Internal Medicine... Ramblings of a third year medical student

Morning Report... nobody is actually listening. 

Finally, the much anticipated rotation is here: internal medicine. I have been looking forward to this rotation since... Forever. Why? Because I would actually be doing what I believed I would be doing for the next 4 years. Internal medicine is the stepping stone for two of the things I like the most in Medicine: endocrinology (hormones) and hematology/oncology (blood and cancer).

Behold, the apocalyptic hospital beckoning me at ungodly hours. 

But the reality has been quite the opposite from what I expected. Reality has been quite... anticlimactic. I have basically been running around the halls of the hospital, moving on from my sedentary lifestyle to going up and down stairs, looking for records, writing the progress note and...that's it. We are not allowed to do much there, just follow the residents and the attending physician. Basically, annoy them to no end with our questions on how to write the damn progress notes. I guess I can't complain much, since I don't really have to answer any questions because questions here are directed to the residents and interns, and we obviously know nothing.  I have to get up at 5am to be able to get to the morning report at 7am (where we don't actually learn anything because we are too sleepy to function), and then we get out at approximately 4pm. It doesn't sound like much but I get home absolutely exhausted. To top things off, no real endocrinology (although diabetes is rampant) and no hematology/oncology cases... Yet.

I need to buy this book. Notice my emerald nail polish. 

So all my dreams are sort of crumbling down at the moment. To be fair, it's my first week. One pro to my list of cons is the fact that my attending physician may be (on the risk of sounding borderline) the best in the world. I have never encountered such a caring doctor. He combs the hair of the patients, rubs their backs, gives them massages, holds their hands, I mean, I'm on the verge of tears every time I see/hear him talk to the patients. And that, my friends, is totally worth it. Plus he takes his sweet time explaining EVERYTHING to us which is fantastic for us, and really bad for the residents who just want to finish and get the hell out of there to study. Which reminds me, I have to go back to studying. :(

What I should be doing, instead I am here, letting out my frustrations. 

But I feel I miss OB-Gyn, I miss psychiatry... And now I don't know what to do with myself. One contrast I see is the feeling I got when going to the OB-Gyn rotation. I don't know if it was my group of classmates or what, but it didn't matter how early I had to get up, I always found myself with energy to last me throughout the day, even into the night until my shift was over at 11pm. Also, going to the psychiatric hospital was amazing, no rush, no stress, everything just felt good. Here I am stressed, annoyed and I don't want to be there at all. I don't know if it's me and perhaps I just need iron supplements, but I just have no strength! We'll see what happens.

The "doctor" is in. :) 

So far.

So far, after I came back from my vacations I have been super busy with school but there are still some stories to tell. I will be working on that shortly. In the mean time, here are some pictures of Puerto Rico :)

German Christmas pt. 8

Next thing I knew, it was Christmas. Well, Christmas Eve to be more exact. They don't really celebrate the actual Christmas day here but they make the party the 24th. So I awoke to a hectic house. Preparations. Preparations. Preparations. In Mr.J's house they have a preparty party, where the mom makes lots of cake, lots of coffee and gifts and conversation are exchanged.
As I made myself ready I could hear all the drama downstairs but I was glad I didn't understand what was going on. The German was too fast for me and my vocabulary never seems to be enough. Some of what I did understand was that the mom told Mr.J's sister to get some chairs from upstairs, she didn't want to and told Mr.J to do it but Mr.J was too busy figuring out how the iron worked so he could iron his pants. A lot of scary angry German language ensued and thus I experienced true fear. You have never experienced fear until you've experienced Germans yelling at each other over God-knows-what.
But things calmed down and I went downstairs as soon as I heard the first guests at the door. Soon the house was full of laughter, cake, the smell of freshly brewed coffee and Lotti, Mr.J's dog.lotti was dressed as Santa Claus and spent the afternoon trying to avoid Lutzi the Pug who also came to visit. Apparently they are mortal enemies.
I spent the afternoon trying to understand what people were saying and it was exhausting. I don't think my brain could take it anymore. But also, I spent the afternoon cooking the turkey for the night. I had seen the huge turkey the night before and thought that we should take it out but Mr.J said no and by the time it arrived to the house the next day it was still frozen. I thought we would need a Christmas miracle if we wanted to eat that day but an hour later the turkey was ready to be prepared and put in the oven. Mr.J had asked me how we prepare the turkey in Puerto Rico and of course because I had never actually done this I had to ask my mom. After I told Mr.J how we actually do it he felt the Germans wouldn't want the ridiculous amount of garlic we use. I'm not gonna lie, I was a bit offended! Why would he ask me how to prepare the turkey if he didn't want to use my techniques? By the time we had to prepare the turkey he realized how silly he was and we put some garlic. It smelled delicious. We also incorporated a technique we use in Puerto Rico and that is taking an injection and injecting the turkey with its own juices. Every 30 min we did this and so it occupied most of the afternoon.
Then came Christmas dinner which is held at the house of Mr.J's sister. I wasn't hungry. I had a cheesecake binge during the day! So while the turkey cooked some more I played with Mr.J's niece.

German Christmas pt. 7

Continuing on with the good stories, coming back to Werne was like coming back home. I felt comfortable, everything felt familiar and good. I wanted to be here and it felt like I was always supposed to come here.
I was greeted by Lotti, the Italian mutt. She doesn't speak italian though! She happily barked and I was so glad to see her. It felt like I was cheating on Mr.Baby. But I was also so glad to see everybody else and to be greeted in such a warm way like the Puerto Ricans do, people actually glad to see you back. It felt like happiness.
The next day we had to get up super early so we could have time to visit Aachen. Today was the only day people actually could come with us and before the Christmas Markets closed on the 23rd. It was early so there was no sunlight yet, but I was full of expectations of what awaited me in Aachen, a city I had not seen when I was studying in Germany. I was also filled with the thrill of the new adventure. By the time we arrived to the train station, morning was upon us. Kamen has a small train station and we waited there by the bakery for a few minutes. It smelled so delicious. It served only to remind me how hard it is to carry a diet when such things like pudding pretzels covered in icing exist here. First stop was Bochum, where we met with half of the group. I was glad to meet with old friends and meet new ones. Then we took a regional train to Aachen... I remembered the first time I went to Cologne in one of these and this was the same route. These trains were always super full and this train was no exception. But we managed to find seats, which was a bit hard for one in our group who is 2 meters tall.
Two hours later we arrived at Aachen. We were greeted by the second part of the group, a beautiful couple from Vietnam. I was finally able to speak a bit more English and their German was surprisingly easier to understand. First stop there was the Lindt outlet. Let me repeat this... LINDT. OUT. LET. Chocolate outlet? I didn't even know these existed... let alone Lindt... delicious Lindt chocolate.
As we arrived there, we were supposed to smell the smell of chocolate but today it started raining and it is holidays so I couldn't smell anything. Inside the store there were all classes of Lindt chocolate I had not even seen before. I thought I wasn't going to buy anything, but these thoughts were useless as I saw there was 99% cacao chocolate which I thought my dad would love. All I did was buy chocolate to bring back home.
Next stop was another outlet. This time it was Lambertz, what Mr.J called the "kingpin of sweets in Germany". Here we bought Printen, a traditional Aachen cookie. Also Mr.J bought some Dominos cookies which are filled with marzipan, a horrible fruit jelly and a cookie, all covered in chocolate.
The day was gray and as we got out of this outlet, it started raining harder. We took a bus into town and now I could see all the old houses and traditional architecture that I was waiting to see. We decided to go eat first to this Lebanese restaurant but it was too full and the weather was too bad to go outside with the food. We kept looking and looking and everything was either full or closed. We ended up inside a mall, and ate... a burger. :) I guess with the rain and the trouble with finding a place to eat, comfort food was all we needed.
After this we carried on to the Aachen cathedral, where Charlemagne is buried. From outside it doesn't look like much and it is much smaller compared to other cathedrals like the one in Cologne. But inside, the real treasure lied. So. much. GOLD. All the ceiling was full of mosaics with real gold. Different patterns, different colors, everything was beyond beautiful. This certainly made the weather and the trek there worthwhile.
But the weather carried on. It was cold, it rained, there was no more sun. I didn't feel any more adventurous, I just wanted to go home. After looking around the Christmas market, we went home. I guess nobody was enjoying themselves anymore either. Everything was full, there was nowhere to sit and nowhere to go. We then went home.

German Christmas pt.6

Christmas time has been quite hectic and I haven't had much time to sit down and think about what I've been through. I am trying to enjoy every moment for I know that my time here is running out.
Every time I come to Germany I fall more and more in love with it. Even with its recycled toilet paper that sometimes feels like cardboard, even with it's unspoken rules of how to properly open the door and I was not aware of it, I have even gotten used to the stares! Germans love to stare.
This time, my German was perhaps a fraction better (there is still a lot of space for improvement!) and I could see how the people I had met before are even more funny than I thought. And how the people that I didn't like much before, I like now even less.
The other day I was with Mr.J and we met some of his friends at his apartment. I guess we were going to go out later but Germans meet somewhere else first to catch up and catch up on beers. So I met some of Mr.J's people and it was interesting to see how the themes we don't talk about with friends back home as to save the friendships (namely politics and religion) are pretty common topics here and people think nothing wrong with discussing and attacking other people's beliefs. Germans are so direct as to scathe. German humor is also direct and back home I would think "¿De dónde sacó éste tanta confianza para hablarme así?", but here my Puerto Rican skin would have to thicken in order not to feel offended.
There was a moment in the endless stream of German conversation that I realized they were going too fast, that I didn't understand where words began and others ended, that I didn't understand at all what they were talking about, not even the main topic. I was reminded of this episode I saw of the series "Switched at Birth". If you haven't seen it, they deal beautifully with deaf people and the problems they face. The scene I was reminded of was when the deaf kid was surrounded by hearing kids and they were all laughing and making jokes but he couldn't understand, he couldn't read lips and the camera zooms into his point of view and all sound goes out. This is how I felt at this moment. And nobody seemed to notice/mind/care.
On to nicer stories...
The next day I went back to Mr.J's hometown and it was unusually warm for this time of the year. Even though it was dark outside when we were driving, I remembered the streets and houses and I remembered the lights in the windows and the Christmas decorations. But it was not going to be a white Christmas this year like I hoped for! When we finally got home, it felt just like that... Home.

German Christmas pt.5

Days have gone by quickly. I try to squeeze every last bit of enjoyment to every minute that I spend here but it has been kind of hard considering I'm sick. It started out as a cold which ended up in asthma. I haven't been able to do my exercises either because who wants to do Pilates with all this sinus pressure and feeling like you were run over by a truck? Besides the amount of walking and going up stairs, I figured I am doing something at least.
I've also met some new wonderful people, and this I have enjoyed a lot. After I went back to Puerto Rico from my exchange semester I felt I needed more time in Germany. I needed to meet more people. In med school you are stuck with the same people for four years so it ends up being exactly like high school. But coming from a college with 20+ thousand students, going to a class of 65 was hard to get used to. And after going on exchange, I got addicted to meeting people from all over the world. It feels great to have had this opportunity now. Hong Kong, Taiwan, Denmark, Spain, Cuba are some of the countries that I remember of the people I met. This opportunity I would certainly not get it in Puerto Rico and much less in med school.

International Students

Something I have been doing lately despite my state of health, is shopping. Shopping is after all therapeutic, right? And after getting myself in a mall during holiday time I see no difference between Germans and PRs when it comes to shopping. We all go a little bananas. I have dragged poor Mr.J who hates crowded places to small make up stores after falling in love with a brand last year in Florence. But in one of such shopping trips I heard someone behind me say "Entschuldigung!" which is German for "Excuse me!". Thinking that I was in someone's way (as I so often am) I move to the side, but the entschuldigungs persisted. I looked back. A Turkish girl smiled behind me and proceeded to ask me where I got my jacket. I smiled and said "Nicht hier." ("not here") but Mr.J, in a very right-to-the-point German manner said "Nicht in Deutschland!" as to make the conversation shorter. He was dying to get out of H&M. But this moment made my hunt for the perfect coat all worth it.

Oberbaum Bridge

Oberbaum Bridge

Another thing we did was walk to the nearby district of Kreuzberg. We crossed the famous Oberbaumbrücke and made our way into what Mr.J calls Hipster-town. Little did I know that Kreuzberg was the place where I had stayed in my first visit to Berlin in 2009. Here the graffiti is art and hipsters were not a thing last time I was there. Kreuzberg is full of small shops selling hipster stuff. What is hipster stuff? You might be wondering. Well, ironic junk. Stuff you may find at thrift stores and a LOT of vegetarian/vegan places because here it's a thing. I drink soy milk because my intestines decided not to like lactose anymore but these people drink soy milk just because. This concept is beyond my understanding or strength so I'll leave it here. There's no understanding when it comes to why hipsters do the things they do.

Graffiti at Kreuzberg

After Kreuzberg we went by the East Side Gallery which is part of the Berlin Wall left and covered in murals. I enjoyed this quite a lot until I realized exactly how long it was, and how COLD it was and how far away the train station was. Well, I took pictures anyways. Maybe I'd enjoy the art later, in the warmth of my home.

East Side Gallery

Yesterday we spent it doing some Christmas shopping. Where Mr.J lives is also a bit of Hipster town but it is full of shops that sell you small stuff you didn't know you needed. And we went to like 20 of these little shops. I must have seen EVERY item on my Stuff I want Pinterest Board. Good thing that my loan hasn't arrived yet or I would wreak havoc.  Seriously.

Then we went to Christmas markets which I LOVE! Small little kiosks in the shape of the little houses they are selling + currywurst (Sausage smothered in curry-ketchup sauce) + shopping, count me IN! Jonas managed to get me to the expensive Christmas market in town where you have to pay 1€ to get in. Totally worth it, and I could see why they wanted to keep the bums out of this place because this market was simply magical. Some guy dressed as one of this toy soldiers was at the gate to take my ticket, some other guy selling cookies looked right into my soul and knew which cookie I wanted and offered me a hazelnut wonder cookie, and the christmas tree... oh, the tree. Everything was beautiful. And the places where you would get Glühwein (a hot wine with spices that tastes like...  hot cough syrup) are not outside like the rest of them are, they have windows and glass walls to keep the warmth in and the riffraff out. I wanted to buy all the cookies, all the nuts, all the ornaments, so everybody back home could get to see them and get a piece of Germany too. Too bad I'm a broke student.

Christmas Market Shop

I finally went to the movies to watch The Hobbit. There is a cinema here that offers the movie in English, thank GOD. Funny thing about the whole thing is not the movie but since it's so long they offer a small 15 min break in the middle of the movie. Why don't we have this back home? But these Germans are sneaky. Because the movie is extra-long, they charge you extra. AND on top of things, you have to buy your own 3D glasses?! I was outraged.

Where the Cinema is at Potsdamer Platz

Well, I better get going to wrap Mr.J's Christmas presents before he comes back. :) Until next time.