my Bärbel is finally here! Sunday night they arrived on time in Boston (despite the onset of winter in the U.S. and Europe) and we were on the last train to Providence. Overnight, it snowed here over 60cm, and so we trudged arrived by the knee-high snow to my apartment. The last days we had beautiful days together: It was very cold but sunny kingdom. So I was in the Bärbel schneegehüllten Brown campus, downtown or we walked (as best I could) along the bay, followed by many snowball fights. Even Providence large shopping center has us (special Bärbel) done and so it went in the last three days, always from 19 clock in the Mall (was yes to 23h on) and we met Barbara and my shopping needs (I have finally warm waterproof shoes!).
Oh yes, yesterday we are quite anxiously to an unknown Hairdressers just around the corner. Result is "OK" ( Eva-but you are still a lot better !). What we have
else did or planned??
Yesterday : I've worked in half a day in the children's hospital and then we went to the RISD Art Museum . Iceland The Rhode School of Design (also known as RISD ) is the leading College of Art and Design in the United States.
Today-24. December : I am sad, but happy to direct. On the one hand, I do not spend the first time Christmas with my family, on the other hand, it's nice that I can celebrate with Bärbel "our" first Christmas together and that it is extra for me flown to the U.S.! Even the first time they celebrate without her family. Thanks honey!
We go around noon today in the downtown ice skating and evening meal romantic. With full stomachs we enter the Nachgottesdienst in a Baptist church ( first Bapistenkirche North America). Then there's home Clause :-D
morning goes our trip to New Jersey, New York City and finally New Year's Eve Boston. Unfortunately, Bärbel goes on 2 January already back to Plymouth, England, as their school holidays are over and wait for their students. Until then, we are determined to spend but still a great time together.
We wish you "Merry Christmas and a Happy New Year all over the World!"
A relaxing Christmas and a Happy New Year 2010 and that your hopes and ambitions come true, and most importantly Much Health !
My team Silla Hopp I wish you a successful and injury-free season 2010!
Thanks to my family and friends for all the support that you give me from home, thanks to all the hardworking readers (I know that my WEEKLY entries often get very much time for reading in right To take but there is also a lot of work behind it!) And thanks for your recent Christmas wishes! on
Ho Ho Ho's friends, now here in Providence, the cold broke. With days to chill minus 10 degrees and the snow, winter is often 10cm definitely there. I am now in my second week children Endokinologie "and hit me with small children or teenagers and their cheeky diabetes around. If it's cold, what game you should not miss -? Brown Icehockey ! I was with Maren and Meike in Brown vs. . Cornell Game. Despite an exciting game we have lost. The mood was definitely not to blame!
Now to my second Emergency Medicine Report: [...]
Another layer I spent in children in the ER HASBRO-Kinderklinik. Eine komplett andere Art zu arbeiten, was aber auch super Spass machte. So hatte ich sehr viele "Schweinegrippefälle", aber auch ernsthaftere Erkrankungen bei Patienten der ersten Lebenswochen bis zu 18 jährigen. Auch hier konnte ich vieles selber machen und durfte bei einem 17 Wochen alten Baby eine Lumbalpunktion (mit einer Nadel in den Rückenmarksraum um Gehirn -und Rückenmarksflüßigkeit zu erhalten) durchführen. Meist aber sind nicht die kleinen Patienten das Problem, sondern die Eltern, die man "mit behandeln" muss :-). Und es ist nicht immer so, dass ein George Clooney als ER-Kinderarzt mal schnell noch ein Kind 3 min vor der nächsten Werbepause rettet... Was mir im Allgemeinen sowieso vermehrt aufgefallen ist, dass Patienten durch die verschiedenen Ärzteserien ein ganz falsches Bild von den Ärzten und Krankenhauesern bekommen, denn der Alltag sieht nicht immer so rosig aus und der Patient kann oft nicht am nächsten Tag wieder das Krankenhaus verlassen kann.
Einer meiner Schichten verbrachte ich im Rettungswagen , was wichtig war mal miterlebt zu haben, denn bisher habe ich Patienten erst im ER gesehen und war nie am Ort des Geschehens. Ich war der Wache 3 der Eastside Providence zugeteilt. Meine erste Blaulicht Fahrt :-)
In Amerika und fast ganz Europa (außer Deutschland) the paramedics have much more responsibility and freedom of action: They may also be administered as adrenaline and other drugs. We had had a variety of trips from chest or back pain, falls or simple "cold". It is unbelievable how so many people, the "911- system " "abuse" (in 112-D system). We had a 27 year old patient with a sore throat and mild fever without insurance, who called the ambulance because it is cheaper than a taxi in the end, because in this case, the hospital pays about $ 500 for the expensive trip. And the bad thing is that you often can not distinguish from serious illnesses and often with a false sense arrives on site. The day was definitely very helpful and interesting to get an idea of the sequence before to have the Krankenhausankuft.
had in my last week, I see layers Miriam Hospital , a smaller Jewish teaching hospital of Brown Medical School in Providence (it was the writer of the TV series " Scrubs " a doctor, and Miriam just like the series and also has some characters there, like the hospitals chief Bob Celco :-)) -!> No joke!
Here come through the less serious injuries, but the patient often with serious medical problems. The Last is day of my electives in the Miriam Hospital but I be remembered , more specifically, the last 10 minutes of my shift. It was a very min overweight 52 year old patient with cardiac arrest in 30 (ie, from the beginning, little hope) and do many pre-existing conditions in the emergency room. That day I had one of the best Attending my 4 weeks, Dr. Lauro. He has me so well as can do everything, of course under supervision. Despite all efforts, our patient unfortunately died after 30 min resuscitation. What I said Dr. Lauro but then, I will probably not forget. He showed me how the members of one of the worst deliver messages should. Two things are particularly important: the moment at which one conveys the message will never forget the families and therefore you should dressing as possible before the interview (coat and shirt). The other important point is that you should respond directly and not the death of phrases such as "ascended to heaven" or "she passed away" is used. So I brought Dr. Lauro and the sad news that I was not even allowed to cold.
Emergency doctors work in contrast to many other disciplines through a layer without a break, but are then replaced by the next shift and then have free. It has no Stadium work or operations such as orthopedic surgeons in the emergency room clear D. Yes, you must create often at weekends and overnight, but so far I still love the night shift (but have no family, too ...). In addition, there is another big advantage: the characters of the doctors in the Emergency Department : All are fun on it and have a Arts ! The doctors do sports, have fun and family and do something together outside of work! Something like this is, for example in internal medicine often, because often they are there more and less focused on team work out (hopefully not soon comes to suspect that I am the interior nicht mag: Nein!!! Ich bin ein großer Innere Med Fan, aber habe jetzt in meiner Zeit hier ein wenig Vergleichen koennen!!). Das Beste war immer, dass viele meiner Attendings und Residence wöchentlich vor oder nach einer Schicht mal kurz zum Wellenreiten sind.
Am letzten Tag musste ich dann vor gesammelter Ärzteschaft eine Präsentation über einen besonderen Fall halten und dann über diese Erkrankung reden. Also ein Fall mit typischen Symptomen, aber einer untypischen Erkrankung oder anders herum. Ich hatte das Glück einen Patienten mit Myxödema Koma (lebensgefährliche sehr seltene Komplikation einer Schilddrüsenunterfunktion) präsentieren zu dürfen. Und da ich es Liebe vor Leuten zu sprechen, und Glück mit dem Fall hatte, war es eine erfolgreiche Präsentation.
Schade, dass die 4 Wochen so schnell vergangen sind. Ich hab unglaublich viel gelernt und viele nette Ärzte getroffen. Ich glaube kaum, dass ich in einem anderen Elective freiwillig Überstunden machen würde. Jetzt kommt nur die Frage auf "was mache ich nach meinem Studium?!" Ich wusste schon vor der Grundschule, dass ich Arzt werden will (damals noch mit dem Traum Kinderarzt und Hausarzt). Doch jetzt stehe ich hier, sehe viele interessante Fächer (und auch einige Fächer, die ich nie machen würde), jedoch für was ich mich am Ende entscheiden soll, I do not know. Many sites I like, but it's missing the last decisive kick. He has only convinced me so far right. It was ever since the idea to start my residency in the U.S., but I'll probably make less. Determined since three months, I'm wondering about a daily basis. For a few weeks I'm going more and more certain, but perhaps this later ...
On Sunday evening lands Bärbel finally in Boston and I have for their short time here a lot planned, including New York, Boston and many things in Providence. 'm Looking incredible (after 4 months which is enforceable even think to). I've fortunately one weeks from tomorrow Christmas holiday.
Emergency Medicine: I have found my specialty! Or?
Hello friends, I would not really more about my enthusiasm for Emergency Medicine, so my last Elective report, because I think my Eurphorie has come over well in my last comments. But just why it is worthwhile to tell more of it again. But one thing vorbemerkt: my report is written very enthusiastic!
So I would now, after all my internships, clerkships and Elevtives, willing to say that would be Emergency Medicine (Emergency Medicine =) my later definitive specialty if I would not prevent a major snack-exist in Germany, there is no Specialist in Emergency Medicine (yet !)... But first of all, it is important to know how it goes on in American health care system in this case at all.
The Emergency Department (ED =) is the first point of contact for patients with an acute medical emergency, but also for people with normal disease, particularly for many patients who have no insurance have (a very large proportion of the population!), for a ER, rejects false accusations against many of the foreign media, never a patient! This is a U.S. law! For example, patients come into the ED with chest pain (heart attack, pulmonary embolism, etc.), Gastrointestinal disorders, with psychiatric problems (suicidal overdose, severe depression, etc.), patients with abdominal complaints, cuts and bullet wounds, and of course accidents, and much more . What I want to say is simply that every citizen has the ED as a first point in the hospital serves. Often, unfortunately, because they have no family doctor.
In Germany you go with the particular problem to the emergency departments of the various departments. Thus, for example, goes to the emergency room with chest pain of cardiac or abdominal discomfort to the gynecologist. So the emergency department in Germany is divided into different disciplines. This has unfortunately also disadvantages, such as that a symptom can have many diseases as a cause and it is often a very wrong specialists or that cardiologists, mostly 75% work on the station often have little emergency medicine experience and on the contrary, the specialist of the "Emergency Medicine", only those patients seen. In the U.S., the patient after the acute diagnosis and treatment of the various disciplines transferred. Moreover, Europe has the department of emergeny Medicine "is already established with the exception of Germany, Austria, Switzerland and Norway. However, it is now hard at work in the next 5-7 years Emergency Med introduce in D! But until then, I should then have been working.
That's it ... Now to my "Emergency Medicine Elective in Rhode Iceland Hospital. The Emergency Department is rown in a brand new architecturally beautiful building and has the latest and most serious lunar equipment, besides the one B ED Program, which is the specialist training (residency) to the top 5 in the U.S. . Demnach war die praktische und inhaltlicher Lehre super in mein Elective intigriert und alles hatte Struktur.
Das Department im Rhode Island Hospital ist ein Level 1 Trauma Center, d.h es kann jede Art von Verletzung Annehmen, da es jede Fachgebiet gibt (zB. Neurochirurgie bei Kopfverletzungen). Es nimmt also fast 95% aller Level 1 Traumas im ganzen Staat Rhode Island und großen Teil Massachusetts an, so dass man interessante Fälle zu Gesicht bekommt. Hier ein Video zum ER Brown Program Am ersten Tag hatten wir erstmal einen ganzen Tag Unterricht bevor sie uns auf die Patienten los gelassen haben. Mit mir haben 4 anderen Medizinstudenten angefangen. So waren wir hauptsächlich an Hightech Puppen (wie wir sie in Tübingen haben!) im Simulationcenter , die mit uns reden konnten, einen Puls und Blut hatten, und die Hautfarbe ändern konnten. Wir haben jeweils zu zweit verschiedene Notfallszenarien durchgespielt (Asthma Anfall, Herzversagen, etc...) und mussten von der Medikamentengabe bis zum Intubieren versuchen den Patienten am Leben zuerhalten. Danach wurde der Fall auf einem Video analysiert und durchgesprochen.
im Simulationscenter
Meist hatten wir neben unserem normalen Dienstplan jeden Tag 2-4 Stunden Kleingruppen-Unterricht in dem wir über Krankheitsfälle und deren Pathophysiologie geredet haben oder were shown on a track to create or pork to sew. While my layers , which usually takes around 8-10am, I was assigned to a Attending and had in over 60 exam room, my own patients with whom I have spoken, and then studied and then introduce my Attending needed. Everyone wants to know after Attending the brief presentation 5 differential diagnoses of each case to initiating diagnostics and treatment (ie what diseases I guess). This is precisely the difference with other disciplines, for here there is in contrast to internal medicine, not only of the most common diseases, but by the Serious and rare. Moreover, the attraction is there, find out the patient's disease and its symptoms from zero through investigations. So I have done in the ER (Emergency Room) Psychiatric interviews, gynecological and neurological examinations performed, smears judged under the microscope, simply treats each patient group: whether poor, wealthy, sick or foreigners . If intubate practical things like sewing, or lumbar puncture gave, I was usually called by the Attending or Residence.
For most of my electives so I spent in the ED outpatient clinics of the Rhode Iceland Hospital (RIH). Part of my classes I had in the " Critical Care "(trauma room). Here come towards the patients brought by ambulance or helicopter were and are" usually "(more later) have serious illnesses and injuries. The RIH has some 12 trauma rooms with fully-art equipment. For comparison to have hospital Ludwigsburg whole 1 1 / 2 trauma rooms, and University Hospital in Tübingen has 4 dream rooms, they say can not hold more than 4 seriously injured. so I had to get in my first Critical Care layer is equal to the day that a Attending later as " Disaster Day called "had. Thus began my shift on Friday (16-1am) came to only quiet, but within the first 3 h various Notfälle: Patienten die 15 Meter gestürzt sind, akute Lungeninfarkte und intubationpflichtige Patienten mit über 5 Promille Alkohol. Dann gegen 1 Uhr (also Schichtende) kam die Nachricht von einem Auto-Massenunfall mit 10 lebensgefährlich Verletzten. Die Räume wurden systematisch vorbereitet und jeder wusste was er zu tun hatte (das war echt beeindruckend!). Dann ging es wirklich ab wie man es auf der Fernsehserie "Emergency Room" mit viel Blut, klaffende Wunden und Geschrei kennt, aber die Ärzte blieben professionell. Jede Schwester, jeder Arzt hatte eine andere Aufgabe, die er verfolgte. Ich wurde total eingespannt, war aber eher mit kleinen Sachen beschäftigt. Fazit dieser Schicht: Viel gelernt und seen dead end of the shift by 7 clock, no one is! and I was first to the laundry :-).
real life: Part of my former favorite show TV series "ER " (1994). Who would have thought 10 years ago that I once since in real life playing?!
The wars have of my first part of the report, as it would otherwise become too long (and now already is!) And I did not leave my children's ER and my present term as told to my career choice ... So until then it's good!
your Denis
ps. Incidentally, today I've finally got swine flu vaccination :-) and still 8 days to come Bärbel !
Thanks friends, Thanksgiving I am now also a home: Everyone would like to thank every one is happy and eats, eats and eats all day ... is there anything better? Jew, a friend at Brown has kindly invited me to her family in New York. You can see once again how nice Americans are, for me to have my Attending Jew and two other friends want to invite to Thanksgiving at her house.
We are, in my second to last Tuesday night shift along with Brandon (Jew's Friend) in the direction of New York down. In between we had an accident (with fire, smoking car and the police, but not injured), but off we went. evening in New Windsor, NY arrived, I was Jude's mother received a warm welcome in their Thanksgiving decorated house and cooked for the first time. The next day we were all busy to cook, decorate and evening to go to Bartour.
with Jew (right) and her friend on Kneibentour
On 26 November was the last of the day that erupted in the house a wild goings is, for the full 12-member family (Italy-abstämmig) came to visit. Thus, the turkey cut up, and literally 20 other dishes served ( see pictures!).
Jew's Mom Andrea with the turkey
at the table is in turn thanked people who are important to you. So I thanked the family that they have accepted me for the day as warm and my family at home, especially my parents what they have allowed me and that they are for us three such wonderful parents ( THANKS! ) . It began us to eat, which started by 13 clock and 19 clock with seven different desserts was not yet over.
was so overwhelming a beautiful day with full stomachs to an end. But it was wonderful how I love an unknown family has donated! went the next day then back home, I had the weekend to work again.
Last Friday I was again on a beautiful Acapella Concert of Brown Chatter Tock ... wow! Have extra for Linny again made a video:
weekend were Thomy and Eve (Großonkel aus Toronto, Canada) zu Besuch in Providence und ich habe sie im größten Schneetreiben mit der Stadt und meiner Uni bekannt gemacht, worauf sie mich gleich zweimal zum Essen eingeladen haben :-)
Thomy und Eva in Providence
Mein Elective Emergency Medicine ist leider am Freitag zu Ende gegangen und ich hatte meinen ersten Tag in meinem neuen Fach: Pediatric Endocrinology (Kinder Hormon-und Stoffwechsellehre), welches sehr langweilig angefangen hat, obwohl um mich herum nur weibliche Ärztinnen sind :-) After this Elective I can certainly say more but if later Pediatrics something for me or not, because so far I was not averse to it, plus I love kids!
now I'm well settled into my new Wohung and luckily I do with my super Mitbwohnern!
my roommate and Meike have to eat in my new home
But to all, now more, because in future I have more time to something from my blog . Leave Write me calm again!
