How sad and bad and mad it was – but then, how it was sweet!

March 2, 2018 § 5 Comments

Today marks nine years since I moved to Norway. Every year on this day, I take the time to reflect on everything that has happened. On who I was then. On the challenges experienced. On the memories created. And finally, on who I have become. This time nine years ago, a man seated next to me on the plane asked me where I was going and how long I would be there. “Norway. And, I have no idea.”, I’d replied. I remember getting lost in Heathrow during my connection. I remember feeling the most alone I’d ever felt in my life. As the plane passed through the clouds blanketing Oslo, it hit me. There was snow – everywhere – and I hadn’t seen snow in almost a decade. From that point, from that shattering realization that home was no longer a familiar concept, everything changed. I am no longer that clueless, hopeful girl with a one-way ticket.

It’s been quite a while since I wrote. It’s not for lack of caring – or lack of reflection or content – but rather lack of time. The weeks following USMLE Step 1 were extremely tough for me, as can be gathered from my previous post. I was exhausted and felt completely defeated. I set my focus on my trip to the states and any motivation I was able to muster up was funneled into preparing for my final exam in internal medicine (one of the biggest exams of our final year).

On December 13th, on my way home from the gym, I got THE email I’d been waiting for since the moment I’d selected “submit”. At that point, I had absolutely no idea how I was going to react. So, I continued home, where I started cleaning and organizing the apartment. After half an hour or so, Amir called me. It turned out he’d been waiting in my apartment building for the past twenty minutes. The results are released on the Wednesday three weeks after your exam at around 15:00. I’d initially wanted to be alone when I opened the results, but I invited him in and tried distracting myself with cleaning and meaningless conversation. He finally convinced me to stop avoiding it. If you ask him, he’ll tell you that the moment the result loaded on the screen, the look on my face told him I’d failed.

“Oh my god…. I passed.” Pure shock ran through my body.

Allowing him to be there while I got the result was the best decision I could have made. I had been so sure I’d failed, that I genuinely didn’t know how to respond. Having your best friend there in such a moment, celebrating you with such pure excitement, is priceless. It dragged me out of my state of shock and allowed me to start feeling the relief and happiness that one should feel after such an accomplishment.

After that moment, a certain confidence began to set in. Pushing myself through those months of studying, the countless hours spent going through questions and memorizing pathways and tables, had altered my brain. It took all the unfiled knowledge I had packed away in my mind after five years of medical school and put it all into place. It taught me how to think like a doctor. The first time I realized this was on a night shift in internal medicine. As we were running up the stairs to see a patient who had just been admitted to the endocrinology department, my doctor said, “Patient presenting with severe dyspnea and hyperkalemia. How do you treat hyperkalemia? Think about it and tell me when we get there.” Initially, I felt panic. I told myself I didn’t know and began to worry that I would look stupid. But then, I stopped myself. I pushed away the immediate block I’d put up, took a deep breath, and began to think it through. By the time we got there, I was ready.

T: So?

B: Insulin.

T: Good. Another?

B: Mmmm, diuretic?

T: Which one?

B: Loop. Furosemide?

T: Good. And a third? (She gave me the hint that it was an ion)

B: Calcium?

T: Yes. Good.

Had I learned this in pharmacology? Yes. Had I been tested on it in my endocrinology exam? Yes. Was it knowledge easily accessed as a result of studying for school exams? No. Was it knowledge easily accessed as a result of studying for Step 1? Absolutely. Preparing for that exam has made all the difference. It took my mindset from that of a medical student to that of a clinician.

We left for Minneapolis the day after our final exam in internal medicine. What followed was three blissful weeks with my amazing family. I allowed myself a break from everything. After the year I’d had, I wanted to check out and live completely in the moment. I was going to need a rested body and healthy state of mind to tackle what lay ahead.

Sitting at the airport in Amsterdam on our way back to Budapest, Amir asked me how I felt about coming back. At that moment, it felt like I was heading into hell. While studying for Step 1, I’d pushed off everything I possibly could. Coming back meant having to finally deal with everything. My thesis (which I hadn’t started), applying for internships and summer jobs, starting the study process for Step 2 – all on top of my rotations, exams, and teaching.

It’s been a little over a month and a half and now I’m standing at the top of the mountain, looking down at everything I’ve accomplished and all the possible futures that lie ahead. My thesis is finished and my defense is scheduled for next Friday. I’ve submitted applications to the U.K. and Norway. I’ve registered for Step 2. The things that at one time felt so impossible are now just ticked boxes on a checklist.

So, what do I have ahead? Interviews. Step 2. Rotations and rotation exams. Boards.

After that? We’ll just have to wait and see.

25 days out

October 30, 2017 § 2 Comments

I’ve told myself almost 100 times now that I can treat myself to writing a blog post when I reach my goals (for that day). Clearly, that hasn’t happened yet! So here I am, sneaking time away from studying even though I’m nowhere close to finishing today’s task list.

Studying for this exam is unlike anything I’ve ever experienced. I’m literally being tested on everything that I’ve learned, every single subject simultaneously, and there is absolutely no end to it all. I could probably study for this exam for years and years. Luckily, that isn’t what is required to pass this exam.

I am 25 days out from my exam and I am officially freaking out (while still being mildly functional). For at least the past month, I’ve lost my ability to communicate like a normal person. I can tell when I am having conversations with my friends that I’m just not making sense anymore. How do I know? Because even I don’t know what I am saying! I’ve also lost my ability to come up with metaphors that DON’T have something to do with medicine (e.g. “Haha, he’s just like a retinoic acid receptor!” or “You’re just like Class IB antiarrhythmics, both of you have a predilection for damaged tissue”). I wish I was kidding about that.  This sort of mania is something that I think only people who have studied for this exam before can understand. My friend Stephanie is the best example: she NEVER gets stressed or anxious for exams (or honestly about anything) and yet, even she had panic attacks while studying for this exam.

Luckily, teaching has been really helpful and I’ve enjoyed the break away from the books to spend time with my students. We are covering neuroanatomy this semester and preparing for the lessons has made me ace almost all my neuro questions. They’ve been amazing and are always so engaged. I share some of my Step 1 questions (the ones relevant to their material) in our facebook group and I love seeing how they process and discuss the possible answers. I’ve been so, so impressed with their knowledge and efforts!

So, what exactly is my life like right now? I wake up at 5:00 (sometimes 6:00 if I’ve had a rough night sleeping, which happens more often than not), throw random grains and nuts in the rice cooker (if I don’t have some leftover), do cardio while doing questions/watching Pathoma or Sketchy videos, shower, settle in for rounds of questions (UWORLD: I do a full block (40 questions), random (all subject and disciplines) and on timed mode every time. This is the best way to simulate the exam experience. The exam is as much about knowledge as it is about endurance.). Doing the rounds and their subsequent review can take the whole day (and it usually does). I study as late as I can and then I do flashcards in bed until I fall asleep. If I’m lucky, I’m asleep by 22:00. Obviously, there are various dips in energy and focus throughout the day. I haven’t been able to nap longer than 15 minutes for the past two months and now I’m even down to only 5-10 minutes before my brain starts going through uncontrollable UWORLD withdrawal. Now that I’m starting to get even more anxious, I’m going to start studying out of the apartment more. I need to dissociate my exam from my home if I am going to stay sane these next few weeks.

Everything in my life right now is 100%, absolutely full-force USMLE. I’ve tried to minimize all other obligations so that I can (a) have more time to study and (b) prevent spreading myself too thin and doing horribly in all areas of my life. I’ve pushed A LOT until after my exam. This includes my thesis and my gynecology final, as well as a huge chunk of my internal rotation (which I am doing now). My friends Marianne and Dushyant have offered to take some of my anatomy classes, which is extremely helpful. It is really important to me that my students have a good teacher and I’m so lucky to have strong, competent friends who are willing to step in when I can’t be that for them. Marianne is doing most of her rotations in Norway, but she is here for two months to do her pediatrics rotation and she’s been at my place studying almost every day.

Ok, the books are calling, so I’m going to leave you with some pictures that I’ve taken the past two months. Clearly, my life is little more than studying, cooking (I’ve been making literally all my meals in a rice cooker – those things are amazing!!), and going out for groceries or to walk Baloo. Luckily, I live in a really beautiful part of Budapest, so leaving my apartment is always a treat.

Music has been my saving grace through all of this. I listen to music from when I get up until I go to bed – and the selection is all over the place!

 

Starting over

September 2, 2017 § 8 Comments

I’m struggling to find the words to describe where I am at this point in my life. These past two and a half months have changed me. They’ve forced me to face parts of myself that I either never wanted to face or didn’t know even existed. I’ve had to evolve and grow all while embarking on some of the greatest challenges I have yet to encounter.

I’m in my final year of medical school and the idea that I will be a doctor this time next year is… paralyzing. It’s exciting, yes, but paralyzing at the same time. I’ve spent more than half of my life trying to get to this point and now that it’s finally here, I feel like I don’t know what to do with myself. Knowing that I am about to achieve THE goal leaves me feeling almost empty. Checking that box will mark the end of almost 20 years of doing everything I possibly could to make this happen. It makes me wonder, will anything ever even come close to that?

Since I last wrote, I’ve been re-familiarizing myself with… myself. All while studying for one of the biggest exams I’ll ever take. There have probably been more bad days than good days, but the bad days are becoming fewer and fewer as time passes.

We started sixth-year rotations in the middle of July. My first rotation is surgery, which lasts for about 8-9 weeks. I only have one week left now and will take my final exam on September 12th. I’ve really been struggling with how to balance everything on my plate. I’m planning on taking Step 1 at the end of November and that exam requires EVERYTHING from me. But I can’t give it everything. I have my final exams in surgery and obstetrics and gynecology (not to mention the rotations themselves). I have my thesis. I have teaching. I have applications for next year. It’s…suffocating.

So where am I now? What am I doing? What am I going to do? These are all questions I’ve asked myself almost daily since the beginning of June. If I’m going to be completely honest, this has not been an easy summer for me. Everything I thought I knew about myself, my life and my future changed. My foundation fell out from under me right when I needed it the most. I needed to be the best version of myself and I didn’t know how anymore. So, I slowly started picking up the pieces, forced myself to accept whatever I was able to produce – regardless of how small – and pushed forward.

I turned 30 almost two weeks ago. I really wish I could describe the feeling I had that day. I know that birthday means different things to different people, depending on where they are in their respective lives. For me, it meant everything. It meant saying goodbye to myself. It felt like starting over. Like stripping myself of everything I knew. Complete and absolute vulnerability and, oddly enough, strength. What made the experience even more “life-altering” was the fact that I celebrated it in the historic city of Acre, Israel with my best friend and his family.

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In the days leading up to my birthday, I was in a constant state of reflection. With the way my life has developed, the multiple life paths I’ve entertained, the struggles I’ve endured to get here…it’s not uncommon for me to take a moment and think about where I am versus where I would have been. Whether sitting on the banks of the Danube with a bottle of wine, wandering through the crumbling barracks of Auschwitz, looking out over the fjords from Tåkeheimen, reading the names on the stone plaque beside a Sarajevo rose, or feeling the jasmine scented footprints of Muhammad at the Al-Aqsa mosque in Jerusalem, I always have the same thought: I wasn’t supposed to be here. In that moment, I think about all the points where the course of my life changed, all the decisions and challenges that brought me there and how rich and special my life is as a result. On the eve of my birthday, I stood alone on Amir’s parent’s balcony and watched the sun dip into the sea. As I sipped a glass of wine, I said goodbye to myself as I knew me in my 20’s and reflected on who I will become in my 30’s.

 

 

That trip changed everything. I had a moment in the car on the way to Jerusalem where everything clicked. Suddenly, I could see my future. I saw exactly where I want to be and what I need to do to get there. Every time my future has crossed my mind in the past two years, it’s been followed by absolute nothingness. It’s been a source of anxiety and fear and prevented me from enjoying the present. So when everything clicked, the feeling was indescribable.

Once I’ve worked out some details and made some progress with my plans, I will share them here – I promise.

Otherwise, things aren’t very exciting here. I pretty much only sleep and do practice questions. I’ve been sick since last week and my cough has been pretty extreme. Since I’ve been holed in my apartment studying, I didn’t even notice that I’d lost my voice until I went to the pharmacy to pick up an expectorant. When I opened my mouth to utter the first words I’d spoken aloud in three days, nothing came out. There were a few strange squeaks, followed by a long, intense cough. The pharmacist began to laugh. I laughed and coughed. Exciting stuff.

It’s off to bed for this one! To be continued 😉

 

A picture is worth a thousand words

June 20, 2017 § 4 Comments

So much has happened in the past two months that I hardly even know how to write this post. It makes me sad to think that there are memories that are lost or that will fade because I didn’t have the time to write them down here. This blog has documented almost every step of this journey – from applying to medical school to now. Though this year has a bit less documented than the others, I plan to continue it until the end.

The weeks after we returned from our trip to Ukraine were a complete whirlwind. I honestly can’t even organize my mind enough to put those weeks into words, so I think my only option is to describe these past months in photos.

Ukraine Trip
April 26th

Helping out at the anatomy competition

April 30th

Even Baloo finds studying for exams exhausting

May 1st

Baloo brings everyone to the yard

May 3rd

Notes everywhere! I was trying to gather together all the hematology notes I’ve taken since 3rd year, since we were tested on it again in internal medicine this semester.

May 4th

Going through cranial CT scans in neurology

May 5th

Jannie’s 30th Birthday!

A quote I wrote in her birthday card

May 6th
May 7th

May 8th

That feeling when your puppy sleeps in the same room as you so that you’re not alone during your all-nighter

May 10th

Marianne signing her contract as a student doctor!

May 11th

Cram time!! 4 days out from Internal and Gyno

May 12th

Huge day – LAST LECTURE EVER!!

Last dinner with the gang

May 13th

Weekend of hell! I had 6 exams the following week and had already been cramming for weeks up until this point.

May 14th

An idea of what I was up to during the month of May

May 15th

May 16th

May 19th

Sword and Scale is my ultimate guilty pleasure podcast!

May 20th

It’s nice that some of us get to sleep in

May 21st

When your notes randomly pop up somewhere on the internet..

May 24th

Studying for my last exam with Marianne!

May 25th

DONE WITH MY LAST EXAM PERIOD EVER! Still can’t believe I survived 10 exams in 2 weeks.

May 26th
May 30th

Dedicated Step 1 studying time – here we go!

June 1st

Charlotte’s Birthday!!

I love this city!

June 2nd
June 3rd

Wandering the city and running errands while listening to a new favorite podcast

June 5th

Goodbye dinner with this one 😀

June 7th

Re-discovered my old, little notebook of quotes

What happened after all this? Well, a lot. After 8 years together, Skjalg and I split up. We love each other very, very much and will continue to be good friends. As he is off to Stavanger to complete his 6th year (and I am staying here), I’ve moved into a new studio apartment. The past two weeks have been a bit heavy, but now that the moving is complete and I am finally in my own space, I’m really happy. I whittled down all my belongings to the essentials, donated 3/4 of my clothes, gave away tons of my notes to one of my students. I tried to take only what I really needed. It is so utterly liberating to not be tied down by tons of things. With the recent changes in my life, my future is now a blank slate. I have no idea where I will end up after medical school, but I’m really excited for the year that lies ahead, for the challenges that await.

Here is my new place before I moved in:

And here it is “Biancified”:

Alright, back to studying I go!

World, stop.

March 19, 2017 § 4 Comments

This weekend, I finally took some time to breathe. Since I last wrote, I’ve been busy studying for Step 1 of the USMLE (which I’ve been planning to take in June), studying for my classes and enjoying some time with friends and family. Step 1 requires many, many months of dedicated studying and trying to manage that in addition to my normal “life” load has been really difficult – and exhausting! I’ve been waking up every morning at 5:00 am to complete a block in UWorld (the quintessential question bank). After that I work out from 6:00-7:00, go to class and then come home to review my questions from that morning ands study. Each block is 40 questions and reviewing an entire block can take a really, really long time. Sometimes, I’ve even used up to 8 hours reviewing a single block! Each question comes with detailed theory pertaining to the correct answer, as well as information behind each wrong answer. In addition to doing my blocks each morning, I should be reviewing the various subjects. I had planned to cover at least one subject each week. Have I been able to do that? Nope!

In the beginning of March, we visited Krakow with a group of friends. I kept my studying up during that time, but it was not easy! Waking up at 5:00 while everyone was still asleep for a least a couple more hours was…lonely and frustrating.

Outside of that, the trip was amazing! The city has so much history and it was such a unique experience to visit Auschwitz. It’s really something I will never forget.

After we arrived back in Budapest on Sunday evening, I only had a couple of days before my mom and brother arrived (from the US and Oslo, respectively). We haven’t been together – the three of us – in 4 years, so this was an extremely special trip for me. In the beginning of their visit, I tried to balance studying with family time. By that Friday, I gave in. This past month has shown me that I’m not going to be ready for the exam in June. I’m not planning on going back to the states in the immediate future and you can only take the exam one time, so I would rather push the date and take it when I am more prepared. It felt good to check out of my study world for a little bit and fully enjoy time with my family. They mean the world to me.

Their visit was perfection. We tried out new restaurants in Budapest, including an AMAZING new one called Makery where you make your own dinner. You are supplied with prepared ingredients and a fully stocked workstation. Each person chooses their dishes (just like in a normal restaurant) and then follows step-by-step video instructions to make it. Such a cool concept! We also did some escape rooms, had a cocktail night with all of our friends and took a day and a half trip to Vienna.

We even got to celebrate Christian’s 27th birthday on the day! Our friend Amir brought over a bunch of fresh goods from his favorite bakery, which we served alongside a collection of cakes we’d brought back with us from Aida in Vienna. Then we watched Chef (one of my favorite movies, which Christian had never seen before). After that it was shopping on Vaci utca, two escape rooms, drinks at a roof top bar close to the basilica and dinner at Iguana with Dushyant and Amir (including the dogs! My mom’s dog Romeo and our dog Baloo).

My mom and Christian left on Thursday and I spent the rest of the day reviewing for Friday’s anatomy exams. Since I have my own group, I’m a main examiner during midterms. This means that I may be in charge of examining an entire group (other than my own). I like to vary my questions as much as possible, so I try to do a thorough review of all the topics before the exams.

In addition to exam day, Friday was the day of Baloo’s surgeries – yes, surgeries! Technically, there was only one surgery with three parts, but when your dog weighs less than 1.5 kg (3.3 pounds) you worry a bit more! On top of being neutered, he had two baby teeth taken out (some of them have been a bit stubborn) and a suspicious lump on his head removed. Luckily, the lump turned out to be nothing more than a hair follicle that had grown inward! If any of you follow Dr. Pimple Popper, then you’ve seen these before. If you’re curious, check out this compilation video.

I was so thankful for the distraction of examining students for the anatomy midterm during Baloo’s surgery. I was so nervous that something would go wrong! When Skjalg picked him up at 14:00, the vet told him him that everything went smoothy and there were no complications at all! Afterwards, he was a bit loopy, but by Saturday he was almost back to normal and even playing fetch!

​The only problem now is dealing with his cone. Because he is so small, the cone they had that fits him is really hard and narrow. He absolutely hates it. While it’s on he will stand in place for 10 minutes then get tired and try to lay down somewhere (but never really get comfortable). I slept on the floor with him the first night, since he can’t navigate the stairs leading up to the bed in the dark. Last night, we tried putting his jacket/harness thing on instead. He was able to sleep through the night, so hopefully that is enough of a “blocker” for any licking or scratching he might try.

Otherwise, week 8 (already!!) of the semester starts tomorrow. I’m starting with new material for my students, which I will prepare tomorrow morning before my class at 12:00. We are in the middle of our forensics block, so I might start with preparing my notes for our final at the end of the semester. I’m considering October for Step 1, so I will start studying more for my current course load (I’ve ONLY been studying USMLE so far this semester). I’m going to have to sit down tomorrow and make a study plan for the rest of the semester.

 

 

My First Scientific Conference

February 11, 2017 § 8 Comments

It’s almost 3 in the afternoon and I’ve only been awake for 2.5 hours. Even still, as I lay here in bed writing this, I’m considering taking a nap (Edit: it’s now 19:00 as I continue writing this… I fell asleep for another 3 hours).

This week was scary, amazing and all-consuming. Almost everything I did was outside my comfort zone. There were some really high high’s and some very low low’s. Everything is changing now. We are nearing the end of this giant, life-altering chapter of our lives and that fact sinks in deeper and deeper with each passing day. I feel like I’m standing in a giant room with every door and window open; time is running out and I need to escape this room, but I don’t know which door or window to go through.

Now, let’s take you through the past week:

MONDAY

  • 8:00-12:00Hematology practice on the Buda side
    • Leave an hour early to make it to anatomy on time
  • 12:00-13:30 – Teach anatomy
    • Colleague is sick, so take on his class as well. Come up with a plan for making the practice useful for your now 25 students.
    • Teach cardiac embryology and hope that they at least understood half of what you were saying.
  • 13:30-14:00 – Try to help your students with a scheduling problem they have with PE and anatomy.
  • 14:00-15:00 – Last minute preparation for public health (PH) research presentation
  • 15:30-17:30 PH research presentation
    • Mock presentation of your research for the entire department
    • Note down critiques and tips and answer any questions
    • Sit in on the presentations and critiques of two other Hungarian students – all in Hungarian
  • 17:30-18:30 – Get home and eat dinner – you’ve only had two protein shakes so far today
  • 18:30-22:30 – Work on changes to your PH presentation

TUESDAY

  • 8:00-13:00 –  Hematology practice
    • Try to pay attention and learn something, but you are 18 people crammed into a small room and you can’t think about anything other than your research projects.
    • Leave early with Amir to work on surgery research project. Note to self: make-up missed session later (just another thing to deal with).
  • 11:00 – Find out you’ve been rejected from the 6th year program in Stavanger, then immediately after, get a call from your boyfriend that he was accepted. Feel extreme happiness and sadness simultaneously.
    • Ignore your emotions so that you can focus on your research project
    • Best friend pushes you to talk about it. Feelings and fears about your future as a doctor rush forward. Freak out about the future for 30 or so minutes.
  • 12:00-22:30 – Surgery research project
    • Literally 10.5 hours of constant work on your presentation. Remember all that statistical analysis you did in December when you wrote your abstract? That doesn’t make sense anymore. Re-learn it and do it again.
  • 22:30-02:00 – Home to finish up project while talking about Stavanger with boyfriend
  • 02:00 – Submit presentation to advisor
    • This still counts as Tuesday night, right??

WEDNESDAY

  • 8:00-13:00 – Work on presentations
    • Make final changes
    • Look up any articles/data needed for any potential questions about your research
  • 13:00: Find out that you need to attend the laparoscopy competition on Friday and need to find someone to cover your classes 
    • Luckily, one of your TAs is a close friend and amazing human being! (Thank you, Marianne!)
  • 14:00-15:00Surgery research presentation for your advisors (one of which is the head of the department)
  • 15:00-16:00 – Watch 4 sessions of the Hungarian student conference while waiting for your public health advisor
    • Get smacked in the face with the reality of what is going to happen to you tomorrow.
  • 16:00-16:30Meet with public health advisor to go over finishing touches on presentation
  • 16:30-17:00 – Rush into a store to find a suit jacket for tomorrow
  • 17:00-18:45 – Amir’s place to work on changes to surgery presentation
  • 19:30-02:00 – Work!
    • Finalize both presentations
    • Practice presenting
    • Make quizzes for anatomy class – and start grading quizzes from Monday!

THURSDAY

  • 07:00 – Get ready and practice presentations
    • Realise you’ve made a mistake in your presentation and go through the data again. Make the change in your presentation.
  • 10:00-11:00 – Attend presentation by Thieme at the anatomy department.
  • 11:00-12:45 – Practice presentations at conference location
  • 13:00 – Session starts!!

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  • 13:35 – Surgery research presentation
    • Maximum 10 minutes
    • 5 minute question section, where jurors can ask any questions regarding your work. Some of your questions:
      • How did you account for the potential bias of those that volunteered for the experimental group (i.e. that they were already interested in surgery as a profession and therefore likely more skilled)?
      • Do you plan to redo the study and if so, what measures will you take to increase the statistical significance of your results?
      • What role do you think gaming systems play in the development of laparoscopic skill and technique?

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  • 13:45 – Rush out of room with Marcus (a fellow 5th year student presenting with you in the next block)
    • The block for your other presentation is already halfway done and you have to sneak in and upload your presentation during the break
  • 13:50-14:50 – Observe presentations of all other students of your block.
    • Marcus does an amazing job and gets more questions than you’ve seen anyone get (he worked on a study comparing different EKG readers).
  • 14:55Public Health research presentation
    • Maximum 10 minutes
      • Get a little thrown off when one of your animations messes up and shows Dresden and Munich as being in the middle of the North Sea. Marcus tells you later that you made a nice save.
    • 5 minute question section, where jurors can ask any questions regarding your work. Some of your questions:
      • What explains the age difference between the analysed subgroups?
      • How did students specify their desired specialty?
      • Do you have similar statistics showing predictive factors of other specialities?

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  • 15:15-19:00 – Pictures, celebrate and nap before the closing ceremony.

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  • You didn’t finish grading the quizzes from Monday, so you have to do it while celebrating with your friends at Spiler.
  • Luckily, your friends are awesome and split the grading with you. Cocktails and grading for the win!

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  • 19:30Closing ceremony
    • On the way here, Skjalg brings up how he thinks you could win. You tell him to stop bringing it up because you don’t expect it and don’t want to start thinking about it. You’re just happy with having presented.
    • The ceremony starts and people keep asking you what section you were in. You honestly don’t know. Getting through the day was literally the only thing on your mind.
    • You recognize a name in 3rd place of one of the sections. Skjalg, Amir and András (your advisor) get antsy. Second place is announced and you see your name flash across the screen as it is read out loud by the conference director.

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    • You walk up, get your prize – in complete shock – and then return to your friends.
    • The next section results are read. You’re busy looking at your prize and diploma – still in complete shock. Suddenly, your and Amir’s names are read out loud for 1st place.

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  • Back to the front you go – is it possible to be more in shock than to be in complete shock? You and Amir are both so surprised that it makes for one of the most endearing and genuine moments.

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  • 22:00 – Bed
    • Have you ever been this tired before? Probably, but it doesn’t feel like it.

FRIDAY

  • 06:00 – Suturing practice
    • Laparoscopic competition is at 8:00 and you haven’t practiced suturing in a long time
    • No chicken breasts or bananas present….this kitchen glove will have to do!

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  • 8:00Laparoscopy Competition
    • 1st round – Peg transfer: you do great during warm-up, but when the comp starts, you drop your rubber tube twice! This adds 40 sec onto your best time and puts you in 12th place.

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    • 2nd round – string 5 pieces of straw onto suturing thread: you drop one of your straw pieces (again!)

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    • You (somehow) manage to snag 4th place. Your amazing boyfriend rocks it with 3rd place!

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  • 13:00-17:00 – Last day of haematology practice on the Buda side
  • 17:00-18:00 – Psycho-cleaning of the apartment
  • 18:00-midnightIndian night with your friends!! And a perfect way to close a hectic week.

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Click here for all of the abstracts by presenters at the conference.

In summary:

  • I was rejected, and Skjalg accepted, from Stavanger. This means that I will be here in Budapest for 6th year and have to find a new place to live (for myself). Skjalg will be in Stavanger for the entire year and will come back to Budapest every few weeks for exams.
  • I won 1st place together with Amir for our surgery research project and 2nd place for my public health research project.
  • Skjalg won 3rd place in the laparoscopy competition.
  • I have amazing friends from all over the world.

I’ve slept for about 16 of the last 24 hours, which is a pretty good indication of how I am feeling right now. This week was a heavy one. A really, really heavy one. But in the end, I am so happy for it. It felt so good (afterwards) to have pushed myself through something I never thought I could do. I’m happy that I have the strength to throw myself in new directions and the support system to care for me when I don’t quite make it.

 

Surgical Olympiad in Moscow

April 25, 2016 § 3 Comments

It’s been a little over a week since we returned from Moscow and I feel as though we’ve only just recovered. In the days that followed our return to Budapest, I think I slept almost 30 hours. It’s a good thing I got that sleep because with exam period only 3 weeks away, there is no time for rest!

The biggest hurdle ahead of us now is pharma. We have a midterm this week, the competition (for those who dare to attempt it) during the last week, and the final exam. Most of us want to get pharma out of the way in the first or second week of the exam period so we can “rest easier” with those that remain. The only problem is that there are nowhere near enough spots for everyone to do that. When we have registration next week (we haven’t been notified about the date yet), things are going to be crazy!

Pharma exam dates

Now, back to that trip to Moscow!

The Olympiad spanned four days: the first day for registration and training for the microvascular and tracheal intubation events and then three consecutive days of contests within different specialties. This being our first time, we had little idea of what to expect and hence, we decided to participate in all but two of the scheduled events. We later found out that most teams were divided into groups focusing on only one or two events, influenced by their desired future surgical specialty.

We were met at the airport by Prof. Dr. Sergei Dydykin, Head of Department of Regional Anatomy and Experimental Surgery of the 1st Moscow State Medical University, and 4th year medical student and representative of the university’s surgical club, Sergey Mindlin. From that point on, we were guided with the utmost care through our entire stay, including each and every step of the competition. In addition, we were supplied with all the requisite instruments and suturing materials we needed for the contests.IMG_5803

On the first day of the competition, we participated in the desmurgy, surgical knot-tying, tracheal intubation, gynecology, and microvascular repair contests. The day began with an Opening Ceremony where we were introduced to the members of the faculty and the 25 other teams participating in the Olympiad. Of all the teams, we were the smallest – by far! Most of the teams ranged between 10-20 students and some close to 30. While standing in the back and watching the ceremony take place, we noticed quite quickly that we were completely surrounded by students practicing knot-tying – and all of them averaging about 30-50 knots in only 30 seconds. It was at that moment that we realized what we were in for.

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All of of the contests included a case report, simulated clinical situation, lab/imaging findings, tasks and criteria. Various criteria were considering in grading each of the events (depending on the type and various components of the procedure), for example: aesthetics, stenosis, impermeability, teamwork/coordination, time to complete the procedure and theoretical knowledge of the case, and methods and materials used.

Here’s an example of the information we were given for the Abdominal Contest Amir and I did that Saturday.

Abdominal surgery contest

Clinical case: iatrogenic total hepatic duct intersection (before cystic duct joins it, type 1 Bismuth­Strasberg ) during laparoscopic cholecystectomy. 

Task: to reestablish integrity of gastrointestinal tract performing  Roux­en­Y type reconstruction (see fig.1). 

 Requirements

  1. Mobilize the intestine, ligating mesenteric arteries. Perform a stump in the end of the left intestine.  
  2. Perform a hepaticojejunoanastomy applying any preferred kind of hand suturing technique. 
  3. Perform an end­to­side jejunojejunostomy using any preferred kind of hand suturing technique. 
  4. Close defect of the mesentery. Screen Shot 2016-04-25 at 20.46.20Screen Shot 2016-04-25 at 20.42.02Screen Shot 2016-04-25 at 20.42.13Screen Shot 2016-04-25 at 20.42.28

Time given to complete the task: 70 minutes

  • Suture material provided: Vycril 4/0 ­2 packages, PDS 5/0 – 1 package, Nylon 6 (kapron) for ligatures. 
  • Surgical instruments ARE NOT PROVIDED. You are expected to use your own kit 
  • Usage of surgical staplers is forbidden. 
  • Team: 3 to 4 persons. 
  • Highest possible score – 30. 
  • The received points will be multiplied by a factor (f) according to the formula: f = 25/max points, f=0,833 
  • Material provided – ~ 6 cm long, 5­7 mm wide part of common bile duct, 45 cm long part of jejunum

Skjalg and Tamás represented us in the gynecology contest (where they received almost full marks) and the microvascular repair contest. For the gynecology contest they performed a laparoscopic salpingectomy on a pig uterus. The microvascular contest was divided into two parts: first, an end to side anastomosis on a chicken femoral artery and second, an end to side anastomosis on the iliac artery of a live rat.

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On the second day, Luca, Cintia and I took part in the endovideosurgical contest, Tiago in the trauma contest, and Skjalg and Amir in the coloproctology and cutaneous suture contests. The endovideosurgical portion also consisted of two parts: the first, a laparoscopic gastrostomy on a human stomach using one of two surgical methods (Depage-Janeway or Beck-Carrel-Jianu) and the second, a biliopancreatic bypass on a live, anesthetized pig. In the trauma contest, Tiago performed a four-core suture of an Achilles tendon – which was then tested with a 12-kg weight. Coloproctology consisted of an obstructive resection of a human sigmoid colon with creation of a double-barrel flat colostomy and the cutaneous suture contest of a necrectomy and Z-plasty.

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This was our third day in Moscow and the first day where we had time to actually see a bit of the city. On our list: Red Square!

On the third and final day, there were five total contests that took place simultaneously in one large dissection room. As a result, Cintia, Tiago, Amir and I were perform our urological and abdominal procedures at the same table, at the same time. For the urological contest, Cintia and Tiago performed an orthotopic neobladder procedure in which they made a bladder from a resection of the colon. For the abdominal contest, Amir and I were tasked with a Roux-en-y type reconstruction, which included a hepaticojejunoanastomy and end-to-side jejunojejunostomy, that we had to perform in a 15x15cm styrofoam box. While performing our tasks, we were approached by the judges as well as various students and faculty members who asked questions about our methods and decisions as to what material we’d used and why. It definitely added a whole new level of pressure and I was grateful to be at one table together as a team along with Dr. Székely, Dr. Juhos and our translator/guide Sergey, who was quick to aid us with absolutely anything we needed.

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Throughout the Olympiad we were approached by curious students wondering where we were from, why we chose to study in Hungary and how we ended up competing in Moscow. We’d organized Russian sim cards on our first day and we’re so grateful for the internet access when we found ourselves without a translator and needed google translate to carry on our conversations. It was such an amazing experience to meet fellow medical students and to share in our passion for surgery despite having such varied backgrounds. I was so struck by their drive and motivation and very humbled by the experience as a whole. We did better than expected considering that we’d only had a couple weeks of practice. The organizers of almost every one of the events remarked at how impressed they were with our efforts, especially upon hearing that it was our first time for some of the procedures. All of the students there showed a true love for surgery and the talent and drive necessary to go after it. Some of the teams had so much practice with each other that their procedures looked more like a choreographed dance than a surgical task. There was no need for them to speak because they already knew what the other was thinking and exactly what steps lay ahead.

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The Olympiad ended with a closing ceremony and an after-party at a club that they’d rented out. The ceremony was delayed for a few hours, so we went out for a bit to eat and then home to change and relax for a little bit.

Everything was in Russian (not a surprise by this point) so we weren’t really sure what was going on when the ceremony started. We soon figured out that they were giving awards for each of the events separately and then for the entire competition at the end. The surgery club of the university hosting the event (I.M. Szechenov 1st Moscow State Medical University) won the competition by a landslide. They were so, so impressive in every single one of the events. On top of their skill and preparation, they were in in charge of the Olympiad as a whole. They organized all of the events, invited all the judges, and obtained and prepared everything needed for the contests.

In one of the most heartwarming gestures of my life, we were called to stand in the front of the hall and introduced to everyone. They explained that it was our first time at this event and that it had been our first time attempting some of the procedures. Suddenly people started to stand up, first on the sides and then filling in to the center. It was such a surprise (as can be seen in my face in the first photo) and probably the most memorable part of the trip for me. It was such an amazing feeling to be honored in that way, to be honored and acknowledged for our strength and perseverance, for our venturing into the unknown. For that moment it felt like they’d pushed the competition part of it to the side and were just praising our shared passion.

The experience as a whole was something we will remember forever. It was an honor to represent Semmelweis, to attend as a team of Hungarian and International students, and to gain a glimpse into our futures. We were truly humbled and inspired by every step of the process and will use what we have learned to fuel us in our paths to becoming surgeons. We are so grateful for this opportunity, for the guidance, training and support we received from Dr. Székely and Dr. Juhos, and for the instrumental assistance and kindness of the students and faculty of I.M. Szechenov 1st Moscow State Medical University.

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