A look back at the past week

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.