Wien

Operation TLUX

Saturday, October 10th, 2015

It was on one of my days at my praktikum I heard there would might be a patient who would receive a lungtransplant. Already at the beginning of my praktikum here at the ICU ward “9D Transplant” at AKH I told my supervisor it would be my higest wish to be watching an organ transplant. Though the lung-transplant (besides of the combination transplant heart-lung, which is not made that often anymore) is the biggest kind of transplant you can do compared to any other transplants.

So there I was, put to the operation. It took a while, because there are a lot of doors before I could reach the right operating-room and find the right operation-nurse who would take care of me. At first Dina took care of me, but they changed later and afterwards Brigitte was the operational-nurse who explained a lot to me. She was a wonderful woman who guided me through a lot of my questions and even had so much more information I would never find in a school-book.

So there they where: 2 big boxes containing a lot of ice and one lung each – of course packed in 3 plastic bags to contain steril. There where a lot of people in the operation-room. I counted at most 13 people: 2 operating surgeons, 1 surgeon-student who was assisting, 2 operation-nurses (one assisting at the surgery at the time, the other assisting the nurse who assisted the surgeons), one person watching the ECMO-machine (a mashine I already wrote about earlier), 2 foreign doctor-students, one other student (for a job where they sterilize probs for operations), 2 anasthesia-personnal (I think on nurse and one doctor) and med. So you can understand that it wasn’t so easy to take a look at the operation. I wasnät able to see everything, but I cpould see a lot. E.g. I could see how the cheast really looks like spare-ribs from the inside. I was even allowed to touch the new (through the plastic bag) and the old lung with gloves on, but I could feel the damage on the old lung.

The person who was operated on was a girl, 18 years old. She had lung-fybrosis which is a disease who gives the person not only a hard time to breath after some years, but it also gives the person problems with hormones. That means that this girl actually looked like she only was 12 years or younger. Now, the new lung was from a boy only 14 years old. The operation-nurse sayed the lung was really beautiful and it would be good for the girl to get such a beautiful lung!

I feel really gifted and happy for this opportunity, because to be part of and watch an organ-transplant was my greatest wish at my internship at AKH. They called this surgery school-book-example transplant becaause a lung-transplant often needs 8-10 hours of operation. Even the recovery of the girl went well and she could get from our traansplant-ICU to an ordinary ward within 2 days.

This transplant was a dubble-lung-transplant. Earlier years they mostely used to transplant only one lung, but it is now more common to transplant 2 lungs at the same time. In Vienna the lung-transplant is a really common transplant-procedure and approx one lung per 10 days is transplanted in Vienna. Acctually all lungs in Austria are transplanted at AKH in Vienna. But that doesn’t mean that it isn’t a complicated procedure. There are some risk to consider by having lungs transplanted in your body. E.g. is the approx life-time of the transplanted organs 10 years, which means that this girl might has to have another lung-transplant in some years. Of course not having a trannsplant wouldn’t have been an option in her case, though of her heriditated disease, but you should consider smoking or not wearing masks in certain working-enviironments – for the health of your lungs. Other complications by transplanting lungs ccan be infections, but there is a risk that the organ that is transplanted not is in a good condition. I have still not really understood why the AKH do transplant organs that are not fully fit for transplant (e.g. a lung that is from a smoker and not so much better thann the lung the person had before – this does not regard the young girl, but other patients I have seen). But I can think of 2 reasons why:

  1. There are not enough organs to choose between. Austria is indeed one out of 3 counttries in Europe where every human beeing automatically is a organ-giver (besides you write a will not to before you get sick/die), but they are also part of an organization ccalled “Eurotransplant”. This is a organization between 8 european countries which work together to distribute organs in these countries. But, they do still have a transplantt-list and people do have to wait for organs. So if there is a person in desperate need for an organ, the person will get it, even if it is not fully fit.
  2. Prestige of doctors – doctors who like to do surgeries and want to keep up a high rate of organ-transplant on their Curriculum or for the hospital. Or because people “buy iin” themselves for an organ. I have accutally heard that this was possible once, but I have no idea if it still does.
  3. There is procedure where you can put e.g. a lung in a glas cube to ventilate it before extransplant it.

WIT – Wiener Intensivmedizinische Tage, Vienna Intensive care medical days

Saturday, October 10th, 2015

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As I am about to write this I am sitting on an empty train, waiting for it to depart so I can get to work on what I think is going to be a beautiful morning (I feel that today is going to be a sunny day). As I am sitting here I saw a train pass through the station i Mödling where I stay at my mothers house. I often say that my mind is like a child and my patients have thought me that you never loose that child inside of you, no matter how old or sick you are or get. So I did what I always do when seeing a industrial-train: I count the waggons. This time: 36 empty car-waggons.

A week ago my supervisor said there is going to be big congress for hospital-staff, especially for intensive-care staff. He had three tickets for the staff in his hand and said “Oh, look at her, I can see how your eyes just sparkled!” Yes, of course they did! My brain is constantly telling me to want more information and knowledge, it is like a sponge that just won’t fill up till the end! I can only explain this phenomena for myself through the fact I was told when I was little: the human will never use it’s brains full potential, the human brain can just be used partly in life. By writing about that I am thinking about how science has found out that people who use their brain more in their life, e.g. through reading, learning and brain-excercises, tend to have a lower risk of getting dementia. So I can always say that this is my way of preventing dementia in the future.

Well, Wednesday came and the first day of the big convention started. The congress planned 2 Rookie-seminars: one for doctors, one for nurses. So I thought I go to that Rookie-seminar for nurses working in intensive-care. I went to the congress that morning but they told me at the counter that this seminar was not included in the ticket I got from my unit, it was an extra seminar that would coast an extra fee and besides of that it was sold out, the lady told me. At first I was sad and thought, why? I wanted to go to that seminar so badly! So I went up to the unit, sad and disappointed. There I thought about it and how in Vienna the way of thinking is more soft than in Sweden and Germany. So I asked a co-worker if I should try to sneek in instead – he agreed. So I went back. Now with my confidence in my pocket that I would get in as a paying member. It worked! Noone asked about an extra ticket or a booking-confirmation. Besides of that the lady must have meant that the Rookie-seminar for the doctors was sold out, because when I got to the seminar of the nurses, the room was only filled with about 75% of the people who would fit in.

About the seminar: There where especially 2 presentations that cought my interest. The first was about aromatherapy – something they use here at the ICU for their patients. This can be by putting essential oils (in a really small amount) into the rooms of the patiens or by massaging or washing/bathing the patient with a small amount of oil mixed with water. These eessential oils are acutally not used for therapy in the hospital, but they are used for nursing. It is important to know that diffrent oils are used for diffrent purposes. E.g. is peppermint used for cooling, while lavender is for warming but still, calming. It also depends on how you use the oil. E.g. in massage or to smell in the room. Did you know tthat smell is the only sense that goes right up to the brain without talking “extra sidetracks”? That means that the smell is the first sense the brain realizes. And did you know that the airport in Frankfurt, Germany uses lavender in tiny amounts in the air for calming and preventing flight-axienty? At least they told me that at the seminar. The amount of lavender used in the air is so small you can’t smell it, but the brain still can. This is acctually sientifically proven, the woman told us at the seminar. For me this information is especially interessting because I am studying a course about complementary and alternative medicin, or integrative medicin during my time in Vienna at Linneaus university, over the internet. In Sweden we learned a lot about diffrent integrative methods, but I didn’t hear about aromatherapy before that. So I am really going to take that with me as a future nurse and maybe I can be one of the nurses to start using aromatherapy at the hospitals in Sweden one day. Here in Austria this woman was one of the first to use it at her hospital and now they use aromatherapy at many different hospitals in Austria, even at the ICU where I had my praktikum.

The second seminar that cout my attention was about humor within nursing, means keeeping up the spirit at your workingplace with the other co-workers and with your patients. The semminar was so good so the audience laught the 60 minutes he was holding his lecturing. The man told us about how he often found empty boxes in the medicin-cabin, wondering who would ever put an empty box in it! That meant that he got angry about his collegues and this made his day negative. He told us then that he changed HIS attitude by thinking “where is the empty box”, “where are you?”, expecting it to come out and when he found it he got happy. I am acctually thinking right know that there is something I have had hard times to handle in my life. That one thing is everytime someone askes me where I am from. Especially in that small part of Sweden where I live now people tend often to ask me about my heritage. I am actually angry everytime they ask me, because I feel that they judge me asking about this. I don’t want to be “the german” or “the austrian”. The main problem is, though I have multiculture background people always seem to get it wrong where I am from. So maybe this is the time where I have to change that feeling into something good, to think and act like noone else expects me to. Wow, this was accutally a wonderful and fun seminar! He also told us about that there is laughing-yoga you can practise for more fun and happiness in life. And did you know that there is a laughing-institute in Germanny? The work with sientific research there. I find this so funny and I am thrilled to implement more humor and fun in my life. I am acctually already trying my best to be more fun and saying things people don’t exepct me to. Of course, I am not that fast of a thinker when it comes to humor, but I hope I soon will be able to live my life in a more positive and funny way!

Taking a nap at work

Saturday, October 10th, 2015

Did you know that there are studies who have been made with doctors if it is good to take a nap at work when you work a long shift? These studies have shown that it is good, and that you can gain back your concentration. Here at the ward they have the modell to take a 30-minute nap at working hours sometimes. I know that not everybody is doing it every day they work, but I know that my supervisor e.g. does it sometimes. I was allowed to do that too one day and I can tell for sure that this is a modell I would like to have at my future-working-place. I felt so much better and stronger afterwards again. Just 30 min in a nice room with beautiful lights and calm music. This is actually something I want to take with me to Sweden, not just for doctors and not just for people who work long hour shifts!

 

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6 days of sickness…

Tuesday, January 27th, 2015

This is day 6 I am at home, waiting for my body to recover. I do now know that I have a virus-infection. Probably caused by my little brother who got it from his girlfriend. The virus who follows me took away 3 days from my internship, but there is still time to catch up. I haven’t even told you yet about the working-hours here at my ward. There are 2 different shifts: dayshift and nightshift. At dayshift you work 07.00-19.30 and at nightshift 19.30-07.00. Sometimes you can leave earlier at 15.30 from the dayshift. Most people I talk to about my working-hours here think it is hard, but actually I find it much more comfortable to work 07.00-19.30 2 days in a row rather than like we have it in Sweden 13.30-22.00 and the day after 07.00-15.30. I feel that these few hours in the evening give a lot more back than having so few hours to recover the day after. And working 12 hours each shift gives you a lot more free time the rest of the week. At my internship I have to work 3-4 days per week and the rest of the week I have for myself and all my other studies.

At my time at home I had time to draw more pictures of the ward, so you can see how it looks like:

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I am a little bit unhappy for the quality of the pictures at WordPress-blog here, but I can not help it – wordpress cuts them down to 100 mb. On this picture you can see me sitting on the old leather-coach in the lunch-room. On the table you can see a big chocolate-cake: the staff at my ward love to eat chocolate with nuts. So most of the shifts someone buys a big chocolate for everybody to enjoy. You can also see the glasses with differ name-tags. If you work a shift you have a glass with your name-tag on so you can use it the whole shift. In front of me you can see my food. At the hospital I have the pleasure to buy lunch for a reasonable prize which means I get warm lunch every day at work and I do not have to bring my own food with me – a luxury I really like and would like to have at home (but there the food is expensive and you have to get it on your own). Every morning we get to choose and write down which food we would like and than one staff gets down to get the food from the kitchen. On my pants you can see that people usually write down information about their patient. This is a habit I still not have been doing, but I wanted to show you how it looks like on my fellow colleagues.

 

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This drawing shows how it looks like in the kitchen. We have a big water boiler which gives hot water. When a patient wants tea we can take it from here. They have about 7 different kind of teas to choose from – which is great, we don’t have that at home! When someone likes to have a cup of coffee we have to mix the water with Nescafé instant coffee. On the desk you can see some different things, e.g. instant coffee and apple-juice brought by relatives to patients. So there are some patients who get there personal food/drinks – if they like to.

I hope to get back to my internship in two days. I have been to a greek-doctor today and he got me cough-medicin with codeine and antihistamine-tabletts against my swollen lymph. Interesting is that I found medicine which is no longer used in Sweden here in Austria. Besides the medicin I got from the doctor here (I do not know why Sweden no longer does distribute these medicines, but I know they have different ones which practically are the same) I found a medicine at the hospital which is called “Novalgine”. This medicine is not longer used in Sweden since 1999 since many people have experienced severe side effects and after a study the medication was stopped selling in Sweden. But, they still use it here in Austria. I think this is because Sweden has a different approach regarding medicine and side effects – in Sweden the nurses and doctors can tell there concern to the government, in Austria this is something only doctors do, sometimes, what I understood from the staff here.

Now I am getting my head back into Grey´s Anatomy, at least I can watch one hospital when I am not allowed to be at “my” hospital.

Bis bald! – See you soon!

Visiting a nursing-school in Austria, Krems

Sunday, January 25th, 2015

On friday I got sick. My little brother gave me a cold. But the cold didn’t stop me from visiting another city in the land of “Niederösterreich” – Krems. At my internship in Vienna I met a nice girl – Kristina. Kristina is a nursing-student in Krems and the first class which is going to take a bachelor-degree in nursing-sience in Krems. That means that our education is comparable internationally, or at least in Europe. To have a bachelor-degree in nursing-sience also gives the nursing-job a higher standart which in the end means better nursing for our patients.

At the “FH-Krems” or “University of applied science/Austria” I got to see that the university pretty much looks the same as in Calmare. But, there is a major difference (besides that the bachelor in nursing is very new): the view from the university is not the sea (as it is in Calmare). The view are amazing mountains with wine ranks! Take a look:

 

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Here you can see the FH with Kristine in front. On the left you can see a glimpse of the mountains.

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Just besides the university: a wine rank, of course.

At the university I had the chance to talk to a teacher and she wants med to have a presentation for students in Krems about Sweden and Calmars university Linneaus! Who knows, maybe Calmare can welcome Austrian students in the future! 😀

The first week – Right or wrong? Is there even something that is better or worse?

Sunday, January 25th, 2015

Now I have had 3 days at the intensive-care unit for people who have gone through a organ-transplantat. My supervisor has given my free hands for a lot of things. E.g. does he want me to take care of our patient by myself in the morning. That means I have to take care of the documentation of the machines (if they work properly), the medication for the patient and giving them breakfast. On my second and my third day we had a post-op patient who had gone through a bypass-surgery. That means that the surgeons take a bloodvessel from the patients leg and sew it to the heart to by-pass a vessle that is constipated. So this patient had a tub in his throat when he came to us, this because this type of surgery is a pretty big one (took the whole morning).

So the patient who had gone through the by-pass surgery, had a tube. And my supervisor was about to plan the extubation. He got a syringe and gave it to me for emptiing the cuff off the tube (a cuff is small ballon for fixing the tube inside the throat. For extubating you usually have to empty the ballon that is filled with air). So I didn’t really think, just act. I took the syring and emptied the cuff. And because of my supervisor stood on the bedside and was fixing something with the patients arm I thought he saw what I was doing, but he didn’t. So the next moment he asked if I already had emptied the cuff, which I of course answered yes too. He got confused and I said that I wasn’t allowed to do that already, which of course was a missunderstanding of eachother. He than took out the tub of the patients throat immediately, and was confused towards med. Nurses in Vienna are allowed to extubate, but I acted a little to fast… I think, like I always do: you have to make misstakes to make it right, so next time a better time. But it was a little bit embaressing…

There are acctually a lot of diffrences in the care of patients here compared to what I am used to from Sweden. A tremendous diffrence are especially two things that I found out:

1. All Austrian citizens and visitors that die in Austria are automatically bound to be organ-donors. That means that Austria has no lack of organs for transplantation. Compared to Sweden the number of optional organ-donors is 15%. For Austria this means that there are a lot of people from countries around that come to Austria to get a new organs. Austria is part of an organisation called ”Eurotransplant”, where different countries work together for allocate organs. Austria has today 4 hospitals who work with organ-transplant, 3 of them are university-clinics who work with all types of organ-transplant. Sweden also has 4 hospitals who work with organ-transplant, but not all of them work with transplanting all types of organs.

2. In Sweden at the intensive-care unit in Calmare where I worked during last summer the staff was always forced to sit between patients who where waking up from a sedation. Which ment that I as a nurse had to sit between my patient, putting his hands down every time he/she tried to pull out the tube (which is common that people try to do after a sedation when they had a tub in their throat). Here in Austria there only work registrated nurses (not ”little” nurses and registrated nurses as in Calmare) at the intensive care unit. And the nurses in Vienna at the intensive-care unit for organ-transplant never sit between their patients 24/7 as we do in Calmare. So I wondered why. After 2 days of work I got the answer: here in Austria the law has given nurses a different opportunity in caring for their patients: when they come to the ward after a surgery they make the first arrangements together like changing sheets, changing maschines but they also put wrist-bands on the lower arms and tie them to the bed. This is an arrangement which is allowed in Austria and helps the nurses so they don’t have to sit besides the patient all the time as we do in Calmare. Of course the ward has monitors in the lunch-room, in the medicin-room and in the office,  where all the stuff can see the values (blodpressure, puls, saturation ect.) and hear if the alarm. I think this is more convenient, though I found it hardto sit and stare at my patients the whole last summer…

 

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I am not allowed to take any pictures from the ward, therefore I decided to draw what I see. I am not a talented drawer, but I will do what I can to give you a glimpse of what the hospital in Vienna looks like. Here you can see a picture (which I was allowed to take) and how much/little alike it is to what I see. I am trying to prior what is important, so not all details will be shown in my drawings.

 

Auf Wiedersehen!

Day 1 – Finding my way to the ward

Monday, January 19th, 2015

I started my day in the early morning. I went up with my mum at 5.30. We ate breakfast and then she took me to the trainstation. Because my mum had to get to work 30 min earlier than me, I took the chance to buy a cup of coffee and sat down to read free newspaper. My attention got caught by 2 articles:

 

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This article is about a foster-home for children which is called “Schwedenstift” which means something like “Swedenconvent”. Just four years ago I visited this house for my project in secondary school (the big final project), where I travelled after the tracks of Sweden in Austrian/Vienna. There are a lot of buildings and streets in Vienna who are named after Sweden or famous swedish people. I found this amusing to read at 6 o’clock in the morning at the train station – Sweden say’s hello through the newspaper.

 

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The second picture is about an article which tells the reader about the doctors in Vienna who are dissatisfied about there working-conditions. I will later come back to this information, because I got to learn more about this issue at my internship.

 

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Here starts the day for me: the train too Znojmo – even the speaker had troubles to pronounce the city, which is not situated in Austria (but Austria is situated to a lot of borders and therefore there are a lot of trains driving abroad). I am already feeling how I am going to be part of the everyday big city morning traveling…

 

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Now just a quick change to the subway…

 

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Oh, this view of people traveling to and from work gives me a lot of memories of my time when I lived in Germany. It is odd how deep memories can be rooted and it is really a difference from Calmare where I have a 5 minutes bike-ride to school.

 

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Wow, here it is! The “Allgemeines Krankenhaus der Stadt Wien – Universitetsklinikum” – translation: “Generell Hospital of the city Vienna – Universityclinic”. I went into through the doors and wow! A flower-boutique which looks just like the one in my favorite tv-hospital-program “Scrubs”! After some searching I found my ward: 9D Transplant. Wow, now the expectations are high! How will it be? How will it look like? I mean the halls, they look even more like 60’s than the one I have seen in Sweden!

 

Bis später! Means: See you later!

On my way to Vienna…

Monday, January 19th, 2015

It is sunday. I am about to start my journey of about 9 hours to Vienna, the capital of Austria in my former home country. I choosed to apply for an internship in Vienna because of different reasons. At first I thought that I wasn’t interested about going to Africa where a lot of my fellow students are right now. I wanted to go to Australia, or USA. But though of my big commitment to our nursing-student-movement in Calmare I didn’t have much time or energy to apply to the big cities in the world for an internship. I do not feel that this is an disadvantage though, because I now would live at my mothers apartment for 5 weeks for my internship in Vienna. (My mum lives outside of Vienna, about 30 minutes from the hospital).

All started one evening where I told my boyfriend Emil about the idea to do an internship in abroad. We had a discussion one evening and I talked about Austria and how convenient it would be to live at my mums and it wouldn’t be far to travel either. At that point I had looked up a hospital on the internet which was the biggest medstudents-university at least in Europe, I read (I am not totally sure about that, but I read it somewhere…).  He thought it would be a great idea and so I started the process of applying. I went to the homepage of the hospital (http://www.akhwien.at) and applied for an internship. The hospital answered me and told me how I should apply and wanted med to choose which part of the hospital I would like to have an internship at. So there I was, I had to choose between all of this:

 

Clinical Structure

Clinics

Clinical Institutes

So I went trough all the descriptions of the different wards, because there where a lot of them I had never hear of here in Sweden. After a while I found a field that caught my attention: organ transplant. I thought I would gain the most of my internship abroad if I choose a subject I had not heard about very much before and which wasn’t much established here in Sweden and especially not in Calmar. Calmar is a little city compared to the rest of Sweden and in the hospital in Calmare they don’t transplant organs currently. My second choice went to the psyatric ward, though I am really interested to know how they work with different diagnoses in Vienna. But that may be something I can look in later in my life – one step at the time.

So, here I am. Starting my journey to the most beautiful city in the world, they say, Vienna!

 

Byebye boyfriend

 

With tears in my eyes but hope in my heart I left Emil, my boyfriend, and Lovely, my horse – my little family would have to take care of Sweden without me the next 5 weeks.

 

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I “suited up” in my new skiing-jacket in perfect match to the train.

 

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Though most of my classmates toasted themselves for a long journey at the airport, I bought myself a glass of wine to celebrate that I finally headed to Vienna. Cheers!

 

“Auf wiedersehen” – Means: See you soon in Austrian. It is a common frase people in Austria use to say good bye.