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." 

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.