week #4

Tuesday

It was not particularly exciting. Just a normal clinic day. It was just kind of interesting to watch how important the personal secretaries seem to be to appearently all great neurosurgeons.... I have now wittnessed the third one to really have some trouble keeping up with his schedule when his secretary is on vacation..... It was kind of funny.

Wednesday

Another day in the private hospital theater. I got to intubate a patient and practiced catheterizing.... but the more exciting part of the day was the evening! It was the 25th and I was hoping to get a student rush ticket to see Madame Butterfly at the Opera House. I was really worried that it might not work out and that I got all dressed up for nothing.... but it all worked out. I managed to get a ticket worth AUS 250 for only AUS 55! So waiting till the last minute definetely payed off! Even though my heart rate and blood pressure may have slightly been out of normal limits.... ;) I got to sit in Row 13 almost in the center! It was amazing. Unfortunataly the translation was a little bit too high, so that I had to move my head a little much every time I wanted to see what they were talking about, because then I could not see the stage anymore..... The Voices were incredible and it was over way too soon!
While waiting in line I met three other students and we had a quick dinner before going to the show. Two of them were from Germany going to a Language school and the third one was from Japan. The girl from Germany was a lawyer and her name was Anja... (I thought that was kind of funny....) It was a wounderful evening and I am glad I took the chance to wait and not get a for sure ticket....

Thursday

It was a short day in the hospital. We only had one surgery. It was a little bit frustrating to be in the public theater again.... And I was also hoping to finally get to do a little bit more during surgery, since I had been so patient and always let other students who weren't here quite as long as I am go first.... and then this time the intern got to do the exciting things..... It just didn't seem fair, but then life is not fair. (With everybody else I probably would not have minded, since interns are higher in hierachy than students, but it was the fact that is was her that really bothered me.... because she just knows when to say the right things to impress people and when to do overtime.... and she is not very nice to her fellow intern, bossy.... long story!) Anyway. I am hoping to have a go next week. (Never give up hope!)
After the surgery was over I left for the day and decided to go to the harbour and get the most out of my weekly ferry/bus/train ticket. I took two different ferries. I got to go all the way to the west end of the habour (Paramatta): that was a one hour ferry trip! On the way back it was getting dark and I could enjoy the sunset... Really pretty. I sat down next to an older gentlemen, who really loves his town and he was an wounderful tour guide. He told me about places we passed, how things have changed over time... Very cool. On the way back a biochemist from Canada, who is in Australia to do "work and travel" joined us. She is really nice and as it turned out her parents were both from Germany. Once we got off the boat we wandered around circular quai and the rocks for a little while. It was great to have some company and it is amazing how easily one can meet nice people that are willing to share some of their time. The past two days reminded me a little of Hape Kerkelings story (meeting people on the journey, spending some time, nothing serious, just some time not alone....)

Friday

This is probably the most exciting day of the week! My registrar had allowed me to take the day off, so that I could really use up my weekly pass.... I spend most of the day at Taronga Zoo. It is not a big zoo, but a really pretty one and the scenery is awesame. I got to see Koala, Kangaroos, Penguins, Meercats, Wombats, those animals, whose name I can't remember, but that sounds like Enchiladas... Unfortuantaly no Platapus... I would have loved to see them as well. I had a great time. I payed some extra money to be able to go into the Koala Area and see them close up and get a picture with them... Really cool. They are looking so soft! I also saw the bird show with an amazing view acros the harbour and the sealion show. There would have been so much more to do and see, but I was glad that I got to see all the animals....
After the visit to the zoo the day wasn't over. I DID THE BRIDGE CLIMB! It is insanely expensive,but an incredible experience. 700steps, and then the sunset 134m above sea level.... It was amazing! We were on the bridge for almost three hours. I had shaky knees at first and my stomach was little bit unhappy at first, but all that was over once we stepped on the arch. The view is incredible! And reaching the summit is an incredible feeling......
Later that night I used the last chance to take a ferry before my pass expired and took a ferry to neutral Bay to see the harbour at night.... Amazing!!!! I think it will take me a while to digest all those amazing impressions...

Unfortunately at this moment I can't share any pictures with you, because I am only at a public internet cafe to at least give you an update..... Amazing pictures will follow soon....

no internet

hi everybody. I am still on the face of this earth. I have been very busy over the past week and just wanted to start telling you all about the exciting things.... But I just got told by security, that I can not be in the building anymore and that means not internet access for me until I move... Not even on weekends anymore... I hope you all are doing fine. Tim I hope you had a terrif Birthday and enjoyed the slightride.... I am thinking of you all.

I have had a chance to see Madame Butterfly yesterday and on tomorrow I will do the bridge climb... I wish I could tell you all more about it!

9-5?!?!?!?!

There is no nine to five in surgery..... and I honestly don't mind.... ;)
I started the day with a spine meeting at 7am this morning. The cases are incredebly interesting, so it is definetely worse getting up and seeing things! Later I got to attend pediatric neurosurgical rounds, it was quick, but still great to see some pediatric cases! And then I went to the private hospital. As long as no one cares I will always choose their theater over the public ones. The atmosphere is so much nicer and the teaching is a lot better as well.... I left around noon though to see patients in the preadmission clinic and show my face in the public hosptial again, but since there were only three patients to be seen this afternoon and the surgeries ahd started late this morning so that the case I really wanted to see was just about to start, I managed to get out of clinic and went back to the Theater.... That was at 1.30pm and now it is 8pm and that case is just finished and there are still two more to go.... I want to see the next case as well, but I believe I will probably not stay for the last one, but we'll see how things go. Dr. Teo constantly surprises me how quickly he can finish cases that seem to be major and incredebly long for any other surgeon.... and after all what's waiting outside the hospital - my room and an evening with me, myself and I... So I might as well stay here, see some cool things and enjoy the company..... And we get dinner for free, which is always a plus for a poor medical student.... ;)

Part II
Dinner was delicious.... And afterwards I managed to make the entire theater laugh at me... I got to catheterize my first real male patient (before it had only been dolls...)..... A real penis is way slippier and a lot harder to hold onto with all the glibbery stuff that has to go into the urethra to make the catherter slight in more smoothly.... And of course it being a first it took me a lot longer and everybody watching definetely got a kick out of it. The anesthesists comment in the end was: "Hey we all enjoyed it, even the patient.... ;)".....

brunch and the walk around South Head

This morning I got picked up by Morgan (Neurosurgeon from Milan, Italy) and his girlfriend (Radiologist from Milan). We all were invited to have Brunch with Charlie (Australien Neurosurgeon) and his family. Morgan was perfectly on time considering that he is Italian.... ;) It was really nice to get to know everybody outside the hospital and the food was really good!!!!!
In the early afternoon I left and walked with Aneela to Bondi Junction to take the bus to circular quai. She was late for an appointment and after having done the Manly scenic walk yesterday I could barely keep up with her. That was quite embarrasing..... I had never taken the Bus from Bondi Junction before, so I got to see some new neighbourhoods... Really pretty! Sydney got some really really nice streets - small, neat houses, little yards in front of them, lot of trees, little cafés and shops..... Then I took the ferry to Watson bay. And guess what - it was sunny all afternoon, a little hazy, but sunny!!!!! I woke up to a blue sky in the morning, but that changed sometime between 8.30 and 10... and I did expect some rain in the afternoon again, but fortunately I was wrong about that. Once I got to Watson Bay I did another one of the tours from my book. I walked to the light house on South Head. South Head is the southern border of the entrance to the Sydney Harbor. It's like a little peninsula and it has been used to protect the harbour from invasions, which is still very visible all along the coastal line there..... I also tried to see the Navy Chapel which was marked as one of the things to be seen in my tour guide, but there were guards that wouldn't let me go through..... I thought that was kind of strange since the tour guide didn't make it look like some really well protected piece of land, but appearantly they aren't right all the time! Walking along the coast was once again pretty spectacular. I can't get enough the turquoise color of the water, the cliffs, the breath.... and the Sydney skyline almost always visible. The plants are also really incredible. Today I realized why some of the pine trees kept looking sort of weird to me and I could not quite figure out why... It looks as if their needles are pointing the wrong way.... After I had finished the walk I layed down in the grass in a park with a book and enjoyed an hour of evening sun, before I took the ferry back - into the sunset..... Circular Quai is really lively and since I wasn't quite ready to go back to my small room, I walked around there for a while and enjoyed being surounded by people. It makes me calm just sitting there, enjoying the warmth and watching people..... They all seem to be so very relaxed and that somehow transfers..... It is a really cool city with a great way of life!

Manly Scenic Walk

Friday was a regular hospital day... It was Michelle's last day and the neurosurgical team from the public hospital went out to have coffee together after we had finished rounds. Later wasn't much to do. I helped them "stick needles into patients" and afterwards joined Charlie in his clinic again, since there was nothing left to do on the ward. Clinic was once again really interesting. And I did see him tell a patient that the tumor was inoperable for the first time. I also saw how he deals with patients that aren't sure about whether or not they want surgery.... he tells them not to have it! Which is really good, because usually those are the patients who will end up having complications. And after having seen a patient where everybody in the room agreed that the he did not want surgery, Charlie once more explained to us the importance of never trying to convince a patient that surgery would be best for him....
Today I was hoping for the 10-25% chance of rain, which had been on the forecast for the past week..... But it did not happen: we had showers all morning, but those weren't bad and I did not let them stop me! I took the ferry to Manly. That is a beach at the nothern side of the habour. It is really long and nice beach. Manly too is a pretty litte tourist suburb..... I really enjoyed the colorfull houses along the main tourist streets even though it was raining and thunder storming a little.... When the little baby thunderstorm started I was hoping it would pass through just like all the other little showers and started the Manly scenic walk even though it was raining quite a bit. And I was lucky, after about 30minutes the rain stopped and never started like that again. I had to deal with some spaying and the second rain of the forest, but other than that it stayed dry!!!!! I did not regret having taken the chance and doing the 10km walk along the coast. I had some incredible views across the harbour and parts of the town. The way through the Sydney national Coast park was very adventurous as well - natural stone stairs, small walk ways, lots of trees and very very green plants, ups and downs, wooden walkways overcrossing little waterfalls.... It was really, really great, even though once I got to the part where one had to walk along the beach I whished I had had some more solid ground, because after at least 8-9km of walking up and down, climbing stones .... my feet did not enjoy walking on the slippery sand.... But anyway it was as great trip along the coast again, even though I did not get to see quite as much water this time, because most of the time I was walking surrounded by trees/plants.... Unfortunataly most of the animals were always way to quick for me to be observed closely or even have their picture taken...... And they (birds, lizzards....) do blend in perfectly as well, so they are really really hard to see.
When I finally got to the bus stop where I was supposed to catch a bus going back into town I could not find the numbers from my Sydney guide on the list of busses stopping at that particular stop.... Taking busses is quite convenient, but also really hard if you don't know where you're going.... I don't know how other tourists do it, because on the bus you can't really tell where you are and you never know when the next stop comes up and what it is going to be. The bus ride was quite adventurous as well. I have mentioned before that the bus drivers seem to be pretty ruthless drivers.... Today one bus drive came so close to our bus that it tore off the mirror.... We all had to get off the damaged bus and onto the next one.... And I only knew where to get off, because I knew once we had crossed the Sydney harbour bridge that I was close to circular cay where the bus to Randwick leaves..... So I took the next stop after we had crossed the bridge, then got my map out and figured out where I was....

the excitment of Surgeries....

Yesterday was another Charlie day.... We got to the operating room (Theater, as they call it here) around 8.30 and did not finish surgeries until close to Midnight. Which was still amazing, because considering that he did 3 tumor surgeries und two small cases and got done by midnight is just incredible. I thought the first surgy would take at least 6-7hours and he was done after 4!!!!! It is just incredible. He is quick, efficient and knows exactly what he is doing. It is amazing to watch him and it is even better to be able to assist him.... At 10pm he finally asked me if I wanted to scrub in - what a question! He could have asked me at midnight and I still would have said yes! During the day I got a little upset, because I am not blond and not skinny... and those girls seems to get more attention and chances quicker.... But at some point it was my turn, and I loved it!
After the last surgery was over he invited everbody out to dinner, but I wasn't hungry and wanted to be able to assist with surgeries today and therefore decided to not go at 1am.... it was probably the more reasonable thing to do, but going out would maybe have made things a little bit easier, since those social events always help getting to know people better and have more in common. Maybe next time, even though I don't think that there will be a single day when his surgeries will be over before midnight!
Today I had to jump a few more hops before I was allowed to scrub in, and I believe I may have made the nurses a little bit mad at me, but I just didn't want to accept being told by the scrub nurse to not scrub after I had done all the required things and the surgeons wanted me to assist. Today it was just too much and I did not want to quietly accept it. So fortunately my registrar backed me up and we worked it out together. But it was once again ridicolous!!!!! Apperantly my supervisor had sent out an Email that no student was allowed to scrub on neurosurgical cases (by the way this is a teaching hospital!!!) That message was passed on to the scrub nurses and appearently the note about us being allowed to scrub after we have had the training wasn't.... So we called my supervisor and even though he said over the phone that I am allowed to scrub (since I am on his service and had the session) the scrub nurse still insisted on not letting me do it. Which just really upset me (but I kept that to myself, since getting made wouldn't have made her change her mind and I just let my registrar handle all the frustration....)It is just insane if someone who has made a rule can't make changes to that rule! Anyway we had to go to the next important nurse and she too was not impressed by the phone call and the message from my supervisor who specifically said that I could assist and get scrubbed, because he had sent out an Email a few weeks ago.... We finally found another person, who was able to clearify (not a doctor, not even a nurse!!!!) the whole situation and said since my supervisor said it was ok and since I had had the sessio I was allowed to scrub. And then all of a sudden everybody else wouldn't opose anymore, but I think it is just so frustrating since this is a teaching hospital and the nurses and the Theater stuff (not even the doctors) make it so hard for us to learn.... I don't even want to do much, I just want to scrub in, because I can see better and I don't have to worry about contaminating anything when trying to see better! Once we took care of all that I had two awesome surgical experiences. One of the patients I had seen on Monday in preadmission clinic. I was allowed to assist a little bit and help with the closure. I still haven't quite figured out how to not hurt the needle.... My needles always look like someone tried to kill them once I am done with sutures. The skin on the head is really thick, but the experiences surgeons don't bend their needles... So I still need to work on how to apply the right amount of pressure and how to move it through the tissue smoothely..... But it is still great and I feel more comfortable with the instruments every single time. Even tying a knot doesn't seem awkward anymore - not even with my left hand, because before I came here I had always practiced and done it with my right hand and now I had to learn how to do it with my left hand, which makes holding on to the instruments a lot easier, but was really hard at first. With the second case of the day I even got to assist more, because it was just me and the surgeon! Really, really cool! But I really got to experience the difference between the public and the private hospital today.... The nurses and anesthesia in the private hospital are so much quicker! Yesterday the turnover time was so much quicker and when the surgeon asked for something he/she didn't have to wait several minutes to get it. They were all interested in getting things done quickly, whereas today some things were done soooooooooooo slowly.... For Example with the first case: the patient was taken to the operating room around 8 and we did not start the case until close to 10!!!!!!
But anyway. I had a great time with the surgeries today and I might get some more experience next week on Thursday, when todays surgeon will operate again (she is a female neurosurgeon and so nice!!!!!)

Brain Tumor Clinic

Some Days are definetely better than others. Today I decided to join one of the famous Australian Neurosurgeons in his clinic again. Since he is so well known, many patients that aren't offered any treatment elsewhere do come here to see him. So he has got some really neat cases! And he takes time to explain things to students as well. Time goes by really fastwhen being with him. He had actually offered to supervise me before I came here, but since he is not a University professor that did not work and I would not have gotten credit for it back home...
Some of the patients we have seen today he will operate on tomorrow. That is pretty amazing! Come and see him today and have surgery tomorrow....The surgical schedule will be pretty busy though tomorrow and we will probably be in the operating room till after midnight.... I am still looking forward to that though, because there will be some really really interesting cases and some really exciting procedures. (two very malignant brain tumors, a probaly non malignant brain stem tumor - but a high risk procedure because of the location (probably 5-6hours), and two minor procedures) And as already said, he likes to teach....
I just worry a little about not being in the public hospital, where my supervisor mostly operates, but he is not around most of the time anyway, has not once invited me to join his clinic and as far as I know there aren't any surgeries on tomorrow.
I still don't really know 100% what is expected of me and where I have to be and what conferences I have to attend and when they all are. America may have been very stressfull and there were a lot of things to do, but at least after a few days I sort of knew what was expected and where we had to be and when we had to be there....
I tried to find the other doctors today after clinic was over and nobody was on the ward anymore. I left a note on the message board and I hope that is ok. They all communicate over the cell phones..... I don't have one and I am not quite used to the more relaxed way of doing things around here (and I am not sure if I like it - I hate incertainty!). For Example this morning we had a meeting at 7.30 and I was the only one there at 7.30, everybody else showed up after that..... But that's how things seem to work around here....

a day on the ward and in clinic

Last night I wanted to go to bed early, get some good night sleep and start the week well restest.... well I did not quite make it.... I looked myself out of the room and had to wait for security to let me back in - so I spend almost 20minutes in the hallway already dressed in my pyjamas with only my tooth brush and my tooth paste and a towel.... The doors to the rooms are really tricky, once they fall shut behind one, they can only be opened with the key, so I have to take my key with me whenever I leave the room. I was scared since day one that I will forget at some point and it happened last night.... Fortunataly the security people got a general key and I am not the first to forgett the key - I at least got to wear some real clothes and not just a towel.... ;)
This morning I then almost overslept, because for some reason I must have turned my alarm off during the night.... I am still not able to sleep all night without waking up. I don't know if it is because of the noise (wind, cars) or the cold.... (because the windows don't close properly it feels as if I am outside.... Alex the American neurosurgical fellow actually said "it is like camping outside" and he is sort of right about that.... ) So anyway I am trying to get used to it and thanks to the "survive the cold training" at Tim and Deb's house I am used to wearing sweaters at night and wrapping up in more than just one blanket.... ;)
The day started with a neurooncology meeting. We reviewed scans with the radiologist, radiothearpist and chemotherapists. That was pretty interesting. Afterwards the whole team went for coffee at a nearby restaurant. So that was a great start to a Monday..... It is nice to get to know them outside the hospital as well, because that reveals sides otherwise completely hidden....
Later during the day Michelle and I helped on the ward. We examined a patient and I learned how to make proper notes in the chart and write a consult. I am still having difficulties finding the right words to describe what I have found on examination. Fortunataly they are all really helpfull and when I describe what I found they give me the correct English medical term for that! I also tried to put a peripheral venous catheter in, but the patient just did not have any veins... Not even the intern managed to get on in....
During lunch time we went outside, because guess what: we're back in the hospital and the sun is back outside, but only long enough till our work day is over - seems like it got the same working hours as we do.... !
In the afternoon we had preadmission clinic. That's when we see patients who will have surgery during the week. That is really great, because we get to draw blood (don't have to, but can if we wish), then take the history, examen the patient and afterwards present our findings to the registrar - some real patient interaction! Knowing the history of a patient makes their surgery more exciting as well.... So I am already looking forward to tomorrows sugery... The patient had had a fracture of his first vertebra 10month ago and has been wearing a stiff colar since!!!! I just couldn't believe that noone has offered him surgery yet....
The neurological exams are still giving me a hard time... Not the exam itself, but writting down my findings using correct medical terms. It is a little bit frustrating some times, but at least having had the American training of how to organise a note in the chart and presenting patients propperly makes that part easier - now I just need to learn all the neurological terms and I am finding new ones I don't know every day..... I hadn't thought it was going to be that hard after already having had exposure to Neurosurgery in English....

Australian Museum

Since today was another non sunny day I decided to not take the chance again and get soaked and decided to visit the Australian Museum.... Many other people did have the exact same idea, because it took me almost 20minutes to get inside!
But it was definetely worth it and when they told people to leave at 5pm I was a little sad that I did not have more time to look at things. It was like exploring a whole new world. I am definetely on the other half of the planet. The two most important expositions to me where the ones about the Australian native tribes and the Australian animals. I managed to see both and it was fascinating, but so much that I believe I will forget a lot of what I have read soon. The part on the Aborigines was really great. They showed arts and craft work and described the struggle with the British.... Very interesting. They also had a native Australian perform and talk about some of their traditions. I once again had some difficulty understanding everything at first, because the Australian accent is still giving me a hard time, but it was definetely very interesting.... He explained some of the parts of the music and dance moves they made and it made it so much more interesting listening to him afterwards and watching him knowing what he was "talking" about.....
The part about the animals was like exploring a whole new world. When I went to America talking about animals and plants wasn't really hard, I knew what I saw and only little was different from Germany, but here a lot of things are so very different.... It was almost overwhelming all the information and new names that I read.... I am definetely on the other side of the globe and closer to the equator, but very very fascinating!!!!!!
I have also seen the exposition with animal skeletons (Sabine, you would have loved it - I took many pictures!!!!) and the gem stones. It is amazing how many different kinds Australia has to offer, different in shape, different in color..... Very neat!
They also showed pictures from an international wildlife photocontest! Pretty amazing pictures... Just like National Geographic pictures.....
I did not get to see the part on Dinausaurs in Australia, but I did not really care about them that much anyway. It is also a really great place to do and try out things. Unfortunately I did not have any time for that either.....

A day at Centennial Park and the Race Track

Once again it was grey when I woke up, but at least not raining.... Even though that was going to change during that day.
Despite the grey sky and the 30%change of rain for the day I decided to go ahead with my plans and walk to Centennial Park (one of the biggest and oldest Parks of Sydney). And I can tell you it is big! It took me about 2,5hours to get through the main part.... It is a really pretty park in the middle of Sydney. Almost hard to believe that I was still in one of the world's most famous cities.... I think the variety of trees was what impressed me the most. The pine trees looked just like the ones back home in the dry forests of Brandenburg and then I turned around and saw palm trees and huge impressive trees that could as well have been growing in the middle of the rain forest.... The different birds are fun to watch as well.... And the colors of the flowers. The red and yellow just seems to be to much more saturated and that even without the sun! I had a great time wandering around the park even though it started to rain a little....
Later I went to the Race Track just as planned. I did not get there right from the beginning but that was not the plan anyway... I got a race book and I did bet on a few races. Thanks to the Tim School of How to bet on Horses ;) I actually managed to pick a few good horses and got to cash two tickets and ended up loosing only 40cents.... It was exciting, but just not quite the same as at Churchill Downs. Churchill Downs is prettier and of course its so much more fun if you actually got someone to talk to about who to bet one... Mammoth refused to help me out (appearently he doesn't like to bet....) But we watched the races together.
It started to rain really badly while I was at the race track and when I left to go to the Fox Studios my feet got really soaked! That was probably also partially due to a big detour that I took. I guess the "short cut" problem runs in the family ;) I thought I could take a small road to the Entertainment center, but I was wrong (there were walls in the real word that my map didn't show). I ended up walking for about an extra 45minutes, but I got to see all sides of the Cricket Stadium....and another nice pond with really cool old and huge trees.... Michelle had suggested that I should go to the Fox Studios in the Evening some day, because they got a lot of shops and small restaurants there. And she was right. There were thwo or three movie theaters and lots of bars and restaurants.... And guess what I found there as well. It's almost unbelievable - they are everywhere - THE BAVARIANS!!! They had a Bavarian Beer Café there.... So I can cross that off the list now too and after almost 10hours on my feet I got back to my room and enjoyed a movie.... and wished I had had company and a maybe a glass of wine or bourbon..... ;)

Who stole the sun?!?!?!?!

Some kind of grinch stole the sun and hid it behind rainy clouds.... I want the sun back!!!!!! As you may be able to guess - it was raining again today!
Michelle picked me up around 11 and we went to Newtown and the Sydney University. Fortunately it stopped raining on our way into town and we did get a chance to wander around Sydney University and Victoria Park. The University of Sydney has the oldes medical school (150years.... ;)) and is incredebly pretty. It looks like an old british Castle and People actually go there to have their wedding pictures taken! It is Michelle's University, because she is just like me just a visiting student to UNSW (University of New South Wales). We walked around campus and I got to admire all the pretty buildings and their nice University hospital. Afterwards we went to Newtown, a part of town close to the University with lots of restaurants, bars and shops. Many of the students go there for lunch or dinner at night, because it is not very expensive. It's a pretty "young" part of town and you can meet quite a few excentric people there. We ate at a Thai restaurant - very tasty. Afterwards we walked along the street and back to Victora park, which is right in front of the main University building. It is really really pretty, with a lake and flowers, many trees and lots of noisy birds..... I am really glad that we got to spend a few hours outside the hospital today and that she took me to a place that I would otherwise probably not have visited!
Later in the afternoon it started raining again and after I had finished my grocery shopping and laundry I didn't do much exciting. The girls on the floor wanted to go out again, but I decided it was the kind of night to stay in and do nothing exciting, but rest and read....
I really hope that it will stop raining soon and that tomorrow will be a better day, because its weekend and I want to explore the town!!!!! I already got a bad weather plan, but there are races at the Royal Randwick Race Course tomorrow..... And horse races are a lot more fun without rain!

Education?!?!?!

Today I got really frustated for the. We did not have much to do on the ward and after rounds all that was left to do was to place a peripheral intravenous catheter.... When I walked into the doctors room I saw a book and book that could answer many of the questions I had.... teach me words that I did not know and wanted to learn to get better at expressing myself in English.... It was a really great book with a lot of anatomical terms (which do still give me a hard time) Since the internet is not working at most of the computers and since the number of computers is very limited as well (and most of them are used for real doctor work) I have not been able to look things up while being in the hospital (no internet, no ebooks....) Therefore I was really happy to finally find a book, because those seem to be rare around here as well and the library closes at 5pm (no way I can get there on a regular day...) Anyway I found a few pages that were really great and I went to make a copy.... Suddenly an attending showed up behind me and told me I am not allowed to read that book, because it is for registrars only and for students..... I can understand that those books are really expensive, but not allowing a student, who is supposed to learn to read a book what's up with that!!!! So I returned the book to where I had found it (which was appearently not the place where she wanted it to be.... so she confronted me again later in front of my registrar....) She basically accused me in front of my registrar to have gone into a restricted room, which made me look really bad and that only because I wanted to learn something.... After that incident and the minor frustation over not being able to look things up when required and not being well prepared before surgery (no internet in my room, no internet in the hospital, no books, no ebooks....) I went to the university book store today and I found what I needed - a small anatomy review book that fits in any pocket!!!! But I still think it is kind of weird that they hide books from students, since they are the ones who really need to learn things...... But appearently once again someone must have screwed up in the past....
Other than that the day was not really exciting. Michelle and I had another MRI session with one of the italian fellow. Some people just send their scans in and ask for advice to make sure they don't come in for nothing, because some of the patients that are seen in the private clinic have to fly in..... We got to see a lot of really interesting and different tumors and it is amazing how well they can be differentiated even on scans.....
Tomorrow is a hospital off day.... Once again I had no idea that such a thing exists, but it gives almost everybody a 3day weekend, because the day is considered to be a weekend day with weekend schedule.... Michelle and I will meet for lunch and then she wants to show me parts of the town that may not be in my tourist guide.... But at first I will sleep in!!!!! I am finally getting used to the time and I am starting to be a bit tired from not having slept well over the past few weeks.... I am also still getting used to the noise. It was so quit at Tim and Deb's and now I am living close the the helicopter landing area, the Emergency room and a big street and my windows don't close properly, which makes it noisier and cold.... Thanks to Lisa I was comfortably warm last night, because she had some extra blankets that she could give. It does get quite chilly at night and the people, who could provide me with extra blankets start work after I leave and finish before I get back.....

The pictures are taken at the University of New South Wales. It's incredebly green everywhere, some areas actually remind me of a dschungle or the rain forest.... I think it is really pretty and from some of the dorms the students can see the skyline of Sydney!

getting to know people....

Sorry for not writting last night, but some of the girls on my floor decided to go out for dinner and I figured I take the chance and get to know some more people.... Most of these girls were nurses and originally from Britain. It was good to spend some time with people outside the hospital, but over all I don't think our interests are quite the same.... I really enjoy talking to Lisa a pediatrician from England though, she is really nice and was the first I met on my floor....
At work we spend most of the time in the OR. I got to assist with a spine surgery (first assistant!!!!) and close the skin (10cm!!!!) Afterwards I also got to see how the placed a shunt from the spinal cord into the pleural space - pretty cool!!!!! And I had no idea you could do that. They do a lot of really intersting surgeries here that I have not seen during any of my previous neurosurgical rotations - I really like that! More exposure, more experience and many many "ah, that's how it's done or now it makes sense"-moments....
So now I am on my way back to work and have to get moving to not be late for rounds!

finally!!!!!

Today it was raining... so no worries about fires around here! So far we are save in Sydney!
This morning we had a teaching conference. They really do a great job teaching!!!! Yesterday we had a lesson on brain tumors, today Michelle and I had to describe MRIs and CT scans to the group as if we were talking to an attending over the phone and in the early evening we had pathology conference about histopathology of brain tumors. All of that is really great and even though it sometimes seems way too much to remember I really hope that a lot of that stuff sticks. And the fact that we are asked to participate and do things is really, really helpful! I really enjoy that and fortunately I am getting used to the time as well and am not quite as tired anymore.
The days are still pretty long though, but with the rain outside today it wasn't all that bad to be in the hospital for 10hours. And we got to do a lot all day long, so it definetely did not feel like that much at all. As I already said we started out with our teaching session. I still had some trouble usind the right words and describing things in the right way, but they told me that I basically did mention everything and that I just need to work on how to word it correctly... After that we went to the OR. the first case was a craniotomy for a recurrent brain tumor. At the end of the case I finally got to scrub in for the first time!!! That was really great. I got to help the registrar close up the scalp wound! It was the first time that I got to suture the galea (the layer between skin and bone). I only got to do a little bit, because I still need to learn how to be quicker, but the registrar is an incredebly patient man and always stays calm and explains things very well.... With someone else I may have gotten nervous, because at first I did have trouble with the instruments again and how to hold them right when making the knot, but not with him.... Later I also got to do part of the skin closure! The second and third case of the day were implants of a vagal nerve stimulator. I had never seen that before and I once again was really excited when I got to scrub in, because it just makes following the surgery so much easier! I got to look at things closely without having to worry about making something nonsteril. At the end of the third case Michelle and I got to do another suture, this time it was an subcuticular one. Once again we did take a lot longer than an experienced surgeon, but it is really great the we are allowed to take the time and become more experienced with all kinds of sutures! Today was just like what I want it to be - having the chance to get close to the operating field to really see what's going on and seeing the anatomy of things and to once in a while get to do something myself....
Shortly after 6 I finally left the hospital, even though I could have gone to another conference, but I was starting to get tired and I could not have handeled another 3hour meeting, even though it was one of my favorites (morbidity and mortality conference....) But since I will be here another 7 weeks I am hoping that there will be more of those. In America the conference was at 6.30 am and here it is from 6 to 9pm.... Why can't they just do that at a time when people are actually awake enough to follow....
Anyway they days in the hospital aren't quite as short as promised, but that is ok as long as I get to learn, see and do things.... I believe I have picked a pretty good hospital - lots of nice people and lots of teaching going on!
The only thing I really don't like is the fact that google and wikipedia are blocked on all computers.... I am so used to looking things up during the day (because I hardly ever have the right kind of book with me) and now I can't just go online to find a definition for something or look up some anatomical structures before surgery anymore.... And it makes it a little harder for me, because seeing a word in writing sometimes helps me understand things better than just hearing it... How did generations before us (without those sites) survive in their internships....;)

surprise, surprise....

Last night I had a hard time falling asleep, because I was worried my window was going to fall out.... For some reason even after having closed it the curtains were still moving as if the window was open and it was still as noisy as if it had never been closed.... so all that seemed very strange. I had a look at it again and I found that I could not close it tight anymore.... some part at the top looked as if it was a little lose and I had not noticed that before, but then I had not payed close attention to that.... I am definetely staying at a very old house that could use some care taking....
This morning there was no sunshine when I woke up :(.... Just grey sky! So I got up and thought it was going to be just a regular Monday, beginning of the week, nothing much going on, but I was wrong!
The morning started out with a spine meeting and I can tell you if you have a car accident, let it not happen in Italy!!!! I have heard a scary story and seen crazy pictures of things they do there..... Later on Michelle and I finally had our scrubbing lesson! So now we are officially allowed to scrub in. The lady at the front desk still drives me crazy... I don't want to hear about her weekend, I just want the green sticker, but she definetely needs someone to talk to (poor Lady, but not me!!!!) and she uses her power over the green sticker to make us listen to her stories! The Lady who showed us how to scrub properly had a weird attitude, but it was definetely helpful to see how it is done here, except that she had not done it for a long time and had to read things from a paper that was posted up on the wall.... As we could not have done that on our own..... But there is one thing I definetely need to practice: gowning! In Australia surgeons have to gown themselves! Nurses don't do it!!!!!! And that is not easy!
Oh and the lady at the front desk did not just tell us what she did all weekend before handing us the green sticker, but also about the "no students in the OR before 8.30 rule". It seems as if there is a new ridicolous rule every day.... One of the fellows told us today that she got written up because she had forgotten to fill out one form and was therefore not working fully accredited to work in the public OR... It was a form to get a locker in the change room!!!!! And there are many more stories....
After our scrubbing session we went back to the ward, where our Registrar told us that Dr. Teo had just called him to have us come and observe him today and then go out on a boat to take a tour of the harbor!!!!! So that was really exciting. And of course I did not hesistate to take that offer. So we had a teaching session on brain tumors and after that went to the harbor together with the American and Italian Fellow. It was awesome! The sky was still grey and we had to deal with a few sprinkles, but it was still great!!!!! And definetely better than freezing in the OR, we can do that every day..... So I got to the see the opera house, the bridge and the skyline from a different angle today.... Very cool!
After we got back from our boat tour I took the bus downtown to go the opera house and get a ticket for Mdm. Butterfly, because it hadn't worked well online the last night and I have decided to take the chance to see an opera at the Sydney opera house. They told me that they do last minute sales for students when they got some tickets left and they are a lot cheaper than the real tickets. So I decided to take the chance and will try to get on of those tickets on Feb. 25th, because right now it looks as if that show is not very well booked (yet).... Now I just have to keep my fingers crossed, get their early enough and hope for one student rush ticket and if that won't work out I can still get a regular ticket for a show in March.... Going back to the bus I decided to not take the first possible bus stop, but take the chance and check out downtown.... I found an interesting mix of really old (european like) buildings and incredebily huge, modern skyscapers.... It is a really busy city and the cars all drive on the wrong side of the road.... When Michelle drove to the harbour today I could not watch her drive. I was constantly afraid we might hit something and I could not stop thinking that she is making too wide turns.... It is a very weird feeling and I don't quite understand why it is so hard to get used to. I really want it to feel normal, but it just doesn't feel quite right!