Farewell…

1. Februar 2012 geschrieben von USAmed

Today will be my last post. It’s hard to believe I’ve been a doctor for a year! Where did the time go? Am I really a “second-year” already? I can’t believe how much life has changed. All in all, being a doctor is much more wonderful than I imagined as a student- but also much, much harder. You’ve seen my ups and downs – I’m starting to feel like it’s similar to the stock market: every high is worth much, much more if it follows a low. I mean- The moments I’m down and humbled I am so much more aware of the responsibility I have so that when I am successful (at a procedure, at communicating with a patient’s family), it means so much more to me.

One of the hardest things has been to separate personal stress (whether simply physical as in a lack of sleep or food, or some sort of emotional drama) from work – and accepting that I’m human and can’t always be objective all of the time! I’m also learning to take better care of myself- eating right, getting lots of sleep (who knew sleeping until 8 a.m. could count as “sleeping in”?) and working out.

My experiences have also somehow separated my true friends from those who are more “fair weather” friends- some people can’t relate to the amount of responsibility I have now and the issues I talk about now and that’s ok. Good friends don’t need to be there every day- but when you do talk, it feels like no time has passed. I’m not afraid to open up anymore and talk about what I’m scared of, what I’m proud of, what I’m sick of.

I’m excited to see what my second year will bring! Take care, everyone! Believe in yourselves and be a team player!

Heart of Darkness

28. Januar 2012 geschrieben von USAmed

Put a team of 2-3 doctors in with 10 nurses, 1 secretary and about 12 really sick patients into a small, enclosed area without the ability to look outside, be alone (except for the bathroom) or eat like a normal person and don’t let them out for 8-12 hours at a time. What do you get? The ultimate test of personality disorders, interpersonal dynamics, soft skills, response to stress, and ability to cope with low blood sugar levels.

It would be redundant to say that this week was much tougher. MUCH tougher. I found myself feeling physically trapped at the doctor’s station, angry for having to carefully stuff food into my face (nothing warm, of course, as we have no kitchen) around a computer while forced to listen to other’s banter (I need some peace and quiet sometimes! And I can’t run to the bathroom for 15 minutes when I need to be alone). Then we had some MAJOR situations on the ward- that makes some people yell. I don’t like when people yell, even if it’s not directed at me. I got to the point of having to be EXTREMELY firm with a few nurses who were playing Machiavellian games with the “new girl”. I forced myself to stay polite, but made it clear that I am nice because I choose to be, not because I don’t have a backbone.

I’m exhausted. I feel like I was tested at the end of my limits. Surgery was sometimes more physically taxing, but the ICU is somewhere between Joseph Conrad’s Heart of Darkness and the movie “The Game” with Michael Douglas (hopefully not to be followed by “Falling Down”).

It’s an artificial environment. Patients are either only very theoretically threatened (i.e. the normal post-OP patient) or very really at the end of their life. We have to help their family cope with life-changing events. We can’t always eat, drink or go to the bathroom when we need to. It’s very few people (only 2 attending physicians instead of about 10 surgeons I would usually work with) in a very small space. This is what bands must feel like on the road. Or a hamster in a strange cage.

The horror, the horror.

Damn it feels good to be a gangster

19. Januar 2012 geschrieben von USAmed

Today was a pretty successful day. I was in the O.R. all morning, honing my intubating skills (3 for 3, baby, yeah!), anesthesia knowledge (nice docs who had a few minutes to explain a few things), and central line insertions under stress (just as I approached the left atrium with the wire, my “assistent” made some rude comments about Americans… ugh!). Then when I got to the ward, there was a CT transport (which I pretended to manage while my colleague stood back and critiqued and improved certain parameters, which was super helpful). Then there was another intubation and central line on the ward, then a discharge summary in English, which always makes me happy, then it was time to go home!

It is such a great feeling when I work with my hands and it goes well. I know I help patients when I prescribe an antibiotic, but the moment you enter the subclavian vein and aspirate blood is such a thrill! I guess it’s because it’s tangible, it’s even quantifiable. I feel like I’m “working” not clicking around at a plastic box (which is what I’m convinced my dog is thinking about me now, for example).

I know the day will come when I need 4 tries to start an i.v. and I am humble enough to call for more experience help when it comes to intubating on the ward, but for me, that’s all the more reason to bask in my glory of a scintillating record of manual labor!

Time to wii! (I wonder if they’ll do a wii-intubation game…)

Rookie Mistake

17. Januar 2012 geschrieben von USAmed

I was in a mood when I got up this morning and couldn’t get my tushie out of bed… so I was late. Since I inevitably couldn’t find a parking spot right away, I was later. Since it was raining, my hair was ruined (I had JUST gone to the hair dresser last weekend to get a more feminine, volume-enhanced haircut, too) so I was even more in a mood. Ugh. It was all I could do to look interested and be polite when I got to the ward (after thankfully noting that the attending didn’t seem to notice I had been late…) but I was just too tired to approach all of the new faces AGAIN and introduce myself and chit-chat. I am so SICK OF IT. I have met at least azillion people the past 2. 5 weeks, some of which came to me (I thought I had already met them) and some of whom I had introduced myself twice to (arrrrgh). I have also been on my “best” behavior (meaning super-polite, patient and friendly) with the goal of 1) establishing a good working environment with my new colleagues and 2) working against my “work face”, which I’m told can be pretty scary.

So one girl looks at me pretty ticked off and keeps shooting me dirty looks. I took a deep  breath, resisted the urge to throw something breakable and walked over to her, explaining I had had a horrible rushed morning and just realized I hadn’t yet introduced myself!! (insert cheesy commercial smile).

Long story short, it worked. It goes to show you how important it is to “follow the rules” and introduce yourself (I do realize it can seem really arrogant if you don’t, though after being on the other side, I also know it’s often from insecurity or being overwhelmed). It also showed me just how taxing it is to be new- it’s all of those little things that you need energy for. They’re not medical, but they are so important.

Want some free advice? If it’s your first week (or 3), get some rest, take your vitamins, keep a smile pasted on your face, and if all else fails, there are always caffeine pills…

The Three-Phase Theory

12. Januar 2012 geschrieben von USAmed

My colleague Björn recently informed me about his “3-phase theory” of intensive care medicine. It started a long, convoluted and interesting discussion- I’m curious about what you think!

Phase I: “What the heck?”

You are lost, clueless, overworked, overwhelmed and generally confused. So confused about electrolyte imbalances that you can’t figure out how to work the coffee machine- probably because your subconscious is on overtime trying to grasp it all. Some are frustrated to tears, others are withdrawn and shy due to lack of knowledge and fear of appearing incompetent or making a mistake. Every mistake seems like a big deal and you feel you will never understand it all.

Phase II: You Function.

Somehow you begin to develop a routine and you have internalized the most important things (which you find out to be who to call when you need help, which nurses don’t need double-checking, how to prioritize the to-do list, and how to deal with family members). Night call doesn’t freak you out and you don’t stay up at night wondering if you made mistakes anymore- in fact, you start to return to your former life outside the hospital. Maybe to the point that you don’t even read up on anything anymore, because it used to tax your brain too much.

Phase III: You have mastered.

At some point (so I’m told) you are finally aware of the fact that you have acquired so much knowledge and experience. Note: This does not imply that you actually “know everything” or even think that you do, but you know a hell of a lot and are confident in daily work (everything from admissions, discharge summaries, inserting central lines, solving common ventilation issues and dealing with the most common mini-emergencies). Maybe you even get inspired to read up on some more advanced topics (probably because you finally hae the capacity to do so without falling asleep over your book and drooling).

I can’t wait for Phase III- will I really even get there someday? It’s hard to imagine!

Fresh Start

10. Januar 2012 geschrieben von USAmed

I’m on a new ward now and I’m not the only one of my friends/colleagues starting anew – so many of my friends are either in a rotation system (ICU or step-down as part of surgical training or common trunk, foundation year rotations in completely new clinics and specialties like from general surgery to general medicine, or even switching clinics/jobs). I’m still at the university clinic and I had met most of the docs and nurses while on call over the past year, but it’s a whole new ball of wax when you are the “new girl”- who knows what they’ve heard about me? What do they expect of me? Can I just be “myself” and open or should I observe the “serious” period for a few weeks until they get to know me?

I suppose part of my problem is that I have very high expectations of myself and I am a person that wants harmony among co-workers. They don’t have to LIKE me, but I want to “get along” with everyone. As a beginner in the field of intensive care and still a relative beginner in medicine, I am aware of all the things I don’t know and that I have to ask about. It makes me feel like a school kid again. It also makes me realize how confident I was getting on the regular neurosurgical wards.

I’m doing my best. I’m being myself- for example, I pretended the wheeled stool I was on was a rowboat yesterday to get across the nurse’s station and the anesthesiologist laughed. I was relieved. And for all of the (seemingly) ridiculous questions i’ve asked over the past week, I seem to have done a few things right.

It’s humbling. It’s taxing. It’s important, I suppose. It will be over in 358 days…

Auld Lang Syne

8. Januar 2012 geschrieben von USAmed

Have you ever heard of that song? It’s “THE” New Year’s song and it’s actually a poem by Robert Burns in Scots and set to an old folk tune. It literally means “old long since” or something like “old times” or “a long time ago”. The first verse goes:

Should old acquaintance be forgot,
and never brought to mind ?
Should old acquaintance be forgot,
and old lang syne ?                             (brought to you by Wikipedia)

I think it’s good to look at the new year and all the things you want to do or change or accomplish or move on from while keeping the past in mind. I think it’s important to remember where you’ve come from – metaphorically as much as literally. For example, as much as I try to assimilate to German culture (and often enjoy the process and often feel I’ve expanded my horizons), I need to hold on to my own past and traditions. When it comes to less palpable changes in my life, I find it helpful to remember my old frame of mind when evaluating how far I’ve come. I think it’s a bit of a compass. For example, I used to hoard things and save things “for a special occasion”. I remember I once got really, really fancy expensive chocolates one Christmas and I carefully stowed them away in my chest of drawers without even trying one, waiting for the right occasion. About two years later, in the heat of the summer, I had to throw away the melted remains. What a shame! I’ve since learned to embrace life and enjoy little guilty pleasures – like staying up late and renting a movie and drinking a glass of wine with my husband on a work night. Why the heck not? I suppose one can fall into the other extreme, but if you remember where you’ve come from, I think it’s easier to achieve a good balance.

So I’ll leave you with another song full of inspiration- this one is from the girl scouts. “Meet new friends, but keep the old, one is silver and the other’s gold”

“I guess I’ve got the (post-)Christmas Blues”

27. Dezember 2011 geschrieben von USAmed

I always skip over Dean Martin’s holiday blues-y classic before Christmas- there is just no need to get me sad with all the joy and Glühwein in the air! The joy of Christmas is 24 hours longer in Germany as there are 2 days of Christmas, which I think is fabulous. But today, December 27th, it’s all over. Ok, the glow lasts a few more days- my few on-calls between the holidays don’t even seem so bad and I’m ridiculously excited to see some friends over New Year’s, but I know that come January 7th (when we take down the tree and hence all other Christmas decorations) I will be a little melancholy.

Quick question- is there really a country with “12 days of Christmas”? Or is that just a cheesy song?

Even if there were a country with 12 days of Christmas (I’m assuming everyone gets weight watcher’s vouchers on the 12th day), even there it would have to come to an end eventually. Why do I get so melancholy? The WHOLE MONTH of December, 1/12 of the year, was dedicated to being excited about and planning for Christmas.

I guess it’s because I’m not a winter person and I have 3 whole months before I can be excited about Spring. There are Valentine’s Day and St. Patrick’s Day to get me through- plus, the days are getting longer now (so they say). It was such a wonderful holiday season this year, I suppose I just feel a bit bittersweet, it all came so quickly, i never made it to write any Christmas cards! But the time spent with family and friends has been magical and I finally got some much-needed rest.

Well, enjoy your holiday buzz while it lasts and stay safe!

My soul has the flu

23. Dezember 2011 geschrieben von USAmed

The holidays make me homesick, wistful, sad, emotional, sugar-crazed, over-tired and sensitive. Mostly just homesick. I was wallowing in my sorrow when a colleague of mine pointed out at least 3 cases on our ward, who I definitely would NOT want to trade with. Case in point: I have a lot to be thankful for.

Health is something we take for granted- heck, most people take it as a right, just as education. I am damned lucky. I also found true love- that also makes me damned lucky. The point is, it is easy to get caught up in old memories, former wishes, childlike patterns of thinking and the like around the holidays. I feel we should all take a step back and realize how good we have it, realize how thankful we should be, and maybe help those in need.

Though I have to ask myself- why is it worse that someone gets the diagnosis of a malignant brain tumor around the holidays? What’s the difference to August, for example? I mean you could argue that the weather in December is dismal anyway, whereas someone who has to be in the hospital in the summer must be pitied as he/she could be out having fun. Something about the holidays makes it sad when you realize some people are alone in their suffering. Some people are celebrating their last Christmas and they know it.

I took a deep breath, gathered all of my courage and fortitude and did my best to spread good cheer today, despite my homesickness. I have much to be thankful for. I hope my patients are thankful for their warm “Merry Christmas” and handshake from me, as well as my liberal dispensing of pain medication.

On a side note, if you are looking for a fabulous and classy Christmas CD, check out “What if Mozart wrote ‘White Christmas'” (on Amazon or itunes) and you will be floored and hopefully enthralled.

I guess I’m trying to say make the most of this holiday season. Embrace life, enjoy friends, tolerate family, be thankful for the food we have, think outside the box and feel free. Life is good. He is Born. Someday this madness will all make sense.

“Good things come to those who wait”

21. Dezember 2011 geschrieben von USAmed

I’ve been involved in several research projects. I really, really get into it- I throw myself into it and am very organized and passionate about it. That also means that I am personally/emotionally hit when things don’t work out as planned. I try very hard to be patient, but sometimes the “red tape” here throws me into a frenzy of hopelessness and I just want to throw things.

I’ve learned a few things over the past couple of months- although my energy and enthusiasm is a good thing, it needs to be coupled with much more patience and preparation. Sometimes, things just work out on their own. Sometimes, you do have to explain the same thing to an Oberarzt or the ethics committee over and over again and you won’t get any farther by getting snippy. Sometimes it pays off to “do your homework” and read up on something before presenting it: For example, I was once so set on initiating a new pre-OP protocol that I grabbed at the chance to talk to another doc before I had a chance to read up and prepare myself for possible questions. Let’s just say that talk didn’t go so well- it eventually all worked out, but I think I left a bad impression. The next time, I did take the time to read- even though it took longer- and showed how much work I put into it. I feel I was taken more seriously that time.

I’ve also learned that I’m not alone- everyone has to deal with red tape and others often have really good advice. I guess I feel I don’t want to bother others with my troubles, but it really pays to ask around who’s had experience. And sometimes, just sometimes, things clear up on their own- you don’t have to get all upset about it not working out the way you want to.

I don’t know why I am so easily discouraged- I guess it’s because I faced so much opposition as a medical student and continuously had to prove myself. I suppose I should now be careful not to come on too strong as I AM  doctor, I AM  a neurosurgeon and I AM  a researcher.

A friend of mine once said that every time he asked the good Lord for patience, he would find himself in really long lines or put on hold for a realllllllly long time- he said God must be giving him lots of opportunities to learn patience…