It’s going to be a great week

October 26, 2014 § 2 Comments

Sunday night and I am giving up. It’s the end of a long weekend (four days total) and I have done nothing but study – and it has made me quite the bitter little student! I left the apartment once and that was only a 20 minute trip to return my stylus – for the third time. Yes, I use it so much that I have already gone through three. This model is battery operated and works amazingly for the first few days. The battery life is terrible (go through a AAA once per day, so we had to invest in rechargeable ones) and after a week or so, the entire stylus simply shorts out. They obviously didn’t have medical students in mind when designing it… I ended up getting a different one this round and am really hoping it lasts. Going back a fourth time will make me look like a lunatic.

So, why the four days locked inside studying? Immuno midterm on Wednesday and pathophysiology midterm on Friday. The best part? The immuno midterm is worth 40% of our grade (something I didn’t know about until last week). The weight of that didn’t really sink in until yesterday morning and when it did, my happy little study bubble popped. This feels like exam period all over again!

At one particularly low moment, Skjalg came in to the bedroom (where I’ve holed up these past four days). His little speech inspired the title of this post. He told me that this can be a great week if I want it to be. It can be a week where I face challenges head-0n and grow stronger, no matter the outcome. It can be a week of treating my body well, eating healthy and going to the gym. It can be a week of balance, a week of learning, a week of strength. My response at the time wasn’t so receptive. I told him that every comment he made elicited the same response in my head, “40%”. 40%. 40%. 40%. It’s not always such a nice place in there…

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By 19:00, I was so wound up that I decided to stop and steal the night for myself. I took care of some bank things (someone in Indonesia apparently has a copy of my credit card, luckily the bank stopped the transaction of 3 million IDR and notified me right away), answered some emails and am now sitting in the massage chair writing this blog. Hopefully a little time to myself, a good night’s sleep and a trip to the gym in the morning will set me straight for the week ahead.

In other exciting news, there was a large demonstration that passed our apartment today. It was the largest we’ve seen since we lived here and concerned a very big topic: Hungary might be the first country to tax internet usage. Read more: http://www.thedaily.hu/hungary-plans-to-impose-internet-tax/ and http://www.cnbc.com/id/102111147#.

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A week in pictures

October 26, 2014 § 4 Comments

To accompany a *slightly* negative post I’ve written today (pre-exam jitters), here is one with photos from this past week. Didn’t feel right to mix the two in one post 😉

On Saturday, October 18th, Skjalg and I had our 5th anniversary. It was a Friday schedule for school, so we started the day with classes (unfortunately). After that it was an afternoon of EKG studying and then our official date started at 19:30. We enjoyed an evening-in with way too much sushi, some champagne and a good movie (The Good Year). It was nice to escape for an evening and enjoy each other’s company.
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On Sunday Amir came over to study. He brought presents with him – of course! He once gave me a present for giving him a present. Let that sink in. Our present this round was a taste of home and a taste of home away. He brought with him some homemade bread made by his grandmother, olive oil made by his family and a special herb mix to make a dish of which I have forgotten the name (even though I asked him 20 times). That was the taste of home (he is Palestinian-Israeli). As for the taste of home away, he brought two bags packed with Hungarian pogácsa from a local bakery. There is a bakery in his building that has a bag with his favorite breakfast – mákos rétes – ready for him every morning after he’s finished at the gym. This specific bakery was closed that day (it being Sunday) but he had picked up the treats at a place that played a close second.

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Amir preparing his special dish from home. The olive oil is mixed with thyme and sesame seeds and spread over homemade spiced bread. Then it is placed in the oven and, as Amir said, “it’s ready when you smell it.”. He told us that this is the perfect time of year to eat this dish and that it is normally enjoyed with the family while sitting outside under the trees. It was really, really yummy – and made even more so by the special feeling that came with it.

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During a little study break, we started discussing languages. I’m in awe of just how complicated Hebrew and Arabic are! He wrote our names in both languages, showing us how the word changed with a placement of a simple dot or comma. For Arabic, the spoken and written languages are different – I can’t even imagine what that’s like!

2014-10-19 15.31.202014-10-19 15.32.44  On Tuesday I made my way to the gorgeous Parliament library. I had to leave earlier in the afternoon than I had planned because I wasn’t feeling well. Luckily, the clouds had cleared (mostly) and the walk home was warm and beautiful.2014-10-21 15.06.23  2014-10-21 15.08.052014-10-21 15.09.31Wednesday night was a really special night – a surprise birthday party for our friend Mads! For the celebration, we planned for some cocktails at our place and then dinner at Pomodoro (which was amazing – I’d never heard of it before!). Skjalg was really inspired after our last cocktail night and it showed! The drinks he made were fantastic and so special.After physio TA class that day, I stopped at the gas station at Kalvin for 8 bags of ice – yes, 8! – which I had to carry with me home. By the time I got through the front door, I was exhausted. The sight that awaited me didn’t help – there was coconut EVERYWHERE. Skjalg’s first drink, pina colada, was to be served in real coconut shells. In the three hours before I’d gotten home, Skjalg had been hacking away at coconuts and gotten only three or four done. I spent at least 45 minutes vacuuming just the living room. There was coconut in the couch, in the carpet, on the window sills. Some had even made it’s way across the room into our bedroom! It all came together in the end though – and the night ended up being absolutely perfect!

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Skjalg created the perfect cocktail playlist and had Casablanca playing (without sound) in the background.

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Microbiology Midterm 1 and Internal Medicine “Fun”

October 16, 2014 § Leave a comment

It’s been a long day, run on only four and a half hours of sleep and I’ve reached a point where I am completely useless. So, bed it is! Tomorrow morning we have our first Hungarian midterm, which will cover titles of different doctors, diseases, symptoms and treatment. After that, we have our weekly pathophysiology lecture, which is followed by a two and a half hour practical with my favorite: EKG interpretation. Not my favorite. Definitely not my favorite. It might be, if I had time to go through it all, but I haven’t had time, so it’s not my favorite. Our midterm is in two weeks, so I better start to like it soon!

Here’s a taste:

EKG102

Diagnosis: Atrial fibrillation, absolute arrhythmia, left anterior fasciculus block, type of complete left bundle branch block.

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Our midterm in microbiology this morning went a lot better than I’d expected. I didn’t get as stressed about it as I have normally been before exams and it made me feel like I am maturing as a student (maybe). It was a lot easier than I’d thought it would be (much more clear and to the point) and I quickly realized that I had gone into way too much detail while studying, which is nothing new. I still struggle with knowing when too much is too much. I thought I’d done better this time around, but clearly I still have some work to do. For the exam I had today, I had maybe 30 hours of studying that didn’t apply. No time spent studying is time in vain…?

The microbiology midterm included 10 questions, each worth 1 point. We need a minimum of 7 to pass and can retake it as many times as we need. From what I can recall, my questions were:

  1. Antibiotics and their side effects
  2. Gram + bacteria
  3. Define colony forming unit.
  4. Growth curve of bacteria with phases and description
  5. Definition of disinfection.
  6. Definition of antiseptic.
  7. Antibiotic spectrum
  8. Definition of antibody, chemotherapeutic, chemotherapeutic index.
  9. Agglutination
  10. Role of Serology

Our teacher for the class is quite humorous. It is not always clear when he is joking (difficult to even gauge his mood in general) and sometimes he smiles during strange topics, like fecal bacteria colonizing the vagina. But for what could be a very dry subject, he keeps things very entertaining. While some students were still working on their exams, he received a phone call. When he was finished, he said, “I knew it.”. Soon followed a story that made me wonder what it would be like to have a microbiologist as a parent. He said that a few days ago, his younger son was suffering from vomiting and diarrhea. He then shared that after his younger son vomited, he turned to his older son (who was nearby) and said, “You’ll be sick in two days.”. And right on schedule, two days later during our midterm, was the phone call from his older son’s school saying that he was being sent home sick. Our teacher told us that he suspected that it was calcivirus (if I heard correctly). Apparently it is spread via air transmission and that air in an enclosed space is contaminated for at least 30 minutes after the virus goes airborne. I wish I could hear some of the stories his sons have to tell! In the beginning of the semester, he told us that in order to get them to brush their teeth, he had them grow bacterial cultures from their saliva and look at all the bacteria under the microscope.

Hi! I'm Streptococcus Mutans and I would like to talk to you about tooth decay.

Hi! I’m Streptococcus Mutans and I would like to talk to you about tooth decay.

After micro Skjalg and I studied for a little while at a café before I headed off to pathology and Skjalg headed home to cram for his Hungarian midterm (which took place this afternoon). We met up again on the Buda side for internal medicine practice. It’s an interesting class – and the only clinical one we have – but it is a little stressful. We never, ever know what kind of session is awaiting us. Some are nice and smooth, others extremely awkward. The awkward ones are when we are split off into groups of 2 to examine patients and then left alone with them and expected to gather a full history (in Hungarian) and do physical exam (in Hungarian). Our Hungarian is quite limited and it can be hard to communicate with the patients when we pronounce a word wrong or use even just slightly different grammar.

I doubt there is much enjoyment on their side…they are in a hospital after all and we are just one group of hundreds of students that come through the wards every week. Most of the time the patients have been patient (hehe), but today Skjalg and Vera had a different experience. Sometimes the doctor leaves us alone with a patient for up to 45 minutes and during that time, we do our best to show the patient respect while getting the practice we should be getting. This is honestly the only time where I have ever even considered the downside of studying in a foreign country. Everything we want to do or say is different because of our lack of language skills. We do our best, we really do, but medical terms are a language in their own and needing to learn them in two languages simultaneously is not an easy task!

After 30 minutes or so of Cindy (Hsinti from Taiwan) and I speaking with our patient, Skjalg and Vera entered the room. They explained that they couldn’t be alone with their patient anymore and had to leave the room. They both looked a little shell-shocked and said that it was the worst experience they had had yet, that communication with the patient had been close to impossible and that the patient had just constantly said, “No”.

The doctor was busy with the third group at the time, but soon approached Cindy and I and told us to perform a physical examination (we had already taken our patient’s history on our own and then a second time in front of the doctor, which always ends up as an intense Hungarian lesson). Cindy started by taking his/her blood pressure as I stood at the end of the bed. The patient in the bed next to our patient had been laying there quietly, but suddenly sat up and began to speak to me. She asked me if Cindy was from China or Korea and when I told her Taiwan, she lit up. She then began a 5-10 minute story about how when she was younger, she had lived in Taiwan for four years while working as a German language professor. She has also lived and worked in Finland and England. It made me happy that I was able to listen to (and understand!) her story, even if I did miss a few details.

At this point, Skjalg and Vera had been instructed to return to their patient (which they did not look very forward to). We were left to continue our physical examination, but after listening to our patient’s heart sounds, the patient quickly pulled up his/her clothing and blanket to cover up. We didn’t feel comfortable pushing the patient any further, so we thanked our patient, said our goodbyes, and left to join the others. Skjalg and Vera were out in the hall, along with the doctor and the rest of the group. Their patient was on his/her way back from the shared bathroom and the doctor was asking if they could continue their examination. The patient responded, “I don’t really want to, but it is fine as long as you stop hitting me!”. We followed the patient back into his/her room and began the normal routine (at the end of the lesson, we usually gather around a patient and the group who had the patient presents the history, details, findings and the doctor asks further questions).

The 20 minutes that followed was one for the books. We are usually made to ask the patient the same questions a second time in front of the doctor. Normally the patients don’t mind because they understand that it is a learning experience for us. In this instance, for every question that was repeated, the patient replied along the lines of, “I already told you! You didn’t understand what I was saying? I said this already. Are they saying I didn’t say this? That’s what I said! That’s what I said!”. Then, when Vera or Skjalg were instructed to ask further details about the patient, he/she acted as if the question was unclear or said incorrectly. The doctor kept it a little light-hearted, despite the pure discomfort, and would laugh and tell him/her that it had been asked in perfect Hungarian and that he/she should be able to understand it. (He is very good at being a dominant authority figure and remaining engaging at the same time. He is a big, tall man and one of his techniques is sitting on one of the beds while talking to the patients so that he is at eye-level with them.) In addition to the patient’s frustration at being asked the same questions again, the patient complained about being “hit” by Vera and Skjalg. The “hitting” was just the tapping motion of the percussion technique. The patient was severely obese and they had suspected ascites (see my previous post) and therefore wanted to percuss the abdominal region. Long story short, the patient didn’t have ascites…

Though awkward, it did make for a more entertaining practical session, though I don’t think I’d feel that way had it been my patient….

Our First Heart Murmur, Ascites and Micro Midterm

October 14, 2014 § Leave a comment

Our first microbiology midterm approaches and I can’t wait for it to be over. There are two microbiology midterms this semester and this one is the “easy one”, since it covers basic lab topics and facts we have learned. For the next one, we will be tested on systemic bacteriology, which includes names of bacteria, their morphology (form, structure) and diagnosis and treatment of diseases associated with infections by those bacteria.

I’ve been a bad student these past two days and skipped lectures in order to get some time to study. I really didn’t get into a good study groove until Sunday night and I need more time than what is allowed in my hectic schedule. Yesterday, Skjalg and I left school after our pathology practical (which ended at 13:00) and headed straight to the library. We missed our weekly immunology lecture and our elective, Social Media in Medicine (which ended up being cancelled, lucky us!). Then today, we skipped the microbiology lecture in order to create a 3-hour study gap between our internal medicine practical and our next classes (Hungarian for me and pathophysiology for Skjalg). I really don’t like skipping lectures – it’s the only way I keep track of where I should be – but right now this midterm is the main priority.

In internal medicine practice today we got to listen to our first heart murmur and learn how to investigate ascites. We had just had our lecture on heart murmurs this morning and were very lucky to get to listen to one immediately after, especially since heart murmurs are quite rare (according to the doctor we follow around). The patient with the heart murmur actually had an artificial murmur. He/she had had an aortic valve replacement some years before and the murmur was being generated by that mechanical replacement valve. When we listen to the heart sounds, there are are supposed to be two that we can hear (there are two more, but those are really only in children or pathological situations). These sounds are normally a sort of tapping sound and when there is a murmur, there is a sort of whooshing sound between the two tapping sounds.

The patient with ascites was very friendly and informative (which we were able to gather after translation by a Hungarian-speaking student in our group). He/she had had a double leg amputation due to issues related to diabetes and it was a bit hard to watch the patient struggle to turn around in the bed during our physical examination (he/she had to use a rope tied at the end of the bed to first sit up and then lie down on the instructed side). The appearance of the patient’s abdomen was almost identical to image on the wikipedia page I linked to above. We learned how to tap around the abdominal area, first starting at the umbilicus (belly button) and then radiating outward, and noting the change in the sounds created by our tapping. The patient had to turn to different sides so that we could observe the change in sound as the fluid moved.

The tapping method we use to determine the location of the fluid/size of organs, etc. Termed percussion in clinical practice.

The tapping method we use to determine the location of the fluid/size of organs, etc. Termed percussion in clinical practice.

When the patient was lying on his/her back, we also investigated the wave-like movement of the fluid by placing one hand on one side of the abdomen and then pushing gently with the other hand on the other side. It really felt like a wave moving inside of the patient!

Now I am home and ready to study! Need to get at least 3 hours of good work in for me to feel like I’ve been good today. After that? Bed, up at 6, gym and then library. I’ve already received permission to miss tomorrow’s physiology TA class and will be skipping tomorrow morning’s patho lecture and immuno practical *bad Buda-B!*. I’m going to have a lot to make up for with these missed classes – hopefully it will be worth it!

Here are some shots from yesterday! Gotta enjoy Fall while it lasts!

Sunny Sunday

October 12, 2014 § Leave a comment

Today marks a week of getting up at 6 a.m. every day – even on the weekend – and going to bed before 22:00. The original plan was to stop studying by 22:00, but we started heading to bed by 21:00 and then spending that time reading. Feels a little “dorky” (for lack of a better word) to go to bed so early, but honestly, it’s amazing. After such long days, it’s not like I am really able to get a lot out of those few hours in the middle of the night. I can push myself, yes, but I don’t think I’m really as effective as I think I am.

Yesterday morning was tough. Normally I let myself sleep as long as possible on Saturdays. With such a heavy schedule during the week, that has meant sleeping until 9:00 or even 10:00. By 11:00 yesterday, however, I had already been up for 5 hours. I’d had an easy start with some coffee and an episode of Modern Family, done a load of laundry, studied EKG interpretation for 2.5 hours and crammed in a back and bis workout at the gym. All that in the time that I would have usually just had a cup of coffee. Waking up early also means going to bed early – and sometimes really early. Last night, I was in bed at 20:30 and asleep by 21:00! Skjalg went to grab a glass of wine at Di Vino with Suvi and Mads. I had originally planned on joining, but was completely exhausted by 20:00 – so bed it was!

After yesterday’s workout and an hour of relaxing at home, we met up with Suvi and Synnøve to study at the Parliament library. I’ve never been there before, but have always wanted to try it. Some of the libraries here make you feel like you are at Hogwarts – and this is one of them! Getting in was an experience of it’s own. We had to present our passports to a guard, who radioed in our details to check that we were allowed access. He gave us instructions on how to reach the library and we began our little quest through the outdoor corridors. At the front door to the library, another guard was leaning against the large wooden door frame. The Budapest marathon was going on and part of the race was passing parallel to us on the street level. When I looked back to the library entrance, the guard was gone. Once inside, we had to do a run-of-the-mill airport security check-in, without the shoe removal part. We were then given special electronic passes and directed through yet another set of large wooden doors to the reception desk. Since we are only using the library to study, we are allowed to use it for free. The interior is absolutely stunning!

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This week we have our first microbiology midterm on Thursday and Hungarian midterm on Friday. We have two Fridays this week. Yes, two Fridays. We have Thursday and Friday off the following week due to a holiday and in Hungary, they turn a Saturday into a Friday when this happens to make up for the lost time…

Ok, now it’s time to study! Been wasting away too much of the morning on protein pancakes, Godfather III and blogging.

Suvi also has a blog! Check it out: Borta bra men hemma Budapest. For those who can read Finnish or trust goggle translate 😉

 

Work hard, play… some

October 5, 2014 § Leave a comment

It’s a partly sunny Sunday morning – a perfect day for studying microbiology and immunology! I’m trying to convince myself… Midterms start the week after next and I have been spending all of my time studying pathology and pathophysiology. The department we are in for patho (our year is split between two) does not have midterms and our pathophysiology midterm will take place in week 8.

As I’m writing this, the Balatonman Triatholon is going on outside. Our apartment location makes it so easy to feel like we’re a part of the city.

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This week went by way too fast, just like all the others. My week load is so heavy that the weekend is here before I even know it. I still haven’t figured out the best way to balance everything and I am really going to need to work on it if I want to avoid burning out. Skjalg suggested that I implement a “no studying after 22:00” rule, no matter what. I’m thinking about giving it a try because it might push me to be more efficient and will then leave me some time to sleep. My “will power” (hard to find the right word/phrase) is like a separate entity within me and it does not regard sleep as a priority in any way. This means that if there is something, anything, that needs to be done and it is time for bed, bed loses. So, here goes my first shot at a week of nothing past 22:00.

Though this week went by fast, there were a lot of things that made it stand out.  On Tuesday, Skjalg and I were left alone to interview and examine a patient in Internal Medicine. For this class, we have two lectures and two practicals a week. In the practicals, we are together with a doctor in groups of anywhere from 3-9 people. For every practical, we meet the doctor in his ward and he takes us to see some of his patients. From the stories I’ve heard, it seems like these practicals vary greatly depending on the doctor you have been assigned to. Some groups focused on theory for the first weeks and are just starting to see patients, others have not even had regular practicals, while others still, simply look on as the doctor speaks and examines the patients. Ours expects us to communicate with the patient in Hungarian and translate what we think they have said when they respond. In the first couple weeks, he would tell us what to say to the patient and then translate his/her response.

On Tuesday, we were split into 3 groups of 2-3 students, each of which was assigned to a patient. Skjalg and I were together and had to take the patient’s history and ask him questions about his urine, stool, appetite, weight gain/weight loss, allergies and medications. Then, we had to examine him. This included asking him to remove his shirt and sit-up/lie down depending on what we were examining. So far, we’ve learned how to take proper pulse and blood pressure measurements, palpation (using hands to examine body parts), percussion (analyzing sizes of organs based on the sounds produced by tapping with our fingers) and auscultation (listening with stethoscope) of the heart, lungs and bowels. After having been alone with the patient for almost 45 minutes, the doctor returned and asked us to give him details of the patient’s history, diagnosis and our findings from our physical examination of him. There is still so much more that we need to learn, but it is finally feeling like we are, ever slowly, becoming doctors. We even have to wear doctors coats and stethoscopes to our lessons!

In Thursday’s microbiology class, we got to see the culture of bacteria we had collected at the previous week’s class. I’d heard about the culture preparations from my friend Mads, who has the same lesson on the day before ours, so before leaving home that morning, I’d washed my hands and used antibacterial gel. On the way to class, I proceeded to touch everything I could: escalator handrail, metal bars and handles on the metro and door handles. For my second sample, I did a sample of my iPad and one from under my fingernails (our teacher told us it is especially gross under there – note to those of you who bite your nails!).

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On the right is before washing my hands (after touching everything on the metro) and on the left is after washing my hands with soap and water and using antibacterial gel.

After microbiology, we had autopsy practice in pathology. Our cases are usually in the age range of 70-90, but this one hit a lot closer to home: an 18 year-old female who had died from cancer only the day before. I can’t really describe the affect it had on me, other than to say that it gave be such an acute awareness of time, how fleeting life is and how lucky we are to be alive. That night, I thought a lot about the life I have lived these past 9 years and how every day should really be appreciated one at a time.

Last night we had cocktails and dinner with Skjalg’s former groupmates and their former anatomy professor. For the first two years, we are confined to a specific group and have all of our classes together with those people. Skjalg was a bartender for 7 years before starting medical school and wanted to have people over for drinks before heading to dinner at Iguana. It was a really, really great night and I hope that we get the chance to do it again soon. I take for granted how talented Skjalg is at making drinks!

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We finally hung up some of the drink series pieces I did a few years ago. There is one more somewhere in the apartment of a drink Skjalg invented that won a couple of contests – just need to find it!

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