Munich goes Chicago

Sky-high blogging episode 2

2007-06-03T19:18:00.000-05:00

Hey reader,

as promised - another round of sky-high blogging to complete the circle.

I'm on the plane back from the Windy City after a long morning of finishing up packing, sweeping carpet floor with my broom (a vacuum was not among the things I had bought from Target) and giving heaps of stuff away to one of the Germans and the sociologist. Over the course of just one hour this morning, pretty much everything except one can of olives found a new home and I had to throw away very little.

I was just about done tidying up and getting ready to go around 12pm, Nema, whose flight departed around 3pm was long gone by then. The bad thing about that was that she was getting a ride with one of her roommates to the airport which was just so much more convenient than the one and a half hours of one bus and two train rides with my suitcase and two bags in the summer Chicago heat I was looking forward to. But I had missed that ride, so there I was, dropping off my keys and my laundry card at the graduate student housing office mailbox. Back across the street, there was actually a bus coming.

So far so good - but the driver warned us not to come in because her bus had been breaking down all morning and she couldn't guarantee to take us anywhere. That veered off me plus another young guy with a big bag who asked whether I was going to the airport.

Yeah, I was.
- Me too, been waiting for a bus for 15 minutes and now this, I'll have to take my car. Want a ride?
AWESOME!
- Can you watch my bag while I get the car?

You betcha, dude! Were things shaping up to repeat my incredible traveling luck from the way here?

Not quite!

We found out rather quickly that we had two different airports in mind. Rats. He wasn't going to O'Hare. BUT, he saved me the bus ride by dropping me off at the green line, which did bring me a short distance but otherwise long bus ride towards O'Hare.

The rest went rather smoothly except for me having to find out the hard way after lugging my baggage across the terminal to the Lufthansa check-in that this flight was going to be handled by United again after all.

And this time the bastards actually did make me sit with the cheap crowd. I miss the attention.

But they do have individual TV screens even here now so who am I to complain.

I still don't quite feel like writing the overall evaluation of the trip here so you'll have to wait a little longer for that while I pop in an episode of Battlestar Galactica now. I'm never able to sleep on these flights anyway.

Blog to you later.

Good bye.

2007-05-31T16:27:00.000-05:00

So strange.

After parting with my team today, only saying a proper goodbye to the attending because I'll see the fellow again tomorrow to pick up a letter she's writing for me I went to get the signed confirmation that I'll need for my medschool and turn in my pager. After that, I went up to Brainy's office to say goodbye to her, arriving at the same time as the heart failure team that wanted to round. But Brainy was on the phone anyway and they let me trade goodbyes with her before they started.

It was only after I left her office that I started feeling sad. Like they always say .. you never know what you have until you lose it. Working here was fun. I've pretty much decided not to come to the United States permanently - but that certainly wasn't for the work environment.

Walking down those halls in my terribly ugly short white coat towards the exit for the very last time even choked a heartless person like me up a little. And as if in agreement, a hot summer rain had started just around this time.

Excitement

2007-05-30T17:28:00.000-05:00

The day started out as usual, went up to A700 to get breakfast after getting up to speed with my patients from the past days. I hung out with some Germans and listened to morning report, which was about an interesting case of a 28-year-old pregnant patient that presented to two different ERs with a cough, one of those ERs being ours, both of those ERs making a chest x-ray (yes, on a pregnant patient!) and sending the patient home, both ERs calling the patient back into the ER after having taken a second look at the x-ray. After they did a CT at the U of Chicago (yes, patient still pregnant .. at least pre-CT ..) they found her to have sarcoidosis.

But that was not the exciting part. Neither was my stroll afterwards, at around 11am to the cardiology fellows' room to check in with Missy. She said that she hadn't gotten a consult yet and with a smile on her face offered that if there wasn't a consult by noon, I should go home (the weather today is what other people would call gorgeous .. I actually liked the mostly air-conditioned interior of the hospital at that point). Even when she said that though, I knew that wasn't going to help her karma. It's those days where the morning seems like nothing's going to happen that come back to bite you in the ass. Which was good. I wanted to do consults. That's what I'm here for.

So I left the fellows' room thoroughly expecting the page that came half an hour later about a patient in one of the surgical ICUs. She had received a left lung transplant yesterday. Somehow I still have a high level of respect for lung transplants. But the way they have simply extubated the patient this morning, just about 12 hours after surgery and the way Missy would just send a foreign med student that's still coughing once in a while to see this highly immunosuppressed patient breathing with someone else's lung for a few hours now started wearing down this respect.

Anyway, I went up to that ICU and spent the rest of the time until noon getting started with the consult, jotting down her history and deciphering some of the surgical (i.e. minimal and cryptic) notes of the past days. The reason we were called was that the anesthesiologist who did the intraoperative transesophageal echo found severe mitral regurgitation. I looked at the pre-transplant workup and found a right heart catheter from just a few months ago numbering her pulmonary capillary wedge pressure at 1 mmHg which all but rules out any mitral regurgitation back then. That means if she had MR now, it would have to be rather acute. So I did check in on the patient - who was doing remarkably well, obviously having pain in her chest on day one post surgery but was very lucid and pleasant to talk to - before going back to A700 for lunch and an interesting infectious disease conference on endocarditis.

I had meant to go back to finish the consult about half an hour into the conference, after having enjoyed the excellent free Potbelly lunch. But the presenter from ID did such a great job presenting that I stayed until the end at about 1pm. So that's when I went back to the ICU.

After settling down again with the patient's charts (because they have two on ICU) I happily scribbled away at my consult sheet when the surgical resident from the primary team asked me whether I was from cardiology.

Sure.
- Oh good. Cardiac enzymes just came back positive. Did you see the EKGs?
There were EKGs? You drew enzymes? What's going on?
- Oh the EKGs are not in the charts, huh. Let me see if I can track down the nurse to find them.

And off she went after the nurse to get the EKGs. While she did that, I brought up the patient's labs on oacis and sure enough, she had had cardiac enzymes drawn this morning at 2am and again around noon. The latter ones had just come back positive with a troponin of 0.26 - with the 2am ones already at 0.16. CK-MB ratio was also mildly positive on both.

Just about after I had found this out, the nurse came around with two EKG's from the patient. They had almost identical time stamps to the two sets of cardiac enzymes, 2am and noon. The 2am EKG looked normal enough. The noon one had pretty impressive ST elevations in the inferior and lateral leads, yet not in the anterior ones. With scaredly-widened eyes I looked up to the nurse (the surgical resident had apparently taken off again) and asked her if the patient had chest pain with this.

Of course the patient had chest pain.

Duh. She had had her left lung replaced yesterday.

So this patient had chest pain, positive cardiac enzymes, a new onset of localized ST-elevations on a day after major surgery and I seemed the only one freaking out about this. That couldn't stay that way, so I paged Missy with a text page saying just that - something along the lines of "pt has cp (confounded by surgery), + enzymes and ST-elev. I think you". Apparently, as I later learned, I must have sent the page before I was done writing it because it ended in the middle of a sentence and before I gave a call-back number or my own pager number to identify who sent the page. This may have happened because I was showing Jen, who happened to be there, the EKGs and running to the patient's cubicle to look at the vitals on the monitor while writing parts of the page. Which was why Missy never called back.

Jen was seeing another patient and had come over to chat so I showed her those EKGs. Being a nephrologist, she said she hadn't been reading EKGs in a while but agreed this together with positive enzymes was likely to be either pericarditis or an acute myocardial infarction.

I knew this had to happen on a day that Missy wants to send me home at noon. With Missy not answering her page (which she couldn't as I only found out later) I went to the most extreme measures, came into the patient's cubicle and talked to her. And when asked about it specifically, she'd say that she had no pain in her chest - unless she moved.

Phew.

Her vitals were stable, on two pressors admittedly. But stable, and the patient had no chest pain at rest. Then again, she had a high epidural. I still didn't quite understand why I was the only one worrying there. I was about to send another page to Missy, when she came into the ICU around 2pm. She showed me the botched-up page that I apparently had sent and said that she had checked up on the other patients on the service that were a little more likely to be having acute MIs than mine not knowing where or who the page came from.

Oops.

So I gave her a quick run down on the patient's story and came to the enzyme and EKG part rather quickly. She was similarly relieved by the fact that the patient had no chest pain and a decent blood pressure of 100/60 and also pointed out the PQ depression hinted at in some leads that would make pericarditis more likely. But she asked for another EKG nonetheless, since the one we had was already two and a half hours old by then.

That's when the attending called to go start rounding in ten minutes. Missy had gotten another consult in the meantime (karma's a bitch), so we went down to that other ICU to at least grab that person's EKGs before meeting the attending in the workroom.

We relayed the most pertinent information about our patients to him upfront but he'd of course as always want to look at a maximum amount of "pictures" (read: imaging studies) on all the patients we were going to see. So that took a while and afterwards, when deciding which patient to see first, we went to see Missy's patient. She wasn't as critical as the patient in ICU but geographically closer. Guess that's what you get for being on a regular floor.

Afterwards, we finally went to see the freshly transplanted lady at around 3:45pm but we were apparently just in time, the tech was in the process of writing my patient's third EKG for the day. While we were kind of aimlessly standing around waiting for her to get done, I saw the first Dr. Cart being initiated in front of my eyes.

No, it wasn't on my patient.

I was leaning on the ICU's coordinating clerk's desk which was just a few steps outside of another patient's cubicle. Anyone who's ever been on an ICU knows they are noisy places with ubiquitous and incessant beeping coming from somewhere or other around the clock. There's so much of it you get used to it and you don't even consciously perceive it anymore.

Except for a few kinds of beeping - those ones where the monitor actually means business.

And this was one of them.

When I looked up from the desk into the cubicle right across from me, the blue and red lights on top of the actual screen of the monitor flashed alternatingly, while the screen read multiple wide-complex QRS's in rapid succession - this was ventricular tachycardia. Inside the room were a nurse and a relative - the nurse poked her head out of the cubicle and yelled for the crash cart, while the relative gave a yelp and started to cry, before storming out of the cubicle, seemingly to make way for the influx of the ICU staff that was about to happen. While the nurse that was originally there opened the hinged glass walls on the front of the cubicle another nurse flattened the patient's bed before the rest of the ICU people including my consult team had the patient's bed surrounded and all I could see from the desk was the monitor.

That didn't look good though. The VT had apparently subsided and reverted into some kind of slow narrow-complex rhythm, maybe sinus brady, maybe junctional, couldn't tell from where I was standing. I did see the blood pressure from the arterial line around 60/40 and occasionally dropping further though. I knew nothing of the patient's history but her future seemed increasingly in jeopardy. At this point someone yelled to "call a Dr. Cart", which the ICU clerk right next to me did. Just moments later, the overhead public announcement system made another all-too-familiar overhead page to "Dr. Cart", this time calling to the bed I was standing at.

They started compressions right around that time and since there wasn't going to be much I'd be doing with the code, I grabbed the new EKG of my patient from the tech and compared it to the two other ones of that day. And I must have had that wide-eyed look of fear again - not only did her ST-elevations get worse in the lateral leads, I hadn't before noticed that she had had a solid 1mV R in lead III at 2am, that had become isoelectric at noon. Already then there wouldn't have been much blaming this on lead placement, since these are limb leads and the P axis did not change. But now, on this EKG close to four hours later, this lady did not have an R in III anymore, it was a 1mV Q.

I showed the EKGs to my team who were now more on the outer rim of the Dr. Cart crowd and the attending had an interesting way of putting it .. "oh no. She is losing voltage." Finally, things became more hectic with this patient and the attending told the patient that he'd say her odds were about 60% of having a heart attack and 40% of just having pericarditis and that he'd suggest they do a cath right away.

Outside the room, Missy voiced her concerns about this patient. She wasn't as sure about this patient having an acute MI as the attending and she was making a good point. The patient just wasn't symptomatic enough. Blood pressure was stable on the pressors and she just didn't have any pain. She didn't quite convince the attending though. He agreed that the clinical picture was underwhelming for this amount of EKG changes and that pericarditis was a more likely explanation - so the odds were maybe 40 to 60 or even 20 to 80. But even with only a 20% chance of this person having a huge infarction - can you afford not to cath her?

While the attending was talking to the primary team I followed Missy to the cath lab, where she was about to inform their people about the patient and show them the EKGs. On the way, she made another good point, being that the patient was severely medically immunocompromised and about to be wheeled through the hospital to the cath lab where someone would be poking wires around her freshly operated-on mediastinum. The cath wasn't a benign procedure.

This was a really tough decision to make.

Missy said that she was "only a fellow" and was afraid to be "too cavalier" in her opinion to rather "ride this one out" rather than sending the patient to cath. I disagreed in so far as I didn't find it cavalier to be seeing the whole picture and to be afraid the patient could die of overwhelming infection with totally clean coronary arteries just a week from now if we do wheel her to the cath lab.

When we returned to the ICU, though, the decision was basically taken off our hands. The attending cardiothoracic surgeon of the primary team answered his page and talked to our attending. Two new pieces of information prevented the cath - for one thing no one among all those people involved in this so far had been privy to the fact that during her transplant surgery, not only the pericardium but also the left atrium had been cut open for the anastomosis of the pulmonary veins. That was a good explanation of the cardiac enzymes and pericarditis on EKG and made them even more likely, still didn't quite rule out infarction though. However, the other piece of information was that the surgical attending expressly forbid us to use aspirin, clopidogrel or heparin even if we did find something on cath. The only thing he would let us put her on among the usual MI medication was a beta-blocker, which she got. With all those meds out of the picture and stents therefore not being an option there wouldn't be much point in a cath anyway, with angioplasty being unlikely to change much.

So unless a third set of enzymes would come back exceedingly high, there'd be no cath on her today. This will be something interesting to follow up on tomorrow.

After getting home this afternoon I met the sociologist again and he took me to one of the two places in Hyde Park to go out in, as I learned from him there. And apparently, he now also is a reader of this blog so I cannot say any more evil things about him. Rats.

During the several hours we talked I learned among many other things that the University, owning a significant portion of Hyde Park, actually and actively prevented more leisurely (read: alcohol-dispensing) places to open up around campus.

Shame on them!

Look, it's half an hour into Thursday already - my very final day in the U of C hospital. Time to finally write that summary report I've been promising, isn't it.

Well if you're waiting for that, just hope that no more exciting days come in the way.

And tomorrow afternoon the entire Chicago gang is invited to barbecue at CS's place.

I may just end up blogging the retrospective report from Germany - or maybe the plane. Some sky-high-blogging for the perfect circle. See! It did pay off to have read this whole thing for that beautiful sense of closure, right? RIGHT?

OK never mind, I should sleep.

Blog to you later.

Yes I am

2007-05-24T14:10:00.000-05:00

still alive and kicking. I've been sick over the weekend and I actually took Monday off, partly because it's just annoying to be blowing your nose every few seconds but mainly because I just don't want to be responsible for a ton of ID consults on patients and staff just about a week from now.

When I did work last week though I kept surprising myself by having a lot of answers during discussions and rounds. Especially with this one attending that "rounded" with us at his desk (much like the very first renal attending). He was a stud, appeared very young and overflowing with confidence, obviously was working out and judging from the pictures in his office he had his trophy wife tucked away (OK now I'm going a bit too far). Obviously, he was knowledgeable - you don't become an attending for nothing here. So while rounding in his office with Missy and the female intern on the team as soon as I started presenting my patient he'd say that we were going to have a "guy discussion" from now on, which apparently meant that we'd leave political correctness and etiquette aside - which was very refreshing and fun.

I didn't see much of that attending - he only filled in for the regular one that day. But from what I have experienced and heard about him I guess he is an extremely - maybe overly - confident guy that will be your best friend and not worry too much about taking care of patients himself as long as everything goes well. Apparently though, the yelling starts if ever things go south and he may ultimately be made responsible for something he should have taken more care of. So he's a nice, extremely suave and cool guy and he does seem to know his stuff but I still wouldn't want him as my attending - whether I'm on his team OR his patient.

But like I said, my experience with him was brief.

Over the weekend, like I said, I was sick and didn't do much except raiding the pharmacy for cold medication that turned out to be placebos for the most part - including the facial tissues. The stuff they sell there really is a very bad joke. Unless you use at least three of those tissues at once you might as well blow your nose into your hand directly. While at home with my headache I did get started typing down an exposé of the mentoring project the Chicago group has been working on. As of last night, it was up to 10 typed pages, I'm still waiting for the rest of the group to read it and sign off on it so we can pass the first drafts on to the good people in Boston and Munich. But I have high hopes for the next project meeting tonight at 6pm.

In other news, the service has been very light these past days and I was able to attend a lot of conferences today. Among them was a so-called "code review" where they discussed a few of the Dr. Cart (=cardiac arrest) calls that had happened during the past week. Primarily, I learned two things: one is that they actually physically record their resuscitations. This includes the patient's EKG, ventilations, depth and frequency of chest compressions and even audio - audio! as in what the team is saying around the patient as they are coding them. That is so cool! The software gives you a full report, placing EKG reading, respiratory curves, chest compressions, end-tidal CO2 as well as information on whether or not the patient had a pulse at the time on time-synced visual graphs with the option of playing the audio at any time. That's so awesome for discussing what went right or wrong during the traditionally hectic conditions of a code situation which is exactly what they did. We have to have this in Germany.

And the other thing that I learned today was actually another piece of evidence that Americans are crazy. In a nice presentation on the benefit of post-code hypothermia the ED presenter mentioned this report, where investigators placed nine healthy volunteers (read: medstudents) under general anesthesia (yes, intubated and all!) to infuse them with ice water and see how their temperature drops. If you don't believe me, click on the link. Combine this with the concept of fecal transplants and you have definite proof beyond any reasonable doubt that these people are loco.

Allright, I'm going to let you go for now. I'll be done with the hospital exactly a week from today and flying back to Germany two days after that.

There are two things you should be able to expect from me during the upcoming days .. one should be a comprehensive review of the two months I've spent here and another should be a discussion on what the heck I want to do with my life (you definitely don't have to read the latter).

Blog to you later.

Case report

2007-05-18T11:22:00.000-05:00

The very first patient I had seen in this hospital - the one Jen sent me to see the morning of my very first day here - has just been presented to the residents in morning report. The 50.000 IU of vitamin D per day for months. The attending overseeing the presentation shook his head in the end and said this is something you will hardly ever see.

Except if you're a student fresh from Germany starting on renal consults.

Over time.

2007-05-16T17:04:00.000-05:00

I had a very good one and a half days.

They'd probably not be very good by everyone's standards as I've been in the hospital for 26 of the past 33 hours.

So here's how that happened. Yesterday started at 7:30 with critical care rounds again, I was pretty tired after around four hours of sleep - it had gotten rather hot and humid in Chicago that night and I needed to wait for Monday's episode of Heroes to download and be watched, obviously. But it went on to be a pretty normal day on the heart failure team. I was still enjoying having a load of time to go to all the conferences, with ample time to check on the three patients on our service. Jess was in clinic, but that didn't matter too much. It only meant that we'd be rounding a tiny bit later than we were used to, started maybe at around 3pm. A patient from the critical care unit was in surgery at that time and on our way to a lecture by a German liver surgeon we met his family. News from the OR had thus far been good, except for the fact that he was oozing blood just about everywhere, since he was on argatroban being heparin-intolerant which is non-reversible. So Brainy answered their questions and told them that they'd just have to wait for the bleeding to stop and that things would be fine. Even at that point in time, she was a little too definite with that last statement for my tastes when talking about a very sick patient from the unit undergoing open heart surgery.

Brainy and I went to the lecture, we were sitting rather isolatedly amidst all the surgeons. As it seemed, Brainy really didn't have any barriers when it comes to hierarchy and the likes. It was awesome. From the way we talked, joked around and exchanged candy in there she might as well have been a medstudent or I may have been an attending or we could basically just have been friends. I mean I really appreciate it and I'd love to see it the same way when or if it ever will be the other way around, with me not on the bottom end of the hierarchy I mean. Unfortunately, Brainy was paged during the lecture that the patient had died on the table, so she left and brought the bad news to the family.

Now, CS had told us two days before that she had changed to the cardiology inpatient service and was going to be on call yesterday. There were no U of C medstudents with her that night so she had invited any two of us to join her and admit cardiology patients that may come in. She was also planning on continuing the little EKG tutorial she had once started with us at six and had asked us to decide upon the two of us that would be on call with her yesterday. I figured, we might as well do that together during the tutorial since I expected all of us to be there. Unfortunately, I learned through a page during the lecture by the German guy that EKGs were cancelled. During the day, some of us had talked about who wanted to go on call and it seemed that not all were interested to do it and people from the second wave of the German invasion were kind enough to say that they'd probably have more opportunities to get a taste of on call inpatient admissions. Nevertheless, when I paged CS after the lecture at 6pm, I fully expected the jury still to be out on who'd be doing it.

"Philip, yes. Come down to the ER, Nema's already here and I have a patient for you."

So that was that then, it seemed.

Apparently though, my questionably bad luck with on call nights has turned since our service got slammed last night. CS was actively and actually sweating with the number of patients pouring in and that was the main reason why I was actually in the hospital until almost midnight - so six hours later. CS would not let me see more than one patient, but she wanted to hear my entire presentation on her and go through assessment and plan before she'd let me present to the attending the next morning. That was not an easy thing to get done while new patients required a cardiology bed left and right and CS was wheathering the storm. Still, she took a remarkable amount of time to listen to our presentations and give us hints and corrections for when we'd present to the attending the next day. So apparently the deal was that I should just see one patient and then go home - which is what I did. From what I heard from CS, their attending was going to arrive around 9 the next day and I was to present the patient I saw during their rounds which would be around then.

So I went home and slept. Critical care rounds this morning had unfortunately been pushed up to 7am, so I guess I wasn't really all that fresh again when I came to the hospital this morning. This time though, I arrived before Brainy (so far they had always been rounding for at least five minutes before I came stumbling through the door). So I paged my new fellow on the general cardiology consult team (because I was actually switching teams today, from heart failure to general cardiology). I had never seen her or heard of her in the hospital - I guess she must have been away, maybe on vacation before. I should ask her about that. When Brainy came, we rounded for just half an hour until we went up to cardiology case report conference at 7:30. The cases were pretty interesting. At 8:30, the conference was done. Walking out of the conference room, Brainy saw the intern that was going to be on cards consults with me and introduced us. While we were still walking down the halls, I got a page from CS at 8:36 reading "Phil, rounds in 5th fl WR now. Thx, CS".

Uhm, ok. So I went to the workroom where last night's team was assembled - CS, the two interns, Nema and myself. CS asked me whether I had checked up on my patient and was displeased to hear that I hadn't - I thought I still had time. One of the interns had grabbed the morning vitals and labs on the patient though and kindly brought me up to speed before the attending came. When he did, we went to a little windowless conference room (apparently nicknamed the "Bat Cave" by some as I had learned the night before), sat down and got introduced. The attending asked for our names and pager numbers. At first, I said he wasn't going to need my pager since I wasn't going to be on his service. Turns out I was wrong, though, since he would also be the attending for the general cardiology consult service.

Speaking of which, I hadn't heard back yet from the fellow of that service that I had paged at 7am. But hey, I tried to touch base .. what more could I do. So after that short introduction, the on call team started rounding with the attending and I just followed along, since I didn't have anything else to do anyway. While they were seeing the first patient, which was not mine, I paged my new fellow again and this time she did respond. I talked to her on the phone while the team was rounding, it was around 9:20. The new fellow, let's call her Missy, said she was just on her way in and that I didn't have to come in this early. I told her that I had just come for CCU rounds and the conference. She said "oh, OK" and then asked me to just hang out until she'd get there. I told her what I was doing, that I was rounding with the on-call team from last night because I had a patient to present. At that point she got confused and asked who I was again. I reiterated and explained the whole thing, emphasizing the fact that me staying at night was an exceptional thing but already then I feared she would expect me to know much more about what I was doing than I actually did. We saw another patient first, then Nema's and only then did we come up to mine, it was around 10:30 then. Now here's where the main part about the goodness started - I think the presentation went very well. It didn't seem like I had forgotten anything major and sometimes must even have sounded like I knew what I was saying. Having just come off the heart failure team, I was even able to back up some of what I said in the discussion of the plan for the patient with actual trial data. Of course the attending knew much more about the subject and taught us some new stuff but I still think it went exceptionally well. Unfortunately, now I seemed to have two people to convince not to expect too much from me since I seemed to have made rather favorable first impressions on both the fellow and the attending. They're going to be so much more disappointed when they find out the truth about me after initially having this distorted picture of me being highly competent. I would have been much more comfortable if they took me for the rookie I am.

Unfortunately, when I met my current team, fellow and intern a little bit later, Missy handed me an EKG strip to interpret. Despite the fact that I strongly emphasized how little I knew (which as feared, Missy didn't believe) I interpreted the strip correctly as being sinus with incomplete left bundle branch block that turned into overdrive-suppression by a ventricular automaticity focus that paced the heart only slightly above the sinus rate. At that point, Missy completely stopped listening to me when I pleaded that I didn't know what I was doing. So now I was screwed.

She gave me one of the new patients she got today to see and while I was presenting this patient to the attending, I got a glimpse of what was to come when they finally realize the extent of my knowledge. Missy asked me what I thought of the use of "Cardizem" in this case. I truthfully replied that I didn't even know what that drug was. At that moment, I caught a short glimpse of astonished jaw-dropping on Missy's side. I asked her whether that was a brand name and she apologized with a hint of relief that it was diltiazem. After that, I could answer her question somewhat satisfyingly but I'm not sure I want to see what happens when they find out how vague my understanding of things like the anatomy of coronary arteries or cardiology in general actually is.

Still, today was a good day and I can now comfortably watch the new episodes of 24, House and Gilmore Girls, since I don't have to be back in that place until 9am.

Yay!

Blog to you later.

Americans.

2007-05-15T14:53:00.000-05:00

Morning report today focused on long-term care of patients with chronic conditions like diabetes or hypertension and the difficulties we are faced with in that area. So the first case was on a 64-year-old african american female who was - of course - overweight. We were told the story of how she started out on one medication in 2003 and when her blood pressures never responded in subsequent clinic visits, how her regimen was gradually extended to four different blood pressure medications.

At this point in the slide show, the next slide posed the question "what else can you think of to optimize treatment of this patient's hypertension?" to the audience. I was convinced that I knew what this slide was going to show. To my surprise, what they were looking for here were the questions "is the patient taking her medications?" - all right, good one. "Can the patient afford her medications?" - uhm, I see. "Does the patient have access to her medications?" - as in - can she get her obese self to the pharmacy and back? I guess that's a valid question too. But that was it.

Whatever happened to "Did anyone ever talk to this patient about less McDonalds and more exercise?" Is educating people about sodium intake and physical exercise and the likes of that so out of fashion that it doesn't even come up in a discussion of the management of primary hypertension?

Sociology

2007-05-14T22:41:00.000-05:00

Hey reader,

today was another good day.

It started off with me coming to critical care unit rounds at 7:30am that my attending had invited me to last week. When I met them, they informed me though that there'd be a conference on pulmonary hypertension upstairs. Oh and there would be bagels a resident said. Sold!

The conference was interesting. I met Jess there. She told me she'd be doing a lot of right heart caths today so I stopped by there after the conference. There, she just asked me to check up on our old patients - the whole service! Now that would be much more of a shocker if the service had consisted of more than three patients. Muahahah!

This way I had leisure to check out morning report at 10, which was a somewhat-interesting discussion on how the U of C hospitals should extend community clinic services. Between around 11:15 and noon I actually did look up the labs on the patients and checked in on them. I was back in A700 in time for the lunch conference :D .

For the first time (in the history of the residency program as I later learned), there was actually a drug rep there who sponsored the lunch and handed out journal articles and leaflets. I conveniently (but honestly) missed the piece of paper on the wall stating that this lunch was restricted to interns and sub-interns. I guess that's why the rep did not hand out the articles to me. I'm clearly identifiable by my horrible short coat. A second-wave medstudent from Germany whom we had warned was wearing his regular long coat, so he was "welcome" to the lunch I guess.

Well, whatever. I got food.

After I sat down, somehow a conversation with the person next to me began. Turned out that he, as well, wasn't really entitled to his long, white coat. He turned out to be a sociology major, there to observe. His thesis had something to do with social networks in the medical profession and specifically how people are perceived by others, like some people that are deemed knowledgeable by their peers yet not arrogant, but pleasant to work with. Like my current attending. He had been following a lot of medical teams around over almost a year by now and only had time to come to the lunch meeting for the first time today. He, of course, was very interested in what I had to say about my impressions here and I very much enjoyed exchanging them with someone who was in very similar shoes. We both had been thrown into these "teams" that were alien in many ways for either of us. The noon conference on an interesting case of lupus complicated by myocarditis interrupted us, but on the whole we spent about 2 hours talking. And I did have the time to do that. That was so nice.

And with Brainy (who will be a prime subject for his research) and the mentoring program we're trying to build in Germany and differences between US and German systems we did not run out of discussion topics, so we said we'd meet for lunch again some time.

So around 2:30pm I strolled back to the cath lab, where Jess was doing the same thing I had left her with: right heart caths, just got done doing the seventh. While she was almost done, she asked me to page Brainy to find out when she would want to round. Turned out she was right through the doors of the cath lab in the cardiac critical care unit (nice infrastructure!) basically waiting to round with us. I actually brought her into the cath lab, because the first patient we'd be rounding on had just had pieces of his replacement heart removed by Jess.

So we saved ourselves that trip. Mentioning that second patient only evoked tirades from the female rest of the team about what a sexist womanizing jerk he was. Seeking to provoke, as I usually do, I threw in that I liked him. My attending then explained to me that the advantage of her being smaller than me was that she was perfectly positioned for a right hook to my jaw. She demonstrated the movement and I saw her point. Dude, can you imagine a German attending kidding around with a mere medstudent like that?

They ended up deciding that we didn't need to see that patient that day.

That left only one patient to see, which we did. He had been sent to the floor from the ICU today and was ostensibly doing just peachy.

The three of us subsequently chatted pleasantly for a while until Brainy sent us home around 4.

Brilliant!

Catching up

2007-05-13T19:59:00.000-05:00

Hello readers,

I grew a bit tired of blogging, which is strange since I have basically way fewer patients to see and therefore more time during the day.

On Wednesday, yet again, my attending changed. And if I was impressed with the last one, this new one is even more incredible. She has never admitted to her actual age, keeps making up numbers jokingly. So I'll have to guess her at around 35. She's born in Chicago, daughter of a sociology major and a physician somewhere in Switzerland, I think. She studied European history in college, which is where her comments about Hegel she shot at me during rounds must have come from.

When I first saw her, in the ER, she was in the middle of listening to the presentation of a patient by the ER resident. She was scribbling down things on a pad, looking up the patient's labs and sending text pages on the computer while intermittently grabbing the phone when her pages were answered. In between, the attending shot short questions towards the resident when she had forgotten to mention something. She would talk fast, but friendly. It seemed like she could remind you that the thing between left atrium and ventricle was the mitral valve and still make you believe that it wasn't a big thing to forget and that it could happen to anyone. In the middle of all of this, one of her ever-moving hands reached out towards me, she smiled and introduced herself to me with her nickname and last name. I had time to shake that hand and say my own first name (I have given up using my last name permanently over here) before the fraction of her focus I was allotted at that time was taken away again. I didn't mind, on the contrary, I was pleased with her productivity. Rounds would be good.

And I thought Jen was the embodiment of the ability to multitask - this new attending was like Jen with a quad core processor.

A resident I know from renal consults, who is now on the ICU team that the new attending also rounds with, found a nice way to describe what her impact on her surroundings is. While the new attending - let's call her Brainy (heheh) - was busy working up a patient with the rest of the team and the ICU staff, the resident and I stood to the side and he muttered to me

"dude .. she's like a tornado."

True. But now in this picture that I've drawn so far, you'd probably imagine Brainy to be excited or appear stressed-out. And here's the strange thing, that couldn't be further from the truth. She's more laid back than almost any attending (except for the first one I had over here, no one can match that guy when it comes to taking life easy). She'll never speak in anything but a calm tone albeit fast and direct. Every other phrase coming out of her mouth will be ironic or funny in some other way but to the point. At the same time, she will never try to make you feel inferior (you just inherently do) despite the fact that the collective jaws of the heart failure team will drop every so often when she just never seems to run out of answers to just about any question there is.

For example - a patient post heart transplant turned up with undulating fevers that no one in the hospital could find a reason for in the past weeks. Outside the patient's room, while flying through the pages of the chart, Brainy asked for the patient's tacrolimus level (an immunosuppressant for the transplant). It was rather high. Brainy frowned a bit, skipped ahead to the medications list and then asked the nurse practitioner to hold his tacrolimus dose for three days. She also said that they shouldn't even bother drawing blood for another level tonight, it would be high again. Naturally, the team sported blank expressions and one of us managed to blurt out the question how she came to these conclusions. She pointed at the medication list, specifically a rather new order of voriconazole and looked at us with wide, but friendly eyes. This didn't help us much so she quickly explained that voriconazole will inhibit cytochrome P450 3A4/5, which is responsible for tacrolimus metabolism. Uh-huh. Well - you can still write this off to being her tools of the trade. She's in heart failure and involved with a lot of transplants. Big deal. But it got better.

After asking this same patient questions that we could halfway relate to about contact to kettle, cats and rabbits the patient said he hadn't had any contact to those kinds of animals. Oh, just his niece had brought a turtle. Instantly, Brainy asked the nurse practitioner to add cultures for salmonella. Turtles have salmonella? Of course they do. Did any of the rest of the team know that? Nope. After Brainy imparted some more wisdom on the patient (including how to clean your ears without a q-tip) we left that patient's room and Jess confronted Brainy with "how do you know all this?". Brainy just downplayed it as not being a big deal as she would always do.

But this woman is not limited to theoretical knowledge. We rounded on another patient who had broken his leg while carrying another person's heart in his chest (which is where we came in). He was going to be operated on by ortho as soon as the swelling in his leg would go down and his platelets (that were down for some unknown reason) were back up. Now, cooling the leg would have been helpful with the swelling, right? So Brainy asked the primary team's resident that took care of the patient why there was no ice on the patient's broken leg. The resident replied that he had written for it, but the nurses couldn't do it because the ice packs they had were too small for the leg, they'd always fall off. Brainy abruptly went to the nearest garbage container, took out the trash bag and gave it to me to hold, grabbed a fresh garbage bag that they keep inside these containers, went to the ice machine in the nourishment room, filled it and that was that. While doing all this, however, she would NOT give anyone a hard time about it. She would not even say anything about people having lost common sense and practical skills somewhere around their medical training. I challenge anyone to not even making a single remark in that direction in this situation.

The next day, that same patient was to receive one of those little plastic machines that you blow into for breathing exercise. You know, with the three little balls you have to blow up. The resident said he agreed that he should have received that thing and started practicing the sooner the better but the nurses just hadn't gotten around to giving him one yet despite him writing the order. He was a rather tall resident, so he had to duck when Brainy opened a closet high up on the wall right in front of the patient's door. It contains a number of frequently-used items in patient care, such as urine cups, syringes, foley bags - and the little plastic breathing exercisers. She took one and handed it to the resident. She also advised the patient to drink a lot of cherry juice and stay away from watermelons during the summer. By now, I have totally forgotten why but I'm sure it makes total sense just like all the other pieces of knowledge this attending has been spraying out.

Can you tell I'm a fan?

Now don't get me wrong, I believe I couldn't stand her personally if she kept up the pace she brings to work every day. But since I only see her at work and we have a minuscule patient load I get to profit immensely from her - since she enjoys teaching.

Problem is that CS, Jess and Brainy all keep stacking journal articles on me "to read" - the number of these being only directly proportional to the amount of bad conscience I come to work with, since the number of articles I'll read will remain constant right around zero.

In other news, after interviewing the director and an associate director of the residency program in internal medicine the chicagoans got togetherand worked on the mentoring system we're supposed to institute at our medschool back in Munich. It's slowly taking shape and at least I for one believe that it's going to be an extremely cool program.

And on Friday all of the chicagoans came to Looptopia - a brand new festival premiering this year in Chicago celebrating the loop.There were artists on the streets and numerous events all over the buildings around the loop. It wasn't that much of a success for us though, since we didn't have much of a plan of what events to go to and we ended up waiting in line most of the time and giving up and walking out somewhere halfway through.

Allright, that should do for now and keep you busy. I'm off to do happier things like finally finishing that book on EKGs or something.

Blog to you later.

Finally!

2007-05-07T23:29:00.000-05:00

Better late than never .. after playing basketball for a few hours with a couple of sociology students, we went for dinner and a few drinks in chinatown. Finally reminded me a bit of high school over here, when we used to take someone's car and go out to eat somewhere at least every other night.

Good times.

Of course, I still have not read those papers my fellow has given me that I should have been long done with. But since today was another "weird" day and we never "had a chance" to "sit down" and "discuss" as she put it and tomorrow is shaping up to be another one of those weird (or rather, usual) days I think I'll be just fine :)

Anyway, I need to catch up on missed sleep again after having been listening to a-capella-trash-metal till 2am last night (do ask!) and I need to have my liver work on the Tsingtao in my system.

Blog to you later.

Small, strange world.

2007-05-05T17:22:00.000-05:00

I've been getting used to weird coincidences lately. Still, today was a bit stranger than most other days.

The line at Hyde Park Produce was exceptionally long today, from the cash register all the way back to the deli counter. In line in front of me was a couple and the girl was wearing a sweater with a little label from the show "popstars". I couldn't refrain from asking whether you would actually have to be in the show to get a sweater like that or whether you could buy them. She turned bright red and kept saying how "peinlich" wearing the sweater was for her. Heheh. Anyway, she had a PhD in neuroscience and he was a post-doc in biochemistry, both from Germany naturally, with him currently working on tumor immunology with the same mouse strain I am (or used to be). He's using retroviral treatments though in contrast to my immunostimulatory molecules. There had to be a tiny difference, otherwise chances are I would have known him.

Anyway, that was the "small" part of the world - here's the strange part.

I went to the pharmacy afterwards to get water and milk, but also because I had a herpes blister on my lips (guess I may have been immunosuppressing myself lately with poor nutrition, little sleep and endogenous steroids). I quickly scanned the aisles of this huge (compared to German ones) pharmacy and then went to the "pharmacist"'s counter. Said pharmacist was apparently working in the aisles, the aids said. So they asked me whether they could help me. Sure enough, I thought, this is easy enough.

So I said
"I'm looking for some topical acyclovir for lip herpes."
- "What?"
"Acyclovir. Like in an ointment."
- "Uhhh .. do you have a prescription?"
"A prescription? No I don't. I have a herpes blister on my lip. Here. Look."
- "Uhhh .."
"I'm just looking for some acyclovir ointment to put on there."
- "Oh, you mean like a cold sore?"
"A what now?"
- "A cold sore."
"If that's what you call it."
- "Uhhh .. I think you're looking for Abreva."
"Am I. So where's that."
- "It should be there!" (Points to end of an aisle)
So I go look, there's several kinds of chap stick and finally I find a label of "Abreva" saying I should contact customer service for this. The pharmacist aids said if it wasn't there I should go up to the cash register.

So I got my milk and my two gallons of water and stepped up to the cash register, asking for Abreva. That prompted the person at the register to point to another rack of worthless chap stick among all the candy, lighters and magazines and to comment "we may be out of it".

I couldn't refrain from replying "Isn't this supposed to be a pharmacy?".

This building could house at least three full-fledged German pharmacies that carry multiple formulations of topical acyclovir which is one of the safest drugs in the world. And this 24h-open so-called pharmacy offers beans in a can, fresh milk and frozen pizza for crying out loud but nothing to take care of a friggin' blister on your lips.

That's messed up dude.

Murphy's Law or just bad karma?

2007-05-04T16:24:00.000-05:00

Miraculously, my team was willing to let me go at 4pm today. 4pm!

But hey, that doesn't sound like something that could happen to me, does it? Of course not. CS had scheduled a meeting for us at 6pm since the beginning of the week.

That would have been fine any other day up until now but they had to have a heart for me on Friday.

After CS came by the residents' workroom though and declared that it looks more like 6:30 I did go home and I'm now waiting for the page - it's 6:05pm right now.

In other news, there's nothing out of the ordinary to report for today except that I stepped out of the very boring cardiology grand rounds to go up to the residents' luncheon in A700 and didn't regret it, for after several other announcements they projected this hilarious and nerd-a-licious persiflage of a Justin Timberlake song on the silver screen as well as the three plasma panels in the room.

I'll take my gym stuff with me to the hospital later - if CS ever does page us to come.

Blog to you later.

Day three

2007-05-03T18:38:00.000-05:00

at the new service.

Life's kind of okay.

Feet are hurting but rounds were still done at a somewhat-reasonable 6:30pm despite the attending having been in clinic again today.

The morning started slowly, after the transplant meeting at 7:30am. Yesterday I was told it would start on time, so I arrived at 7:30 sharp and naturally, I was the first one in the conference room. "On time" my behind. But they did start at 7:40. I'm not sure why I "had" to be there - I mean it was nice to see CT (cardiothoracic) surgeons are the same kind of narcissistic studs they are back in Munich. But I can't say I learned a whole lot or had anything to contribute to the mostly organizational meeting.

Anyway, after the meeting my current fellow, let's call her Jess from now on, told me that I was actually free to do what I wanted. Wow, that's new. She said I could follow up on whichever patient I wanted, she would want to teach me a thing or two about heart failure around 11:30 and there was going to be a conference on door-to-balloon-time at noon (that is in addition to the M&M meeting at the same time). Cool stuff. I could also follow the attending to clinic if I wanted but the resident was already doing that today. So I declined .. for one thing I didn't want to double-team looking over his shoulder all day plus then Jess would have no one to see new consults - should they actually come in. Which today, they would.

But first things first, around 8:30 I went up to A700 for the nice, usual Thursday ample warm cholesterol-packed breakfast. Yum. And guess who I found already sitting at a table there .. three Germans. During the course of the morning, we came and went but we still maintained a strong German presence in that room most of the time. I would have had to start getting smart about the first thing about heart failure but hey, I'm lazy and I'll prefer conversation over studying any time. So that's what I did for the following hour and a half, until morning report at 10. After a somewhat-interesting but not terribly new lecture on rhabdo I went to look at my young lawyer with the questionable sarcoidosis in his heart before going to see Jess.

As I have getting used to with my fellows, she was getting paged every five minutes while handing me and orally summarizing a few more papers. I'm not sure whether she expects me to read all this stuff any time soon or in my life, for that matter. She gave me six papers yesterday, three more today, which is in addition to the three I got from Carolin - all of these on heart failure - not even counting all the stuff from uptodate I printed on sarcoidosis (half of which I actually have read). I'm afraid this may very well turn out to be a sad waste of trees.

But interestingly, she also had two new consults. I actually had to ask whether I should see one of them and the answer was "sure, if you like". If I like? Really cool stuff. Sure I "liked" .. but then I had to choose which one. One was 77, with amyloid cardiomyopathy requiring pressors that the primary team now has trouble weaning off. The other one was 22 (!) with chest pain. Why would he be on the heart failure service? Well, because his dad knows someone that knows our attending. And as we know, our attending is good.

So I had to pick between 77-year-old guy with amyloidosis and 22-year-old with chest pain. Considering my past karma with everything I touch turning into case reports (if the biopsy's positive for sarcoidosis, we're actually going to write one) I just couldn't be responsible for this 22-year-old turning out to have some rare deadly disease. So I took the 77-year-old.

Before that though, I went up to A700 for some pizza and juicy M&M. M&Ms are usually packed, and so it was today, even though Borat was the only German I saw there. But I guess it was better that way, the place was packed despite the fact that they took out the room separator with some residents actually having to stand in the back.

After the M&M meeting, I went to see my patient. While working him up using chart and computer in the nursing station actually Jen came by. We had a nice chat, wallowing in memories of the good times we had together after having been separated for less than a week and of course making fun of the ridiculously long rounding times I was suffering from with my current attending. And following CS's suggestion, I did belatedly take her up on her offer to write an evaluation for me. Who knows, I might consider a career with the pill-pushers after all.

I just don't know anymore.

Anyway, quite a while later, at precisely 2:59pm, Jess paged me that we were "apparently" starting rounds in the ICU "now". I was at that time still extensively chatting with my new patient and his wife (attending's exuberant bedside manner already rubbing off), rushed through the exam at that point and met the team in the ICU. The attending was still discussing (what else) stuff with the ICU team, since he double-staffed as their attending as well. Meanwhile Jess was sitting at one of the computers there frantically looking up stuff on patients. She said our attending had just "dropped three more consults on her". That's not a nice thing to do minutes before rounds.

I asked her whether I could help her in any way and she declined. But having a hunch about rounds taking a while again today I sneaked out while the attending was talking to another family on the ICU down to the gift shop to get supplies (i.e. water and candy) to better make it through the rest of the day. I asked Jess and the resident whether they wanted anything and only the Indian guy accepted. I bought more though which Jess would later be grateful for after we had gone to cath the sarcoidosis suspect in the middle of rounds and her blood sugar was running low as well.

Anyway, I'll spare you the details about rounds and I'll get myself back home before it's dark again. Have been blogging for 40 minutes again. I guess I'm addicted. Will go into rehab back in good old Germany.

Oh by the way, the team is determined to take me to a karaoke place next Thursday. I'll be sure to vocally make them regret that.

Blog to you later.

Special touch

2007-05-02T18:07:00.000-05:00

There seems to be another recurring theme - my very first patient on a new service apparently regularly turns out to be case report-worthy.

Remember, the patient I saw on the very first morning I started in this hospital was the deaf-mute lady that ingested 50,000 units of vitamin D per day for an entire year and came in wildly hypercalcemic.

I also told you about the young guy yesterday that could easily bench press me. Turns out, heart failure apparently was the right service for this guy after all. (Actually, general cards, electrophysiology as well as we ourselves were all consulting on this same guy.) During rounds today (that thankfully ended with only two hours of overtime), we got a call from the general cards attending that had evaluated this guy's cardiac MRI, who was apparently very excited about it. So we went to his office and had a look. He demonstrated patchy hyperintense infiltrates in the myocardium very much consistent with sarcoidosis (or maybe some other form of myocarditis). We call-conferenced with the electrophysiology attending and my current attending on the heart failure service received kudos for actually having come up with sarcoidosis on the differential in this guy even before the MRI.

So we (fellow, resident and I) had our work cut out for ourselves .. look up sarcoidosis and its manifestation in the heart till tomorrow.

So that's what I'll get started on while still here in the hospital, since I'll need access to uptodate and medical journals.

But I'm hungry, tired (got only 5 hours last night) and my feet hurt up to the knees.

Surgery suddenly looks very attractive right now. My feet are going to hurt anyway and at least I won't have to think anymore.

Blog to you later.

Wind of change

2007-05-01T17:56:00.000-05:00

So, lots to tell from these past days. I'll start with the "highlights".

Yesterday was my last day of renal consults. And I actually felt sad about that. Jen asked me whether I needed an evaluation. Before I could respond by saying "no, thanks", the attending chimed in with "don't worry about that I'm on top of it". Uh-huh, I am being evaluated now? I felt tempted to ask who she was going to send that evaluation to but refrained. She said I had nothing to worry about there, I was a "ten". Uhm, OK. Now I'm hoping that's not on a scale from 1 to 100. Anyway, renal days are over. I'll miss 'em.

Today is May 1st, started on a new service. I was actually scheduled to do regular cardiology for all of May but so was another student from Germany that arrived a few days ago. That's why CS spontaneously arranged for me to go join the heart failure team, basically a different kind of cardiology service. She asked me to come to the EKG conference this morning .. at 7:45am, mind you! So I did. The conference was good, strongly reminded me of the electrolyte conferences nephrologists hold. I guess the EKG is to the cardiologist what lytes are to the nephro guy. And similarly, the conference was almost equally sophisticated.

Afterwards, CS paged the heart failure team. The fellow was a little busy .. as was to be expected on the first day on the new service. Problem was that she also just received a new resident from Boston University who didn't know the way around the hospital (later on told me he spent an hour in the morning trying to find where he was supposed to go), didn't have a pager and didn't have access to the computer systems here. So in addition to having to deal with the patient collective of a new service, she had to get this resident settled in. Naturally (from what I gathered from listening to CS's side of the conversation), she was not so happy about having to deal with a new medstudent on top of everything. Oh, by the way, Tuesday afternoon is her clinic.

That's why my new fellow said she'd meet CS and me later and CS let me go for a second breakfast after the one at the EKG conference. So I went up to A700 around 9:30am, sending a text message to one of the two new Germans that had started today that I had time to show them where they could get free breakfast. I figured they'd probably be working on getting IDs and the likes right about now. So I sent the message and went up to A700 to find all other German medstudents were already there. So I guess my work there was done. I spoke to them shortly, went to the back to get my usual bagel and orange juice, came back and they were gone. Guess they hate me or something.

Anyway, I sat down and started peeking into one of the papers on heart failure that CS had printed out for me before. Shortly thereafter though, I was relieved by the student that I'll be sharing the cardiology services with this month. He was brought back up there by his resident and told to see the "conference", meaning morning report later on. We chatted for a while until one of the chief residents called us in for morning report. The case presented was a somewhat-interesting patient CDCD (as I just learned .. circling the drain awaiting celestial discharge) whose disposition seems to have raised numerous ethical dilemmas. Before I could find out what happened to her, around 10:30am, my pager went off and Carolin asked to meet me.

She brought me in to my "new team", which was basically that fellow I told you about earlier with her new indian resident who was in bad need of some orientation and access credentials. The fellow started rotating pretty much at that point, between the signout list she had opened on her computer, talking to the new resident, receiving pages, "welcoming" me, introducing all those people around her and mentioning that she had a consult. She asked me whether I could see this patient. Now at this point I got a flashback to my very first day here. "It's kind of a crazy day, could you just go see this one?" The new fellow did not quite exhibit the same amount of grace and good humor while massively multitasking but nevertheless, the resemblance was striking.

Anyway, while she was still spinning on that chair trying to get things for the day organized she pointed to one of the nearby laptops, asking me to get started on the patient right away. So I started collecting information from the computer. About 20 minutes later, she was ready to go on what would turn out to be her own little version of rounds, including a little tour for the new guy. Which would be the resident. She rounded just with us, without the attending, because - naturally - he was in clinic. As she would be later on, which I had already mentioned. But I actually only learned these facts about halfway through the pretty small list of patients on the heart failure service. Apparently, what she was discussing with us was our preparation to round with the attending later.

Ain't that something.

The clock was advancing towards noon-ish, at which time the fellow had to leave to her clinic. She handed me a sheet listing the patients on the service, asked me to look up the serum levels of immunosuppressants on three of them and to see the new guy until "rounds". I asked when that would be and she replied it'd be whenever the attending gets out of clinic, an indefinite amount of time that he will page us at.

The resident stated he would get lunch now and started walking out the ICU in the wrong direction, so I printed out the map of the hospital that had served me so well before for him and sent him on his way to "au bon pain".

In the meantime, I would have liked to go to Grand Rounds and eat lunch but that would have meant I'm out of the game until 1pm with no idea when the attending would want to round and be presented with my first patient on this service. So I went there right away. The case was rather straightforward, what kept me busy was the fact that I had extremely negligible experience dealing with heart nuclear scans, echos and catheters, all of which this 32-year-old guy had had. But I worked through his chart and computer files in the usual manner and talked to him for quite a while afterwards. He was a nice guy. Lawyer. Tall, bulky, but lean. He bench presses 250 pounds, he told me. I wouldn't dream of that. What team am I on again? Heart failure?

I'm glad I remembered that before automatically asking him for a urine sample. Might have wanted to do a tox screen though. He sounded like an upstanding guy but his muscular shape seemed pretty borderline towards having used stuff to get a little edge in the weightlifting game.

Anyway, back to the day. I was just about done with him around 1:30pm, going back to the T elevators to go down to the lobby. I wanted to get some candy from the gift shop to make it through the day and also in order to break a $20 bill. I'd probably need $1 bills for the bus later. Because I was scheduled to meet a friend tonight. A friend who lives in Berlin that I haven't seen in many years. She was in Chicago with a friend and she would be here until tomorrow morning. The three of us had a date in the Signature Lounge on the 95th floor of the Hancock Building tonight at 7pm. Even though I'd need about an hour to get to downtown from here, I was confident that I'd make that given that I've never really had to stay longer than 6pm.

Boy, was I wrong.

Anyway, on my way to the elevators, I met the Indian resident. He expressed his relief that he had found his way back from "au bon pain" to the fifth floor, where the patients were. He seemed a bit surprised that I had seen the patient by now and said that he would have wanted to see the patient with me. So I took him back there with me. Unfortunately, the patient was about to leave for another echo (with contrast this time) and that would mean his chart goes with him. So the Indian resident and I sat down at the nurse's station, I logged in with the credentials I still have from Jen (he won't get his until at least Friday), gave him a 5-minute-crash-course on oacis and left him reading the little info on the patient there was while I headed down for candy, change and a double-chocolate muffin at "au bon pain".

Muffin in hand, I went right back up. By now, it was around 2pm. I asked the resident whether he knew when the attending would be out of clinic to round with us. He said he had heard someone say "around 3". Ouch. And I had actually been under the illusion that I'd have time to go the extra lecture on preeclampsia at 4pm in the lecture hall today that my old attending and Jen had recommended to me yesterday. If we were to start rounding at 3, that would probably not happen. But hey. This service was tiny compared to renal before.

During that time, I counted April's renal consults that were still on Jen's and my list in oacis. There were 115 patients total, 3.8 per calendar day, 5.5 per workday (which is when consults are most often called for). I saw only 25 of these patients, which works out to 1.2 per working day. I believe there were only two days in the month where I did not see a consult alone. At any one time, there would be roughly 22-30 patients on the service.

Compared to this service, which apparently actively carries 7 patients right now, plus the new one I got today that was able to bench press me lying flat on his bed (as compared to the renal patients, more than half of which were on one of the ICUs, most of those intubated).

So you'd think we would be done somewhat quickly wouldn't you.

At 2:30pm I did dare to text-page our fellow that I was done with the patient and whether there'd be anything else we should do awaiting the advent of the attending we had never seen yet. She actually called me back and said that our attending was just about to be done in clinic, I should hang on a few more minutes. After a few more minutes, I decided to go to the bathroom while the resident was hovering over the phone. When I came back, he said that the attending wanted to meet us in the echo lab. So we went there.

In the echo lab, the other cardiology team with the other German medstudent was already happily rounding along, their attending apparently teaching them intermittently on the interpretation of cardiac echos. The resident and I waited outside for ten minutes. And another ten. Around 3pm (so the prediction was going to be correct) the attending showed, with a pharmaceutical doctor in his tow. After we had gotten acquainted for about 30 seconds we went into the dark lair where echos were evaluated on screen and the attending started a discussion with the cardiologist sitting at the computer about residency programs, research, this-and-that attending and just about anything until after maybe 10 minutes we started looking at the echo of "my guy" before I had even presented his case. Didn't seem to matter much for two reasons .. one was that the attending apparently already had heard the gist about him and the second reason was that he really didn't have much on his echo. Which was good. The guy was 32 after all.

So around 3:20pm we got out of there. The attending declared that we would now have to see the transplant patients first, since that was what the pharmaceutical guy was here for. And first on the list was the 12-year-old heart-transplanted kid from Japan. 12 years, man. Myocarditis is a bitch. So we went all the way over to the children's hospital and spent the better part of the rest of the hour watching the attending while he was talking to this kid's whole family from Japan via an interpreter, examining the child and having various discussions with the huge crowd of various health care providers ranging from nurses to physicians to case managers to the pharma guy. My only contribution was the tacrolimus level for this little guy that I had looked up around lunch. It was high.

While they were still discussing, it got very close to 4pm so I found a nearby computer and text-paged Jen that I wouldn't make it to the lecture, asking her to pay extra attention for me.

Shortly after 4pm, the attending seemed satisfied for the day with the child's healthcare.

So we headed back to the adult building. We met a nurse practitioner on the way. The attending now declared that we would have to see an "NP" case now. This guy wasn't on our lists. We went up to the sixth floor to this 60-ish-year-old patient that had lost both his legs to peripheral vascular disease, had received a combined heart-kidney-pancreas transplant almost 10 (!) years ago, was now developing a squamous cell carcinoma on his neck and still came on to the female nurses and docs on this floor. Can't really blame him though because he was right, they were "lookers" as he pointed out. So after that took about another 20 minutes, we walked back to the elevators around 4:40pm. The attending looked at his watch and stated that he actually had to be interviewing someone for a job here at 4:30pm and was scheduled for a meeting with "his boss" (whoever that is) at 5pm. He was fully aware that we had seen one out of the seven patients on the list of this service and apologized, saying he was afraid this may become "a long night".

Uhm, kay.

So he took off. The resident asked me whether we should go for coffee then since it was going to be a long night. Very funny. So we went down to "au bon pain", I got a cookie with m&m's in it and a bottle of water and sat down with the Indian. We talked for a good while - about airplane companies, his family, the transplanted playa, stem cell research, abortion, religion, God until we were tired of talking. All the while, I was sending cell phone messages back and forth with the friend from Berlin that I was supposed to be meeting. At around 6pm we gave up waiting down there and went up to the residents' workroom where I had actually started this blog entry close to six hours ago.

I saw both other new Germans there who were obviously done for the day, one of them preparing something for tomorrow it seemed. CS also stopped by and I tried to tickle some sympathy out of her for the fact that the one day that I actually had some kind of social activity planned out here in over a month I would be spending a "long night" at the hospital it seemed.

And I really couldn't just go - not without presenting the patient I had seen to the attending. That's really, truly, unthinkable. Naive and optimistic as I still was (can you imagine me optimistic? I was!) I still thought I could maybe make it. Down in "au bon pain" the Indian had offered to take me downtown in his car after rounds. He would even let me change quickly at home.

So when the attending finally paged us around 6:15pm, I still had a glimmer of hope that I'd only be late for the Signature Lounge and that I'd get to see the girls before they went on through the country. The attending said we should meet him in the D5 ICU in "around 10 minutes", he was still seeing yet another patient there. The guy was seeing yet another patient that wasn't even on our list. I urged the resident to come with me to D5 right away to see what the heck was going on.

And there he was, standing amidst the on-call D5 team. One of the residents of that team had been on renal consults with me before. So in between the vivid but somewhat repetitive discussions on what to do with this patient that was CDCD I asked that resident whether they had curbsided our attending on this. He looked puzzled and replied that he was "their attending". Apparently he was double-staffing D5 and heart failure.

That's fine. There's not really much to do on the heart failure team. But at some point, you have to actually start doing it!

The attending did no such thing. As I watched the minute hand of the clock on the wall calmly tick towards 7pm, they were still talking circles around this patient's care and how they should *not* wake the attending if he coded at 4am.

After 7, the attending apologetically turned to us and declared to the ICU team that he would now have to see to it that we would get home. How nice. The problem was that by now, I had understood that this guy just doesn't do quick consults. In the subsequent rounds he did with us, he initially flipped through the charts a bit faster but other than that did not really change his pace. Thankfully the patient on ICU was intubated. For the other ones were not and boy, did this guy have time to talk to them.

I was still constantly pushing back my calculations, deciding to skip changing and having myself be driven downtown right away but it was just no use. At 7:45pm, when we still hadn't come by my own patient, I wrote to my friend that I was sorry.

And I really was. I was really looking forward to seeing her again as well as getting an excellent opportunity to see the Signature Lounge and to get out of my apartment, maybe even to find some kind of attractive side to this city.

But I guess that's Internal Medicine for you.

Talking, talking, fiddling around with numbers and medications and some more talking.

But here's the scary part. The attending did an incredible amount of talking to all of those patients. But - he did it well. I actually *liked* listening to him. He's such an example of speaking to patients on their level, comforting them with compassion and care but at the same time being absolutely but NOT brutally honest. He could relate to them, be their friend instantly yet still emanate a respectful exterior and they'd still be smiling at him and nodding when he would speak about the direst truths.

After I had given up hope on the Signature Lounge, he actually wanted to let me go at 8:30pm, right after having finally seen (and talked extensively to) my one patient for the day. But at that point a patient's daughter (of a patient we had seen right before mine) asked to talk to him. And I voluntarily stayed at that point, because I really did enjoy listening to him talk to patients. Since it was decided that my plans for the night had to be scrapped, I also went along to the follow-up on the last patient. Here, even the attending showed signs of fatigue but I still didn't regret tagging along just for hearing this guy speak to the patient.

It may be partially blamed on severe hypoglycemia on my part after having skipped lunch and dinner today but in the end I couldn't even be mad at this attending for ruining the one glimmer of a social life I was going to have here.

I'm so weak.

And right now it's ten after midnight, my blogging time is clearly feasting on my sleep and I do feel worn out and hardly able to keep my eyes open.

Good thing that I can type blindly.

Too bad that this has probably been too long for any of you to still be reading. If you are, I congratulate you. If not, I'm sure I'll be reading this myself around ten years from now. Or probably not. I'll have too many interesting new things then to spend time on I hope. If not, I'll be smiling right about now plus ten years.

Allright. That's enough. It's even clear to me now that I need to sleep. So I will. Soon. Bye.

"Ummm, I'm thinking about math."

2007-04-28T00:20:00.000-05:00

That was the answer from the guy on "my" team when I asked him what his major was. He was a first year college student.

Then those kids started kicking my ass on the basketball court again.

I'm old.

Oh!

2007-04-25T20:19:00.000-05:00

And looking at the post below I just realized that I forgot to tell you what prompted the post's title .. "routine".

I meant to tell you that I finally had a routine down in the morning, going up to A700 in the morning after having thrown my jacket into the residents' workroom, picking up the current list of patients on the consult service in the dialysis unit on the way, then paging Jen from one of the phones in the kitchen, putting a halved bagel into the toaster, pouring orange juice into a cup, at which point Jen will return the page, I talk to her, after which the bagel is done and I put some toppings on it, after which I go sit down at a computer and check up on old patients in the computer or, if I'm lazier than that, I'll just check my mail, read the news or start blogging.

I did the latter today, but was rudely interrupted by the first later-to-be-cancelled consult in mid-breakfast as you can read in the post below.

Blog to you later!

Routine

2007-04-25T08:42:00.000-05:00

Yesterday, the service was back up to its usual five consults. Most notable exception was that my patient for the day was in the ER again, a place I still like to go to. Although I'm far from being an expert yet, nephrology is already becoming a bit monotonous. If I imagine focusing on the kidney for a significant number of years, like my attending would approve, it doesn't seem like that could still be interesting then. And I don't feel like one has to be particularly smart to do it. There's a large but still limited number of diseases a kidney can have and it still holds true that hearing hooves usually signifies horses. And figuring out the occasional zebra will certainly be satisfying but rare (and we're here at a good university hospital in a consult service that deals with the cases the primary teams cannot or will not figure out - so pretty selected collective of patients already). I'd still rather be in the ER, obviously things were less repetitive in there.

That said, it's not completely boring here. Physicians mix things up by overdosing people on Lasix last night, for example, poor guy's in the ICU and probably deaf right about now. I guess I shouldn't go into details on that.

And another interesting mix-up happened .. apparently someone was very much post-call and wrote an order for DDAVP (desmopressin, basically vasopressin with an arginine attached) for a patient with a sodium of 120. Apparently they got it confused with another medication starting with "D": Demeclocycline, a vasopressin antagonist, after having been awake for too long. I guess we're all human.

(Disclaimer: These stories are needless to say purely fictional and any resemblance to actual events or persons is, of course, coincidental.)

(I started this post with breakfast in the morning. This is the third time I was interrupted and I'm continuing this draft, it's 7:30pm and I'm back home.)

So, where was I. Ah well, what does it matter anyway.

The reason I was interrupted so often today was that the two residents we had up until yesterday were done with their renal consults. We got one new resident today, but she was, of course, in clinic this morning. That left Jen and myself, Jen having a kidney biopsy scheduled. That's how I ended up with my first consult at 8:45am, when I had spent one and a half hours on it and was close to getting done she paged me again to let me know the primary team had just cancelled the consult. They'd send the patient home this afternoon. 20 minutes later I got another patient, HIV+ with PCP in the MICU. 33 minutes later, at 11:07am (I'm reconstructing this from my pager) Jen called again to inform me she was about to start the biopsy and given that this had taken more than an hour yesterday she would like me to get started on a third patient. I replied "Sure. So you're planning on rounding around 5pm, right?". I was trying to make sense of this guy in the MICU's chart again but failed miserably. He had apparently been turfed from one place to the next a lot, hitting one normal ward, one step-down service and three different ICUs in little more than a week. Naturally, they all had different kinds of flow sheets that overlapped (good luck trying to figure out ins and outs there) and medication orders were a mess.

To paint you a picture: One and the same medication, Bactrim, was showing up on the same day's medication sheet three times. Once as p.o. medication, with a "d/c'd" behind it, as in "discontinued". One more line saying "Bactrim", this time i.v. and with some number of mg/kg but no times of administration behind it. And a third line on that same page starting with "Bactrim", i.v. again, this time saying 250mg and followed by four different times of administration. Two of those time points were circled, two were crossed out, all carried some hieroglyphs around them - presumably initials from nurses but they could mean anything as long as you're not familiar with *all* of the abbreviations that could be used on these medication order sheets. It turns out that the circled times of administration are doses that are not actually given to the patient, while the crossed out ones are. And that's only one of the four different antibiotics this person has been given in the time he was there, not even speaking of the plethora of other medication this 69 y/o HIV, HepC, PCP, HTN, CRI now septic patient has been given over the past week. It took me probably about five minutes of deciphering interns', residents' and especially surgeons handwriting just to find out when the guy was intubated - namely yesterday.

I would have needed a very high threshold for frustration today, which, alas, I didn't have. It was frustrating that it still takes me forever to assemble the simplest pieces of information and I'm still not sure how I can speed it up.

The best way probably is to keep doing consults. Although it probably wouldn't hurt if someone at some point sat down with me and gave me an introduction into things like "a circle around a time point on the MAR record means that this dose was actually not given". Thank you, you've just saved me half an hour of grief and the recorded fluid intake on the flow sheet finally goes together with the fact that this antibiotic is administered in 500ml IVPBs.

You live, you learn.

Day off

2007-04-23T17:52:00.000-05:00

Wow .. just one single little consult for the entire service today. And since I checked in after one of the residents this morning, he got it and I didn't even have to do it. Now I know what hem/onc service must feel like ;D

I had time for morning report as well as electrolyte conference today. I'm going to miss the latter next month. The attending - or should I say guru - at the head of the table has an extremely calm and wise aura about him as he infers incredible amounts of information from little more than about a dozen lab values and how they develop over time. Actually, the fellows go through the labs, commenting them, and the attending - who never heard about the case before either - asks questions. Questions like (I'm just making these up for illustration, don't even have a clue whether they make sense) "so, what would give you a urine osmolality this high with a TTKG (trans-tubular potassium gradient) of 5 in the setting of severe dehydration?" Or "what's the mechanism of renal failure in severe hypercalcemia with non-gap acidosis?" Uh, well, uhm .. luckily the fellows react similarly often enough, which makes it even more humbling and awesome when this attending kindly and most of all vividly describes (or leads us on the way of finding ourselves) the pathophysiology behind everything.

Yes, you read right. Physiology. This man does care about mere ions and ion channels and enzymes and pathways yet manages to not only integrate all that knowledge into an astoundingly accurate clinical picture of the patient (without history, physical exam or any other information, just part of their labs over one or two weeks!) but he also describes them as entertainingly and plastically as only Americans can. It's like a German professor in pathophysiology crossed with an American teacher.

He's awesome.

If my kidneys ever get sick, I'd rather have this man take a look at my labs for one minute than 10 other docs conferring for hours.

Oh, and I believe I had already mentioned that the pizza is good.

Lake Michigan

2007-04-22T19:19:00.000-05:00

Hello reader,

another little picture post.

I didn't find out the weather was so beautiful yesterday until I stepped outside on the way to the library. It was surprisingly warm again and I was wearing way too many clothes. Then again, I thought the library would probably be air-conditioned. Because I actually went to the library, shortly. It was pretty much deserted as it has been the only other time I had been there. Interestingly, their first floor is open 24/7 for your studying needs - and so far hardly anyone is in that huge, endless library even during the day. So I decided I wouldn't be in there either, took my stuff and left, riding my beach cruiser bike eastand further eaststill goingeast on 55th (can you feel the tension rising?)crossed the metra tracks (almost there!), look to the sidewalk on the right to get an indication of the temperature yesterday
and boom!The lake.With a mild breeze and plenty of sunshine.I sat down at the tip of the headland up there and got my book out. Took me about 20 seconds to get distracted not by these guysand not the viewbut those three people in the middle, walking away.The two people on the right are married and from Finland, with him doing an internship with a law firm and her doing research in pharmacoeconomics here. The girl on the left is actually from Germany and also doing an internship in the law firm. They were here to kill time waiting for their tickets to Body Worlds that they had bought at 10am to become valid at 6:15pm. Apparently they sold tickets for the same day at that place that would make people wait more than eight hours to get in. Well, as you probably know any excuse is good enough for me when it comes to not having to study, so I talked to them.

A day at the U of C

2007-04-21T21:58:00.000-05:00

Hello, reader.

As per popular request, this will be a picture post. You're right, my past posts have been .. shall we say biased towards text. So I took the camera with me on Thursday - and you'll have the questionable pleasure of following me along on that day. There'll be huge gaps in between - that's when I either felt I shouldn't be pointing my camera at people or when I simply forgot to take pictures.

Here we go.

At around 7:30, I got out of bed, which looks somewhat like this.
As anyone who knows me will be aware, my first order of business is switching on my computer - yes, the thing in the middle of the mess on my desk.After checking my mail in the morning, which usually isn't much given that people in Germany are usually still at work at this time, I visit my beautiful bathroom.After about 1 minute to shave, 30 seconds for the hair, two minutes for my teeth and 15 minutes for my tie I look somewhat like this.Notice the camera bag on the right, that baby is coming with me today.

Out the door and to the left, we're heading down the corridorto the stairsthrough this door into the laundry roomto find my beautiful bike.Can you see it? You should know what it looks like by now!

Well, I found it and with it, I headed out. Three doors later, which I'm actually not going to show you, we hit this fence.After having overcome even this obstacle, we go down the driveway,Make a right onto this little street, glancing at Ratner's across the intersection, (yes! This part of the story is very detailed!)carefully making sure there's no police cars when I fail to stop at every friggin' stop sign around here before making a left at this intersection.One left turn later, we go straight ahead across 55th street (the red lights seem to be another suggestion to stop around here, how anyone gets from A to B here is beyond me).Look at that! There actually was a police car across the street there.

We're on Ellis Avenue now, going south - in case you'd like to know so you can follow along on Google Earth. Quite exciting, isn't it.Here we are, merrily whistling a song while going south on Ellis.We wave at that nuclear thingy, before pretending to stop at yet another stop sign and making a right turn onto 57th.After that turn, we find yet another stop sign. By the way, that pedestrian crossing connects Crerar library on the left to the Pritzker med school building on the right. Isn't that interesting.
Next stop sign - let's make a left here. It'd really be shorter to go one more block ahead and then turn left but hey, I'm taking the scenic route for you guys.We're getting closer .. look to the right.At the end of this street, right where it says "Adult Emergency", we turn right.There we are .. "The University of Chicago Hospitals".Let's make a sharp right in front of the new Duchossois Centerand park our vehicle.Turn around - and there it is.Mitchell Hospital. Where I'm going to be for the next 10 hours.It must have been around 8:30am by now. It was Thursday, which meant Jen would be in clinic all morning. That's not a good thing. By now, we actually had two residents on the service. Interestingly, both were post-call this morning. That means they have spent the night here and courtesy demands they should be let go as quickly as possible, usually until noon.

That was semi-good for me, it meant that the residents would get the very first consults this morning and I could go have breakfast.

So I entered the hospital through the lobbyand went on throughto the "T" elevators.These elevators actually have three cars but sometimes you're just out of luck and they're not coming by any time soon.

So I took the stairsup to the fifth floor.My first stop as every morning is the residents' workroom.

You can actually see the door, it's the first one on the left in the corridor ahead.

This is where I leave my jacket during the day.But we said breakfast, right? Right! So we leave the workroom and navigate towards A700.You are going to see parts of the way there, I took a picture whenever there wasn't anyone coming the other way.

I went down the D corridor, past the Clinical Research Center (this is a place where they emulate any kinds of conditions they need for patients enrolled in studies. For example, there was "wake at 7:06am" written on one of the doors. I fought the urge to knock on it, heheh). But today, I walked past the CRC in the W corridorand continued straight ahead - the D corridor is from here on called M corridor. And no, there is absolutely no logic behind the naming of corridors here. The whole complex has been designed to get you lost.After I made a right at the next intersection - you'd expect to be in a corridor with a different letter. And that's true most of the time - except M (as well as at least C, D and W) is an exception here. I made a right, yet I was still in the M corridor. I'm telling you - if you're there for the first time without a map you will not find anything by yourself. Nothing.

Strolling down the M corridor, I saw a familiar face.After confirming with Borat that there'd still be food for me upstairs I continued on merrily.A left at this intersection brings us to the A corridor! Hooray!

So all we need to do is go two floors up.And we're here!

There's "hot" breakfast on Thursdays, so it's a good idea to be there rather early (as opposed to 10am with morning report).There's "breakfast pizzas" in here. I'm sure that sounds like a strange idea to some of you - but as you can probably imagine, I can eat anything at any time of day, and I like pizza.In the back, around the corner, where the "cold" regular breakfast usually is, beverages await.And there you go, a nice, fresh, warm, cholesterol-binge breakfast to start off a beautiful day.Sooner or later, I would have to inform Jen that I was here though, so I paged her.She called back and said - as expected - she didn't have anything for me yet. And actually, one of the residents was up there in A700 with me, so he hadn't been sent out yet either.

But this was actually rather normal. The primary teams get around to calling consults only after they're done rounding in the morning. That's usually not until 9:30 or so.

That meant, I had time to check labs and imaging studies on my old patients. So I sat down at one of the computers up there and had a look around in oacis, their clinical data software.Not too long though, since as expected, Jen chimed in around 9:30.65 year old female with protein and blood in her urine for over a week. Jen gave me the parts of the story that the resident on the primary team had relayed to her and off I went to 5NE (five-north-east) in the main building.

Down the stairsThis time I chose to take the W corridor, so straight ahead past dialysis and the urine room (don't worry .. you'll get to see that later ..)Back into the D corridorpast the ICUs (there's a different ICU on every floor in the D building, or rather the "Rubloff ICU Tower")
and on towards the Mitchell main building.We're heading north here and if I make a right turn behind these doors, we will be in 5NE.An example of what I could have found out about this lady is on the picture below.

Naturally, I cannot divulge any information about my actual patients, so the information in that picture is purely fictional and written down by me as an example template. Any resemblance to persons, living or dead, is of course purely coincidental.

Click on the picture to magnify.I spent about two hours on this consult, including actually talking to the patient, physical exam and acquiring the patient's urine. I spent most of the time rummaging around nurses' and physicians' notes and deciphering handwriting since I was interested in the time course of this lady's surgery, hematuria, foley placement and antibiotic administration - which of course had to be reconstructed from clues hidden around the chart.

So around 11:30am, I went on my way all the way back to the W corridor (I'll spare you the way there this time) and entered the urine room.

Ta-daaa!Yucky, isn't it.

Before I could dip the urine and spin it down, the pager went off again.Jen again. Uh-oh.Next consult. Patient with questionable altered mental status. Oh, and she doesn't speak English, only Spanish. Yay.

Jen also told me that we'd try to get together to round around 2pm.

After I was done dipping the urineand looking at the sediment, it was almost noon.

I decided that I'd have lunch despite the consult and went up to A700. And at the prospect of food I actually forgot to take any pictures of it. Sorry. It was good though. About 15 minutes later, I went to see that other patient.While I was starting to look if I could find anything that would correlate severe iron overload with renal failure, I was interrupted by the pager again.OK fine, no looking things up yet again.

Jen wanted to meet soon, so I had to go spin down this patient's urine now.

After all three of us (residents were at home by now) had looked at today's urines, we unanimously decided to sit down in the nephrology conference room to discuss the new patients.This is the conference room with Jen and the attending trying to find the stuff they'd need to make coffee.After that, there's not much more to show. After Jen and I had presented our patients to the attending, we went on to see them all (6 today, three seen by the two residents, two by me and one Jen managed after clinic) plus the old ones. When they offered for me to leave at around six, they were not done rounding yet.

I got some bad news from Trillian, so I went home quickly to talk to her.

I needed water (still not convinced to drink the tap water here that has so much chlorine that showering reminds me of a swimming pool), so I went grocery shopping afterwards and brought back another two gallons. They last for about three days, at least my fluid intake seems to be good enough.

Anyway, that was my day, hope you had enough pictures to last you a while. Next post will contain pictures as well, though.

Blog to you later.

Ups and downs

2007-04-18T19:51:00.000-05:00

Hello, reader.

Today, I heard something nice and something really disgusting.

Which do you want to hear first?

The disgusting thing?

I knew it. So, here goes.

As probably 90% of the readers of this blog know, you can get antibiotics-associated colitis if you eradicate your normal intestinal bacterial "flora" by ingesting antibiotics. If you're unlucky, one of those buggers that is normally suppressed by its peers, called Clostridium difficile, takes over your gut and gives you nasty diarrhea.

This wasn't the bad part. This review from the Annals of Internal Medicine lists the different treatments for C. diff-colitis. One of the items on the list is - I kid you not - something called "fecal transplant". This is explained as "30-50g fresh stool from healthy donor (LOL! "donor"!) in normal saline delivered by enema or nasogastric tube".

In English: They shove somebody else's crap down your throat (I guess you're lucky it's going to be inside a tube), in order to give you all the "healthy" bugs that'll eventually heal your diarrhea.

Thank you! I'll stay with actimel.

Who the heck came up with this .. crap? How do you ask a patient for consent to give them a "fecal transplant" from a healthy "donor"? Who "donates"? The physician maybe? Is that revenge for the old times when our profession had to taste patients' urines to diagnose diabetes?

Wuah. Bah.

OK, now on the nice thing I was told today.

The new attending we've been rounding with since yesterday shot the question at me today whether it was true that I wanted to go into emergency medicine. After I cautiously confirmed that, she yelled "Don't!". A little worried, I asked why. She answered "you're too smart to go into EM. And what's that I hear about anesthesia? Don't even think about that either." :D

I tried to suppress my gleaming and immediately went into my tirades about all those lying Americans and how you could never trust them when they give you a compliment.

But these past days have been good. I'm not afraid of kidney disease anymore.

Here goes

2007-04-17T17:30:00.000-05:00

Just read the "Plays" written by Cho Seung-Hui. They do sound disturbed to me but then again I haven't read what other seniors majoring in English are writing. I don't think anyone's to blame for "not reporting" this guy.

If they were, they'd end up having way too many people under surveillance.

A lot of the comments I have been reading from people on websites are upset that "nobody reached out to him". It'd be extremely interesting to see if these people would have done that in the face of this guy.

From what I've read about him so far, Cho seemed a scary guy. Quiet, gloomy. Angrily rejecting a girl offering him candy just like that. I think that's already quite far out there.

I don't think I would have done that, certainly not have done more.

Would you?

I'm aging very rapidly here.

2007-04-17T16:54:00.000-05:00

While people on the Basketball court still had a hard time believing I wasn't in college anymore, yesterday the pathologist assumed I was a resident and today a surgical fellow mistook me for a renal fellow.

At this rate, I'll be retired by Friday.

I'm alive and Grand Rounds

2007-04-17T13:15:00.000-05:00

Hey readers,

first of all, I am fine. Not shot yet, for the ones that were wondering.

Naturally, there has been an uproar about the Virginia shooting around here - but at least so far it doesn't seem to be as big as Columbine. I was in the midwest in '99 when that happened too (coincidence! I swear!) and it seemed like a bigger deal. Columbine was a high school shooting and I was in high school back then, this was university and I'm a university student now (again .. happenstance! Really!) but I'm not really in university per se. Still, I guess people are getting used to this kind of thing as they'll get used to anything. I fear soon school shootings will be "in other news" like suicide bombings in Irak, Palestinians and Israelis killing each other or AIDS killing millions. The one thing I see a lot of shaking heads around here about is stuff like "the president believes that there is a right for people to bear arms, but that all laws must be followed".

Yesterday was a long day in the hospital .. partly by choice though. Rounds lasted until around 7 and Jenn and the new attending did suggest I leave but I wanted to see that last patient, younger than me status post coronary bypass surgery.

Other than that, there's not so much to report. I'm still seeing one or two patients per day and still not completely satisfied with my presentations on them. Jenn keeps saying that I'm doing "perfectly", but you probably know how much that statement is worth out of an American ;) . There always seems to be a question the attending can ask about a patient that I have no answer for. Maybe by the end of this rotation I'll have the "perfect presentation" down.

In other news, I was just at Grand Rounds again and I'm a fan now. It's again been wildly interesting and I'm still amazed how American speakers can make anything interesting and captivating. Not that what this guy had to say about electrophysiology of the pulmonary arteries from the cell up to new clinical trials wasn't interesting in and of itself.

Gotta go get urine and go to rounds, blog to you later!

The day in hell

2007-04-13T17:15:00.000-05:00

Like yesterday, Jenn and the painstakingly thorough attending are still rounding, they sent Tony and me into the weekend though. It's 5:15pm now. Last week, with the other attending, rounding started at 1pm and took around two hours, was laced with teaching and I was home sometimes before four. Today, we started rounding at 11:30am and they're still at it right now.

I'm rather sure that this is why people hate internal medicine.

Right now, I'm sitting in the residents' workroom waiting for Borat to call me back when he knows how long his rounds are still going to take. If he will be done within a reasonable amount of time, we would try and find the chief residents to interview for our mentoring project. But he said I should go if he didn't call me back within 10 minutes. I'll give him 20 I guess.

If there's no call back within that time I guess I'll call it a day and go grocery shopping and maybe even to the gym.

Blog to you later.

Slammed.

2007-04-12T18:37:00.000-05:00

That's the term Jenn used after a rather relaxing morning for me. Checking up on my old patients wasn't so much work since many of the first ones had been discharged by now and I'm getting better at quickly extracting the important information about the new ones.

With Jenn and the attending at the clinic all morning and therefore completely off the radar, I was cautious though and went up to A700 early, at around 9am, to get breakfast. Because once I had that in me, they wouldn't be able to take it from me again easily. But I got to eat in peace and even had time afterwards to write a little more on the mentoring project page before the pager went off close to 10am, right before morning report.

Jenn asked me whether I felt comfortable seeing a "complicated" patient. Of course I would see that patient. It's what I was there for. Out of curiosity, I asked what would happen if I said "no". She replied that then she would see the patient after clinic and before rounds. Well, she could do that anyway in case I mess it up. So I went to see this patient in medical ICU. She was indeed not a clear-cut case, mixed connective tissue disease with idiopathic pulmonary fibrosis status post bilateral lung transplant with history of gastro-esophageal reflux disease status post multiple dilations, Botox injections and finally Nissen's fundoplication surgery that was revised a little more than a week ago. She grew partially insufficient with her gas exchange, so she was intubated, later tracheotomized. She coded for half a minute these past days. Her sputum grew pseudomonas, so they placed her on ciprofloxacin. It took me a while to gather this information from the charts and the computer. Now she was in acute renal failure, trouble was that my job was to figure out why.

Hypotension/hypoperfusion with acute tubular necrosis? Dehydration? Cipro or cyclosporin toxicity? Contrast nephropathy? The time course of her renal failure would have fit most of these causes. I talked to her, which wasn't so easy since she was tracheotomized and on a vent and examined her, she seemed pretty dry. I took a few ccs of the urine she was still making and went to dip it and spin it down. When I was just done looking at it, it was about 12:15pm, would have been just the right time to go up to A700 again to grab lunch and listen to the M&M meeting. But that's just when my pager went off, Jenn told me that we were getting "slammed" today and asked whether I could see another patient right now. "Sure", I said, not yet knowing what I was going to get myself into.

This was actually going to be a 24 year old female - I was relieved, that couldn't be too hard. So I actually went up to A700 and took about 15 minutes to munch down some very good food and listened to the middle of the M&M meeting (attendance was astoundingly excellent, by the way - 100 people easily) before going back down to see this second patient. Problem was that she was brought over from another hospital because they couldn't figure out what they should do. So they sent her over, along with records of what they had done so far in the past two weeks. She had been admitted on March 30th, so exactly two weeks ago. The records lying on the table outside her room were in three thick envelopes full of copied pages. The stack was as thick as both volumes of Harrison's together.

Splendid.

Right around that time, Jenn text-paged me informing me that we were to round at 2pm in the nephrology conference room. So I had little more than an hour to sift through this litany of photocopied partially hand-written reports, consults, flowsheets and whatnot, talk to the patient, examine her, take her urine and analyze it. Not surprisingly, that didn't work. About ten minutes to two, I had still just about covered 700 pages or so, not even seen the patient yet, I text-paged Jenn back that I was sorry and that I'd be at least fashionably late. At one point, I just gave up trying to look for everything that I'd want to know and quickly got the rest of it done, then showed up 25 minutes late for rounds with fresh urine in a cup in my pocket.

The attending didn't comment on my late arrival at all. I assume she was displeased. The new resident on the service, Tony, had also seen two new patients and Jenn managed to also squeeze one in between clinic and rounds so we had five new ones so far, with another one that Jenn was called to see but didn't have time for yet. We got done presenting the new ones to our new, very thorough attending at about 3:15pm - that's when we finally got started going to see them. Of course that meant, looking at their urines first.

Mercifully, they began rounding on a route that would lead us to my two new patients rather early. At close to 5pm we were on my second new patient's ward and went into the visitor's lounge with her three envelopes of paper. The trio of Jenn, Tony and the attending started sifting through the stuff for a while too before they declared that it looked like those people didn't know what they were doing. So they decided to re-do all the tests they did and to biopsy this young girl's kidney tomorrow to see what's going on. Which is what they have also planned for the patient I saw yesterday.

While we were rounding, Jenn got two more calls for more consults that we'd have to do tomorrow. That plus two biopsies. And normally, we start a day without any debts from the day before. That's why tomorrow is shaping up to be "another day in hell" as Jenn put it.

And she's going to be on call tonight.

Oh, and she has her parents visiting her these days.

I guess the medical profession has the same effect on your cortisol levels and social life anywhere in the world.

"Thank you for keeping patient confidentiality!"

2007-04-11T12:56:00.000-05:00

Walking into the hospital today, I got this greeting followed by a lollipop ceremoniously handed to me. Americans can be so funny.

But it was good remuneration for actually coming to work today, the weather was and still is miserably hideous, snow/rain and a lot of wind turning over my umbrella.

I got another new patient when I came in this morning and Jenn supposedly had another one for herself as well. Turns out she tricked me, her consult was cancelled later on because the patient was apparently improving on his own. So the new attending and Jenn were already rounding when I paged Jenn at around 10:30 informing her that I was done with my patient. So I caught up with them and we went to see my patient and her urine shortly thereafter. Rounding with the new attending was pleasant, more quiet and much more thorough. She actually even examined the patient herself.

When we were done half an hour ago, she said "see you in the afternoon". Actually I'm clueless as to what she meant but I'll page Jenn in a few minutes. She may know.

Blog you later.

Volleyball

2007-04-10T22:44:00.000-05:00

Hey reader,

the kidney biopsy was pretty cool. Well-organized and radiologist, pathologist and internist working together smoothly in the same cramped room. It was astounding to see.

Afterwards, surprise-surprise, now that the attending was gone, there was another consult. It was the cardiac ICU calling who had received a new patient. Yesterday, his glucose was 136, his potassium 4.0, his bicarbonate 24 and his creatinine 1.1. Today, he was rushed to the ICU unresponsive with a glucose of 11, a potassium of 6.1, a bicarbonate of 5 and a creatinine of 2.6; pH 7.1, base excess of -25 and lactate at 19.5. This is going to be one heck of a case for the electrolyte conference next monday.

After spending about an hour from 2:30 till 3:30 getting informed about him, Jenn got him started on CVVH, after which we went to a nephrology conference, taking a look at his urine on the way. Somehow I got the rotation upside down - these days I have someone with me most of the time - this would have been a better way to start off the rotation. But it'll change again tomorrow. Justin is coming off the service and the new guy has clinic tomorrow morning. So it'll just be Jenn and me - plus a new attending who is apparently more thorough.

Anyway, what I wanted to tell you about: Jenn dragged another attending to see this patient with the whacky labs. When we actually went in to see him a family member was there. After they had discussed a bit, the attending asked her whether she had any more questions. She denied and left. And then the attending did something strange - he turned to me and asked "do YOU have any more questions?". Does that ever happen in Germany?

After finishing up with that guy it was 5:30pm, not quite the short day it had set out to be. In spite of that I did go to the gym again today, adding some more to the blisters on my feet - this time there were actually people playing volleyball. There were only five of them, so again, I asked whether they'd let me play while they were warming up. They said they're actually just a few members of the team that are going to compete in some national thing over the weekend, the other ones didn't show today, they'd just be "goofing off". Ah yes. But they let me goof off with them and it was a fun game, even though I missed my kneepads dearly.

For the daring ones among you, here's a picture of my foot afterwards. Be warned .. GRAPHIC CONTENT. NOT INTENDED FOR CHILDREN, QUEASY GIRLS OR PEOPLE WITH ANY KIND OF HEART CONDITION. Click AT YOUR OWN RISK.

"Grand rounds"

2007-04-10T13:05:00.000-05:00

I know, the name is misleading. No one rounds or goes round or turns or spins or anything on "grand rounds". It's a lecture.

But a good one - at least today. The way Americans give talks is something I dearly missed over in the motherland. The added comfort of a voluptuous catered meal is an added bonus, but this would almost have been worth listening to without food! I can see that screening for colorectal cancer is not everybody's first choice to listen to over lunch but all I can say is it was informative, interesting and even halfway pertinent to my doctoral thesis on gastrointestinal tumors.

And the reason I had time to go there today was that things are extremely quiet. As blogged before, the attending left very early for Florida today and we actually had no consults before rounds. We got hit with one shortly after rounds, but when the dream-team dynamic duo of Jenn and Justin went to work that one up they were done inside of 20 minutes and caught the attending before he could leave for the airport and even though we were called with the consult at around 11:15 I was able to make it to grand rounds at noon.

Jenn is about to do a kidney biopsy at 1:30pm, I'll meet her in the patient's room. And this time around I was smart enough not to assume I'd do the biopsy myself nor did I even ask her about it ;D .

Blog to you later.

Wind of change

2007-04-10T08:35:00.000-05:00

Hope you guys back in the mainland had a happy easter!

Seems that things are about to change around here - tomorrow half my team will change, we'll get a new resident and a new attending. I'm a little worried - according to Jenn, rounds will be significantly longer under the new reign. We'll see.

Right now I'm up in the residents' lounge waiting for my beeper to tell me to quickly go see a patient before rounds at ten today. Our attending is flying to Florida to give some speeches for the National Kidney Foundation at 1:30pm. So he wants to be out the door at noon sharp. That means we'll round with him at 10am instead of the normal 1pm. Unfortunately, calls for consults usually trickle in at around 9-9:30am, which will not leave us a lot of time to see the new patients before rounds. Actually around half an hour instead of three and a half. I'm afraid that won't work unless we're really lucky and get no more than one patient each.

Speaking of which, I should finish checking up on my old patients before I get a new one. Blog to you later!

Oh no! There goes my offspring!

2007-04-08T19:44:00.000-05:00

I'm sorry. I really was going to leave you alone for today but I had another "may contain peanuts"-revelation while getting ready to iron my shirts that I have to share with you guys.
What can I say. Californians are smart. Thanks guys.

Don't even get me started on the State of Fear issue (thanks Michael Moore). I mean all I want to do is iron my stuff and they have to threaten me and my kids with cancer and birth defects?

And LOL! I was going to leave it at that but then it came to me - did they warn me that the iron may become hot? I didn't recall such a thing so I went back to it and turned it over.

Before they educate me on the fact that the iron is hot though, they have more for me to read.

Do not immerse in any liquid
Household use only

(whatever they think I'd be doing otherwise ..)
And only then

CAUTION: hot surfaces

I love this country!

I've got blisters

2007-04-08T17:58:00.000-05:00

Hey gang,

so as expected, this weekend was rather dull. Even the Hyde Park Food Produce was closed when I went there this morning. Closed! Something about easter sunday and what have you. Just when I was getting accustomed to this buying groceries on sunday thing. Oh well, so I got some water, bread and milk from the pharmacy next door. Heheh.

After that I went to the gym. Now the plan was to shoot some hoops - or at least try to - first to warm up, then do my weight routine, shower, sauna, shower, done. So I borrowed a basketball and went to the little "auxiliary" gym. In there were three guys playing on one hoop. I did walk past them and started shooting on my own but it felt impolite not even to offer to play two on two. How could they know that I haven't played this game in almost seven years.

So when I offered two on two, they surprised me by saying "sure, but let us finish the game first". See, I didn't even know you could mount a "game" with three people. So I went back to shoot at another hoop by myself and while their game was still going on, two more people went through and said that they wanted to play on the main court. Soon afterwards, when the initial three were done playing, they said they'd go to the main court and that I should come.

Uhm, well, OK.

So the new arrivals were actually four people - just like the four of us that had been in the little gym. So teams were pretty much decided on right off the bat.

I did get a warning in during warm-up shots that they should beware of me. Trouble was that during those warm-up shots I miraculously got a few three pointers in so the people on my team probably thought I was full of it. Oh well.

Those four that had arrived together obviously didn't team up for the first time. They had their act down and destroyed us in the first game. Obviously, we wanted to rematch and this time it was a closer game that we actually won in the end. So of course, we needed a tie breaker. This was the point that I knew I had to stop - I was wearing the wrong shoes for this and that tiny little bottle of water I brought was drier than moon sand by now.

Unfortunately, that would have left the teams uneven at three to four, again, not really a polite time to go. So we played that third game and I finally have my blisters - same place on both feet, dang those shoes.

So I'll give my best impression of House, MD limping across the wards these coming days.

A look back at the past week

2007-04-07T16:25:00.000-05:00

Hey, reader.

I think it is time to stop giving you exact reports of what I've been doing on an hourly basis. It's way too much for me to write and I'm sure it has been way too much for you to read for a while now.

Instead, and as I have been prompted to do so by one of the people sending us here, I will try and summarize my impressions of this past week.

Was it as expected? Yes and no.
Consult service is like what I imagined it'd be. Checking on patients that present a problem with your "area of expertise", hardly getting your hands dirty while giving them a minimal physical (sometimes from the door, if you're really pressed for time or uninterested) and getting an overview of what's going on with the patient. Then discussing what you found with your attending, interspersed with a lot of "ooohhh no"'s and "they did WHAT?" and "what service is this patient on? Surgical? Ouch! This patient needs a real doctor." thrown in by him. The attending does a good amount of teaching during rounds, as I had reported. It does feel like Jenn, the fellow, would like to do the same in principle, but I hardly see her during the day except for rounds. That is because usually so far neither of us has had time for that.

And that's the part I had not expected - seeing the first patients by myself starting on the morning of my arrival. Actually, thinking back now, it had been the same way in New York. I remember having had no idea what it should include when they said "see the patient in bed 16". At the time, I could easily attribute that to the fact that this ER was busy and there simply wasn't time to hold every medstudent's hand and show him where the bednumbers, IV lines or urine containers or even admission forms would be. Likewise, I got lost initially looking for my first patient here, it took quite a while finding everything I needed in the charts and the computer and up until rounds that day I still had no idea how thorough I should be with the history and physical and I didn't know the way to the room where I could spin down the urine sediment.

I guess I hadn't expected my start here to be equally confused and uninformed as back then because of all the preparation that went into it beforehand and because of the fact that contrary to New York this was part of a "program" and I felt taken care of well because people were organizing and worrying about things for me. And I'm not complaining about that - they did a wonderful job at it. I guess what I'm saying is this lulled me into a feeling that things would continue as well-organized and as manageably as before.

But enough about that - some cold water never really hurt anyone and I do get the feeling that just like in NYC the curve may be steep but things will be fine very soon. Actually, they're not really bad as it is at least judging from what Jenn and the attending have been telling me. But how much can you rely on that, we're in the States after all - most everything you do will likely be "a superb job".

And it's not like it hasn't been fun so far. Granted, during the majority of the day, I do feel like I have to do three things at once and time is the one thing I wished I had a lot more of. But so far, things have worked out most of the time, sometimes even with a few minutes to spare to eat or read up on something. And that will likely improve as well when I finally start getting things organized and prioritized in my head and I become more efficient in planning my way around the wards in the morning when checking up on old patients and seeing the new ones. And hopefully I will also start to foresee all the questions about a patient that the attending may be going to ask me - this will likely happen just around the time I start being able to actually focus on the medicine - because I will finally have the things surrounding it down.

About the hospital - if you count the buildings adjacent to the main wards, it is quite huge and a poor unsuspecting student that forgot to bring a map may well spend a week or two wandering the convoluted hallways of the adjacent buildings for a week without finding his way back. Note to the three waiting to get here: a pdf version of the map is on the intranet here - I suggest you print it out and have it in your lab coat, I'll send you a copy if I remember when I'm there.

In terms of quality of care, teaching and research I am positively impressed by this hospital. They certainly don't seem to be lacking financially and the atmosphere is very good throughout all activities of daily life of a medstudent. The attendings I have spoken to and talks I have heard so far lead me to believe that this is no small provincial hospital and their motto "at the forefront of medicine" isn't to be taken all that lightly either. Still, even the higher-ups here seem accessible and they are not afraid to joke around with you, pat you on the back or use some time at rounds to privately teach you something.

All in all, things are good.

The thing I'm lacking so far is some social integration - Nema and Borat are way ahead of me with that. With Trillian gone though I suppose it'll only be a matter of time until I will actively pursue this when the ceiling will finally appear to fall on my head. So far it's OK though, I needed the time to do other stuff today anyway, laundry and dishes as well as tv-show episodes were stacking up to be done and seen, I still need some groceries (although not many since I'm getting a lot of nutrition at the hospital) and I'll still be going to Ratner's today for some more basketball and other exercise.

Of the past days, only three things come to mind that I should tell you (and myself, when I read this in five years) about.

Dinner with CS and BT at their place was fun and very good. BT made greek salad and home-made lasagna for us and they had ice cream for desert. We had initially planned to go into a blues bar afterwards that our hosts actually had wanted to go to for a while - but postprandial weakness overcame us and we just moved to the couches where the conversation rapidly deteriorated though, since we ended up discussing the project we are supposed to do that would introduce some form of mentoring into our medschool at home.

In other news, my very first patient turned out to be very interesting - so interesting actually, that my attending keeps asking for a case report to be written on her. After the lab values for vitamin D finally came back it was clear that this was a case of vitamin D toxicity. This lady had been ingesting 50.000 IU of vitamin D every day for a year. That dose should only be given weekly under supervision of a physician. Normal dietary supplements contain 200-400IU max in their daily dose. The half-life of vitamin D is 20-29 days, so this lady's calcium will probably be an issue for a while.

And the third thing I have to report is that I was in this hospital's ED for the first time on Thursday. It looks and feels very similar to the Bronx and brought about many good memories.

Now, dear readers, I retire from blogging to go about my errands. Shouts out to Europe and Bremen today in particular.

Day three

2007-04-04T16:29:00.000-05:00

Today was better. Finally less of a haze.

Also, since I didn't have a meeting at 10:30 this morning I finally could go to the so-called "morning report" from 10am-11am.

But first, when I came in this morning, Jenn had another patient for me. After a little begging and convincing she gave in and allowed me to see this patient together with Justin instead of alone so I'd finally see how they actually do these consults.

So after checking in on my patient from yesterday I paged Justin, he said it was fine that we'd see that new patient together and we went to morning report.

This was one of the places where there was free food.

I had a bagel with cream cheese and two glasses of orange juice while listening to someone reiterate the different forms of machine ventilation and their advantages and drawbacks. They do seem to have quite different preferences here from those in Germany but that's not really surprising.

After that, Justin and I went to see that hypertensive patient in one of the ICUs and it seemed that he didn't do too many things differently. When we were just about done with what we could get out of the computer and from the charts the patient just started getting physical therapy, so we went back up to "A700", the residents' area, to read up on the causes of secondary hypertension and wait for lunch and .. uhm .. this noon conference of course.

This one was actually on chronic renal insufficiency. I would have liked to listen to it all but I still had to see both my hypercalcemic and my new hypertensive patient before rounds at 1pm, so I just grabbed a can of soda and one of the hundreds of Potbelly sandwiches lying around (yes! Those delicious ones I told you about weeks ago!), gulped it down and went to see the patients at 12:15.

Contrary to the past two days, I felt better prepared for rounds today even though it were three patients that I would report on. Of course, I still would have liked to have more time to think it all through but at least I wasn't missing anything obvious today that I could have thought of myself. That was a start.

Rounds were good, I had some more answers today and had more instances where it must have at least seemed like I halfway knew what I was talking about.

We actually went to see a renal biopsy Jenn had taken yesterday with a pathologist today. This took place in a room where about a dozen binoculars were connected to a single microscope. I wished our university had that kind of money.

I have to go through this rather quickly since we got done rounding at 4:15pm today and as I said, CS invited us to dinner. It's 4:50pm now and CS is going to pick me up at my place around 5:15pm. Since I'm in the residents' workroom now I'm going to have to get home and changed by then.

So please excuse my brevity but I know that I probably wouldn't get to blog today anymore otherwise.

And Jenn has clinic duty tomorrow and asked that we do show up early tomorrow .. early as in 8-8:30am .. heheh. Bad news is though that Justin is on call tonight, so he will be post-call tomorrow. That means I may get stuck with more than one patient tomorrow morning. So maybe I shouldn't have too much at the bar tonight.

Anyway, have a good night for now.

Day two

2007-04-03T22:16:00.000-05:00

Allright, I'll try to do this. The last entry was written in the residents' workroom on the fifth floor - internet is fast there and I needed some uptodate.com information. But let's start at the beginning.

After saying goodbye to Trillian who is on the plane back to Munich for about another hour now, I walked to the hospital today since it was raining. I arrived around 8:45am. Beautiful. I went up to the residents' workroom on the fifth floor and started reading yesterday's patient's labs while paging Jenn to "touch base", as she likes to say. Also I needed to tell her that CS had arranged for me to present one of my old patients to the director of the cath lab at the hospital, as I remembered this morning. That was scheduled for 10:30am-11am. Jenn said that wasn't a problem, she would need me to see another patient before rounds at 1pm though. And she had decided to give "my" patient 20mg of Lasix this morning. So far so good. While I started jotting down the new lab values of my hypercalcemic patient (they draw blood every 8 hours here it seems .. internists ..), I paged the resident, Justin, that I couldn't make it to the conference at 10am for donuts and coffee.

I used the time between 9 and 10am to try and get up to date on the hypercalcemic patient. When I went up to her to give her another physical exam, the girls from physical therapy were just about to start working with her. And I was pleased to see that my theory about physical therapists also seems to hold true in this country.

After a bit of fun with the girls from PT and the obviously improved patient I went back to the workroom to page Carolin and print out my old admission note of the patient I was going to present to the attending from the cath lab. Carolin said on the phone that she'd come to the workroom at 10:20 so I used the time to review the old note - I had seen that patient in November of last year, so almost six months ago. Carolin came and led me to his office, where we waited for him to finish his conference call.

When he was done, Carolin introduced me to the not so tall but in-shape and intimidatingly serious attending. Despite his stern exterior we started out with a friendly but very business-like discussion about how studying and graduating works in Germany, what my own plans were and what I'll be doing here in Chicago. He probably wasn't so pleased to hear that internal medicine was actually a required part of the final year and that in that respect I hadn't chosen to be in his specialty. But he didn't let it show. Anyway, he then asked me whether we should focus on my written note or on my oral presentation. I chose the oral presentation, since I wouldn't really be doing pure admission notes here on the consult service anyway.

So I started to present that patient as I normally would and the attending took notes. When we were briefly interrupted by a phone call, I had a chance to look around his office and see the same kind of intimidating plaques and certificates on the wall, firmly linking this director of the cath lab to a certain medschool in Boston and one of the many awards was indeed for teaching. I finished my presentation and he, being a true American, started by saying that I did "a perfect job" before starting to criticize what I did. But I think it went pretty well nonetheless.

After a pleasant goodbye with him at 11:15 I went back to the workroom once more. I had another hour and 45 minutes for my second patient. She was going to be a bit more complicated than the last one, having a sudden rise in serum creatinine after a cycle of multiple chemotherapy drugs last week for her Hodgkin's lymphoma. As I started reading about her on the computer in the workroom, something weird happened.

Green-grayish goo was sprayed in thick drops over my notes, my computer and me from the left. This was accompanied by a rather big commotion in the room, there were about ten people in the tiny room rushing towards the resident next to me who apparently had lost her cup of broccoli soup out of her grip, causing it to fall down and land with a splash. She sprayed a good portion of it on herself, but considerable amounts also landed on my head, my keyboard and the note I was writing the new patient on. Luckily, almost miraculously, only minimal amounts had found my pants and coat. The people in the room were busy cleaning the resident that dropped the soup, jokingly asking her whether she seized. No one really paid attention to me as I got Kleenexes out of my pocket and started crisis management. After clearing the worst parts of the soup off of myself and the computer I tried to save the note but it was beyond presentable unfortunately.

So I got up and set out to find Jenn's office by myself for the first time. After several pit stops on maps posted at the elevators and discussing the map with one secretary I did find the place eventually. In there, I got a new inpatient consult sheet. With that, I went back to the workroom. It was noon by the time I had the labs and similar info on that sheet and was up on the sixth floor to see the patient. Before even going to her I paged Jenn again and expressed my doubts that I could come up with a very thorough or even intelligent workup, assessment and plan in the remaining hour by myself. Jenn regretted to inform me that she had two new consults in the meantime and really couldn't come to my rescue. So I said I'd do the best I could.

And not surprisingly I wasn't feeling very good about my second patient on the way to rounds, since even on the way there I could think of at least three things that I had forgotten to look up on this patient. And they were obvious things because even I could think of them. Things like how long she had been on her present medication of antibiotics, antifungals and antivirals. Or her exact liquid intake and output over the past few days. Kidneys, dude. Think! Yet again, after the rest of my presentation, these things did, of course, come up. The attending smiled and said that "we will have to get more info on this patient" - I'm not sure if he was disappointed, if he was he was rightfully so, but he didn't show it.

Somehow I still feel in this haze at the hospital - I can't really think straight, especially not about medicine. I constantly feel under time pressure and a plethora of everyday things is still totally unfamiliar. I lose my bearings walking around the place, something I don't usually do. I feel like I can just about stem the tasks I am given in the time I have but nothing gets done thoroughly. And if something unexpected happens, like broccoli soup, it can seriously mess with my timetable.

I think there is two things that I'm lacking and if I had at least one of them, I wouldn't miss the other one so much. One is time, the other one is a working familiarity with all things renal. After four months of surgery and four months of anaesthesia, now several years after the semester I learned medicine in, I feel about as far away from nephrology as from Munich.

Anyway. Since Justin, the resident, had seen another two patients too we actually had to present five new patients total to the attending, including discussing what happened to the old ones. After discussing what to do with them intermixed with a lot of teaching from the attending as usual, it was 2:30 when we got up from the office to actually start rounding them. First, we looked at their urine samples in the lab, though, as always. Then we visited all of them individually. On the way there the attending kept quizzing us, that was becoming a habit. Oh and he did remember to ask me about the assignments he had given me yesterday, the effects of different diuretics on serum calcium and the effects of calcium on the ECG.

And I do have to confirm yet again the old prejudice against American medical professionals. Physiology is not their forté. The right answer to the question "how does digoxin work?" is not "it inhibits the sodium-potassium ATPase" but "it increases contractility and decreases AV conduction".

So you can actually replace the question "how does xy work" with "what are the effects of xy on the system". This is valid even if the question is rephrased to a "why does xy do yz?". For example - if asked "why do thiazide diuretics lead to hypercalcemia" the right answer is actually "because they lead to increased calcium reuptake". People start looking at you funny if you start with the answer any German teacher would expect by talking about basal or luminal transport systems in the distal tubule and ionic potentials driving the calcium out.

Results count here, apparently. And they do have a point, that is what does count in the end and that is what you should really try not to get wrong by trying to explain it from the bottom up and getting confused. The attending does seem to have a weakness for pathophysiology though and is thoroughly pleased if I sometimes do know why something is the way it is.

Seeing all those patients and finishing up my note on the Hodgkin patient that was lacking lots of important stuff as well as looking at some more urine took until 5. After that, I did run down to "au bon pain" in the lobby and got myself a cookie before I went back up to the resident workroom and read a bit about Fanconi syndrome, my assignment for tomorrow, taking a break to write the first blog entry today that is right below here.

By now, Trillian has informed me that she has safely landed in Munich and is on her way back to town. In all likelihood, CS and BT will have all three of us over tomorrow for a barbecue (if the weather permits) and hitting a bar afterwards.

Chicago kicks butt! (Insert picture of me complacently waving to the east coast here).

Thank you Amsterdam and good night

Day one

2007-04-03T18:07:00.000-05:00

Hello dear reader, the rotation has started.

I am - of course - pressed for time, still I want to try and write down the details of the past two days before I forget everything.

So, yesterday started at aroud 7:50am, when I met Nema and Borat in full medstudent gearoutside the building where we were supposed to hand our checks in. $26 per month each for something called a "health service fee", $200 as collateral for the pager we'd receive as well as $10 air service fee. Luckily, CS had been so kind as to provide these checks for me in exchange for cash (since I get cash without any fees here as opposed to money orders).

Anyway, we waited outside the offices for as long as seemed appropriate and entered them at 8am sharp with two other visiting medstudents - one other actually from Stuttgart, studying in Berlin. Must have felt like a German invasion to the one guy from the U of Michigan. Rightfully so.

We received paperwork entitling us to pick up our IDs and pagers
and all of us together went a few blocks south to pick them up.

Note the back of the ID in the meantime.

After that, we entered the main hospital building and called what we assumed was a secretary in the internal medicine department from the main lobby. I only got voicemail, but when Borat tried a while later he actually got said secretary. She was very nice and gave us pager numbers of members of the teams we'd be with.

We paged them in turn - I was actually given the numbers of my resident and fellow, somehow the secretary seemed to know that the resident wouldn't really be the one I'd need. I spoke to the resident first, also a nice guy, who explained to me though that he had clinic duty this morning and that I should page the fellow. After I had done that, Nema paged her own team and picked up on the first return call. After my fellow, Jenn and Nema had taken about a minute to find out they were talking to each other in error, Nema handed me the phone and Jenn explained that she was swamped with consults and that I should come up to her onto the ward.

Right there I was glad CS had given us a rudimentary tour of the medical wards, because I almost didn't get lost on the way there. Anyway, when I was on the ward and asked for Jenn, she was indeed there.

Pretty much right off the bat Jenn reminded me of "the cute resident" in New York. She talks faster than I can think, only interrupted by her almost continuously beeping pager. After a quick hello and an even quicker introduction to the computer system she apologized and explained that she had just started on the service today. That meant she was just handed a stock of 18 patients that she needed to get semi-acquainted with plus three new requests for consults this morning. She apologized again but asked me to see one of the three patients right away, she wouldn't have time to explain things right now.

Ummmm, kay.

She gave me a "nephrology initial inpatient consultation" sheet, wrote name, medical record number and room number in the top right corner and gave me directions towards where she'd be. It was quarter past ten by now and she said I had until quarter to noon to get this patient's history and see why she was hypercalcemic and in acute renal failure. She gave me a quick rundown on the patient's story, including the fact that she was deaf and mute. Great.

So I headed down to her floor and took about an hour to work through the stuff I could find in her chart and on the computer. After I had her chief complaint, history of present illness, past history, family history, social history, allergies, medication, review of symptoms (since I wasn't going to be able to talk to her), vital signs, lab values and radiology reports all assembled from somewhere and copied onto my sheet, I actually went in to examine her. Of course, she immediately started talking to me. Or trying to. She mumbled incomprehensibly and pointed to both her feet alternatingly. My gesturing in response didn't help much. It wasn't going to work this way.

I went back out and found the nurses that had worked with her, asking them whether they understood what she said or had found another way of communication. They hadn't. So this actually wasn't going to work.

Oh well.

Using gestures, I could kind of make her do just about what I needed her to in order to give her a quick physical. I jotted down what I had found and then paged Jenn again, it was now about a quarter to noon. She asked me whether I knew how to get urine from her foley for "us" to look at. Well, uhm, I didn't really. So she came up and took the urine, then we rushed down incredibly convoluted corridors to her office, dropping the urine in a room on the way and making another quick pit stop at the dialysis unit where she apparently also had to do something. She took a stack of paper from her office and led me to a conference room, where a lot of people in white coats were already sitting.

I didn't take in much of the scene anymore since there was pizza on the table. Mmmmmh. Jenn told the group who I was and the attending at the head of the table invited me to grab some pizza and a soda, have a seat and enjoy the show. I complied most willingly.

The "show" was actually Jenn handing out pieces of paper that showed nothing but the age, gender and lab values over time of two patients. The residents and fellows at the table took turns to look at some of these values and give their opinions on it. I munched pizza happily. They tried to find a diagnosis and guessed at what was happening to the patient in terms of course of the illness and treatment outcome based only on the lab values, primarily electrolytes.

These guys knew what they were talking about.

I was for the most part barely able to keep up with them, actually still thrown off by the mere fact that they call Na "sodium" and K "potassium", which I should really have gotten used to by now. They were using lots of other abbreviations, presumably kidney stuff, only part of which I could figure out on my own. Naturally, I was never called upon by the attending to contribute anything to the discussion and I didn't. Maybe I should have, because the group spent a considerable amount of time discussing some "outlying" values at one time point of the second patient. They were apparently so wrapped up in their theories on the electrolytes and why this was going up here and dropping there that they didn't notice that at this time point that they found so particularly strange, everything was lower than before except for sodium and chloride, which were higher.

As I'm sure is evident to you now, this blood draw had been watered down by mere saline solution. I didn't dare to chime in on such a high-class meeting on my very first day so I listened to their discussions on these strange, aberrant values until someone else slapped themselves on the forehead and found the technical, yet simple answer. See, mom? I can shut up! ;)

That conference was over at around 1:15pm. Jenn told me on the way out that "rounds" would be at 1:30pm. Not knowing anything about how things would work here, I asked who is actually rouding with whom. She said "the attending with us". Ah great so I'd get to present my patient right away .. thanks for the warning.

When we sat in the attending's office a short time later we were joined by the resident who had thereby finished his clinic duties for the week. As it turned out, the attending was also new on the service so he would have to hear about all the patients. He wanted to start with the new ones though. Ah great.

At least, Jenn also had a patient to present so I happily left it to her to start off. And she did. It was pretty quick, but the attending - while seemingly a very friendly but also extremely competent guy - kept asking her difficult "teaching" questions. I was trying to listen and follow for most of the time, but I was distracted by my own case that I was thinking about and growing ever wearier of presenting later. At the point where I additionally glanced up to one of the frames hanging in the attending's office that showed he was one of "America's top physicians", he shot a question at me. "What else could it be, Philip?"

No clue. This is not my league. At that point I wasn't even sure whether I could roughly point at a person's kidneys.

When I admitted that I had no idea, it luckily didn't seem a big deal.

After Jenn's presentation, they were both looking at me expectingly. Thankfully, the attending said after a short pause, "don't worry, I won't be as hard on you as I was on her".

And he wasn't. It went quite OK. And as he asked me a few more questions - some of which I was even able to get partially right he seemed overjoyed.

After we had discussed the patients for today, we actually went to see most of them on the floors. This gave me a chance to get more acquainted with the resident. A rather quiet but very friendly guy - future cardiologist - who later on gave me a run down on what conferences to be at at which times in order to get through the week with the maximum amount of free food. My kind of guy!

After rounding, the day was over. At about 4pm. When I asked when and where I'd have to be the next morning, Jenn said I could come "whenever I wanted", I'd just have to check in on my patient again and it'd be nice if I touched base with her some time around 8:30 or 9. Hooray :D

So I went home happy.

This was going to be the last day that Trillian was in the US, so I called around and we arranged for a little impromptu party at Nema's place.We bought some drinks and had a lot of fun together until Trillian and I felt that we couldn't keep Nema up anymore at 12:30, since her day would apparently start at 7:30 the next morning.

I've had it!

2007-03-31T20:38:00.000-05:00

Just ordered DSL!

It should be here on April 5th. Just six more days of painfully slow page loads and blog post pictures taking all day to upload. Hooray!

So here's what I've thrown at AT&T so far:

I started out by making a $85 deposit that I still have no idea about how it will be refunded. Then about $47 for the setup of my phone line. It'll be about $42 for my basic phone plan that doesn't yet include the local calls it took for me to dial into 550access, my current 56k online provider. This one costs $5,50, as the name suggests. So now, with DSL, I'm out another $49,99 for the modem, which it will cost another $13 to ship plus $30 for the DSL access itself. That adds up to about $200 for something Nema and Borat had instantly and for free when they came here - acceptable internet access.

By the way, my paper asking to share internet access with someone else that I hung up downstairs was greeted with a post-it stuck on it that stated that this was illegal. Sometimes, this country still surprises me.

Ratner Athletics Center

2007-03-30T20:34:00.000-05:00

No pictures today!

Only noteworthy thing I did today was my first time going to Ratner's.

The manager recognized me and even knew my name (for those of you who know it - that's quite a feat for an American!) and signed me in without problems. He gave me a lock but I did have to come back to get an explanation how it works - it wasn't quite like my locker back in high school and even that was a while back. But I did get the hang of it, got changed and first went to the "rotunda", that's the circle of exercising machines actually overlooking the lobby (you can see parts of it on the pictures of Ratner below). Almost every one of the thirty machines there has either an individual TV (yay, maybe I will get to watch 24 here!) or a screen in front of it, that makes riding the exercise bike feel more like a video game than a workout.

After about a mile on the treadmill I wanted to explore more of the place and went downstairs to the weight room. I trained a bit and then felt an itch to try if I could handle a basketball after 7 years of not having touched one.

I got my driver's license - the girl at the reception trading balls for IDs didn't seem too bewildered by it - and received my ball. It seemed small. The gym that I had seen people play basketball in when I was coming in now suddenly had a volleyball net and girls with volleyballs trickling in. Bugger .. the schedule next to the gym said "varsity volleyball" for this time slot. But the schedule also said "auxiliary gym". After a bit of wandering around I found the main gym which of course, also had six basketball baskets.

Not feeling ready to participate in the game right away, I shot some hoops by myself and was surprised to find that it actually seems like riding a bike.

After close to an hour on the court I had to get going, since Trillian was ever more likely to arrive back from her trip to town that she did today. I made a 15-minute stop in their sauna, but even though their thermometer showed 210°, it felt like no more than a warm summer breeze in there. Oh well.

The place rocks anyway.

Hope I get to go there during the coming weeks.

Bulls

2007-03-29T23:47:00.000-05:00

This morning, CS informed us that she'd have time to show us around the hospital and our wards today after all. And then Borat called and asked me whether I wanted to come with him to the secretary we all would have to visit by Monday. He apparently had called her before but she had reacted rather impatiently as he reported.

That meant I had to find an air pump to be able to use my bike. Naturally there was none in the laundry room downstairs where the bikes are kept in this place. Naturally, the one-dollar-store didn't have any either. Naturally, the gas station's pump did not have a barometer so I couldn't really be sure not to instantly blow up my tires. All that was left in the little time I had left before having to meet Borat was that ridiculously overpriced hardware store on 55th that I actually had to leave $11 at to get an air pump.

Oh well. With pumped-up tires I cruised towards the hospital with my one-speed bike that is way too small for me and met Borat. We did meet up with the secretary but that was just about as much use as calling her. We did find out that we couldn't expect to get a student ID from her and even with the hospital ID she seemed kind of reluctant to make any steps towards setting things in motion with the nurse who apparently was in charge of them. When we asked about the Ratner Athletics Center that was primarily for students that Borat and I did want to sign up for she did say though that we should try and sign up anyway.

We would try that, but only after we had met CS at noon in the hospital.

She took us up to the fifth floor, where the apparently recently-built residents "hall" was - a tiny room crammed with people in white coats sitting at and hacking into computers. We left our jackets there and followed CS on one of the wards, where she explained the computers and patient records to us. No rocket science there, really. Interestingly though, even though we were on a normal cardiology ward and not the ICU, every patient was hooked up to monitoring that was displayed at the nursing station.

Other than that, we were only introduced to one fellow resident. The rest of the staff gave us sometimes curious, sometimes irritated looks - at least that's how it appeared to me. We'll see if that changes once we wear our terribly demeaning white coats as well as shirts with ties.

After leaving Nema and CS behind with an attending that she was supposed to present a patient to for practice (Borat and I aren't scheduled to do that until next week, when we have already started our rotations), Borat and I went to the Ratner Athletics Center and after a nice chat with the manager we were allowed to become members. Not as regular students, which would have been free, but as non-registered students which came to $60 for the two months we are here. That's a very good deal I think - in Germany I am used to paying much more for much smaller facilities.

After the sign-up process we met Nema on the street by chance and she came over to my place to eat. Borat still had to do something before we would meet again at my place to go out. Because today was the day that the Chicago Bulls were to be squashed by the Detroit Pistons and that we - thanks to yours truly :D - had tickets for.

But I realized I hadn't brought gym clothes since I hadn't expected to find such a nice and affordable gym right across the street from my apartment. So I asked Trillian, Nema and Borat whether we could leave half an hour earlierto re-visit yet again the Bestest Store in the World (tm).After I had bought two pairs of sweat pants and swimming trunks (yes, Ratner's has a pool!) we returned to the L-tracks, where the view was beautiful today,and headed east, past strange places.(I wonder what they treat .. actually feminism? Do they make women better people by changing their sex? Heheh.)

A few more blocks to the south-west was our goal - the United Center! Yes! United! The people that gave me Filet Mignon and a massaging-chair on the flight here :D .Yeah, we did want jerseys. Then again, we did also like our ability to afford food.Which Nema and Borat did.I actually missed my chance to get food because we were waiting for this guy.He was going to draw a picture of us. For free. Compliments of the Bulls. Of course I'd get something for free at the UNITED center. I love those guys.

They also gave all four of us free Chicago Bulls umbrellas. I have no idea how I will transport that thing home but it's a very cool souvenir.The guy actually took an entire hour to draw us.Really. An hour. We missed the start of the game, because we were still sitting there with him.But after a short chat with him - he wanted to practice his not-so-shabby German with us afterwards - we did make it all the way up to our seats.

They were "cheap". Only $46 per person. So they gave you a great .. overview.But it was OK. You were actually still able to follow the game from here.They really made much of a show out of it, including showing random people in the crowd, multiple sponsored lottery-style events, the mascot trying to score with his back to the basket from center court in order to win $3000 for someone, the InflataBulls and of course the luvaBulls, the Cheerleaders.The game itself was quite exciting in the end actually, as you can see from the scoreboard below. 81 to 81 in the fourth quarter with 9.8 seconds to go.I do have a video of the final three minutes that followed (still three free-throws and a time-out to go :) ), but uploading that to youtube is currently not something I'm willing to try with this line.

The ride back using buses was surprisingly easy and unfrightful.

Guided tour and Highway to Hell

2007-03-28T22:36:00.000-05:00

We went to get one of the guided tours around the U of C campus today. There are actually two per day, 10:30 am and 1:30 pm on every weekday. If you thought this was hard to believe, then get this: there were actually about 40 people taking the tour with 5 guides on this totally normal Wednesday morning.

At the totally crowded admissions office, where the tour started, they asked around loudly "so, who of you guys is actually a senior in high school?". No hands were raised. "Oh, so you're all juniors? Oh boy. Oh, err, any transfer students?" I raised my hand halfway and said "kinda". They asked me to have "my tour guide" bring me back to the office after the tour.

Outside the door, we split up into the five groups and a girl from - was it South Carolina?, she was a first year (oh great), started walking backwards in front of us and talking and talking.This is what the insides of the "main quadrangle" on campus here look like.They have a small chapel here that U of C students actually seem to get a discount at when they get married. Scary.

We also entered in some hallways around classrooms.The people you see are actually in the next tour group.

Here, I couldn't help but digress from our tour guides' explanations to take a picture of a bulletin board on the wall. The Educational Guidelines for Sexual Consent :DAs you can imagine, I was appalled to read that "According to the Illinois Criminal Sexual Assault Statute consent cannot be given when any person is intoxicated, unconscious or asleep". Whaaa?

What's worse: "Giving someone drugs or alcohol with the intent to impair his or her judgment or make them unconscious violates the Illinois law." Huh? So what exactly are those 40-ish-year-old dudes doing buying those future trophy-wife barely-legal college chicks drinks? That's illegal! And I thought only Germans had a tendency to over-regulate things.They did have nothing but pretty buildings in the main quadrangles and what our guide told us about initiation ceremonies and lots of other fun and cheesy traditions that we do need to introduce in Germany as well.

But I doubt that this has a chance - it feels like pretty much everything around here is upside down when it comes to university. The tour that first year student gave us felt more like a sales pitch. Even when she told us that she does feel secure on the campus. Yes she does. And those big poles with the red panic button that say "emergency" in big blue letters are there to make you even more secure. She said that you could even hit them while running from your predator. By the sequence in which you hit on the buttons the police will be able to tell where you're running. So cool! The little girl's mom that was with us started hyperventilating. Anyway. It still felt like that tour guide was trying to sell the university to us. Which I suppose she was. The university here gets a huge deal of money through tuition so there actually is a competition between universities trying to attract as many students as possible.

Well, she didn't quite convince me to pay tuition.

Later, back in the admissions office, I explained my status and asked whether they saw a chance that I'd get a student ID. The nice lady explained that the medschool really was quite detached from the rest of the university and that I would have to check with the "secretaries over there". I did want the student ID for several reasons .. for one you get into a lot of stuff much cheaper, you get into frat and sorority parties at all, you get public transportation around campus, you get free access to the Ratner athletics facilities, free wireless on campus, access to libraries (yeah, I know, what for) and to student eating places (ah-HAH!). So we would have to check with the secretaries later.

First, Trillian and I checked out the Co-Op book store our guide had mentioned in the tour. That one was fun. It was underground.I don't know what text book rush is but it sounds scary.Trillian really loved this place.Images can't really convey the crammed atmosphere this place had, where books were stacked up to the low ceiling, even between pipes, and shelves were individually constructed to hold a maximum of books in the twisted little rooms.The place was pretty big though. I for one couldn't make out any kind of order though in which the books were arranged. I believe finding what you're looking for in here was a mere game of luck.One section apparently contained the books required for certain courses at the university and were conveniently arranged with course numbers. Service is everything over here.Walking back home, we passed the fraternity houses that had banners hanging out. There was actually an announcement for a "dirty doctors and naughty nurses party" on Friday whose proceeds would benefit doctors without borders supposedly. Unfortunately, U of C ID would be required there, too. Oh well.Back at home, I needed some calories since I hadn't had breakfast.When I had eaten this little pizza, I felt strong enough to make more food (heheh) for the return invitation of CS and BT who arrived at 6.When they arrived, we feasted and had a nice conversation even though CS was post-call.The food cleared out nicely.Right before the other two girls had arrived, a UPS man had been at the door. I was in the kitchen busy at the stove, so Trillian went down (our door buzzer doesn't work). We didn't know it was a UPS man. We expected the girls. So Trillian was surprised to find the UPS man with this package.A beauty, eh? Cleverly, the guy made Trillian sign for the package before he showed it to her. When she alarmedly ran up to me to get me to look at it, I saw nothing but the back of the UPS guy running across the street to his van getting in and driving off.

I wonder what they do to these packages to make them look so terribly worn.The inside wasn't that much better off. The back fender was pretty nastily twisted and buckled and there was a huge scratch on the bike itself. But other than that the parts of the bike seemed kind of usable.Yes, "parts" of the bike. Assembly required.So I went at it.Maybe half an hour later, I was sitting on my 1-speed beach cruiser bike.While it IS pretty, it's much too small for me (but the biggest/only size they had for male adults .. this was the USA, right?) and even after extensive bending of the fenders, there's still something apparently rubbing on the front wheel.

Oh well. Now I just need to find something to get air into those wheels.

Field Museum

2007-03-27T22:34:00.000-05:00

Wait a second. Me? A museum? I can see anyone who has even remotely met me before shaking their head now in disbelief. I understand.

Of course I didn't want to go to a museum. Hello? We were walking towards the Shedd Aquarium- the biggest indoor aquarium in the world! Yeah, the head-shaking now turns into mere eyebrow-raising. An aquarium .. big deal. But you have to admit it does sound vaguely interesting. They're supposed to have sharks and everything.

Alas, despite it being a perfectly normal working day during the week and even before noon, the line in front of the aquarium went on .... and on ..
.. and I'm sure you can see where I'm heading.
Away from here.

So the aquarium obviously was an interesting place but interesting for way too many people.

Guess what is right next to the aquarium and doesn't have any line at all .. And - probably because I hadn't been to a museum in a long time - I couldn't remember why exactly I didn't go into museums.

So after minimal fiddling with the lease of my apartment (to prove I'm a Chicago "resident") and after starting to explain that we had no U of C ID "yet" (like I'm ever gonna get one .. heheh), we would be happy to show our German student IDs though, the woman at the "guest relations" desk of the museum quickly gave us the student discount and got rid of us. It seems that if you go to that much trouble to make up such an incredible story like that you're visiting students from another country and not having proper ID "yet" - you deserve the discount anyway. She wanted to see neither lease nor German student ID.

Once inside, I found that the place held some promise for me after all ..Yum.

And then, there was an exhibition that supposedly was time-sensitive or something, since it said on our tickets that we were scheduled to go there at 12:30. So we did.This did look somewhat interesting.And these Americans seem to know that museums are generally boring and they do try hard to keep you interested. And as we all know, the things that sell best are sex,cute little funny animations (lots of them actually)and of course, murder/death/kills.
Lots of them also.But hey, they really did put a lot of effort into this exhibition.And who would have thought - some of this stuff was actually interesting. Some.And those comedians/museum geeks really went all out .. "Don't blink - you might miss these tetrapods that lived only during the Triassic Period." Haha! That's funny stuff.Needless to say, by now, I was bored. And it all came back to me .. why I avoided museums where I could. They were boring! How could I forget that?But Americans really are something else. Right outside the exhibition was this. At first I thought they had some really lifelike robots in there. But no, these were actual people, one really old guy at the microscopes and a considerably younger one discussing apparently something about dates, since they were gesturing towards and fiddling with a calendar on the wall. "Is this a real lab?" the panel reads below the probably one-way mirror that formed their walls. And the answer was: "Absolutely! It's one of three labs here at The Field Museum in which vertebrate fossils are prepared."Freaky stuff!

"Do Not Knock on the Glass!" the paper on the wall read. "We are working on very fragile animal fossils from all over the world. These bones are very important research specimens, and can be easily damaged. Preparing fossils requires patience and careful attention. Please help us out, and do not try to distract the preparators." Uh - sure. But could I maybe pet or feed them?Right along those lines is this Native American making a Totem Pole on displayand this woman knitting away for everyone to see, comment on, critique and throw their kleenexes at. Weird.
Anyway. In between, by the way, we had gone into a temporary exhibition about the work and life of Mendel that was also beautifully done and interesting, alas, top secret. As in, no pictures. Oh well, less for me to upload.

The one "big" attraction this Museum boasts is Sue. Sue's head is depicted below. It's the bigger one of the two. No, I mean the one on the right. Kidding! Don't kill me!Anyway, that head above belongs to the skeleton below.It's a Tyrannosaurus Rex. Or rather it was one. One bone-digger called Sue found the first few of her bones so they named the big Rex after her.She is kind of pretty I have to admit. And they seem to think so, too.So far unwilling to forfeit the rest of the day so easily that we had paid the admission fee for, Trillian insisted on going to the exhibition on the "Ancient Americas" and "Ancient Egypt". I will try and bore you only minimally with the "highlights".

Like "in Spanish only" - does anyone else find that weird?Also in this exhibition, they did get cute with us.But after the Ancient Americas and on my way to Egypt I was just about ready to lie down next to herand have someone say this:But there was some fun to be had in the Egyptian exhibition after all. For example this thing:When I looked through the hole, I first saw this.A lightbulb? Wonderful indeed. OK, here is what I guess you were actually supposed to see.Just ignore the huge bulb at 12 o'clock. So much work and attention to detail and they find no better way to light it all than to put a bulb in your face. Oh well - I won't be curator of this museum any time soon luckily.

So we looked at Trillian as an "Ancient Egyptian" before even she got bored and we headed out.Of course they'd intercept us right before the main entrance with another huge pile of merchandising products.Full shopping mode.When we made it outside, Trillian was harshly introduced to Chicago weather and its extreme unpredictability. While a T-shirt had seemed more than enough in the morning sun, Petrus had in the meanwhile done a one-eighty.One look at the Hyde Park Shopping Center sign expressed in numbers, what we had felt right outside the doors of the Museum. 4°C. Fridge temperature.

Navy Pier and the Hothouse

2007-03-26T17:26:00.000-05:00

Today's weather started out beautifully,so we got ready to implement Trillian's plan codenamed "sunshine", consisting of Navy Pier, some Picasso statue and the Sears Tower.

Firstly, though, we followed Nema's advice that she got from her roommates and went all the way east on 57th, passing the Museum of Science and Industryuntil we hit the lake.Just in case you were still doubting me when I told you the weather here is incredibly warm today:As additional proof, all three of us got a sunburn today.
There actually was a pretty nice view of the skyline of Chicago around here, but even though you could see much farther today than the day before yesterday, downtown was still a little misty.
Be that as it may, we crossed the freeway and went downtown,towards this place,stopping only, of course, for the girls to recharge on this stuff:Another proof that it was objectively warm today - when you stood in the glaring sun it felt even warmer though.
So this was Navy Pier.... apparently famous for some huge things .... and the usual blatantly superficial American values.After all, if a person utters any of these things in your presence, they are friendly by definition and no Sir, there is no FREE meal in it for you.

Given Nema's hot dog thoughand my tasteless burritothe food actually should have been free and not so ridiculously overpriced.At these prices, the girls even managed to steer clear of a "SALE SALE SALE" sign of a "fashion bazaar"!
Taking pictures in the beautiful weather was free though.As opposed to the lemonade. $6 anyone? And I thought this was a family place.Pictures were still free though.After Navy Pier the girls wanted to see Millenium Park - this $450 Million partly-green patch downtown that apparently was supposed to be done by the year 2000 but was in 2004.

The list of sponsors of the park (donating $1,000,000 and above) was impressive though. Americans do like to donate.There was even a name among them that I'd see more often in the coming two months. Can you find it?This is the bean. That's way more fun a sight to see than most others as I'm sure you can imagine.After all, people are said to have fallen to the ground while walking under it .. muahahah.I did have to get one or two more poser pics in.Then guess what. Nema hadn't seen Macy's yet. ARGH!I'll spare you with the details. After crossing that ugly Picasso thing off the listwe decided to skip the Sears Tower given that it was $12 to go up there and offering pretty much the same view as any other skyscraper we could go up into for less to nothing (for example, Nema had been in a bar on the 91st floor for free).

Back home we had some foodbefore the arrival of the third Munich medstudent, let's call him Borat (meheheh), and we were taken to check out Chicago's night life by Nema's roommates like the one on the left - let's call him Milo.One more time, I felt lucky to be a guy since I ended up being asked to dance infinitely fewer times than the girls did. But they said they enjoyed themselves and so did I. The barman was extraordinarily generous with the liquor he put into cocktails.

Sunday

2007-03-25T21:08:00.000-05:00

This was, as God intended (hey, I live next to the Lutheran School of Theology, for you-know-who's sake), a slow day.

After waking up at DG's place, we strolled back home in an incredibly hot and humid air. I wouldn't have believed anyone who would have told me this so I can't blame you for your disbelief now. Yesterday, I was wearing three rather thick layers and was still cold, being able to see my breath in the cold, foggy air. Today, when we walked past the shopping center on 55th wearing nothing more than a T-shirt and still sweating in the glaring sun, a panel showed 75°, that's 24°C.
Anywho, we went to a bookstore on 53rd today that actually had some more very interesting merchandise .. ah the temptation.
I did have my reconciliatory dunkin' donut afterwardsand also robbed an ATM of most of its twenties in order to pay the rent in advance tomorrow.
Then, I tried to make something out of the stuff we had bought at Targetand I started another desperate attempt to overcome this painstakingly slow dialup connection I still have right now.
After all, people are currently obviously returning from spring break and there's bound to be more business in this ghost town in the days to come.

We'll see.

We have big plans for tomorrow (mostly touristy stuff), I'll try and keep you posted as always.

Arrival of DG

2007-03-24T23:15:00.000-05:00

DG, another medstudent in this Chicago scholarship, arrived yesterday. She actually did not accept the place she got with Student Housing since she already had a spot sharing an apartment with three roommates. Organizing this from Germany may seem like a daring thing to do, but when we paid her a visitthis morning (she conveniently lives just two blocks north of my place), it seemed like it paid off nicely. The place was quite big, roommates all students, one medical it seems.

The person whose room DG inherited, who is now technically subletting the apartment to DG, insisted that both she and her newly-wed husband would give us a tour of Hyde Park. They took us in their car and drove us around the nearest shopping areas and the university area, mostly places Trillian and I had already been exploring these past days. Still, it was a nice gesture and they let us make a stop at the currency exchange, where we quickly acquired a 7-day-CTA-pass for DG so we could all go downtown later on.

The other new piece of information that we got from this tour was that we had pretty much seen everything. Of course, not the inside of the university buildings or hospitals but we had now been to pretty much every "place of interest" in Hyde Park. Going further west or south (as Trillian and I had also learned from our own experiences) was pretty much off-limits. East is Lake Michigan and north was downtown Chicago, a place with also not that many more things for us to see anymore. Yes sure, we would have to go up the Sears tower, see Navy Pier and maybe a few museums and we needed to catch some night life around here. But it doesn't seem as daunting a task as to "do" New York City or even a town like Munich "in a week". Either we haven't really found out yet what a tourist is supposed to do around here or there just isn't that much to see.

Again, I'm speaking from a tourist's perspective here. This has nothing to do with what we'll be doing professionally and socially once I start working at the hospital or once we go see the Bulls take a beating by the Pistons on Thursday ..

Anyway, I was babbling away there for a minute. DG's landlady dropped us off at the place called "Potbelly" where I got one of those delicious sandwiches on day two.
DG, not having eaten since the plane ride yesterday, seemed to enjoy that part, only being disappointed by the fact that her "juice" really only contained 25% of "actual juice". Yes, things can be confusing around here.

We then took the number 6 bus back up downtown, where we attended to DG's amply-voiced caffeine needs. Something about helping her normalize her circadian rhythm. Whatever, DG, I know a junkie when I see her ;)
Just kidding .. I think.

A hot chocolate for me, as well as a café mocha, a white chocolate mocha and a double espresso for the ladies later, we felt readyto go into the heart of town.

When we reached the corner of State and Madison, the origin of Chicago's street naming system and purportedly the very center of this lovely city, events started getting out of hand. Out of my hands that is. The ladies' energy suddenly seemed independent of their caffeine levels and they purposefully steered into the stores.

They were in full shopping mode.I did feel out of place and as any guy will know, full shopping mode is a force of nature to be reckoned with.

However, this place,Sears, must have been a disappointment since the ladies found me in the electronics department (which Sears mercifully had, a husband/boyfriend-daycare-center) only about 15 minutes after entering the store saying that it was a bust.

Hooray, shopping-mode suspended!

Now growing increasingly aware of priority number one, food. Since DG wasn't particularly fond of the idea of spending tonight alone at her place again (her roommates wouldn't return from spring break until tomorrow) and Trillian and I didn't have a mattress for her at my place we decided to all crash at DG's new apartment for tonight. We wanted to cook our own meal but we would need supplies for that.

So where would we go but our own good-old ..

About an hour later we emerged happily, with lots of food in plastic bags in our handsand waited for the green line to bring us back south to Hyde Park.

Note that today's weather chose not to let us see the lake from here.

When we arrived at Garfield Station, which is south of downtown and west of Hyde Park, we had to wait for the number 55 bus for quite a while. There was only an average number of people asking us for money or to "help the homeless" that we had to actively ignore but there were a few more groups of people loitering around us, none of them white or even hispanic. While the bus still wasn't there after about half an hour, actually a police car was. Standing across the street, officers apparently staring purposely at us white folks and our half a dozen bags of groceries. Apparently, they waited for us to get into the bus. I for one thought they might as well have picked us up and brought us home if they worried that much. Anyway, the girls said they didn't want to transfer at that station anymore. So that effectively bars the L-train for us down here and we'll have to keep taking the number 6 bus up and down the shore from now on. Bugger.

Anyway, after arriving safely back in Hyde Park, we came by my place to drop off some of the groceries and pick up things for the sleepover and then went to DG's place. From there we went and bought some fresh vegetables, witnessed DG pick up a couple of hundred bucks at an ATM to pay the rent later and then hit a liquor store. Naturally, I tried all the booze they offered for free in there - corona in a can was a bust though. Tasted just like regular Corona - which was terrible, lemon or not. Anyway, I had to take all the liquor on my tab since of course, Trillian didn't have an ID on her. Probably made me look really good to be buying booze with two girls who couldn't or wouldn't prove to be over 21.

Oh well. We then started cutting up all the vegetables and improvising something edible out of them (yes, I did have a part in it that went beyond documenting it!).

After toasting with the stuff we had taken out of the liquor storewe went on to have a quite tasty meal, surprisingly so since it must have been healthy as heck, what with no meat, no grease and probably tons of fiber and vitamins and all.I'll make up for it with a donut or burger or something tomorrow.

Touring the U of C

2007-03-23T20:12:00.000-05:00

Need I say more?

Soon someone will graffiti on that thing "... until the arrival of Iccy".

But first things first - this morning I had another look at what was offered bike-wise on craigslist.com. Lowest I found was $60 for a functional-looking bike somewhere all the way in Cicero, lacking fenders of course that would protect my fancy clothes from the every-so-often-present precipitation around here. Most halfway-decent bikes were priced around $100 and up on there so I checked out target.com. Told you, the best store on earth. They had new "cruiser" bikes (including fenders) for $79.99. Granted, including shipping this bike put me out about 110 bucks but I believe judging from the prices on craigslist (someone's bound to be paying for all that stuff?) it should have great re-sell value in two and a half months when I return to Germany.

It should be delivered some time next week.

Then, we went out.

On our way exploring south, the first thing we came across was some art school apparently. I'll let you judge for yourselves.

Next we stumbled across the beautiful Gerald Ratner Athletics Center.
Naturally, it's primarily for students so it'd really help if I could somehow get a U of C student ID. I'm sure that'd also help with a lot of other stuff. We'll see.
The "Nuclear Energy"-sculptureas well as some other pointersled us on the right track.

There it was.So pretty.I felt right at home.
Then we found the place I'm sure Phèdre would love.
Never passing up an opportunity to make good money, there were tons of U of C/Pritzker merchandise available. And I, never passing up an opportunity to be a sucker for that kind of stuff, walked out with some of it in addition to a nice new book on EKGs (it's time I actually started to know what I'm doing) and a terribly ugly hip-length white "coat" (jacket, really).

No matter. We went on to find that the "University market", defined as grocery store on Google Earth was a very small and as always down here very overpriced little shoppe.

Not impressed, we returned home to deposit our gadgets from the university bookstore. We found an e-mail from one of Trillian's friends in Detroit saying that Walmart was actually even cheaper than Target. Intrigued, I looked up the closest Walmart stores on the internet and found one that was about exactly as far away as the Target store, just in the opposite direction.

So Trillian and I took a bus a couple of stations west and then went south all the way on the red line. Even though we ended up being yelled at by just one beggar on the train and only two obviously mentally deranged people held their monologues too close to us for comfort, we decided to turn around and head back while we were waiting for the bus on 95th street.

This was mainly because we felt very out of place not having seen any non-African American faces since 55th street - and the many faces that were there didn't exactly smile at us (at least not in a sane way). So the rich white folks got scared and ran away to the suburbs, joined the NRA, got three guns each and voted republican.

You'll notice that there are no pictures of these events.

So we ended up scurrying back north all the way to Target - did I mention it's the best store on earth? And we went on shopping happily.

On the way back, the humid, foggy weather invited me to take some more pictures outside the Target store and on the platform of the L-train.

Exploring Chicago

2007-03-22T19:20:00.000-05:00

Just a few steps out the door this morning I took a picture of Greenwood Avenue.

Looks nice, doesn't it? Almost suburban.

Trillian and I first set out to the bike store on 53rd street by the lake that was closed yesterday. This wasn't much use though, the owner declared he currently had no used bikes for me and new ones started at $300. Too steep a price for two and a half months of transportation. The dealer said he did have a "ladies' bike" that he however hadn't yet gotten a chance to take a look at. He even told us that this was a bike that had been abandoned by its owner, the lock had been broken by the police and that's how he acquired this piece of metal. He said he'd probably be pricing the street find at around $100. Go figure.

We then walked to a currency exchange that formerly was on 55th, now 53rd, that sold CTA multi day passes according to information on the internet. I asked for a 5-day visitor pass (priced at $18) assuming that the place shouldn't sell normal multi day passes (these were sold in fewer selected locations according to the net). It seemed the lady behind the counter didn't have any visitor passes, so she came back with two transit cards in hand claiming that'd "be the same thing". Which was a lie. Transit cards don't give you unlimited rides like the multi-day pass - they're basically a Streifenkarte instead of a Wochenkarte. When we refused that "bargain", she suddenly had multi day passes for one or seven days. So we suddenly got 7 days of unlimited rides for $20. Good enough to take the now familiar #6 Jackson Express bus downtown.

Naturally, I had forgotten the Chicago guide as well as that ridiculously overpriced tourist map at home. The latter wasn't that big a loss - bus lines weren't on it anyway and there were better ones for free waiting in any subway station. But before we got the subway map we jumped off the bus at Van Buren Street Station and just aimlessly walked north down Michigan Avenue.

Before long, we found a piece of Bavaria it seemed.

Under closer scrutiny, the place was actually called the Art Institute of Chicago. I wonder what they do there .. :)

All that thinking made me hungry, what else. People came out of this place

with promisingly-looking bags. Feeling curious as well as adventurous, I set out to solve the mystery of the bags and asked the nice people across the counter for what they call a "burger". About what felt like 15 minutes later my order was up (whatever happened to the "fast" in fast food these days?) and it was an OK burger, nothing special really though. I would have expected more from my first Chicago burger. What a letdown.

Trillian chose Subway, less adventurous, but at least you have a better idea of what you'll be getting.

After some more aimless strolling through the streets, we stumbled upon a full-fledged brass orchestra
in the Richard J. Daley Center that played beautifully.

After listening to them for quite a while, we turned east
and thereby headed for Lake Michigan.

After sitting at the edge of the pier for a while and relaxing in the blatantly gorgeous early afternoon sun with a fresh breeze at a perfectly comfortable temperature even though neither of us had brought a jacket.

We then turned back towards the city.

Next stop was going to be
Macy's.
When Trillian got impossible to restrain vis à vis a seemingly endless collection of clothing, shoes and wedding apparel (yikes!) I had to forcibly remove her from the premises.

Next stop:

The most beautiful store on the entire earth.

I've made a list of what I have bought yesterday and today in terms of "necessary equipment" for the formerly very empty apartment I live in. Here it is.


$ 1.99 4 big plastic glasses
$ 1.32 Dish soap
$ 5.99 Phone
$ 1.99 4 plastic cereal bowls
$ 1.99 4 plastic plates
$ 0.99 Plastic pan turner
$ 2.89 Scrub sponges
$ 1.49 Large plastic salad bowl
$ 3.19 Trash bags
$ 4.99 Flatware set (4 forks, 4 knives, 4 spoons)
$ 4.99 Pillow
$ 7.99 Pan
$ 9.99 Pot
$ 4.99 25' phone line
$ 4.74 3 "bath" towels
$19.99 Bed sheet set (1 pillow case, 1 fitted sheet, 1 flat sheet)
$27.96 2 fleece blankets
$ 0.99 Can opener
$ 1.29 13 Hangers
$ 6.99 Steam iron
$14.99 Iron board
$ 9.99 Toaster
$ 5.59 Toilet paper

That's under $150 total. Given that this has made the formerly uninhabitable apartment a place to live I find the price not so bad and in terms of bang for your buck I'll be curious to see a store that can just offer bedding for two, dishes and tableware for that price, let alone all the stuff listed above.

Before the second shopping spree, first one together, we (or rather I) needed some energy.

After some more power shopping, we left the store with loads of bounty.

The trip back home was rather uneventful despite the countless bags we traveled with, but the scenery was very nice.

Getting settled in

2007-03-21T22:45:00.000-05:00

We did leave this morning at around quarter past seven and luckily for me, BT had to make a quick stop at the hospital - THE hospital - before going to work. So she took my luggage and me along for the ride. Since the student housing office wasn't open yet anyway I followed her on the stop to my future workplace. It will come as no surprise to anyone who has remotely made my acquaintance that I immediately found my future center of the universe.

What I saw during the rest of the time I had this morning looked very nice, colorful yet elegant and the place had a nice atmosphere to it. I think it'll be fun working there.

Afterwards, BT kindly dropped me off at the student housing office, which conveniently was right across the street from my future home. I was cordially received there even though it was only 8:30 in the morning. Usually, I'd not be awake enough for this kind of joviality. Anyway, the manager handed me the key and asked me to take a look at the place before we'd sign anything at all. That was fine by me so I crossed the street, fumbled around with those half a dozen keys on the chain and finally found my way into the second floor, where my apartment number 206 was. I was greeted in the hall by a nice Croatian guy who said he was going to re-tile my bathroom and followed me into the apartment. The place looked very old but somewhat-maintained and as big as could be expected for the hefty price of around 750 quid per month.

Now here came problem number one - this "studio" had a futon without beddings, a kitchen devoid of anything in cupboards or drawers - let alone little things like hangers in the wardrobe or towels in the bathroom. So I was going to have to buy bedsheets, a blanket and at least one pillow as well as dishes and silverware. Luckily, I had been suspicious enough to bring at least two towels with me from home.

So I went back into the office and signed a heap of papers. I was too preoccupied asking myself how to transport all the stuff I'd need to my new place to actually read all the stuff I signed. I know, same old mistakes that led to huge financial losses in New York. But if I actually read all the pages-long ramblings about "lead paint" and "pest control" in there I'd still be standing in that office now. So after I signed the nice lady across the counter led me in on the fact that I had no phone service over there .. yet. She was somewhat sure that there'd be a phone jack in the wall so they kindly let me use one of their office phones to call AT&T. After about 15 minutes on hold and another 30 minutes chatting with another nice lady we agreed that I'd get the cheapest regular phone service they had, thirty-some bucks setup fee, then twelve-something a month, 3 cents per call. So far so good. Then she wanted a $85 deposit. And no, we could not do this over the phone via credit card. I would have to go to a certified dealer. Or something. Give them my money and receive a confirmation number. That'd be the currency exchange parlor on 53rd street. Whatever.

After that, the nice people at the office also let me use their internet to sign up for some of my own. When stowetel rejected my credit card numerous times I sent SMS to Germany and Detroit in vain (thanks guys, nice to be able to rely on you ;P ). When stowetel then rejected another credit card though, I was fed up and googled for another provider. They agreed with my card. So now I'd have the internet account, I'd just need to get phone service.

Now was the time then to get my stuff into the new place. Of course I didn't recognize the phone jack as such and had to have the Croatian guy call the janitor over to show it to me. But he did so nicely.

I then went out into the general direction of the closest shopping center. The first thing I found was a tiny computer store that actually seemed to have at least several years old equipment. No flatscreens, just regular old electron shooters. I bought a 6-foot phone cable there for a buck. I would need a cable like that to connect the notebook to the phone jack but I later found that this was way too short to be convenient.

Anyway, time for lunch and a belated breakfast.That was extremely yummy, have to go there again.

Next stop was a US cellular store but I was out quickly after finding out that they don't deal in SIM cards.

After having already walked several kilometers just to get to the shopping center the next stop would have to be the bike shop on 53rd. That was about a mile away again and of course it was open every day except Wednesday. I strolled back on 53rd and walked into a store with the familiar colors of T-mobile. A good talk and about 20 minutes later I had a US cell number and was charged with 150 minutes. So far so good. I decided to do the AT&T thing after all, despite the fact that I found five wireless hotspots with decent to excellent signal strength at my place. They had of course all been encrypted and I would have had to find the people actually owning the routers to ask them whether we could share access. That'd be so complicated.

So I went to the currency exchange thingy and had another talk with a lady behind the bullet-proof glass. She did seem to know what I meant when I talked about the deposit for AT&T. I then used the pay phone in that same establishment for another conversation with the computer voice of AT&T .. I started chuckling at the "mmmmkay" he kept saying whenever he finally understood my zip code or reason for calling. When there was a human girl again she at first insisted that I had to "fill out an application" first, using the order number the other girl had given me before she could be convinced though that plugging in my phone cable was actually possible now. After about another 15 minutes of painful setup, she said it'd be done by midnight.

Oh well. Since I was almost home, I stopped by there again before setting out to finally get bedding, kitchen tools and groceries. The handiman was still happily laying down tiles and I gave CS a quick call to let her know my new cell phone number. Then I was off to that same shopping center again, this time carrying my now empty sports bag and after a quick pit-stop at T-mobile to ask what text messages on that prepaid thing would cost I went straight to the hardware store.

Boy, was that overpriced. After I had three things off my list in the cart I was convinced buying everything here would cause me to have to cut the trip short. So I put the stuff back on the shelves.

I had learned in the office that there was a Target store downtown - there was no doubt in my mind anymore that I'd need to go there.

So I went up to the Metra station and found that - of course - the last one had left about 15 minutes prior so the next one could be expected in 45 minutes. So I went on a couple blocks further to find a number 6 bus station. This express bus took about 20 minutes up to the Target store's street and I only had to walk about six more blocks

to reach the discount store of my dreams. They have shopping cart escalators for crying out loud ..

Anyway I found everything I'd need to survive the first night and morning at my place. Tomorrow I'll try and get one of those multi-day CTA passes and I'll probably take another swing at that marvelous, huge store full of very reasonably-priced goodies.

I carried all my prized new acquisitions home, always a few steps ahead of the incoming thunderstorm
and taking one picture to make phèdre jealous, then arranged them neatly for you to see. So please look at the picture and be aware that I now have dibs on the patent for what I plan to call the Chicago Survival Pack (tm).

When I plugged my brand-new $5.99-phone into the wall I was only mildly surprised to find a dial tone on it - long before midnight. Next step of course was to plug in the laptop and try out that brand new dialup internet access I had bought in the morning. Boy is this stuff sluggish. Especially bringing you these pictures even after having scaled them down to below 100kb is a major pain that I hope you guys appreciate. All those offers by AT&T to upgrade me to broadband right away don't sound so unnecessary anymore ..

Just minutes after plugging in the laptop and actually going online this strange sound resembling a ship's horn that was later identified as a doorbell announced the arrival of Trillian, which for reasons I am too tired to get into now I didn't expect at all.

I have now been blogging for over three hours and I'm sure if you're actually still reading this you'll be glad if I call it a night for now. Still have to upload 20 pictures to this post which will take me at least another 30 minutes. DSL is just $14.99 a month .. hrmmmmph ..

How sweet it is!

2007-03-20T23:37:00.000-05:00

I know, that's Brooklyn. Still, it was the first phrase that came to mind and the only phrase that kept resounding in my head. This is about the eigth time I have arrived in the States over from Europe and I didn't think it would still be this kind of a buzz. The marvelously green road signs alone gave me a warm, fuzzy feeling even though I used to be rather certain that I didn't want to live in the US anymore.

After the rather relaxing flight, INS was a little scary for me since I was re-using my visa from New York. But as hoped the incredibly slowly-moving person just wanted me to tell him a little bit about the program and show him the letter from the U of C until he was satisfied and gave me the "admitted"-stamp. So, you can re-use a visa that says "first entry medical clerkship".

As had to be expected, my luggage was just about the last one to arrive on the belt, customs were quick though. And there I was in the States .. suddenly without much of a plan. After a moment of hesitation, I took one of the $100 bills out of my pocket and traded it for a $10 calling card and some change. I set the time difference in my watch wrong, so I initially thought I still had time to get the key for my dorm room. I then learned that Chicago is already on summer time, while Munich wasn't yet. So we had only 6 hours of time difference and it was five already. No dorm room for me yet.

That meant that CS, our sponsor for this scholarship, was actually going to have to make good on her offer to give me a bed for the night. It wasn't all that easy to reach her - neither shuttle bus nor airport express would drive me all the way to her, I was too cheap for a cab after just having spent a fortune on an extremely touristy street map of Chicago so I got a chance to try out CTA. And it was a good choice. Except for the fact that I didn't know you could buy higher-valued cards then only using parts of them. I had only one 1$-bill left. In the vast subterranean walkway leading up to the rails
I would have needed $2 for a ticket into town. And the polite but not-so-useful service personnel just informed me that if I followed that vast walkway further and took the first left turn, there'd be a store to break a 20. So I regretted again that I had packed like a girl with my huge suitcase, sportsbag full of stuff plus carry-on and went to that store. Of course they wouldn't just break that 20. "Only with a purchase". Oh no, my friend, I did not walk all this way to get ripped off again now. So I went even further .. reached the Hilton hotel
and the nice reception guy in the lobby gave me some change. All the way back in the train station I could now enter the waiting blue line that'd bring me into town.

One stop due to "technical problems", as the overhead speakers in the unmanned train announced in a voice you'd expect from a tv commercial trying to sell you something, and me (of course) walking into the wrong direction firstly due to a minor but in this case decisive inaccuracy of my tourist map later I was at CS's place, where I got not only a shower but also a full-fledged home-cooked meal with loads of water (again) and a beer.

This is great.

Tomorrow we'll apparently have to leave here at 7:15 and the two girls (CS and her friend BT) expect me to "be awake anyway". We'll see, girls. They obviously haven't become acquainted with my easily-derailed circadian rhythm yet.

Heheh.

Sky-high blogging

2007-03-20T10:32:00.000-05:00

Hello dear reader. Just a few hours into the trip and I already have things of interest to tell you.

I didn't feel I was exceptionally late for a 12:10pm flight standing in line at check in around 9:45. Yet, when it was my turn at 10:15, the lady at the counter regretfully informed me that she cannot assign me a seat on the plane. When she saw my wide shocked eyes she elaborated that she only had "pre-reserved seats" left so I should report to the gate and wait for my name to be called. That didn't help me much. When she placed these frightening tags onto my checked luggage, I was terrified. After confirming with her three times that they would take me with them on the plane in any case I went on through passport and security checks.

At the gate I was displeased to find that there were apparently no restrooms or any food or beverages to be found on this side of the last security check. Little did I know that this wouldn't matter later. I started counting the number of screaming infants in the waiting area around me and came to a fair five - that wasn't too bad. And things were even looking up when several of them were dragged by their progenitors to another flight to Washington departing earlier.

So I started reading the articles I had printed out so I could finish writing the overdue progress notes on two patients I still had with me.

About fourty-five minutes later they started boarding and I waited patiently for them to call out my name - which indeed, they did. Now this time around I wasn't unprepared when it came to seating. I had read all about those nasty A and G window seats on Boeing 767-300s that had boxes beneath the seat in front of you limiting your leg space on seatguru.com. But the only thing worse would be a D seat - that's one of the three seats between the aisles - more specifically, the middle seat. No way to stretch out your legs to either side - and if those seats next to you would be occupied by a mom with her baby on one side and an obnoxious man on the other side like in Trillian's case I'd be in for a rough ride.

Na-ah, that wasn't going to happen to me. I found that I had been at the check in early enough. I even tried to check in online the day before - which I couldn't, due to my lack of confirmation or etix number. Expedia informed me I'd get that at check-in today. No fair. I wanted a good seat!

So when I went to the gate today after they had called out my name, the lady handed me a boarding pass out of the small pile in front of her. It read 8D. I sighed and turned to the other woman processing boarding passes counting my blessings that they actually stuck me with the loser card .. a D spot.

Then I took another look at the pass .. it was a funny color. Golden .. not blue like the others. Then it hit me .. it said "United business". They didn't. Did they? Row 8 was an awfully low number. They must have.

They bumped me into business class.

With a broad smile on my face I could hardly conceal I found that 8D was actually much more comfortable than I had imagined when I saw the ominous "D". Even while I was still coming in and looking for a place to "stow" my carry-on stuff a flight attendant carried around a tablet asking whether we wanted champagne or orange juice. Another one offered to "hang my coat" while I was still fiddling around with my stuff trying to choose whether to put it on the ample room on the floor or in the overhead bin. So much space. So hard to choose.

This was going to be awesome.

Just minutes later I was handed the in-flight menu. The .. menu. Now, smoked thyme chicken and smoked salmon with couscous salad, pine nuts with lime crème fraîche, fresh seasonal greenes with caesar dressing, pan-seared oh-so-tender South American filet mignon with smoked bacon demi-glace (mmmh), pommery mashed potatoes and an asparagus, carrot and red pepper sauté laterI am sitting/lying here in an almost horizontal position, the seat periodically pumping up a balloon in my lower back and the glass of water next to me hardly ever going low before someone refills it without even asking. One of the in-flight-entertainment channels is running on my own little screen - if I don't like it, I can just switch channels. I did pass on desert since I haven't totally forgotten my poor lower-class economy roots. Had a sandwich and toblerone later instead. Heheh.

But I did get those progress notes almost done, so I'm reasonably proud of myself.

Not sure whether they'll be able to pry me off my seat after we've landed in Chicago.

Now I'm almost hoping for that immigrations officer to deny me entry to the States - I'll just stay in my seat then.

I hope Lufthansa will be equally interested to have me as a future customer on the flight back, it'd be very frustrating to go back to coach after this.

Student housing

2007-03-13T17:04:00.000-05:00

I've never lived in a dorm before. Somehow I doubt that I'm dorm material. The only time that I have lived in an apartment with other people was in New York .. and loyal blog readers will know what a catastrophe that was. At least this time I get my own lockable door it seems.

On the other hand, I guess campus dorm/frat parties every (or maybe every other) night can be something I would get used to easily.

We'll see.

Round two

2007-03-11T05:59:00.001-05:00

Hello again, dear reader.

In keeping with the glorious tradition of NewYorkBlog, come to expect pictures and text stories of the two-month elective in Internal Medicine of yours truly at the Chicago University Hospital.

On the farewell party two nights ago, I was presented with a t-shirt that skriehma and I had come up with the design for in New York. It is pitch black and reads in marvelously white letters "Don't shoot me just because I'm white ..." on the front, followed by "... find a better reason." on the back. Contrary to Trillian's pleas I'm planning to bring this marvel to Chicago. I'll decide there whether or not to wear it - should there be a sudden stop in my reporting here you can assume that I have.

All the best,
Iccy