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:
Diagnosis: Atrial fibrillation, absolute arrhythmia, left anterior fasciculus block, type of complete left bundle branch block.
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:
- Antibiotics and their side effects
- Gram + bacteria
- Define colony forming unit.
- Growth curve of bacteria with phases and description
- Definition of disinfection.
- Definition of antiseptic.
- Antibiotic spectrum
- Definition of antibody, chemotherapeutic, chemotherapeutic index.
- 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.
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….