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! 

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