12 hours with no food or water and one bathroom break (which was at that point already 6 hours overdue) and I am about to crash. Today I had my first ever patient and wrote my first ever report. Was I ready for it? It certainly didn’t feel like it, but maybe it’s something you’re never really ready for.
The day started
as it did yesterday (our first real day) and as it will every day for the rest of the month. All of the doctors on shift in the different departments meet in a large meeting hall at 8:00 and discuss the new cases from the day before. With all the doctors and residents, this ends up being about 30 people. On one of the side walls there are three more: Skjalg, Hilde (a fellow classmate from Semmelweis who is originally from Bodø) and I.
It was a little intimidating yesterday. Pretty much everything we are experiencing right now is brand new and that makes things feel so much bigger than they are. We were supposed to start on Monday and the only information we got was “Skjalg will be in gastro, Bianca will be in kidney. If you want day experience, go to the emergency room. Otherwise meet up at the “vkat meeting” at 15:30 in the cardiology department”. When we showed up at the cardio dept we were directed to a guy who had never heard of us and who had no idea what to do with us. He asked us to wait 10 minutes while he finished up some things. After an hour of waiting in the common area, Skjalg went to go check and found his office door closed. Luckily, he popped his head in a few minutes after and explained that he didn’t know what to do with us and that he was pretty sure it wasn’t him we should be talking to. Then he had us jump in the middle of a shift meeting between the evening doctors – which was, suffice it to say, quite the awkward experience. We ended up getting pawned off on one of the doctors, who then proceeded to lead us on the most confusing and fast-paced tours of my life, and suddenly we were heading towards the car with scrubs in our arms. So first day, not so great and really quite disappointing! Luckily, we were told to just show up at the department meeting the next
morning so that we could find the man we had originally been in contact with.
So yesterday, Tuesday, ended up being our real first day. We started
with the meeting with all the doctors and at the end of it, the meeting leader said, “and I see we have two new faces over there”. Skjalg and I stood up to introduce ourselves and as soon as we were done, the doctors packed up and shuffled off. A woman approached me to introduce herself as a resident who would also be in the kidney dept. She is Russian and has only learned Norwegian in the past few years, so I feel a lot better knowing that I am not the only one. My Norwegian is good in conversation, but in a medical environment? Let’s just say that I have a lot to learn!
Skjalg and I met up with the guy we’d been emailing with and he led us on yet another little tour. Soon enough, I was dropped off in a smaller meeting room in the kidney department and the door was closed behind me. One of the doctors asked me to tell them a little about myself – something
I was really not prepared at all to do – and I ended up with a little ramble about being from Oslo and California and studying in Budapest. Everything after that was a bit of a blur. I sat through the meeting between the doctors of the department, who went through all the cases of the day using a giant projector screen showcasing the amazing patient file system they use in hospitals in Norway
. Everything is so integrated and clear. I couldn’t help but be impressed! Also, the hospital is beautiful! They are remodeling, so there is a bit of mess and confusion in the older part – but the new part: just like the hospitals you see in shows and wish you could work in! On top of that, the views from the building are stunning. It makes me so happy to see that the patients have such beautiful views!
Back to the meeting. At this point, I still had really never heard “medicine” in Norwegian. I sat there quietly trying to soak up every word/phrase/value and took some small notes in my little notebook. At one point, one of the overleger (title for doctors who have worked more than 15 years) asked me what I was writing, just out of curiosity. I had written pas = pasienten (patient). There are so many short-hand terms and this was my first one – so into the notebook it went! He teased me a bit about my choice and moved on. There were several points during the meeting where they made funny comments towards me (i.e. a patient that had once visited California with whom I could maybe speak “Californian”). I would laugh and then they would laugh and then all of a sudden they would be back to the lab values. It took me a while to follow how quickly they jumped back and forth. Imagine a conversation where someone says something funny to you, you laugh, they laugh, and then they say, “so his creatinine
was about 600 and I want to wait for it to drop to 300 before we consider sending him home.” Bit of a mind game!
After the doctor meeting, two of the doctors (there were three to start
) snuck out leaving me, the Russian resident and an overlege, whom we can call RR and Dr. J, respectively. We waited for a while, making some small talk, which included a conversation about how Norwegians can find Americans to be a bit false in their interactions (i.e. smiling and being “too nice”) – a topic which came up because I smile a lot. I wasn’t so sure how to interpret this at the time. Skjalg and I ended up discussing it later in the day, as there are apparently quite a few things I have to learn about Norwegian culture, and he told me not to overthink it. He reminded me: Norwegians don’t need to talk all the time, if they have something to say, they’ll say it; if they want to know something about you, they will ask; people aren’t usually trying to be mean/rude. (That said, Dr. J’s Bianca-teasing topic of today was how studying is not a hobby… He’d asked me what I do with my free time and studying was seriously the best I could come up with.)
After maybe 15 mins of small talk, one of the nurses came into the meeting room with several folders. For the next hour or so, she and Dr. J proceeded to go through all of the cases assigned to him in great detail. I was really impressed by the communication between them and the whole process in general. Great respect is shown by both parties and they introduce the patients by name, give a little information about where they come from, why they are here, how they are doing/feeling, and further tests and treatment. After they had gone through all the cases, we went to visit all of the patients we’d discussed (or rather, that RR and I had watched them discuss). During this round, I met three times with something that I have never seen before: an AV fistula! I learned later from the other overlege (let’s call him…. Dr. X) that when doing hemodialysis for patients with chronic renal failure, there are two options: jugular catheter (which is avoided because it comes with high infection risk) and AV fistulas. The AV fistula is formed when an artery in the forearm is surgically connected
to a vein, which ended up forming a channel that can hold up to 200 ml of blood. When dialysis needs to be done, this is the point where there dialysis tubes are connected to the patient’s blood stream. In two of the patients the fistulas were quite small, hardly even visible to the naked eye, but the turbulent flow could be felt by placing your hand to it – it felt like a humming electronic apparatus of some sort. The third patient (a refugee) had such large AV fistulas that large mountain shapes formed on his/her arm.
I’m really starting to crash now, so I have to start typing faster and getting more to the point. It’s just so hard when everything is so new and exciting! Feel like I want to get every detail down! So, jumping back to today. We started the day with the doctor’s meeting (less intimidating than the first) and then the department meeting (also less intimidating, at one point, Dr. X and Dr. J even started talking about Skeletor and He-Man and told the new doctor, Dr. S, to look it up because she had no idea what they were talking about). After that was the doctor/nurse meeting and the patient rounds. It is so, so, so unbelievably nice to understand everything the patients are saying! We get bits and pieces from what the patients say during our internal medicine practices in Hungary, but many of the small details are lost. Of course we clarify everything with yes/no questions, but it really adds a different element to the whole experience. After rounds, there was really nothing left to do. Some small talk in the nurses area was followed by me mentioning that I would like to see the next
patient being checked in and with that, I was off to the emergency department! Why? Because apparently that is where most of the patients get checked in. Plus, there was nothing to do in the kidney department anyway.
I was a little nervous being “dropped off” there. I thought I could just follow one of them around and see what they do and watch how they work. I ended up pairing up with the resident there, who was in charge of the day shift. I’m not really sure how it happened, but somehow it ended up being agreed upon that I would get my own patient and that she would help me. When she said this, I assumed that she meant that she would be there by my side
the whole time making sure I did everything right. It didn’t end up that way! It was an hour and a half before the patient was to show up and during that whole time, I had no idea what to do with myself. The patient was a tourist, so I knew that I would be able to speak English with him/her and that was a huge, huge plus!
Energy is out and I need to be up at 6 for yet another day! To be continued