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 :)

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