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." 

A Difference

A few hours ago I would have rushed at the chance to be done with this elective. But, as I left the emergency room for a final time and looked back at the impressive building that held it, I couldn't help but to feel a bit of sadness.

Yes, it was rough. Yes, I did cry more than once. Yes, my parents called a few times to make sure I was still alive. But, it was worth it.

After the initial week of terribleness everything slowly got better. By the time I got to the final week I felt like "I've got this." I finally knew what I was supposed to do, how I was supposed to do it, and I could present patients to the attending like a boss. My last shift was SO much better than the first, I felt like a completely different person. 

There was one lady who really made my day this week. She was being admitted and I got to talking with her about some of her medical problems. Near the end of our conversation she said, "I wish all my doctors were like you and would listen to me. Make sure you never change." I wanted to hug her. After the last few weeks, one lady made everything seem possible. 

It didn't hurt that the same night my attending said I did, "amazing work."  

Yeah...it was a good night. 

  

Right Now

Things aren't going well.

I think I made that pretty clear in my last post.

I'm really trying hard to improve and I think I have in some areas. Which for just a week of being here, is really great. But it's not enough.

Today I got a phone call.
It was my elective coordinator.
She wanted me to come in to go over how the elective was going.

Not good.
I spent the hour before the meeting spazzing out (figuratively and literally- I've had some twitching issues lately). I spent about 30 minutes crying before I marched up to the office resolved to face the music.

You see, I knew exactly what she was going to say. I know, probably better than anyone, how much I need to improve and what needs work. Pretending that I don't would be ridiculous. I might suck clinically, but I'm not stupid.

I walked into the office and she told me to sit down. I did.  She smiled and asked me, "How's the elective going so far?"

I knew she'd ask. I might as well tell the truth: "Challenging" I replied.
That's a nice word, had I of been in other company I would have said, "miserable." But I think she got the gist. It's not what you say, but how you say it.

From there she delved into the issue as nicely as she possibly could.
I wish everyone would just stop being nice and say it. Beating around the bush just makes it worse when it does come out.

Basically, the attending's are used to treating 4th years like interns and having them be able to take patients on their own. I obviously am NOT ready to do that yet. I'm not yet at the point where I can make any sort of diagnosis or treatment plan or anything like that on my own. And quite frankly it sucks, because I want to be there and I am trying to be.

So today was spent, "reassessing the goals of the elective."
Her words not mine.
An e-mail is also going to be sent out telling all of my future attending's that I'm basically incompetent, okay well not incompetent but inexperienced (same difference). And that they should expect less of me than they do for other students in the same year.

And even though these are all things that I already knew, it hurts.

It hurts...

Elective #2

I finished my first elective last week. I had so much fun and learned a lot! I know it looks like I spent a lot of time not doing clinic type things, but I assure you during the week I was in the office everyday either treating patients or learning about x-rays, or other random things.

On Saturday last week I flew from that elective to a big city on the East Coast to start my second elective. Talk about a huge difference!

The elective that I'm in now is Emergency Medicine. I've only done a few shifts, but so far it has definitely been the a$$ kicking I thought it would be. The ED is massive, there are 4 wards associated with it and every ward has at least 15 beds, that's not including the beds they usually have to put in the corridors and waiting area when it gets busy.

I walked in the first day bright eyed and bushy tailed with absolutely no idea of what to expect. I left 8 hours later with my tail between my legs feeling quite a bit stupider than I have in a while.

Over the course of my first shift I spent the first few hours following one of the PA's around getting the lay of the system after that I started taking my own patients.

I feel like every time I was talking with them I would forget to ask something important. And then when I headed to report about them to the attending I'd get nervous and totally (pardon my french) f*** up the presentation or leave something out. Granted considering I've never had to fully present a patient up until now I think I'm doing okay, but it could use some improvement.

And forget about patient management or procedures. That's one thing my school really screwed us over with as far as teaching- they did a great job teaching history and physicals, but patient notes and learning how to do little things like suturing is something they never really emphasized that would have been VERY helpful. I've never written a real patient note until last month and no one said anything about what I wrote, so I didn't know if I was doing it right or wrong.

I only had 3 patients the first day.

I felt like such a failure as I left.

My second shift I had 4 patients (the shift was only a few hours) which I was much happier with. But, I know the Attending's were talking about me. Eventually they asked me where I go to school and as soon as I said "Poland." They exchanged these looks and one said, "well that explains it."

I feel like I'm not doing well. I want so badly to be good at this and I'm trying as hard as I can, but I'm so far behind and it's painfully obvious to anyone who watches me. I have no idea what I'm supposed to be doing, I don't know how to improve quickly when I'm so far behind.

Yellowstone

I've been having a great time at my current elective! Not only am I learning so much but I also get the opportunity to travel around and see things, which I love!

This past weekend a few of the other med students and myself headed to Yellowstone National Park! Despite the fact that it is pretty much freezing cold at night and there are bears here that would like nothing more than to turn me into a snack (I wouldn't be good for too much more than that) we decided that we were going to go backpacking and camp overnight at the park. 

I borrowed most of my gear from a guy I met just a few days ago- most of my own gear is still in Poland and I wasn't exactly planning on camping here. One great thing about small towns is everyone knows everyone and where they work and for the most part everyone is so nice. I got a pack and sleeping bag from him and then one of the receptionists at the clinic loaned me a tent. The only down side was that he only had a summer bag, which meant that I had to pack lots of extra clothes. 

We got to Yellowstone on Saturday morning and got our backcountry permits and picked out a nice 13.5 mile hiking trail near Shoshone Lake and Geyser Basin. Now I'm okay with marathons and all that good stuff, but walking 13.5 miles with a 40 pound pack on my back is not really okay with me. It ended up taking around 5 hours for us to get where we were going and it was mostly up hill. 

We stopped only once on the way because we lost the trail and it took about an hour to find and ended up requiring crossing one very precarious looking tree which acted as a bridge over a fairly deep stream.

By the time we got to our site near the lake I wasn't sure if I'd be able to make the trek back the next day. Taking that pack off was devine! 

We pitched our tents and then made dinner- freeze dried pasta with veggies not the most filling thing in the world, but it was warm at least. And then we headed to the lake which was a mere 30 second walk from our site. The sun was setting as we got there and the view was AMAZING. We sat there for the next few hours as the sun set and the light gave way to darkness and the stars. 

We had heard a rumor about seeing the aurora borealis also known as the Northern Lights, but as 11:00 p.m. came around and it became darker and colder we reluctantly trudged off to our tents ready for bed. We never did see the aurora, though we don't think that anyone did so we didn't feel so bad for skipping out early.

Ah...sleep. I didn't do very much of that. I was wearing 2 pairs of thick sox's and a pair of tights with a long sleeve shirt, a sweater, and my jacket, as well as a hat and a pair of gloves- and I was inside the sleeping bag pretty much freezing my behind off. It got down to 18 degrees that night. 

I woke up almost every two hours either cold or having to pee. 

There were a few problems with getting up to go to the bathroom: 

#1. I was too cold to get out of my sleeping bag, as little as it was helping it was still better than being without it.

#2. I kept hearing strange noises emitting from the woods surrounding me and I was 100% convinced at the time that grizzly bears were ravaging our campsite. 

#3. I didn't bring a flashlight and my friend was in another tent. 

Needless to say I spent most of the evening wide awake with bear spray in hand.

We woke up the next day and warmed by the sun felt much better. After a breakfast of oatmeal we marched back to Old Faithful where we had started. The hike that had taken 5 hours the day before only took 3.5 hours the second time- either because it was all down hill or we were so hungry, I'm not sure which. We were both dreaming of bison burgers the entirety of the hike, I even jokingly suggested that we go find one ourselves and march it to the butcher (though I would have done it had either been readily available). 

Once we reached Old Faithful I got to see the geyser erupt. Which for me while kind of touristy was the highlight of going to Yellowstone. It was way more built up than I expected and the mass amount of elderly tourists kind of caught me off guard, but it was really neat to see. 

After that we headed back "home" for a nice bath and some neosporin (which my very blistered feet and cut up hip- from the pack, really appreciated).

We never did get that bison burger though...

First Elective

 

I'm out west in my first elective now.

I am having so much fun being in the clinic!!! After the boredom and inattention in Poland I had forgotten that learning could be fun. I have seen almost all of the patients and done basic exams and histories with vitals on them, I've written up their notes, taken blood (4 times, I've only missed once, but the person who I missed took the doctor 3 tries and he only got it in his hand), reviewed x-rays, and practiced suturing. I'M LEARNING SO MUCH!

When the end of the day comes around I don't want to go home, I love seeing patients and talking to them. And even though it's a small walk in clinic I've had several interesting cases. Everyone is really nice here and so helpful, the doctor I'm with really knows his stuff too especially orthopedics because of the area and even though we haven't seen anything (yet) he's taken time to show us x-rays and talk about different types of breaks.

I have a bit of free time too to explore the area on weekends which is great. There are two other med students here with me from the US and we're planning on hiking this weekend and then I'm tagging along when they go backpacking and camping next week. I just need to find some gear- I have everything I need back in Poland!!!

I've also been using the time to get some exercise in. I'm normally a pretty avid runner, but since being sick last month and with final exams and moving I haven't had much time. Since being here I've ran almost every day. The first day was really rough because not only have I been getting over being sick and not running but the elevation is WAY higher than I'm used to. I had a saO2 of 94 when I got here, almost a week later my saO2 is 99- I'm not going to lie I'm pretty proud of that even if I don't really have any control over it. Most people here I've noticed hover around 95/96 because of the elevation.