Happy Tuesday

November 18, 2014 § 3 Comments

This morning started with our second lecture of the week (followed by our first practice of the week) in internal medicine. The topic of the lecture was Nuclear Methods in Medical Diagnosis. It was a bit of a heavy topic for 8:00 a.m. and brought back a lot of memories from biophysics (which we took during first year). The topic is a bit out of place…we’re not really in a place in our education where we can truly understand the applications and we won’t be tested on it, but I guess it’s good to get our feet wet.

After lecture the ten of us that had attended headed immediately over to change into our white coats for the practical. Today was the first day that we didn’t see any patients. Instead, our doctor sat us down and did a detailed run-through of how the exam will be and how to properly fill out a Hungarian medical chart. There is a lot to remember – and that is just on the medical side. Having to do it in Hungarian is something else entirely. Our doctor said we will be paired with a patient whose information our examiner knows intimately. We will then be left with the patient and have to do a full exam and fill out the chart. Once we are done, the doctor will review the chart and see how well we did. Our doctor is probably the most strict doctor (at least from what we’ve heard) so I am really happy we won’t be having him on our exam. He kept mentioning things that are an “easy fail”. Because this is all common sense, right? He is not so much a stickler about the medical part (he knows we are too inexperienced to properly diagnose a murmur) as he is about the Hungarian. He believes very strongly that without Hungarian, we can’t learn internal medicine.

These are the scribbles I managed to get down during the practice, just to give an idea of what we need to know and focus on.

I ended up skipping this afternoon’s lecture for microbio in order to go home….and study microbio. We have our midterm in two weeks from Thursday and I’m considering taking it as one of my first exams this exam period. The lecture falls in a block of about 4 hours and I decided that I would get more out of that time by studying at home. I’ll of course have to make up the lecture later – all in due time!

For this micro midterm, we have to know about 25 bacteria. After today, I’ve studied all but two, but will need time to review and commit to memory. To study each bacteria I’ve been watching SketchyMicro videos, reviewing notes written by a teacher in the department, reviewing the slides from our practicals, reviewing lecture slides and finally, reading in the textbook. No wonder it takes me so many hours to cover one bacteria!

SketchyMicro is a great tool for visual learners. They create a picture with a bunch of memory stimulating components specific to the bacteria. I save a copy of the image on my iPad and then add in the notes as I watch the video.

This is what I have for the bacteria Staphylococcus Aureus. It’s a big one, so there is a lot more information for this one that others.

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Now, while reviewing, I’m putting all the info into a table. It’s forcing me to pick only what I think is the most important and will be much easier to review than reading through my notes again. Gets a little messy when using so many different sources 😉

Screen Shot 2014-11-17 at 20.34.00Ok! Bacteria tables await!

 

 

Success first, happiness second?

November 16, 2014 § 1 Comment

I’ve allowed this semester to consume me (and take my sanity hostage) and now I need to actively work to get it back. It’s not like I’ve gone crazy, or that you would even notice that I am where I am mentally, but inside my head, when I am at home studying, it’s a mess. This past week I have been pushing myself especially hard, which means studying until I physically can’t anymore (when everything hurts and I can’t see straight) and getting up earlier than I should. It never works. It just leads to hysterical burn-outs.

On Thursday I was a total zombie by noon and feeling the initial symptoms of Skjalg’s cold. So, I took the rest of the day off (my day was supposed to go until 21:00) and went home to not study. That night, I told Skjalg that I need more routine. We’ve slowly slipped away from going to bed at 22:00 and waking up at 6:00. I’ve gone completely off the radar on that one, Skjalg is a little more regimented. I also suggested that I study in the guest room, which has been more or less Skjalg’s man-cave since we moved here. He’s been spending more time studying out in the living room and since the space is not a familiar space to me, it might be a good spot for me to get quality studying done. Our apartment has also taken Murphy’s law to a new level – and it is impossible to relax in that kind of chaos.

While at school on Friday, Skjalg hit the reset button for us. The class for which I am a teaching assistant in anatomy (I am only joining for the histology practicals this semester) had their histology midterm. I arrived earlier and stayed about an hour later to help grade their exams. On the way home, Skjalg texted me to ask that I pick up some dinner for an impromptu date night. My brain played around with the panic switch as I thought about how exhausted I was and how it was not going to be a fun night (I’d envisioned us eating dinner while watching an episode of Parks and Recreation, then having to clean the apartment for however many hours until bed). Instead, I came home to a glittering clean apartment alit with candles and a glass of wine waiting for me. I actually teared up when I saw it and spent the rest of the night telling Skjalg how amazing he is and how much I needed that reset. (Yes, med school is so stressful that a clean apartment elicits tears of joy.)

Yesterday I spent the day studying at the Parliament library with my friends Hanna (who is actually a childhood friend of my friend Stian, from Oslo, and in 5th year), Suvi and Synnøve. Our second microbiology midterm is coming up soon and it is going to be a big one. While studying at a café a couple of weeks ago, Amir and I formed a microbio “support club” to help us get going. We have been doing 1-2 topics from the topic list every day and then text-test each other in the mornings. I’ve been spending so much time on those topics that all the other subjects have kind of been pushed to the side. So yesterday was all immuno! We had our midterm in immuno a couple of weeks ago (I think during week 8) and I might be eligible for the competition. It depends on how they set up the qualification. I got 31/40, so if they take the top 70/75% then I’m in! We have 6 exams this exam period and it would be so nice to get one out of the way ahead of time.

As for the title of this post, it’s meant to be a little reminder for me of how not to think. Skjalg and I have been trying to read non-school related books before bed (we were successful for the first week or two). We started by both reading Meditations by Marcus Aurelius. It is amazing and enlightening… but also so, so heavy to read before bed. So, we’ve switched over to The Happiness Advantage after being inspired by this TEDtalk:

I was reading it last night before bed and it set me in the right mental place before ending the day. Why? Because even in the first couple of pages, it was exactly what I needed to remind myself of. The point was that success does not lead to happiness, but rather happiness to success. Here are some of the quotes that I highlighted:

But with each victory, our goalposts of success keep getting pushed further and further out, so that happiness gets pushed over the horizon.

 

‘The Mind is its own place, and in itself can make a heaven of hell, a hell of heaven.’ John Milton, Paradise Lost

 

They felt overwhelmed by ever small setback instead of energized by the possibilities in front of them.

Only five pages of that book was enough to ground me (that plus a clean apartment, amazing boyfriend and productive study day). It is so easy to get caught up in the stress of the moment, in the fear of failure and in general insecurity, that I forget how hard I’ve worked to get here. Where I am now is where I have wanted to be my entire life. It’s hard because I want challenge. And happiness needs to be part of the journey. I am happy and I still take time each day to appreciate my environment – the falling leaves, the barbecue and hot wine smell from the winter market, the gorgeous winter sunrises – but it takes work to remember. I receieved two comments on my last post, one from my wise Grandpa and one from Aswini, a doctor in India, and they both meant a lot to me to read. It is always inspiring to hear from people who are similar to you and who have traveled the path before you. Their experiences yield great insight and can help direct you towards the right path.

On that happy note, I’m off to make protein pancakes for my man 😉

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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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….

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