of them were looking for a way to get out of work. We even had one woman who was faking serious abdominal pain to get out of work- we only caught it because I said to the teacher in English that hermanski's sign was positive and while she was talking to her she checked and despite the fact the woman almost jumped out of her skin when I did it, she didn't even notice when the doctor did it. And most ALL of the injections I gave were narcotics.

I guess this explains why the doctor we were with pretty much thought every patient was faking it- most of them were. But, when patients were legitimately ill they got no sympathy. I guess once you see this sort of stuff so many times, you just stop caring about the patients as a whole. I dunno...but what I do know is I don't ever want to be the sort of doctor that brushes people off. I've had experiences with that, and when you are really sick it's very disheartening.

They see patients with it like this. 

Another interesting thing was the aesthetic quality of the clinic. It was messy, I don't mean just dirty, it was that too; I never saw anyone wash their hands, or clean the equipment not once in the entire week. It was messy, there was junk everywhere. The desks were covered in books and pamphlets, the walls didn't look like they'd ever seen paint, it was very "ghetto" and small, very small. And they saw patients in these conditions, better yet patients came to see them with these conditions. Back home if an office looked like this place it would have been condemned and there's certainly no way patients would actually elect to visit it. I understand money in clinics like this aren't the same here, but that is no excuse for the mess.

One of the best parts was when the drug salesmen would come in and pitch their drugs. The doctor wouldn't even pretend to pay attention, so my group was pretty much the only audience. One of my friends made it a point to convince them to give us free pens and notebooks. SCORE!

The only good part about diabetology, or at least the most interesting part was that we had class in a church, well next to it. The hospital had an extravagant chapel we had to go through to get to our classroom. Before we were about to take our final for the rotation our teacher jokingly pointed out that their was a reason we had to go through the church to get to the classroom. When I was getting ready to take a picture of it the first time, I quickly realized there was a priest hanging out, so I quickly hid my phone and took the picture later. I'm not sure how keen they are of people taking pictures of hospital chapels here.

I think we only have another two or three weeks of internal med before we start surgery or psych - I'm not sure which. I've enjoyed internal med, but I'm really ready for it to be done. If I felt like I were getting anything useful out of it the majority of the time I'd be alright, but I feel like I'm just going through the motions lately.

On another note, last Thursday was Donut Day! A.K.A Fat Thursday. Needless to say I'm still coming down from my sugar high. 

Teddy Bear Hospital 2014

Once again Teddy Bear Hospital was an awesome success!!! 

Like last year I had one heck of a time trying to get out of class even with my deans office excuse  which we applied for almost three weeks prior to this. Basically, I was missing three hours of a rotation that doesn't even exist in the US and they wanted me to pay 600 zl to make up the class. But the real kicker is that they didn't tell me or anyone else this until the day before we were supposed to go. Needless to say those of us who were going were not having it. In the end we sorted it out with the head of the department so it wouldn't be a problem, but not without some serious anxiety first.

The whole group of us (about 8) all met at a local grocery store and cabbed it to the other side of town. The international school we affiliate with for this is not exactly close so it takes a good amount of time just to get there. Once we were there we got everything all set up and ready to go for the kids. Basically (if you don't remember from last years post about this) there are three stations and kids bring their bear to each station to try them out.

The first station is just basic sort of doctor stuff. The kids tell us what's wrong with their bears and we fill out a little piece of paper with the bears vitals and then we have the kids listen to the bears heart, take its blood pressure, check reflexes, give shots, and stuff like that. The funniest thing in the world is to play pretend with a five year old. "Why don't you listen to the heart? Can you hear it?" "Oh YES I CAN HEAR IT." (I must need my hearing checked).

The next station is "imaging." My friend and I made an x-ray out of a box and collected some old x-rays to show the kids (so that we wouldn't have to tell them that the ribs were an arm again).The kids would put their bear inside, we'd shake the box around, and then we'd pull out an x-ray showing the body part the bear was complaining about. Getting x-rays when most places use computers is a little tricky so we had a few print out versions.

The third and final station was the operating room. We had a big table covered in a sheet for this and some fake scalpels and bandaids. We also brought gloves and masks along for the kids so they could get more into the role. I remembered to bring my sewing kit this year because last year kids brought bears that were legitimately in need of some stitching. I got to sew up one dalmatian- though I don't think the kid really cared.

The kids we had this time around were younger than the ones from last time around ages four to six. And for many of them it was their first year of speaking English so trying to understand them or even get them to talk sometimes proved a bit difficult.

Near the end of our time there some of the kids were really riled up. So instead of releasing them to the teachers as wild hooligans we had everyone get in a big circle and we taught them how to do the "Hokey Pokey" because that's what cool doctors do.

Overall, we really had a blast and I think the kids did as well. If anything though it's taught me pediatrics probably isn't really my thing. I just can't relate with kids well and quite frankly I think they hate me.

The Woman in the Black Reeboks

http://wrzesnia.powiat.pl/pub/uploadimages/popup/nowa_przychodnia2.jpg

The old woman was hysterical. She had come to the doctor for a simple stomach ache and the diagnosis ended with atrial fibrillation. She dabbed her face with a tissue as the nurse tried to calm her down. She was in her eighties, but this was her first major medical problem. "My son, I have to call my son. Where's my cell phone?" she cried over and over.

My classmates and I stood in the corner helplessly, not able to say anything to comfort her. Barely even able to ask her how she was doing. For the moment, I wanted nothing more than to be able to speak Polish.

The nurse let her lay on the ECG bed and the doctor instructed anti-anxiety medications to be administered. Almost twenty minutes later the woman was still shaking. Crocodile tears covered her wrinkly face and the doctor ordered the ailing woman back to the waiting room to wait 30 minutes before she would have another ECG. "We need the room, we have other patients," she said.

The nurse not at all pleased by the doctors decision half carried the anxious woman back to the small waiting room which was nothing more than a converted hallway where seven other patients sat.
Some time later the nurse and I half carried the woman back to the ECG bed. She had calmed down, but only a little- tears still filled her blue eyes. I helped lift her feet up onto the bed and noticed her black Reebok sneakers. The same type of sneakers my own grandmother wears on a daily basis.

The ECG was performed again and confirmed the diagnosis. The woman's son arrived half way through the test, and the look of relief on her face was enormous. Like any good son he was very concerned about his mother, checking to see if she needed anything, asking what was wrong. The woman was never told the diagnosis, the son was taken to the hallway to explain the situation and she was referred to a cardiologist.

Before the woman left to go the doctor performed an abdominal exam- Hermanski's sign was positive, she had guarding in her abdomen. The main doctor came in and conferred with the one who had done the exam. They spoke in Polish, so I still don't know what they decided the cause of the pain was.

While the woman was buttoning up her shirt the main doctor turned and said to us. "So there are some problems, but I think she is faking it. She is doing this for attention."


And that is the attitude towards most patients in almost all of the departments I have visited. But, it's fair to say it was the worst in family medicine.

Nephrology

I spent the last week in nephrology. It was really tough, but fun. I think it's safe to say that I pretty much still have no idea what's going on with those crazy retroperitoneal organs that filter everything, but it's still much better than I was before. I actually kind of enjoyed the challenge.

The teachers in that department were a bit more "interesting" than some of the other places we've been. One professor found the need to insult our Polish skills at every given opportunity and then proceeded to drop us off at patients and leave us there alone to take histories- knowing full well that even the best persons Polish wasn't enough to get us through the exam. It was actually pretty annoying. I mean, if you don't want to be bothered with students, why volunteer to teach us? We don't need much, just someone to translate. Yes we want to know Polish, we are in Poland after all but making the patient and us suffer when we're taught everything in English is kind of silly. 

This same doctor found the need to berate the patients for not knowing their exact lab values- I mean what patient knows those? I'm in med school and I don't even know the values of the last blood test I had. Most of the patients she took us to wanted nothing more than for us to go away, and I really can't blame them. She also had a habit of dropping us in a hallway with a handful of x-rays/CT's and saying, "I'll be back, and when I do you can tell me what's wrong." Usually the x-rays were pretty easy, but with the harder ones it was really annoying to be left for 30+ minutes with not even a remote clue about what was going on only to have her come back and play 50 questions with us. Finding new and improved ways to ditch students seems to be a repeating trend here. 

Picture from: http://loudoun.nvcc.edu/vetonline/vet121/gloving.htm

Besides her, most of the teachers in the department were really great. Yeah one guy in my group got in a shouting match with the one doctor, but I'm pretty sure the doctor was right and the student was just having a bad day. We spent a lot of time watching ultrasounds and biopsies. My friend even got to numb one patient up for a biopsy! Even though I didn't really get to do anything it was so much fun to watch her do it. It was even more fun to watch her try to put on five pairs of sterile gloves and trying not to contaminate them. We should really have a class called 'sterile gloves 101.' The irony of the whole situation was that the window was open, and even if she and the doctor were wearing masks, frocks, and the whole get up- no one else in the room was. 

All in all I really wish we could have spent another week in nephrology- but with the better doctors.   Not just because I really need to learn more before I can even begin to be proficient but because even if it was stressful at times, it was also a lot of fun. 

Internal Med

My group has been in the internal medicine wards the last few weeks. We spend around a week in each ward, just enough time to barely cover a subject before we're whisked off again and start something else. Most of the doctors are really great and know their stuff but one week is NOT enough time to cover half the stuff you need to know.

We don't get to see many patients either which is kind of annoying, nor do we get to do actual procedures. I've yet to do a full physical exam, start and IV, learn how to do stitches or anything of the sort- you know stuff medical students are supposed to be learning. On the up side, the theoretical side is being taught much better than it ever was in our general science classes, and these doctors/teachers can actually speak English very well!

So far we've gone through cardiology, oncology/hematology, GI, and we've just started endocrinology. For the most part it's been as boring as all get out, but sometimes the doctors spark an interest in us.

When we were in oncology my classmates and I noticed something odd about the hospital set up. The oncology ward overlooks the cemetery. When I asked about this the doctor simply said, "It's a beautiful graveyard." And I'm sure it is- so long as you're not fighting to stay out of it! I personally don't think I'd be able to deal with fighting for my life when my only view of the outside world is a graveyard! But, to each his own!





The hematology department also let us do blood smears on ourselves which meant pricking our fellow classmates- we're 2 weeks out and I still have the mark! The nurse in a bid to show us what not to do grabbed ahold of my friends finger and caused a fountain of blood to spray across the room directly at me. I guess it's a do as I say, not as I do sort of scenario.


In GI we got to see a few colonoscopy's and endoscopy's which for the most part are kind of uninteresting. But, at least we got to see an actual procedure! I didn't know this but apparently they don't knock you out for endoscopy's here- I'm not sure if they do in the states, but either way having a person awake is kind of brutal. There was this one woman who was not having it! The doctor in charge was so frustrated he was swearing and carrying on like a five year old until a bunch of nurses literally pinned the patient down and he rammed the tube down her throat. All of the other patients went a tad bit more smoothly than that!

This past weekend my friends and I finally had a "free weekend" to hang out and have dinner. Most of them are in another group and are in surgery right now. Apparently it's even more boring than internal med ("yippie!"). I'm really looking foreword to trauma surgery though, it's the closest thing they have here to an ER rotation and I think that's the sort of field I'm leaning towards, then again there's still so many rotations to go, you never know I might change my mind!!!

Winter Break!

It's been ages since I've written anything on here, so long that I really have no idea where to start. I guess right around winter break is where I left off so that's where I should pick up again.

 Before I left my friends and I all went to the Christmas market in the convention center and then Copper and I went down to the Rynek to see all the stuff there. I was looking for gifts for everyone and found some awesome Polish pottery plates for my step mom and some equally cool other pottery things for my Mom and Grandparents. The gifts actually took up the majority of my two suitcases. After that everything happened pretty quick- Copper went to the kennel and I was going home!!!                                                                                                                                                                                    So my flight home was awesome- the lady next to me got really drunk (because apparently there are free alcoholic drinks on transatlantic flights) and she spilled beer all over her seat so the flight attendants moved her meaning I got a whole two seats to myself! Once the seat dried of course! 

So back in the US I spent a few days at my dads house and then made the seven hour trip up north to see my mom. Once my sister got there we went on the traditional tree hunt- during which it rained HARD. We were all very wet after, but it was the quickest we have ever all agreed on a tree ever.  My parents threw a christmas party at the house and I got to see loads of family and friends which was really nice. We also went skiing (several times) and I got to see some of my old ski patrol friends- I can never seem to get my fill of subzero temperatures and snow. If anything it just made me wish I could be there forever.

The day that I left they had a major snow storm, so my step dad and I got up nice and early and headed out to the ski hill for one final ride before I had to go. The snow was amazing, perfect powder skiing, no one on the hill except for us, a little bit cold, but hey with those conditions it's totally worth it.








From there my sister and I drove to my grandparents house back down south. My grandmother had just gotten back from Australia so listening to her adventures was really exciting. Of course we all gathered around the piano too and sang random songs sometimes in our worst singing voices. My grandfather as he usually does just sat in the background and made fun of us. "Are you crazy" "Well I'm happy I don't have to listen to this all the time." You know the usual. My dad and step mom were there as well and my cousins and Aunt all came to visit (they live quite close) so we all had dinner together - just the once- otherwise the typical family fight might have broken out.

My dad and step-mom left the day before I did and then I rode down to their house with my grandparents. I have to say there was quite a weather difference! It was so cold up at my moms but where my dad lives it was super warm!

My step-mom had some free tickets to go to Mount Vernon (George Washington's House) so we went as a group down there. She also had free meal tickets so we had to use all of those because they were going to expire which meant stocking up on some pretty random foods...other people probably thought we were pigs. The highlight of the day was probably trying to convince my grandfather to take his false teeth out and hold them next to George Washington's so I could take a picture. He would have done it if he hadn't just set the alarm off in the place for touching one of the displays. We can't take him anywhere! haha.

My grandparents only stayed for the weekend so the rest of the week I spent with my Dad and step-mom. Meaning I spent New Years Eve watching the ball drop on the sofa in the dark by myself. But on the up side my dad and I went skiing on new years day, which was loads of fun. It was a pretty small place though so there were tons of people, many of whom had no idea what they were doing so it made the hill a bit like an obstacle course near the end of the day. It's was neat to go to this particular place because when I fly in at night I can see it all lit up!

My time in the U.S. quickly came to an end and it was time to go back home to Poland all too soon! On the way back I got to fly on my first ever 747- as lame as it is, I was ecstatic. We made it to Frankfurt in record time too, even if it was one of the bumpiest rides I've ever been on. The flight attendants were stealing barf bags from peoples chairs to give to three people in my section who had some issues with the turbulence- one of which was behind me. It smelled 'great.' On the up side there wasn't anyone in the middle seat next to me!

And then I was back in Poland. Copper was thrilled to come home from the kennel and I was not so thrilled to start classes again (cardiology). It's really bad, but I've only been here for 2 weeks but I'm already thinking about the next time I can go back!!!

London

Every time I tell people back home that I'm going somewhere interesting they seem to completely ignore the fact that I live in Europe. "She's going to Berlin? That must be expensive." Um...NO, I live two hours away! With London people think the same thing, but a round trip ticket is only around $100. It's not like I'm going on a 12 hour flight and paying $1000 like I have to when I go home!

Now that I've ranted about that...I went to London last weekend. It was my first time and it was amazing! My friends and I picked the perfect weekend for a last minute vacation.

DAY 1: We left Poland very early Saturday morning and got to London at around 8am. From the airport we took the train into the city and then the tube from there to our Hostel. Yeah, I said hostel, not hotel- worst idea ever. I've stayed in hostels before, but this was the dirtiest, smelliest, loudest one yet. On the way I made my friends stop at Kings Cross station, so I could see platform 9 3/4...yes I'm a Harry Potter Nerd. It was hands down the best part of the trip.

Once we got settled at the hostel we headed downtown again to Piccadilly Circus where we spent the rest of the day perusing tea shops, exploring M&M world, and being typical tourists. Our visit was planned perfectly because that night they were lighting the christmas lights and shooting of fireworks, so we stayed for that, which was lots of fun. My back was killing me though after all that walking.

We headed back to the hostel and were in bed by 11p.m. Our fellow roommates came in at around 2a.m. and lets just say they weren't very quiet about it, one also had a very severe case of sleep apnea.

DAY 2: Sunday morning we were out of the hostel by 9a.m. (What can I say, we're medical students, we're used to only 5 hours or less sleep a night). We took the tube back into town, but this time to London Bridge. Which by the way was the biggest disappointment of my  childhood.  Somehow based on the song I was expecting something a little more grand, not just a normal bridge. It was right next to Tower Bridge though, so we walked by the Tower of London and then across Tower Bridge to a tea place for breakfast.

We hung out around that area for a bit and then got back on the tube to go see Big Ben/Parliament, The London Eye, and Westminster Abbey - all of which are conveniently placed right next to each other. When we got there there was a huge parade going on, with Soldiers all dressed up in their fancy hats and what not. We thought we were going to get to see the Queen, but alas we did not.

Apparently it was a holiday - Armistice Day and then Remembrance Day on Monday, so there were lots of things going on. Either due to the holiday or the fact that it was Sunday we couldn't get inside Westminster Abbey, which I really wanted to see. So next time I go, I'm totally going to check that out.
From there we walked through Hyde Park and to Buckingham Palace. The flag was up, so the queen was in! Then we took the tube to Harrods, a really big, fancy department store. We didn't stay long because it was so packed!
We went back to Piccadilly Circus for dinner and to do some souvenir shopping and headed back to the Hostel and were in bed by 9p.m.

DAY 3: Monday morning at 4a.m we left the hostel after a very sleepless night. We took the night bus (yes, they're real things) to Kings Cross Station and then the train back to the airport. We were back in Poland by 10a.m.

I wish we could have stayed longer, but I'm happy to be home. That exchange rate is killer!!!