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.