Surgery Competition: CHECK!

March 30, 2015 § 6 Comments

This semester we are taking the class Basic Surgical Techniques. In this class, we have been learning how to do proper sutures and in the upcoming weeks we will focus on building our laparoscopy skills (link to slides detailing the practicals: here). They offer two competitions, one each for suturing and laparoscopy. Only one person from each of the 18 groups gets to go to the competitions, so we must first compete against each other in our practical group to get the spot. Had Skjalg and I known that before, we might have chosen different surgery groups, since it is not very fun to compete against each other for something we both really want.

We have had three suturing practicals so far and in each of them, we’ve ended the class with a little competition. I placed in the first two, so had a good chance of going to the competition, but it all depended on how I performed in the last group competition this past Thursday. As I mentioned at the end of yesterday’s blog post, everything went wrong. For this last class competition, our substitute wanted us to do a simple continuous suture (the version seen at the bottom of this photo). fig-3-simple-continuous-suture-500x400I had been pretty nervous all class and it didn’t improve when the competition started. Then it got even worse. My thread broke three times, resulting in anything I had done being useless. I felt like giving up and accepting defeat, but decided to just keep going and do the best I could.

Once everyone else had finished, they began going around and placing their votes for the best sutures. When the points were tallied, it was another girl in the group who qualified as the top candidate for the surgery competition. She seemed so surprised when it was announced and then began to state that she really didn’t want to go and that she wanted me to go instead. By then the majority of our group had left and our substitute had left another teacher in charge. I had been washing my hands and really trying to convince the other girl that she should go if she wanted to and when I was about to leave, the teacher told me to stay. She shared that, before the substitute had left, the substitute had told her that I had had the best sutures during the practice (before the competition, of course) and that made it seem like I was the next candidate in line if this true winner didn’t want to go.  The winner assured us that she really didn’t want to go and when I was sure that she wasn’t just being kind, I accepted the spot by default. Afterwards, I was excited, but also a little disappointed. That wasn’t the way that I wanted to get the spot for the competition, but I forced myself to bury my pride and be happy.

It had been an extremely long day – and it wasn’t over yet! On Thursdays I have classes from 8:00 until 18:30. And with the microbio midterm that morning, I hadn’t slept more than 40 minutes the night before. Still, with the competition already the next day, I had to suck it up and push through. Once I got home after psychology that night, I took a short nap and then sat down to practice sutures for a couple of hours before bed. By midnight, I couldn’t see straight anymore and decided to call it a night and head to bed. The next morning, I sat for about 5 hours, making sure to go through all the sutures we’d learned and work on improving my speed with the most basic: simple interrupted suture.simple_interrupted1339023431202I did 6 or so rounds of 5-6 sutures and timed how long it took to do them. Afterwards, I graded their quality. For perfectly spaced sutures, I got my time down to 63 seconds (just divided the total time to finish all of the sutures by the number of sutures completed).

Skjalg and I have been practicing together before the practicals. We pick up pig feet from the market and surgical equipment from the store at school. It is also possible to practice on oranges or bananas, but I prefer the pig feet.

While practicing the night before:

Grading my timed sutures. These were my “perfect”ones. They’ve taught us the 1 cm rule in class and want us to follow that, even if it does seem like the sutures are quite big. They should be 1 cm from the wound edge, 1 cm apart from each other and the knot thread should be 1 cm. I was pretty happy with these ones – especially because I’ve had to train myself to be able to visualize how much a cm is! There is just no easy way to compare it to inches…

I was so nervous during my practicing at home that I was shaking for most of the morning. What ended up calming me was listening to Yann Tiersen’s Comptine d’un autre été l’après midi on repeat for almost the entire 5 hours. Moving my hands with the music and visualizing the suture thread running through the tissue together with the faster parts made the process almost artistic. There is an animation for this composition that makes me cry every time I watch it, in case you want to tap into some deep emotions on your end 😉

On the way to the competition, I ran into our friend Mads. He and I skirted around the topic of the competition and then finally admitted that we were both so nervous, but didn’t want to admit it to ourselves because then we wouldn’t be able to perform. Mads dubbed us “Team Zen” (we’re also, jokingly, Team Burnt Popcorn and Team Little Spoon).

The 18 of us attending the competition changed into scrubs and entered the practice room. We have been practicing on pig feet during the practices, but awaiting us were slabs of raw pork loin with the skin still attached. On the skin, there were marking of an X, a V, and a horizontal line. We were handed sheets on which to write our names and the drawings on it looked like Chinese to me. I couldn’t understand anything of the drawings – accept that this was going to be nothing like what we had practiced. I tried to re-create what the sheet looked like here:

FullSizeRender FullSizeRender-3The competition was split into two rounds. For the first round, we were to cut the shapes into the skin, separate the skin from the subcutaneous tissue (not entirely, just enough to complete the sutures), and then make the sutures as shown in the drawing. Now, in our practices, we’ve only ever practiced on a straight, horizontal cut. The most intimidating for me was the round suture at the angles: the corner stitch! None of us had ever heard of it and I started shaking at the idea of having to figure out how to do a suture I’d never done before. I later found out from a Hungarian TA that they didn’t learn the stitch until 5th year – and even then there was only a lecture and never something they actually practiced.

We were given a little tutorial about what they expected us to do and told us we were to memorize the instructions because they wouldn’t be repeated once the competition started. I was most looking forward to the simple horizontal line – until I learned that it wasn’t a simple horizontal line. There, we were to do a technique known as a Z-plasty, which is done to correct improperly healed scars:

This is more or less what we were looking at. The markings for round two weren’t added until we had finished round one.

FullSizeRender-2After an overwhelming tutorial, we were told that the competition would start and that we would have 15 minutes to complete the tasks! Only 15 minutes!

By the time 15 minutes rolled around, no one had finished. There was one girl who was able to finish right before 16 minutes, but the rest of us finished around 20-25 minutes. We were to be graded on time and quality, with quality counting for more points. As there were 18 of us, we would get points in that order, i.e. 1st person=18 points, 2nd person=17 points and so on. It was so unbelievably stressful that I almost couldn’t contain myself. The only thing I could focus on was the task at hand and I kept shaking so much that the thread often came loose from the needle. It wasn’t motivating either when those around started announcing they were finished.

After the 26th minute or so, those who had been unable to complete the tasks were disqualified. We had a 10 minute break, during which we nervously chatted out in the hallway, while the teachers went through and graded the quality of our sutures. The grades were based on dimensions, tension, placement, knot quality, etc.

When we were called back into the room, I fell into the back and hesitantly looked at the excel spread sheet projected onto the screen. I’d come in 3rd with 42 points and I was shocked. It had all gone so quickly that I had not had time at all to assess the quality of my sutures. If that doesn’t give any indication of the importance of practice, then I don’t know what does! With the time pressure and stress, the quality aspect needs to be a given.

The top 9 of us continued on to the next round (actually 10, since two tied for 9th place). The second round consisted on one difficult task: to remove two pieces of skin containing “moles”, switch their positions, and suture them back into place. There again was the dreaded corner stitch – and four of them to be exact! In addition to the suturing, we had to be sure to remove pieces that were the exact same size AND which met the criteria of having a 1:3 ratio (1 width to 3 length). I lost a lot of time while cutting out the pieces of skin, something I’d never practiced before. I was still on my first one when others had started suturing already.

We were given 20 minutes for the task and I think I finished in the 6th or 7th place. Waiting for the results was torturous.

When we were called back into the room, I could barely read the names projected on the screen. Not because it wasn’t clear, but because the past hour had been so unbelievably stressful. I started at the bottom and worked my way up. My name wasn’t anywhere. I blinked a few times, adjusted my position and tried again. There it was – and I couldn’t believe it: 3rd place! The winner had stolen 1st with a whopping 109 points, 2nd place with 100 and I with 99. The prizes for the competition are quite amazing:

  • 1st, 2nd, 3rd place: Grade 5 for the course – the entire course! Meaning we don’t have to take the final exam! (Which is HUGE, considering we have 8 exams.)
  • 4th, 5th, 6th place: Grade 4 for the course
  • 7th-18th place: exemption from the suturing portion of the final exam (plus, if any of them are selected for the laparoscopy competition, they are also exempt from the final exam with a 5 – regardless of their placement!)

When I went to congratulate Mads, who’d placed between 4th and 6th, he said, “Team Zen for the win!”.

 

 

Midterms: Check!

March 29, 2015 § Leave a comment

This past week took me for all I had. For many it was a calm week before Easter break, but for me and several others, it was quite the opposite.

I started off the week already pretty exhausted since, last week, we had our midterms in medical imaging and pathophysiology. The medical imaging exam was significantly more challenging than we had been led to believe by students of previous years. We’d been told that no one would get anything below a 3. For us, it was quite the opposite: only 1 person got a 5 and 78 people got less than a 3! The class itself is divided into two parts, anatomy and biophysics, and this midterm covered the material for the anatomy portion. The exam consisted of identification of 80 anatomical structures in CT, MRI and gross anatomical images. Since this midterm was at 18:00 on the night before the pathophys midterm, the only studying I did was on that same day, for about six intense hours. Luckily, I ended up with a 3. I would have liked to do better, but I’d made the decision to prioritize pathophys.

MIResultsbypoints

 

After the midterm was done, the last thing I was in the mood for was going home to do last minute cramming for pathophysiology. I battle quite frequently with anxiety before exams and one of the things Skjalg has suggested I do is to set smaller goals for myself. It’s so easy to say you’re going to “sit down and study patho” without actually specifying what you are going to cover. The problem with that is that you will never accomplish that goal. You’ll never be done studying a subject. The only way to feel like you are getting anywhere is to set smaller goals and actively feel proud when you accomplish those goals. So that night, after a little power nap, I asked myself what would make me feel proud, what would make me give myself a pat on the back and go to bed happy. I then stayed up as long as needed to make my goal, did a little extra and went to bed happy.

For this midterm, we had six topics for which we needed to know theory and diagnostics:

Screen Shot 2015-03-29 at 15.42.43

The exam itself consisted of one case, for which we needed to evaluate, diagnose and plan treatment. We go through the cases during the semester, so there isn’t anything new at the exam, but you need to be able to do more than state a memorized diagnosis.

I was pretty nervous before the exam. I spent maybe half an hour walking around in circles memorizing the various values we need to know. When I finally entered the room, chose my topic and sat down to start preparing, I realized I didn’t recognize my topic at all. I had gone through it at least three or four times before, but it apparently didn’t stick. So, I had to go blind, with the knowledge that I had gained while studying and hope that the diagnosis I came up with was the correct one.

Screen Shot 2015-03-29 at 15.43.34

Our examiner for this midterm was the same I’d had for my both my semi-final and the midterm last semester. He prefers you to walk him through your thought process, rather than immediately report the diagnosis. So, I took the time to read through the entire question with him while noting my inferences from the various symptoms and values. At one point I said that I suspected metabolic compensation due to the normalized pH value in spite of the low pCO2 and he asked the only question he asked me during the entire exam, “Is it?” (as in, “Is there metabolic compensation?”), to which I replied yes. At the end I stated the diagnosis – chronic respiratory alkalosis with metabolic compensation resulting from respiratory infection – and said that I would confirm it with a chest X-ray. His smiled and said, “Well…what to do with you…it’s a 5”.

Pushing through this week was tough. I decided to take my microbiology midterm covering fungi and parasitology this Thursday (it is scheduled for the 12th week, but he is letting us take it earlier if we want to) and then there was the matter of the surgery competition! The surgery competition took place on Friday, but before that, I had to pass the last mini-competition in our class on Thursday in order to be the one elected to go to the main one. We had a substitute teacher that day and were going to be practicing continuous sutures. I did ok during the practice and the substitute gave me good feedback, but when it came to our little group competition, everything went wrong…

To be continued 😉


The past is never where you think you left it

March 12, 2015 § 4 Comments

I’ve mentioned before that I prefer to write blog posts when I find myself in a reflective mood, one in which the words simply flow through my fingers without any obstacle of forethought or manipulation. I find that the time between these moments is growing ever so slightly despite my best efforts to stop and appreciate where I am and how far I’ve come. This idea brought me to consider that maybe it’s not just that reflection begets writing, but also that writing begets reflection.

This post is going to be quite the reflective one. The reason? It is March, my “month of change” if you will. I received a notification from WordPress (the company that hosts this blog) wishing me Happy Anniversary with them. It’s officially been three years since I started this blog and six since I moved to Norway in hopes of somehow, someday, becoming a doctor.

In honor of the time that has passed between the person I was when I left Los Angeles and the person I am now, a 3rd year medical student in Budapest, I want to share some excerpts from Marches passed.

March 200921 year-old Bianca living on the island of Tjøme off the coast of Southern Norway with Aunt Vibeke. Next to no money and almost no plan. Just a hope that things would find a way of working themselves out.

Day 1

When the plane sank through the clouds during our descent, my heart began racing madly. For the last three months I have put my full focus on getting to this point and now that I am here I almost feel purposeless. At one point, it even crossed my mind that I should just turn around and go home. I am so out of my element here; I know I have the necessary skills to survive and support myself back in the U.S., but I feel like none of those skills are of use to me here. Literally everything is different and it really confirms the feeling I have of this move as a blank slate. However, underneath all the immediate worry and anxiety lies that deep excitement and yearn for a challenge. I know this is going to be difficult and I set out with my future in mind. All the necessary quotes fuel my confidence: “What doesn’t kill you makes you stronger. Reach for the moon, if you miss, you’ll land among the stars. We’re not here for a long time, we’re here for a good time.” Life really is too short to wonder what things could be like, or to look back at the chances you had to change the course of your existence and didn’t.

Day 7

I miss having friends and meaningless conversations with random people I meet throughout the day. I miss knowing where I am and how to get where I want to go. I miss my family and knowing what they are doing. But in the end, this is where I am supposed to be. I just heard word from my old roommate that the house I was living in in LA is being foreclosed and now they all have to find a new place to live by the end of the month. As soon as I heard the news I was consumed by thoughts of how I would have had to manage everything if I was still there. When you move on to a new chapter in your life and see the chapter you left sort of collapsing behind you, you can’t help but feel a deep sense of relief and purpose – and confirmation. I’m still scared, still lonely, and still have a sense of restlessness, but this is the right path for me. There is a quote that I love, from a kid’s movie nonetheless, about the importance of living your life. I’ve read this quote over and over again at times when I needed to believe that these huge changes would be the best ones I ever make.

“When King Lear dies in Act 5, you know what Shakespeare has written? He’s written ‘He dies”. That’s all, nothing more. No fanfare, no metaphor, no brilliant final words. The culmination of the most influential work of dramatic literature is: He dies. It took Shakespeare, a genius, to come up with ‘he dies.”? And yet, every time I read those two words I find myself overwhelmed with dysphoria. And I know its only natural to be sad, and not because of the words ‘he dies’ but because of the life we saw prior to the words. I’ve lived all 5 of my acts, and I’m not asking you to be happy that I must go, I am only asking you that you turn the page, continue reading, and let the next story begin. And if anyone ever asks what became of me, you relate my life, in all its wonder, and end it with a simple and modest ‘he died’.”

I want my life to have this same sense of wonder and glory. This is how I know that I am taking the right step. If we don’t push ourselves, we will never truly know the greatness we are capable of.

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Day 11

I’ve been asked a lot about my choice to move here. I usually respond with something along the lines of school and the general experience, whatever jumps into my head at that moment. I have a small notebook where I write down everything that makes me laugh, quotes that inspire me and thoughts that I have. I find that, depending on the point in my life, I am drawn to different quotes in this book. As I read through it on the bus ride home today, I came across one with quite an alluring point. It follows in the category of the “why not?” response when inquired about my move.

“For believe me! The secret to harvesting the greatest abundance and the greatest enjoyment from existence is this: Live dangerously! Build you cities on the slopes of Vesuvius! Send your ships into uncharted seas! Be robbers and conquerers… you knowing ones! The time will soon be past when you could be content to live hidden in the forest like timid deer.”

-Friedrich Nietzche

We inherently suffer the fear of the unknown, the fear of change. Why not conquer this fear and throw ourselves out there? The worst thing that could happen is that the stories of our lives would be worth telling.

March 2012 – Med school finally became tangible. At a meeting with a school counselor in Oslo, I learned that there was an entrance exam in two weeks time and that I was eligible to apply.

Entrance exam 1

After I was finished he said, “I am going to change my mind about you. At first, I thought I would recommend that you come back in June and try again. But now, I see that you know much more than I first thought. Like your brother, I can tell that the intelligence is there. But you must review. You must review a lot. You cannot begin medical school without knowing these things. There will be no time to review the basics once you start.” He then proceeded to make some changes on my form and marked the top with an asterisk. “I will fight for you”, he told me, “But it will be hard to prove because your scores are not so good. But I will tell them that you know more and that you will review. I cannot guarantee anything. But I will tell them.”

Only four days later, on Thursday the 8th of March, we all got our acceptance letters to University of Pecs Medical School.

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Christian’s 22nd Birthday

I spent all day today reading Complications and making my brother a cake for his birthday tomorrow. He is turning 22 and in lieu of recent events, I feel it is only fitting to have a medical themed cake – so I made an animal cell! I had a lot of fun doing it, though I didn’t plan for it to take all day. Hope he likes it when we wake him up tomorrow.

First round of acceptance letters

Skjalg and I just received our letters from Szeged. This was originally our first choice, but after finding out that it is not on California’s list of accredited universities, we decided against it. Skjalg got in and I got accepted to their “preparatory course”. It shouldn’t matter much since we have already decided against  the school, but it still made me a little nervous. Skjalg asked me, “What are we going to do if I get into Semmelweis this round and you don’t?”

March 2013 – Second semester of first year

On conquering exam anxiety

So after listening to this a couple times, I came to a conclusion, which I immediately shared with Skjalg:

“The test is simply an evaluation of how I have been studying so far. If I pass, that’s great. I can keep on doing what I am doing and possibly make some further improvements. If I fail, yes, it will suck. However, I will be forced then to review the material more thoroughly, to learn it better and really understand it. In all honestly, I benefit either way. One way is just a little more challenging.”

It’s amazing how much mental power you have over your perception of a situation. Accepting that failure was an option and thinking of the good that could come out of it, rather than focusing on the bad, put me in control. Eleanor Roosevelt’s quote “No one can make you feel inferior without your consent.” applies, not only to other people, but to yourself as well.

Mindfulness: 1 ; Defeatism: 0.

An entire post about reflection

Ponderings of a 22 year-old me 

quote-books

March 2014 – Second semester of second year. Posts are less about reflection, more about midterms and studying. Although, there is one that chronicles a morning I spent enjoying the city.

Appreciating the city

Budapest is Beautiful

night-walk

Upcoming anatomy midterm

We’ve been covering anatomy superficially these past weeks and after Thursday’s physiology tests, we were ready to go hardcore anatomy. Between Friday afternoon and early Monday morning, we studied for a total of 37 hours. For this exam, Skjalg, Jannie and I decided to go through the material together. It made for a fun weekend, albeit slightly stressful. We presented topics on the giant white board, made up funny ways to remember things and peppered each other with spontaneous quizzes. In my post-midterm bliss (aka pure exhaustion) it’s hard for me to recall the horrible anxiety that slowly took root over the weekend. For that, I’m thankful.

March 2015 – the present

You’ll have to tag along to find out…

Quote by Katherine Anne Porter

Where Am I?

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