Monday, November 28, 2011

The Night Bus to Copenhagen

For my next Scandinavian capital tour, I decided to take the night bus from Stockholm to Copenhagen. My rationale was that it would save me the cost of one night in a hostel and would give me two full days in Copenhagen. Online, the tickets seemed cheaper than the train as well; however, the website does not like my American credit card so I had to go to Central Station and buy my tickets in person. For some reason, buying bus tickets in person is a lot more expensive then the listed price online. Since I went to buy my tickets before I had to be at the hospital one morning, I didn't have time to re-think my plan, so I went on the bus...and I will never take another night bus again if I can help it. The ride to Copenhagen was uneventful but terribly uncomfortable. I had two seats to myself which was nice but they were not ergonomically situated well for lying down comfortably in any position. I woke up about every 1-2 hours after some limb fell asleep and had to re-position myself. By the time we got to Copenhagen around 8 on Saturday morning, I was sore and felt like I needed a shower. Unfortunately I could not check into my hostel until 2 pm. I went to København H (Copenhagen's central station) and paid 5 DKK (slightly less than $1) to use the sink in order to brush my teeth, wash my face, and in general get ready to tour the city. 

My first stop after getting ready in the train station was to the tourist information center to find myself a map. I had made a list of places I might like to see while in Copenhagen, but it is always better to tour a new place with a map. The tourist center had a wonderful free map that highlighted the major tourist sights on it. It also gave a suggested walking tour route that hit most of the major tourist sights. I bought myself a coffee and a delicious Danish pastry while looking at the map and making my decision of what to do first. My pastry was amazing and so far I think Denmark is leading in my personal evaluation of the best Scandinavian pastries. After my delicious (but not so healthy) breakfast, I headed off on my walking tour of Copenhagen. 

The first sight I passed was Tivoli Gardens - an old amusement park and one of Copenhagen's major attractions. I had read about Tivoli Christmas in National Geographic Traveler who recommended it as one of the best Christmas lights displays in the world. It was on my list for Saturday night. I continued on my walking tour and saw a beautiful Town Hall with an "Occupy CPH" demonstration happening outside. From there I made my way to a few churches - Copenhagen Cathedral and St. Petri Church - and walked past the University of Copenhagen. Many of the roads were cobblestone and the buildings were large but very tasteful and fit in well with the neighborhoods of Copenhagen. The next stop on my walking tour were the King's Gardens and Rosenborg Slot - a 17th century castle with an actual moat surrounding it. Like Versailles near Paris but on a much smaller scale, the gardens were symmetrical in design and had many walking paths winding their way through the garden surrounding the castle. I then made my way to the Frihedsmuseet - a free museum about the Danish Resistance against the Nazis during WWII. It was a small museum but very well done with explanations in both Danish and English. After visiting the museum, I walked to the nearby Kastellet - a pentagram military fortress that is very well preserved. The grounds and the buildings were beautiful including a windmill and a church. From here I made my way to the Øresund strait where the famous Little Mermaid sculpture sits in the water. Walking along the strait, I saw the impressive Gefion Fountain as well as a statue of King Triton. Continuing along the shores of the strait, I passed the Museum of Art and Design, a Russian Church, and the Marble Church situated directly across from Amalienborg Palace where the royal family lives. I had a gorgeous view of opera house and the playhouse before I wound my way along Nyhavn and the Nyhavn Christmas Market. I bought my first glass of gløgg - a popular Scandinavian Christmas traditional drink of warm spiced wine. As it was nearing the time I could check into my hostel, I followed the map down one of the main shopping streets in Copenhagen that was decorated beautifully for Christmas with street decorations and window displays. I arrived at my hostel in downtown Copenhagen, checked in, and took a long awaited shower. I was comparing my map with the list I had made and discovered I had crossed off several of the sights that I had listed as wanting to see in Copenhagen. It was just starting to get dusky outside and I wanted to wait to see Tivoli for when it was completely dark and the lights were fully illuminated against the night sky. I walked to Christiansborg Palace and the Royal Library before making my way to Tivoli.

Tivoli Russian Christmas
National Geographic Traveler did not disappoint with its description of the Tivoli lights. Even though the entire gardens was bathed in Christmas lights, it was far from being over-the-top and gaudy as some of the light displays at home can be. Before I wandered too far, I decided to eat some dinner. I had decided on a place and was looking forward to having Varm Kakao and Risengrød - a traditional Christmastime dish that looks a lot like cream of wheat. Unfortunately, the man who took my order did not understand my horrible Danish pronunciation and instead of giving me Risengrød, I ended up with a glass of varm kakao and a glass of gløgg. Knowing that this would not help my hunger and instead would likely make me slightly tipsy, I walked to the neighboring stand and ordered some kind of burger. There were at least 3 different sauces put on the burger and typically I balk at any unrecognizable sauce since I have an extreme aversion to mayonaise, but I was so hungry I didn't care and scarfed down the burger. With my hunger satisfied, I started to wander through Tivoli in the misting night. I'm sure the light display is incredible any time of year, but there is something about Christmas that brings light displays to a whole new magical level. The entire gardens was decorated for Christmas and the special Tivoli Christmas theme was Russian Christmas. Beautiful stands and restaurants and rides were decorated in the theme of Russian Christmas and as I wandered through the gardens (twice), I couldn't stop taking pictures. Pictures do not do it justice and again, I must highly recommend that all of you make a trip to Copenhagen to experience a Tivoli Christmas. In fact, I have been quite impressed with all of Scandinavia's Christmas celebrations so far. They do so much with lights which I am sure stems from the fact that it is dark...all the time. But it's so beautiful and one can't help but feel joy and full of a Christmas spirit when surrounded by these beautiful lights. 

Copenhagen is a very green city as is most of Scandinavia from what I have seen so far. Tivoli has a policy of only serving beverages in re-usable cups. They charge an extra 5DKK up front when you order your drink and then have cup recycling machines in the gardens. When you return the cup, you get your 5DKK back. Genius.

I left Tivoli a little before 8 and made my way back to the hostel. I was exhausted and the weather was damp so I decided to head in and try to finish my book - The Girl Who Kicked the Hornet's Nest. I didn't finish Saturday night, but I did finish by the time I left Copenhagen - one week to ready the 563 page final novel in Stieg Larsson's series. 

I slept hard and didn't wake up until my alarm on Sunday morning. I repacked all my things and ate breakfast at the hostel and planned my day before checking out. The weather was forecasted to be quite gloomy, rainy, and windy on Sunday - perfect weather to visit some museums. When I left the hostel, it had not started raining yet, so I decided to head towards the cemetery where Hans Christian Andersen is buried. It was a good long walk, but well worth it. I passed by a church near the cemetery and saw families biking up with their children in tow to go to church. Copenhagen is one of the bike-friendliest cities in the world and they do a lot to make it bike-friendly. The even have free public bikes - you insert 20DKK to take out a bike which you get back once the bike is returned. There are bike parking lots everywhere and bike lanes on nearly every road. The cemetery was beautiful - each grave was like it's own small garden. I have never seen such decorative graves. While Paris was artsy-decorative, Denmark was a much more natural/green-decorative and I enjoyed wandering through the cemetery to see all the graves.

I made my way from the cemetery towards Denmark's National Gallery which I mistakenly thought was free on Sundays. Even though I didn't go to the museum since I didn't really want to pay when there were free museums to visit, I was glad I wandered that way because I discovered another lovely park - Ørsted - that also doubled as a sculpture garden. By the time I arrived at Ny Carlsberg Glyptotek - an art museum that was free on Sundays - I was quite wet and cold and ready to be inside. I dropped my stuff off in one of the lockers and wandered through the museum. After being to the Louvre in Paris, all art museums seem to be so small in comparison (which they are). Still, it was a very well done museum with a good mix of time periods, geographical regions, and genres of art. I spent around 2 hours wandering through the museum and stopped to eat a picnic lunch of trail mix and water before I felt ready to head back outside. Thankfully by the time I got back outside, the sun was out and the sky was clear. Instead of going to a second museum, I decided to walk to Christianhavn and visit some of the churches and Christiania (otherwise known as Freetown). I first went to Christianhavn Church and as I started to walk inside, a gentleman opened the door and informed me that there was a concert that had just started but I was welcome to come in and listen. I had forgotten that it was the first Sunday in Advent and I had stumbled upon an Advent Concert - a tradition in the Scandinavian countries. The concert was small but the singers were quite good and I really enjoyed listening to a combination of Danish and English Christmas music. About an hour later, the concert finished and the sun had just set. I stopped at a pastry shop that caught my eye and enjoyed another very delicious Danish. I wandered to Christiania and was at first impressed by the beautiful graffiti art on all free space within the commune. I didn't stay for long as it was getting quite dark and starting to rain and the winds were picking up. I made my way back across the bridge and had decided to head back to my hostel to eat dinner and check my email before heading to the night bus. The winds were blowing so strong, it was difficult to walk in a straight line across the bridge. The rain started coming down harder and by the time I got back to the hostel, I was quite cold and wet.

I finished my book and ate dinner at the hostel then got all ready for bed and changed into some comfortable traveling clothes before walking to the bus stop near København H. The first bus to pull up was an overnight bus to Oslo traveling through Göteborg, Sweden. I found out from the bus driver that my bus to Stockholm was not coming because the Øresund Bridge from Copenhagen to Malmö was closed due to the weather. When I asked what I was supposed to do, he told me to get on his bus and we would get to the bridge and "see" what happened next. I didn't feel like I had much in the way of other options so I borded the bus to Oslo. Thankfully the bus was equipped with free WiFi and I used Skype on my iPad to call my parents in panic. I knew it would be fine - I've managed this far in foreign countries and Sweden is quite easy since many people are bilingual with English as a second language. I was more concerned about getting stuck, missing a day at the hospital, having to foot the bill for a hotel room and possibly a train ticket. When we arrived at Kastrup Airport, we found out that the bridge was still closed. The new plan was to take a train from Kastrup to Malmö and then buses would meet us there to take us to either Oslo or to Stockholm. The bus driver had us wait until the train came then we all rushed to the train station where we then sat and waited because the train was delayed due to the weather. We finally borded the train and arrived in Malmö where the winds were even fiercer and I could not at all walk in a straight line to the bus. I finally did board the bus and had two seats to myself. I updated my parents that indeed I would make it back to Stockholm at some point and decided that I was done with the night bus. I slept similarly to my way to Copenhagen - waking up every couple of hours and needing to reposition. We made it to Stockholm about an hour after we were originally supposed to arrive and I got back to my dorm at 7:45. I took a shower and got ready probably faster then I ever have before and somehow managed to get to the hospital on time at 8:15. Now I am looking forward to sleeping in a bed and catching up a little on sleep. Next weekend I am headed to Helsinki so I need to rest up for my final Scandinavian capital city tour - this time traveling by boat :)

Christianhavn Church & Advent Concert

Christmas Market

Tivoli Christmas

Friday, November 25, 2011

The 11-Minute Thanksgiving Dinner

Wednesday night dinner with friends
One could almost say that clinical rotations here in Stockholm are like a continuous holiday weekend...almost. It was a little tough to get through this week since Thanksgiving is an American holiday and I would not be able to spend it with my family and friends. I did take some time to reflect on how thankful I am for all the great people in my life (including all of you faithful blog readers!) and for the opportunities I have had to go to medical school and be able to travel around the world this year meeting new people and broadening my life experiences. 

my hospital on Södermalm
This week I started on my second and final 4-week clinical rotation at Södersjukhuset - internal medicine. I was a bit tired on Monday after having spent last weekend in Oslo so it was nice that I had the opportunity to sleep in. Like rotations in Minnesota, the first day of internal medicine was orientation. Quite unlike Minnesota, the orientation didn't start until 10am and was finished by 1130am. I then had the rest of the day to myself. After an amazing weekend traveling to Norway, I was determined to figure out the rest of my excursions while I'm living in Sweden. I didn't sleep in too much on Monday so I could get to Stockholms Central Station and purchase bus tickets for this weekend's trip to Copenhagen, Denmark. As it has gotten closer to my time to leave, I have questioned the thought process of buying overnight bus tickets to save the cost of an extra night in a hostel - I'm just hoping the bus is not too crowded so I can have an entire seat to myself to sleep. On Monday I also purchased my boat ticket to travel to Helsinki the first weekend in December. Also this week I planned for my final weekend - a trip beyond the Arctic Circle to a town called Abisko in northern Sweden. Apparently it is one of the best places in the world to see the northern lights. It's also an 18 hour train trip from Stockholm. So right before I fly home, I will be taking a train to Lapland, spending about 48 hours in darkness, hopefully seeing some northern lights, and flying back to Stockholm. I'm pretty excited about all these excursions as well as the one weekend I will be staying in Stockholm which happens to be the weekend the Nobel Prizes are awarded as well as the St. Lucia celebrations!

my new attire for internal medicine
So, after buying some bus tickets, I went to my orientation. On this rotation there are only two international students and we are both from the USA. The other is a 4th year medical student from Texas who plans to move to Sweden and hopes to do her residency here.  At the orientation, I had several good pieces of information. For one, we do not have an exam at the end. Instead, we are to prepare a written patient presentation and be prepared to discuss it on the last day of the rotation. Second, we get to wear different scrubs on internal medicine - so I am done wearing cuffed pants and shirts! Granted, these scrubs are only a minor improvement - they are all white (and thereby slightly see-through) and I kind of feel like Luke Skywalker from the original Star Wars - but at least they don't have cuffs at the bottom of the pants! 

My rotation will be split in half with the first two weeks on the Endocrine/Diabetes ward and the second two weeks on the general internal medicine & stroke ward. I don't have to be at the hospital until about 815 every morning and so far this week I have left everyday by 330 - and every Thursday afternoon we have off to do independent study or work on our presentations. Yup, pretty much like a vacation with plenty of breaks for coffee to break up the days. 

Christmas lights in Stockholm
We start out the morning going through the night's reports on patients and checking lab values and looking up the information on any new patients that have come in since the day before. Then we do rounds on the patients with myself, my mentor (the equivalent of an endocrine fellow in the US), and his  "junior doctor" who just finished medical school and is doing her working year before applying for an internship. After we complete our rounds, we have a coffee then we meet with the nurses for our patients and have another set of rounding mostly just to update the nursing staff on the plan for the day. Then we have another coffee. At this point the junior doctor and sometimes my mentor do some paperwork and make phone calls. At other times, we have discussed patients or consulted some of the more senior specialists with patient questions. Soon it is time to break for lunch and I enjoy my hour off to eat my daily cheese and tomato sandwich back at Jägargatan. I also spend about twenty minutes reading Stieg Larsson and so I now find myself at the end of the week nearly finished with his third and final book. I am sure I will finish it this weekend which means I read the last one in about a week. In the afternoon we see if any of the pending tests are completed on our patients and go over those. Finally before leaving for the day, we have another set of rounds with the evening nurses. 

I learned some new interesting things about Swedish health care this week as well. Patients are entitled to "sick leave" from work and still get 80% of their paycheck while on sick leave. Anyone can take 7 days for personal sick leave but after that, a doctor's note is required. The employer pays for the sick leave for the first 2 weeks then after that, the government pays. At any given time, about 10% of the Swedish workforce is on sick leave - one of the highest rates in Europe (if not the world...) Patients who need to have extra nursing help at home that are ready to be discharged from the hospital can be "discharged" but stay at the hospital until the government arranges this home help. The government has 5 days to make the arrangements and if the patient is still in the hospital at that time, the government pays for the hospital stay until suitable arrangements are made for the patient. 

The only day that ended a little differently was today. This afternoon my mentor had a meeting so I spent my post-lunch in the medicine wing of the emergency department. Emergency medicine is not a well-developed field in Sweden and is not even really a specialty here at this point. The department is separated into a surgical ward and a medical ward which are staffed by either surgeons, internists, general practitioners, interns, or the post-medical school working junior doctors. This may be why every patient who comes to the emergency department gets labs drawn including a CBC, electrolyte panel, INR, and CRP no matter what the presenting complaint is. Seems like a waste of money and resources to me, but apparently they deem it worthwhile for its efficiency. The emergency department at Södersjukhuset is the busiest in northern Europe and on a Friday afternoon, this was readily apparent. Patients who were just being observed for a few hours had their beds lining the hallways. There are only a few "rooms" with intensive monitoring and several rooms down long hallways far away from the nearest nursing station. It is chaotic but full of variety and lots of opportunities for learning! I hope to spend some more time down there before I finish my rotation in internal medicine since I am definitely interested in Emergency Medicine. 

Café Opera in Stockholm
Outside of my time in the hospital, I continued to work out in Huddinge or swimming at Eriksdalsbadet. On Wednesday evening, I had dinner with my friends from Spain, a new friend from Germany, and a friend from Turkey. I went out to Café Opera with them for a little while before turning in for the night. On Thanksgiving, I was able to spend some time on Skype with my family and made myself a pretty sad Thanksgiving dinner of tortellini pasta which took all of 11 minutes to make. I missed the American traditional dinner as this was my first Thanksgiving away from home, but I have so much to be thankful for and it is in remembering those things that I celebrated the holiday in true Thanksgiving spirit. Soon I will be heading to Copenhagen and you will hear from me again probably on Monday with a new set of pictures and a new blog about the weekend! 

Monday, November 21, 2011

A Tour of my Heritage - Oslo, Norway

Roof of the Opera
After completing 4 weeks of a clinical rotation in Stockholm, Sweden, I finally made a weekend trip to see more of Europe. I spent this past weekend in Oslo, Norway and went with a fellow medical student from Austria that I met while living in Jägargatan. I had been hoping to go to Norway as part of my time in Sweden mostly because I was interested to see the place where half of my ancestry is from. I am 50% Norwegian meaning my mom is a full-blooded Norwegian as are my uncle and grandparents. One of my great-grandparents was from the Oslo area so it was fitting that I went to visit to see the land of my ancestors. 

I traveled to Oslo by train - a little over 6 hours from Stockholm. I had never been on a train trip before and was excited to have the experience. It was definitely nice not to have to do the driving especially since it was dark the entire way there. I was able to get a lot of reading done and finished the second book of Stieg Larsson's trilogy - The Girl Who Played with Fire. Once we arrived in Oslo, we had about a 3.5 mile walk to our hostel. We could have taken the T-Bane (Oslo's metro system) but instead elected to walk and see some of the city. Like Stockholm, Oslo is well lit at night and I was happy to discover that the city was already decorated in Christmas lights - I fell in love with Oslo instantly. Maybe this is where my mom and I get our love for Christmas and start our celebrating earlier than most... There were hostels closer to the downtown area, but I was drawn to the "free breakfast buffet" and decided that staying a little farther out would be worth it if I got a good breakfast! I was a little concerned about my photo-taking abilities on this trip. My camera had an unfortunate accident last Wednesday when I was out with Almudena and Ana. I had my camera in my back pocket so that I would remember to take pictures. Unfortunately when I went to go use the bathroom, my camera fell out of my back pocket and right into the toilet. It didn't work for a couple of days but then started to work again...kind of. Some of the buttons don't work and the flash is not working very well and it makes a really sick-sounding noise whenever I take a picture. Thankfully I brought an older back-up camera with me that doesn't take quite as good of photos but between the two I should be able to make it with adequate photos until I get back home at Christmas and can buy a new camera (they are way more expensive here than they are at home so I will wait to buy a new one).

I went to bed soon after checking in and planned to get up around 7 to start the day. Since I was only going to be there for about a day and a half and the daylight hours are getting to be quite short, I wanted to make sure to maximize the time and the light. The breakfast buffet did not disappoint! It offered a full range of food options including cereal, fruit, an assortment of breads and toppings, cheeses, vegetables, fish, and other unidentifiable food items. I enjoyed a good breakfast before my traveling companion (Andrea) and I headed out. It took a little less than an hour to walk back to downtown and we started our sightseeing by finding the Opera House. The Opera is a relatively new building that overlooks Oslofjord and has a spectacular (and FREE) view from the roof. There were beautiful clouds in the sky and the sun was still low in the sky. The view was incredible and completely breathtaking. After taking pictures from every spot on the roof of the fjord and of the city, we made our way towards Oslo S. The main road (Karl Johans Gate) through Oslo extends between Oslo S and the Royal Palace and many of the touristy things to see are along this road. We started our by touring an old cathedral then made our way to the parliament building. We then strayed off the main road and headed back towards the water to see the Nobel Peace Center and City Hall. City Hall is a large beautifully decorated brick building and is the place where every year the Nobel Peace Prize is awarded. The inside of the building was quite lovely. The main hall had murals on all of the walls and windows at the far end overlooking the fjord. I can't imagine a more peaceful and beautiful place to celebrate the world's leaders in promoting peace. From here  we headed back to Karl Johans Gate and walked through the old University buildings. We then went to the Nasjonalmuseet and discovered, contrary to the guidebooks, that it was only free to enter on Sundays. Although so far we had not spent any money to see the things we had seen, we decided it would be better to wait a day to see the museum and get to go for free. We left the art gallery and made our way towards the royal palace. Changing of the guards takes place at 1:30 every afternoon and we wanted to make it in time to watch this ceremony. We had some time before the changing of the guards and so walked around the lovely grounds of the palace. Even though the trees no longer had leaves, the grass was still green and walkways wound their way throughout the grounds. Since the palace is situated on the top of a hill, we also had a very nice view down Karl Johans Gate to central station and could see the fjord and City Hall in the background. 

City Hall
At 1:30 the changing of the guards took place. It was an elaborate and somewhat comical performance well worth watching when you make it to Oslo for a visit. What struck me the most was how young all of the guards looked. Most of them had acne and I imagine that if they talked, several of them would not yet have gone through a voice change. I'm not sure how these guards are chosen but the boys seemed awfully young. Good thing Norway is one of the most peaceful countries in the world and I doubt the royal palace is under much of a threat. 

I was pretty hungry after watching the ceremony, so I stopped for lunch at a bakery on our way towards Vigeland Park. At the bakery, I couldn't resist the delicious frosted dessert and ordered one with a coffee. Probably not the healthiest, but definitely the most Norwegian - like the Swedes, the Norwegians love their pastries with coffee. Again, I feel that some of my personal traits may be more inherited from my Scandinavian ancestors than I had thought. Vigeland Park is a large park and sculpture garden in the west of the city. Gustav Vigeland was a Norwegian sculptor and it is his work that is on display throughout the park. The sculptures are all of nude people and children and were quite interesting to look at how he chose to represent the human body. I imagine that several of the pieces would never be allowed to be publicly displayed in a free park for all to see in the US. 

Vigeland Park
After visiting the park, Andrea and I walked back along embassy row near the water towards the downtown harbor area. It was getting dark and the lights were on to light up the city in the diminishing light. It was a beautiful sight to see the building lights joined by the Christmas lights - no photos could do it justice. We wandered around the harbor and finally, after 9+ hours of walking, we decided to make our way back to the hostel, make some dinner, and go to bed.

Sunday I woke up at 7 again to get an early start to the day and maximize the time left. After another delicious and satisfying breakfast, Andrea and I started on a walk to Lake Sognsvann. One of my anatomy lab partners (a.k.a. body buddy) Colin spent some time in Oslo this past summer doing research and recommended a walk around the lake. Although it was cloudy and a bit foggy and the leaves were all off the trees, the lake was beautiful. The path around was nicely maintained with trees on either side and a beautiful view of the lake. It was obviously a popular walk as there were many walkers and runners on the path. I can only imagine what this looks like in the sunshine especially in the early fall, spring, or summer! 

Since the lake was further north of the city and would have been a 7-8 mile hike back to downtown, we elected to take the T-Bane back to the city center and then head to the Nasjonalmuseet. This art museum houses the largest collection of art in Norway and definitely the largest collection of Norwegian art. The most famous painting housed here is "Scream" by Edvard Munch, probably the most famous Norwegian artist. One room was dedicated to his works. There were also paintings and sculptures by various other Norwegian artists depicting much of the modern Norwegian art history. The museum had pieces by Picasso, Monet, Manet, VanGogh, and others. It was a well-done museum and even better to enjoy when admission was free! 

After the long morning walk and the museum, I was quite hungry once again and made my way to a nearby bakery. This time I had a more substantial lunch of coffee, pain au chocolat, and a yogurt parfait. We still had a few more hours before we needed to head back to the train station and decided to visit the large cemetery and visit the graves of Edvard Munch and Henrik Ibsen (Norwegian playwright). After touring the cemetery, we decided to walk along the Akerselva River that runs through the city. It is a lovely riverwalk with paved sidewalks on either bank. Small waterfalls are scattered along the river as well as an area with outdoor art. This is one of the things I have loved most about Oslo - you can walk anywhere and find yourself in the midst of the natural beauty of your surroundings. You also don't have to walk very far to find yourself back in the metropolitan and very cool urban areas of downtown Oslo. And with bakeries on nearly every corner...need I say more?

I slept part of the way home on the train exhausted from the previous two days of walking and seeing the highlights of Oslo. I am very glad I was able to make the trip and am very excited to share my experiences with all of you, but most especially with my Grandma Lois as I know how much she would love to visit Norway. She has always had an immense pride of her Norwegian heritage, and after visiting there, I can see why.

I have already booked my tickets for two more excursions which will round out my tour of the Scandinavian capitals and the tour of my ancestry - I will go to Copenhagen next weekend and am very excited to visit the Tivoli Gardens. Then the following weekend I'm off to Helsinki, Finland where I have ancestors from my Grandma Carol's side of the family!  So although I will be missing you all this week as Thanksgiving is not celebrated outside of the USA, I am very thankful that I have the ability to travel and see new places and even more thankful that I have such wonderful friends and family to share my experiences with :) Tack så mycket! Hej då!

Link to my photo album: (I hope it works!)

Friday, November 18, 2011

“If you don’t mind my asking, are you at the top of your class?”

This week was my final week of general surgery at Södersjukhuset which unfortunately meant both a test and a presentation on Wednesday. I had not done much in the way of studying - for some reason, even though I had more free time then ever, I easily filled it with things like working out and reading for pleasure. Plus, since I wasn’t really sure what we were responsible for knowing (general surgery + urology + anesthesia = a lot of stuff to test from), I approached it by just not really studying. Thankfully I had already done 6 weeks of general surgery back at home as well as recently took my USMLE Step 2 CK exam. And, we were repeatedly told that the test was “not too difficult”...whatever that means. The start of the week was fairly uneventful at the hospital. We changed services again and this time I was with the upper GI surgery service. It was nice that I got the opportunity to work with a resident, an intern, and a recently graduated medical student who was doing his 18+ months of optional (I think) work training prior to starting an internship. The service was relatively slow and we spent most of our time doing rounds. I did see one laparoscopic cholecystectomy in which I continually cringed as the cautery tip was placed against the gallbladder during the dissection of the gallbladder from the liver instead of inserting the cautery tip in the dissection plane and pulling away from both the liver and the gallbladder. Just as I predicted, the resident surgeon put a small hole in the gallbladder and bile spilled into the abdominal cavity. This would most likely mean increased post-operative pain for the patient and probably an extra day or two in the hospital.

I stayed up late Monday and Tuesday to finish my presentation on a patient I saw on the urology service with penile cancer and reviewed the powerpoint presentations from our anesthesia lectures on anesthesia basic principles and fluid and electrolyte balance. On exam day, we started out with a coffee (no surprise there) and a discussion of our experiences on the general surgery rotation. Our exam was entirely short answer format and was structured so that I only got one page of the exam at a time - each page provided more information (and answers to the previous page’s questions) and so I had to finish one page before I could move on to the next. The exam was a lot more difficult than I expected and I was incredibly grateful for the medical education I had received so far from the University of Minnesota, especially my general surgery rotation at St. Luke’s Hospital in Duluth with Dr. Lenz and Dr. Eginton, because I was definitely drawing on that knowledge for answering the questions on this exam. I was the first of the four of us to finish the exam and sat and drank some coffee while I waited for the others to finish and for our presentations to begin. When everyone finished, we all had another coffee and then started on the presentations. It was interesting to see how each of us interpreted the assignment and structured our presentations because they were all slightly different. I was the only one who included pictures and diagrams with my presentation and spent a lot more time on general information about penile cancer than on the patient’s particular case. This was probably because my patient had been healthy prior to this cancer and so didn’t have much of a past medical history to expand on unlike the patients that the other students presented on. We finished our presentations and were told that we would get the results of our exams and final grades within the next day or two.

traditional Turkish dinner
I went back to my dorm feeling very happy to have completed the rotation (well, except for going to the hospital on Thursday and Friday). I took advantage of the early finish to the day and went for a long swim at the pool before I came home and relaxed for a while. Almudena and Ana had invited me to a friend’s house (one of the girl’s I met last weekend) for a traditional Turkish dinner followed by going out to one of the clubs that apparently is frequented by students. I was quite tired, but felt like I should probably be social and get out for a while, so I got myself ready and went out. The dinner was delicious - a lenitl-based dish as well as rice wrapped in boiled grape leaves dipped in yogurt. We finished with fruit for dessert and an extra large kaninbulle that Ana brought. We all hung out for a while and talked and listened to music then headed out to Viper - a club that has free entrance for students. It was a fun night - the music was a good mix of international clubbing music and we had a good time dancing. By around midnight, I started to get really tired (my two beers over the course of the night didn’t help either - they just made me more tired) and by 130 am, I thought I would fall asleep standing up. Since I still had to get up the next morning and go to the hospital, I decided to make my way back to Jägargatan and go to bed. I finally turned in around 3am and my alarm woke me up unfortunately early on Thursday morning. Almudena and I both had a couple of large coffees to make it through the morning meeting. All I could think about was taking a nap and hoping that I could duck out for an extra long lunch. Thankfully, my mentor was gone for the rest of the week and since rounds are done mostly in Swedish and the ORs were not too busy with cases from our service, I was able to take a break in the morning and get in a good long nap. I went back in the afternoon feeling quite refreshed. After watching an exploratory laparotomy and another laparoscopic cholecystectomy, the surgeon in charge of the rotation found me to return an evaluation form I had asked him to fill out. I glanced at it - all 5/5 (corresponding to an “honors” grade) and he told me that he was most impressed with my exam. He said he could really find nothing wrong with it. We had a brief discussion about a couple of the questions about disease management and he told me again how impressed he was with my exam and my presentation. Then I received one of the most flattering compliments on my medical knowledge/skills I think I have ever received: “If you don’t mind my asking, are you at the top of your medical school class?” It felt good to have thoroughly impressed the surgical staff at Södersjukhuset and was a great wrap up for the rotation.

Ana, me, Almudena
Friday was pretty much like the rest of the week and I left early after watching another laparoscopic cholecystectomy to eat lunch and get ready to head to Oslo with Andrea - a new friend and medical student from Austria. As I am writing this, I am on the train trip to Oslo although this probably won’t be posted until I get back to Stockholm since we don’t have internet on the train. I am really excited about the weekend and seeing Oslo - I will be thinking of all my favorite Norwegians: Grandma Lois, mom, Uncle Keith, and Grandpa Lloyd. This trip is for you and I will try to take as many pictures as possible! Wish you were all here with me. I will write a post after my weekend and tell you all about my trip :) Hej då!

P.S. I finished the second book of the Steig Larsson trilogy - The Girl Who Played with Fire. That’s a book every two weeks for a total of nearly 1000 pages over the past 4 weeks. I’ll have the trilogy finished by the end of the first weekend in December :)

Sunday, November 13, 2011

Socks with Birkenstocks

Alright...time to switch things up. Since I am only writing one blog for the week + weekend, I'm going to start with the weekend then come back to my week at the hospital on the urology service. 

I got my first piece of mail this week - the results of my MRSA screening. For my non-medical readers, MRSA stands for methicillin-resistant Staphylococcus aureus. It is a resistant bacteria that is unfortunately common in the US but quite uncommon in Sweden - a statistic they would like to maintain. So every person who comes to Sweden or returns from Sweden from being abroad that is working with patients has to be screened for MRSA and treated if found to be colonized by MRSA in the nose or throat. Thankfully, my MRSA tests were negative so I don't have to worry about getting treatment!

liten kaffe and kanelbulle
I have a new love in Stockholm - kanelbulle. The Swedes really know how to do their sweets well. It is a thing in Sweden to get a coffee and some kind of pastry...any time of day. The favorite is a pastry called kanelbulle which is pretty much a cinnamon roll with sugar crystals on top. It's delicious. There is a chain of convenience stores called Pressbyrån that have a great selection of pastries. Their deal is to get a liten kaffe (small coffee) with a pastry for 20 SEK (or about $3). They even have a card - buy 5 and get the 6th free :) I started my card this weekend after being introduced to this delicious tradition by my Spanish friend, Almudena. When you come to Sweden (as I am sure you all will after reading my fantastic blog!), you definitely need to have the Swedish experience of kaffe and kanelbulle. 

Almudena and Ana
This weekend has been interesting for several reasons - one, it is the weekend before my last week of general surgery which means that I have to make a presentation and prepare for an exam on Wednesday. I have been attempting to work on this during the weekend although haven't exactly been the most successful in being productive. For some reason, the weekend days seem to go by really fast - I don't get up earlier than 9:30 or 10 and usually go work out and by the time I get back from that, it's already 3 in the afternoon. Secondly, this weekend was interesting because I actually went out with some people. My friend that I mentioned above, Almudena, is a medical student from Spain studying here for a year. She has a good friend, Ana, who lives across the hall from me in Jägargatan. They invited me to go out with them on Friday night. We started out by going to the apartment of a German friend of theirs who is living and working in Stockholm for dinner. We were quite an international group at this house - 4 girls from Spain, a girl from Turkey, 2 guys from Germany, 2 guys from Switzerland (one from the Italian part, one from the German part), one guy from Singapore, and me - an American. We had fun hanging out and talking for a while then went to a bar that they had heard about via Facebook that was supposed to be a great place to go out on the weekends. When we got to the bar, we learned that it was a 23+ bar and several members of our group did not meet that criteria. So the group split up. I ended up staying at the 23+ bar since there was no cover charge and I felt more like I belonged with a 23+ club then one that was 18+. The group I stayed with included one of the Swiss guys, one of the Germans, and we met up with another German girl and another Swiss guy at the bar. While waiting in the queue, I heard someone speaking what sounded like American English - turns out, it was a guy from Ohio who had been living in Sweden for 5 years and it was his birthday. We talked for a little while in line and I met the group of Swedish friends he was with. When we got into the bar, I spent the earlier part of the night with the Germans and Swiss group that I entered with but then at some point ended up talking with the American and his Swedish friends. The bar was interesting - over 90% of the music was American and it is really amusing to watch all of these Swedish people singing along and getting really into the American music. It wasn't even all contemporary - there was a fair share of bad 80s music that was played as well. According to one of the Swedes that I was talking with, this bar was not representative of the night life in Stockholm and he actually referred to it as the "white trash" bar. I didn't know they had "white trash" in Sweden and said as much - he couldn't really explain to me what people fit into this category but apparently the crowd that frequents this bar does. The bar closed at 1 am and I couldn't find the group that I had entered with and to be honest - I knew this new group for as long as I did the people I came to the bar with. So I left the bar with the American, the 3 Swedes, and a Serbian guy that was with their group and we went to another club that was apparently more representative of Swedish night life. They also served popcorn - I was in! We stayed out until this bar close at which point I was pretty tired. After getting some Swedish fast food (falafel!) I made my way to the T-bana and back to Jägargatan at a little before 5 in the morning. I fell asleep quickly by the time I went to bed and was so tired the next day that I accomplished very little. This is why I don't stay up that late...

I actually did accomplish something productive on Saturday, however. I had been hoping to go to Oslo, Norway for a weekend and for some reason, the online ticket purchasing system doesn't like any of my credit cards. So Saturday afternoon I headed to T-Centralen and Stockholm Centralstation and purchased my train ticket for Oslo! Next weekend - Norway :)

Now for the work week. This week was spent on the Urology service. All four of us international students were back together for this week. Our first day we didn't have to report until 9 which was so nice. When we arrived and met with our mentor of the week, he handed us each a schedule for the week detailing where we needed to be, the times we needed to be there, and a lecture schedule. It was a great sign that this week was going to run very smoothly and as a result be quite enjoyable - I was not disappointed! We were split into twos and each had two days in clinic and two days in the operating room. All of the urology staff knew we were going to be there that week and were very welcoming to include us in both the clinic and the operating room. This was definitely my favorite service I have been on so far. I got some good practice with prostate exams, urological disease management, inserting Foley catheters, and was able to be first assist for a total amputation of the penis for a guy with penile cancer. I won't go into more detail on that - needless to say, it was fascinating. For those of you who know about my first trip to Haiti a year ago, it was the same sort of fascinating as amputating a man's leg with elephantiasis - something you really don't see very often at all, possibly even once in a lifetime. The day I assisted in the amputation was probably my best day of the week. It was the kind of day when you are just "on." On the ward rounds, we had a patient with a UTI and I was able to impress my attending with my knowledge of antibiotic allergies - specifically the use of cephalosporins in penicillin-allergic patients. Secondly, on the ward, we had a patient with tumor literally eroding through his skin and had to do a bedside debridement and re-dress the wound. The attending forgot that I didn't speak Swedish and was asking me for things in Swedish. I didn't need any instructions to know what he needed and when he realized his mistake, he was impressed that I knew what to do without being instructed. Third, as first assist, I impressed my attending with my OR skills. I was able to anticipate what he needed me to do as his assistant without him needing to give me any instruction. He told me that I was really helpful and actually made the surgery more efficient - probably the best compliment you can get as a medical student! Our final day on the urology service, our mentor gave us lectures in the morning then took us all out for lunch in the hospital restaurant. It was a great week and I am actually going to miss urology.

One thing I noticed this week in the hospital is how much the Swedish doctors seem to love wearing socks with sandals - specifically Birkenstock sandals. I don't know if it's because the sandal-wearing season is so short, but I have never seen so many people wear socks with their sandals. It was almost as disturbing as the penis amputation. If the doc isn't wearing socks and sandals, he/she is typically wearing a pair of white clogs which also makes no sense to me especially for surgeons... I do not fit in with my footwear, and I intend to keep it that way!

This upcoming week I am back on general surgery with the upper GI service. I hope it is a good week and the presentation goes smoothly and the test is easy. I am looking forward to completing the rotation and for my weekend in Oslo!

Sunday, November 6, 2011

Just because the sun sets at 3:43 does not mean it's time for bed...

I have really started to feel my northern latitude this past week - daylight savings time ended one week ago here in Stockholm. The days are growing shorter and shorter by about 5-10 minutes per day. Right now, sun rises around 7:20 and sets by 3:45. It is completely dark by 4. Since my hospital hours are between 730-4 typically, this means that I miss all of the daylight hours. Thankfully, the hospital was built with large windows and has a great view of the city on one side and the sea on the other side. Even the ORs are well-equipped with gorgeous views. I think this is a must for people to keep their sanity during the dark winter months. In addition to having many windows, the city is very well lit as it gets dark outside. I went for an evening walk tonight and as I was taking pictures, I actually had a better picture with the flash off because of all of the lights in the city. One result of the increased hours of darkness is that I always feel like it is really late and should be going to bed soon...even at 4:30 in the afternoon. It also makes it more challenging to get the motivation to leave because it feels like it's a lot later than it is. I just need to get over it and go outside in the dark anyway. Thankfully Stockholm is a very safe city and I don't feel uncomfortable walking around by myself even in the dark.
gym in Huddinge

Today was a rather slow day - I got up and went to the gym in Huddinge (pronounced "Who-ding-ah") to work out then came home and showered, ate lunch, read for a bit then went for an evening walk. I had noticed last week when I was out shopping that they were putting up Christmas decorations in the city and was hoping that they would be lit up at night. Although there looked to be some beautiful decorations up, none of them were lit up. I am assuming they probably don't start lighting them until the Christmas season which here I believe begins with Santa Lucia Day on December 13. I will keep a look out for the lights and will definitely take pictures when they are lit as I am sure it will be quite lovely. 

This past week I had a new experience with what it feels like to be alone in a foreign country where you don't speak the language. I was waiting for the Pendeltåg (commuter train) after working out at the gym in Huddinge and the train was late. I figured that out because there is a digital sign that lists when the next train is coming, where it is headed, and also includes an extra time with some Swedish words that I assume translate into something like estimated time of arrival if a train is going to be late. The train was quite late - about 12 minutes - which I took to not be a very good sign for the health of that particular train. I was correct in this assumption. The train pulled up to the station and actually sounded kind of sickly. It moved slower than the trains usually do and sort of jerked to a stop. I looked around me and everyone else that was waiting borded the train, so I did as well. We started on our way moving at a snail's pace (literally I think I may be able to walk faster than this train was moving) which further supported my suspicions that this train was having some trouble. Two stations later we came to a stop and sat at the station for several minutes. A voice came over the intercom and said something in Swedish that I didn't understand at all. A few people got off the train, but most stayed on. Unsure of what to do, I decided to stay on the train. After about 15 more minutes of sitting at the station, another announcement was made just as another train was pulling up to the station. Again, I had no idea what any of the Swedish words meant in terms of me as a passenger and what I should be doing to deal with this train problem. I looked around me and when I noticed that most people were getting up and walking out of the train, I followed. They bordered a train on the opposite track and I again followed since I really didn't know what else to do. Thankfully that train was re-routed to the route we had been on and I made it back to Stockholms Södra station and back to my dorm. After being here and being illiterate and unable to speak or understand the language, I have a built a strong empathy for those who immigrate to a new country and don't know the language and also for anyone who is illiterate. It is a humbling experience for sure and definitely provides a different perspective and respect for all past, present, and future immigrants.

Saturday, November 5, 2011

Week 2: The TakeCare Takeover

Pool - Eriksdalsbadet
Preface: I have been a terrible photo-documentarian this week and only have one photo so far to share for the entire week 2. Also, I have quickly gotten into a routine and as such don't feel like much of a tourist which means that I haven't really done much exploring. There is one more day in the weekend so I hope to have actually done something Swedish before the start of week 3.

Alright, friends. This was my second week at Södersjukhuset and I spent it on the acute surgical ward in general surgery. I was pretty excited about this placement because there was sure to be a lot of surgery and I was looking forward to spending some time in the OR actually doing something. HA! That was definitely far from the experience that I had this week. Something that many of my medical school friends would be quite familiar with happened throughout the hospital on November 1 - a complete change of the electronic medical record system to one called TakeCare. This system change is part of an effort to get all of Stockholm on the same electronic medical record system to enhance sharing of patient information between providers and hopefully lead to providing better care for patients. I have been doing some research for my Flexible MD project on the health care system in Sweden and it is primarily funded by local county governments or municipalities. The hope is that eventually all of Sweden will be using the same system. This would likely cut down some on costs of health care as the system would provide the means for sharing medical information between hospitals, clinics, and providers. The downside to this happening this week in Sweden is that the hospital actually shut down half of the operating rooms and would not allow the acute surgery department to plan any surgeries in advance - they could only operate on acute cases that came in that week and absolutely needed to get done. This meant that instead of having an awesome week in the OR, I had a mediocre week on the surgery ward which basically functioned like a medicine ward in the US and spent a lot of time on rounds and took insanely long coffee breaks. HUGE bummer. Now, for those of you not familiar with the EMR system world, in the US, I have been through several updates of existing systems as well as the establishment of new systems. It is always a pain and it always takes forever to figure out how to use the new system and how to find things in the new system (some take longer than others to figure this out), but the hospital doesn't lessen the productivity to make it easier to transition. No way would operating rooms be shut down for this purpose. 

Unfortunately because I didn't actually get to see much surgery, I don't have much information to go on in making my evaluation of how things are done here in Sweden. But I did my best to observe the differences and similarities and find them to be quite interesting. First off, office hours. Yes, even surgeons have office hours here in Sweden and these hours are from 730-4 daily. Every once in a while a surgeon may stay until 430/5 if something is happening and they can't leave on time, but pretty much the hospital is emptied by 430 in the afternoon. Weekends are off unless you have one of the weekend shifts which are shared between the providers. Coverage for after 4 pm is done with an "evening shift" where one person stays until 8 pm followed by a "night shift" from 8 pm - 8 am. If you are on your "night shift" week, you work 3 of these shifts in a 7-day period. In addition, for taking night shifts or weekend shifts (Saturday and Sunday are split into 12-hour shifts), for every hour that you work, you get two hours of vacation time in return meaning that most surgeons and physicians in general that take call end up with about 12 weeks of paid vacation per year. Work hour restrictions in Sweden are much more strict than in the US - no one is allowed to work longer than 13 hours in a row and works a maximum of 40 hours per week with the ability to take I think one extra evening/night/weekend shift. I, trained in my American medical student ways, stayed one night for the evening and most of a night shift (until about 2 am) then showed up the following morning at 730 for the regular workday. My residents founds that to be really funny that I came in at all the next day and suggested that I put up a fuss and demand to go home immediately. They asked about a million times if I was feeling tired and suggested that I should go home early since that is what medical students in Sweden do. I did leave a little early, but I assured them that this was not unusual to stay all day, all night, and leave partway through the following day so really, I was fine.

Interestingly, I found out from two of the attending surgeons that there is a physician shortage in Sweden and in fact a shortage all over Europe, especially in specialty fields (anything other than a general practitioner). It is very difficult to get into medical school in Sweden - you must score within less than the top one percent on some exam after high school to be able to attend medical school. The nice things is that after you complete your one licensing exam after intern year, you don't take any more tests. After residency which is arranged by the resident with a particular hospital - not a standardized process or training by any means - the resident meets with his/her advisors/mentors/staff to evaluate whether or not the resident is ready to work without supervision. If they decide yes, then the paperwork is signed and the resident can start work as an overläkare (senior physician). During their training residents are allowed to do many surgeries and procedures on their own without a staff surgeon present in the operating room or even in the hospital. 

There is definitely a downside to this system that I discovered early on this week. This downside may have been partially due to the TakeCare switch and the shutting down of operating rooms, but I think it is a problem of the system in general. Every morning we gathered for a meeting with all the surgeons from each department and had a sign-out from the night shift and then went over what is called the "Acute List." The acute list is a list of patients that need surgery for any number of reasons. Every morning, the list is evaluated and it is decided which of those patients who need surgery would get surgery that day. If a surgery is not done during office hours, it likely won't get done as the evening and night shift are primarily there for emergent or highly urgent cases and so don't do things from the acute list for the most part because they don't have any support present in the hospital in case the surgery becomes more difficult. The result of this acute list is that many people wait for surgery and in some cases, this is actually harmful to the patient. There were two cases this week of patients that presented with acute appendicitis and because of being on the acute list, one waited about a day and the other a day and a half to be operated on. The end result being that the appendices in both patients were perforated and so the patients had to stay a few extra days in the hospital to get IV antibiotics. Not only do they have to stay longer in the hospital, but the risk of having post-op sepsis or an abscess increases when the appendix has perforated. We had one patient on the service who unfortunately had this as well. 

Some of the other ways I have noticed that the hospitals cut down costs is by keeping the hospital rooms extremely basic. There are a few private rooms, but most rooms hold 4 patients. There are no TVs in any of the rooms except the private rooms. There is really no waiting or lounge area for families. There are no private bathrooms in any of the rooms. If a patient is receiving IV fluids and is not in the intensive care unit, they don't have a monitor or machine to regulate the fluid flow - it is calculated by the nurses based on how fast to set the drip. I think patients probably are glad to leave as soon as they can since the hospital is really quite boring to sit in. 

One last comment on the hospital for this week. Sweden has one of the lowest infection rates in the world, and you would not guess it based on the method of surgical scrubbing. If I scrubbed for a surgical case in the US the way I did this week in Sweden, I would not have been allowed in the OR. They don't use surgical brushes but instead wash their hands well with soap, dry them with paper towels, then use a boat-load of some kind of waterless sanitizer. It was really odd and felt very wrong to scrub in especially when I walked into the OR and half the people don't have masks on (which I think I mentioned last week in my blog). Well, I guess there is not just one way to do things.

Okay, on a non-hospital related note. I didn't do much this week outside of the hospital except work out everyday and finish reading The Girl with the Dragon Tattoo by Steig Larsson (this is the most I've read for fun in the last 3 years...) I found the large swimming hall in Söder - Eriksdalsbadet - and paid for 10-time swimming pass. It was rather expensive, but I always feel better when I can do some swimming. The natatorium is beautiful with both a large 25m and 50m pool. I have enjoyed getting back in the water a few times this week and am glad that I will be able to return home in good physical shape and being better read. I just started a new book today, the second in Steig Larsson's series, The Girl who Played with Fire. Hopefully I'll do something more interesting tomorrow and can write a more exciting blog on life in Sweden outside of the hospital :) Tack så mycket för läsning!