"Are you fluent?"

I often get asked if I'm fluent in Swedish. This is such a difficult question to answer. I speak Swedish well and I usually understand everything that is said to me. I get by just fine most of the time, although sometimes I have to say "I'm sorry, I don't know what that word means." My dictated or written charts are perfectly understandable, although they do contain grammatical and spelling errors (although when I dictate, the secretaries fix that kind of thing, which I'm very thankful for!!)

But - I don't speak well when I'm nervous. I can't understand people with strong accents from certain parts Sweden. I can't understand spoken Norwegian like Swedes can. I write like a third-grader. My medical vocabulary is very good but my normal, day-to-day vocabulary is not. I mess up articles and prepositions all the time. If people start talking about politics, parts of a car, or types of animals, I'm lost. But then again, do I know the names of all the parts of a car in English? No.

I can't really make jokes in Swedish the same way I can in English. I don't feel like my personality is the same in Swedish, it's like I can't really be myself 100%. It's really hard to explain to someone who's never experienced it, but everyone I've talked to who's moved abroad and learned a new language feels the same way.

So, am I fluent? I don't know. Most people would say that I absolutely am, considering I speak Swedish all day long at school, and when I'm out and about, and with my Swedish friends. But I constantly feel insecure about my Swedish. When I mess up, or when I don't know the word for something, or people misunderstand me. When I try to make a joke that ends up offending someone because it just didn't translate well. When I sit through an entire lecture in Swedish, go up to ask the professor a question in Swedish, and he responds in English, saying "Should I answer in English or do you understand Swedish?"

My Swedish will obviously never be as good as a native speaker's. But can you be fluent without having the language skills of a native speaker? I think so.

When people ask me if I speak fluent Swedish, I usually say yes. Because I know what they are getting at is, Can you get by in day-to-day life, talking to different types of people? Which I can. But every time I have to write an email to a professor, or call the phone company, I panic and mess up. I have to have my husband proofread every email I send and every school essay I write. (Thankfully I don't have to write very much for school, and when I do, I usually ask to write in English and they say that's ok.) When that happens, I don't feel fluent.

I guess by most people's standards, I am fluent. But I certainly don't always feel like I am.

Well-traveled?

One of the awesome things about living in Europe is that there are tons of awesome places closeby to travel to. E and I have been able to travel to a lot of really great places the last few years, and sometimes I forget how lucky we are to be able to do that.

I've been talking to my cousin, S, recently because her husband and son are going on a sports-related trip to Europe. Their family doesn't travel much at all, and certainly not internationally. She's been asking me tons of questions, most of which are at the novice traveler level. I'm so happy I've been able to help her. It's also been a real eye-opener to me because it's made me realize that we really do travel a lot! Today she told me, "Wow, you're so well-traveled, you should start a blog about it!" I don't really think I am that well-traveled, but I have certainly traveled more than a lot of other people.

So, I've decided to start trying to dedicate some blog entries to travel tips so that I can help other people who are novice travelers.


Today's Travel Tips - Transatlantic Flights 101

1. Dress comfortably when you fly. There's nothing worse then squirming around trying to get comfy in your jeans on an 8-hour flight. Wear comfy pants (sweatpants, yoga pants, warm-up pants, etc.), a t-shirt, and a long-sleeved t-shirt or zip-up. Avoid hoodies, because they interfere with the neck pillows when you're trying to sleep (see #2).

2. It is crucial to sleep on the plane if you're traveling on an overnight eastbound flight. Get yourself some earplugs, an eye mask, an inflatable neck pillow (the non-inflatable ones take up precious room in your baggage!), and Benadryl or something similar to make you sleepy. Take the Benadryl when you get on the plane, because if you take it too late you'll be tired once you arrive at your destination. Inflate your neck pillow, put your eye mask on and your earplugs in, and go to sleep! Don't be tempted by the in-flight entertainment, trust me. You'll thank me the next day.

3. If you travel a lot, invest in some noise-canceling headphones. They are expensive, but well worh the money if you are going to use them a lot. E and I both have Bose headphones, and we use them all the time. They're great.

4. Melatonin is the only thing scientifically proven to help with jetlag. There was even a New England Journal of Medicine (very prestigious medical journal) article published about it. For adults, take 3mg daily at bedtime in your new time zone. I take it when I get on the plane for an eastbound red-eye overnight flight, and then every night for a few days. I also take it at bedtime for a few days when I travel westbound. It doesn't really make you tired, but it helps reset your circadian clock faster.

5. Get to the airport early. At least 2 hours for any international flight. You never know how long it's going to take to get through security. And go through security right away. Worst case? You've got time to spare, so what? E always likes to say that there are 2 types of people in any airport: 1) the people who have plenty of time to spare, so they're walking through the airport at a leisurely pace or eating a snack. And 2) the people who might miss their flight, so they're running like maniacs towards their gate. Don't be #2, it's not fun.

6. Bring lots of stuff to entertain yourself. Bring books, some music to listen to, a Sudoku book, a magazine, etc. You never know if your flight might get delayed. Being bored is no fun!

7. Pack heavy stuff in your carry-on. Nowadays, most airlines only let you bring one piece of checked baggage, even on long flights. This is a problem, since often, when you're going on a long flight, you're going to be gone for a long time and therefore need to pack a lot of stuff. By packing heavy stuff, like shoes, in your carry-on, you leave more room in your checked baggage for other stuff. (Bonus: stuff your shoes with socks to save even more room!)

8. Bring an empty water bottle in your carry-on. Then, after you go through security, you can fill it up with water and bring it on the plane. That way, you don't have to buy the super-expensive water they sell after the security checkpoints, but you'll still have something to drink on the plane.

9. Always bring an extra pair of underwear in your carry-on. If you miss your connecting flight or your baggage gets lost, at least you won't have to wear dirty underwear. I usually pack a pair of underwear, a shirt, and a pair of socks in my carry-on. Also, bring your toothbrush and a travel-size toothpaste so you can brush your teeth after your long flight.

10. Figure out ahead of time what your game plan is for getting from the airport to your destination. After a long flight (especially if it's overnight), the last thing you want to do is stand there thinking, ok, now what? Even if you don't decide what you're going to do, it's good if you've at least discussed it.

Patience

Patience is not something I have a lot of, but is unfortunately something you need a lot of throughout the miscarriage/TTCAL process.

I was supposed to get a follow-up appointment with my doctor 4 weeks post-loss. Apparently somewhere along the way, this fell between the cracks and I didn't get an appointment. So I have to wait another few months until I can see my doctor. But I talked to her on the phone today because I wanted to plan for my operative hysteroscopy. First she was like oh yes, I'll start that process right away. But then she was like, actually, to be completely honest with you, you should go to this other hospital and see if this other doctor will do it. He's the best in Stockholm. I'm obviously grateful for her humility and her recommendation, but couldn't she have mentioned this A MONTH ago?!

Of course when I called, the office had already closed. But I'm going to call again in the morning. I hope I can get in to see this man, this King of Hysteroscopies, soon. This waiting is torture. If we didn't have to do all this testing, we could start TTC again after my first post-loss AF, which hopefully will be arriving some time soon. But instead, we have to wait. And wait. And wait. And wait some more. I'm not good at waiting.

I'm so ready to get this party started!

Monday Randoms

1. Spring might finally be coming to Stockholm, after a long, long, LONG winter.

2. The Pediatric Neurology ward is a tough place. The kids are so sick, but they're so brave. And the parents are unbelievably strong.

3. I went for a run yesterday, which was the first not-cold day since like October. It wasn't a long run, due to my current physical restrictions, but it was amazing.

4. My permanent retainer is broken. I've tried to get it fixed twice but both times the glue has broken. So I went to a new orthodontist, hoping she would tell me I could get a removable one instead. But she thinks I should keep the permanent wire. Navigating this system in Swedish has been such a challenge! My orthodontics vocabulary is limited, to say the least.

5. I went to a Michelin-star restaurant for the first time two weeks ago. The food was delicious, and it was so much fun. The restaurant actually had 2 stars. (I'm hoping to write a separate post about this soon).

6. This website: http://whatshouldwecallmedschool.tumblr.com/ is the best website ever.

7. In less than 2 months, I will be working as a physician. On a ward. With real patients. Just a summer job, but still. Exciting, and terrifying.

8. After my day today, I decided I need to choose a specialty in which you don't have to do rounds. Unfortunately, this strategy is not very feasible since it would eliminate like 99% of specialties.

9. I can't believe people think it's ok to throw themselves a baby shower. Yes, a friend of mine sent an email saying she was going to do this (but it turns out another friend was already going to throw her one, so it was, as Joey says, a moo point.)

10. Friends is the best TV show ever.

Nothing wrong with the patient

On Monday, I was cleared to exercise and have sex. So what did we do? Have sex, of course. It had been almost 2 months, after all. After a few minutes, there was blood on the sheets. Cue freak out.

The bleeding was worse the next morning, so I called the office. They told me that as long as it slowed down by the end of the day, I didn't need to come in. It did, so I didn't. But this morning, I was bleeding a lot again.

Now, I have learned in school that bleeding after a pregnancy has ended (whether it's from delivery, abortion, or miscarriage) can mean 2 things: retained tissue or infection. So naturally, I tried to figure out which one I had, but my symptoms didn't really match up well with either one.

Fortunately, miraculously, everything looks ok. Blood tests are good, hCG is down to 237 from 1120 a week ago. She couldn't see anything in my uterus, and my endometrium was thin (4mm). No signs of infection.

Wait....what?  So you're telling me I don't have either of those 2 differential diagnoses? That's not possible. Every time we go through cases in a seminar, it's always one of those 2 things. How could it be nothing?

And then it hit me. In med school seminars, the patient is always sick. There's always a diagnosis, otherwise, what's the point? IN REAL LIFE, some people are fine. Not everyone is sick. Some patients are actually completely fine and there's nothing wrong with them.

They think the bleeding must've been caused by the "trauma" of sex, but they do think it was strange that I am still bleeding so much. They couldn't find any other explanation though, and couldn't find any evidence whatsoever that there is a problem, so that's great news. I just have to hang tight until my next hCG draw next Wednesday.

So the moral of the story is - there is not always something wrong with the patient!

Med student vs. scrub nurse

As a med student, I come in contact with all different types of medical professionals. It's challenging to constantly be moving from rotation to rotation and have to meet new people all the time. You feel like you're constantly surrounded by people you don't know, and you're always trying to make a good impression, while obviously trying to learn as much as possible. I usually spend a lot of time with residents and attendings (obviously), and nurses. Although there are some exceptions, most nurses are very nice, and understanding of the fact that I don't know everything.

Scrub nurses, however, are an entirely different breed. Now, if you're reading this and happen to be a scrub nurse, please don't take offense. I'm sure you're a Type 1. And if, by some chance, you're not, please remember to give us poor med students a break once in a while!

(Side note: For those of you who don't know, a scrub nurse is a nurse who works in the operating room. He/she (but usually it's a she) is, among other things, responsible for maintaining the sterile field, and for all the instruments involved in the surgery.)

Seriously, though, a good scrub nurse makes ALL the difference in a surgery. They are excellent at what they do and are often grossly underappreciated by some surgeons. Additionally, they are responsible for maintaining the sterile field, which is an extremely important and difficult job. People often walk in and out of the OR, and they have to constantly make sure no one contaminates anything. It can't be easy, and I really do get that.

In my experience and opinion, there are 2 types of scrub nurses:


1. Type 1: The Nice Ones. These scrub nurses are friendly, and understand the fact that med students can't possibly know all the ins and outs of every type of surgery. They make you feel comfortable, and are open to questions.

Examples of Type 1 (all things that have happened to me):

"Have you seen this type of surgery before? No? Oh, well then let me walk you through all the instruments used, so you can be familiar with them. That will make it easier for you to assist."

"Are you scrubbing in? What size gloves do you wear? Great, I'll get some for you."

"Oh, when you cut that type of suture, you should hold the scissors like this, that'll be easier."


2. Type 2: The Nasty Ones. These scrub nurses are sick and tired of being bossed around by arrogant surgeons and have apparently decided to take their anger and frustration out on poor, innocent med students. What have we ever done to them? Nothing! But, alas, we find ourselves getting yelled at for merely existing. We do our best, honest. We don't know everything and we know we don't, but pleast don't hate on us for trying. We are there for a reason - we have to learn surgery. We're not just there to bother you, I swear.

Examples of Type 2 (again, all things that have happened to me):

Me, after opening the door to an OR where there are already 2 med students : "Hi, my name is C, and I'd like to observe this surgery."
Type 2 scrub nurse (T2SN): *rolls eyes* "Get in line."

While standing at least 3 feet from any table covered in sterile drapes: "You CANNOT touch anything that's blue!!!!"

After a non-sterile person backed into me: "You just contaminated yourself!! You can't touch anyone who's not sterile!! Go re-scrub!!"

I mean, if I had a nickel for every time I've been yelled at by a scrub nurse for something I didn't do, I'd be rich!!


But to all nurses, scrub or otherwise, thank you for all you do. Good nurses are at the core of a good hospital. I know your work doesn't always get recognized.

** This post was inspired by spending the morning with some arrogant surgeons and one of the nicest scrub nurses I've ever come across. She got yelled at by one of the surgeons a few times for stuff she didn't do, but she didn't retaliate. She was friendly, helpful, and very nice to me. **

Fly

This song came up on my phone as I was walking from school to the bus stop. I've heard this song before, since I've had this album since I was a teenager. I've always thought it was a pretty song, but today, the lyrics touched me in a whole new way.



Fly, fly little wing
Fly beyond imagining
The softest cloud, the whitest dove
Upon the wind of heaven's love
Past the planets and the stars
Leave this lonely world of ours
Escape the sorrow and the pain
And fly again


Fly, fly precious one
Your endless journey has begun
Take your gentle happiness
Far too beautiful for this
Cross over to the other shore
There is peace forevermore
But hold this mem'ry bittersweet
Until we meet


Fly, fly do not fear
Don't waste a breath, don't shed a tear
Your heart is pure, your soul is free
Be on your way, don't wait for me
Above the universe you'll climb
On beyond the hands of time
The moon will rise, the sun will set
But I won't forget


Fly, fly little wing
Fly where only angels sing
Fly away, the time is right
Go now, find the light