Exam Day

Exam Day

I wake up. God. 2 am. I need to go back to sleep. But I don’t know how… Counting stars, counting stars… So said one of my VIPs.

7.30 am. I made it. I have slept. Good.

At 1.45 pm I am meeting Herr Karbownik. We’re probably going to practice the anamnesis. Uuuuff… I’ll just walk to the central station and get something to eat. Coffee follows. I prefer Starbucks, but it was too full. And I wanted to do some revision…

Herr Karbownik just phoned me. 1 pm. Okkk… but I actually understood 1.30 pm. Because I am me. I went to Barmbek to meet up with him. We practised the anamnesis and Herr Karbownik tried to be a mean patient. Funny… Then came Mr Kai, his friend. We practised the anamnesis once more and both said I was good. I don’t think so…

2.40 pm. Ärztekammer. The Slaughterhouse.

We went in and Herr Karbownik showed me where the waiting room is. A nice lady came and asked for my ID. I gave it to her and she made a copy.

3 pm. A candidate just came out of the examination room. She said she had a patient with gastroenteritis. After 2-3 minutes a man came and called my name. Just like Herr Karbownik had said. I should have said: “Guten Afternoon, Dr….” But I was too shy. I just said “Goood…” and we were already walking towards the exam room.

On the way there he asked if I was ok, fit for the exam. Is there such a thing? “Well… yeah.. I’ve got a cold, but yeah…all good.” “So you are fit to take the exam.” “Yes…”

We went in. A man and a woman were already in there, waiting. The man who came to take explained how the exam works.

So began the first part of the FSP. I asked the basic stuff… “When were you born? about 5 cm shorter I guess. ” Patient: “Come again please?” “Date of birth.” “Oh… so… 07.01… 70 years ago.” “How tall are you?” “Well… I wouldn’t know… I used to be taller…” “Approximately how tall?” “170 cm… but now I’m shorter… about 5 cm shorter, I think.” “Ok, that is normal, it can happen with age.” “Why?” I tried to explain it. “And how much do you weigh?” “70 kg. That was always my weight. Unfortunately.” I smiled. I asked the other questions…

Then: “Ok. How can I help you Mrs F? “ “You probably can’t. I have this pain…” “Ok. Where do you have this pain?” “In my back.” And she touched her belly. Great. Dafuq.“When did it start?” “Well, it’s been going on for some time now… But I tripped over some stairs and now it’s become worse.” “Did you fall down?” “No. I mean… I just tripped.” “And the pain is worse since then.” “Yep.” “Does the pain radiate or extent…?” “No. It’s just here.” And she showed me again this spot on her abdomen. “You said your back aches.” “Yeah… well, I’m not quite sure.”  You’re killing me a woman. “Could you describe the pain? Is it rather throbbing, pulling, dull?” “It’s nagging.” I kept asking about the pain, but she was being really vague about it. F**k this ish. Ok. I went on with my questions. “So I have this fat in my liver. What’s it called?” “Hepatosteatosis.” “Yeah that. What is that? Why do I have that?” I answered something quickly. She went on saying she’d been taking painkillers and she’d been having nausea and this really dark stool. So at least I’ve got that to go on. Crap. I’m not going to make it until the end. She kept on repeating: “Come again? What was that? Wie bitte?” Dude, you heard me. I asked it loud and clear: “DO YOU SMOKE?!?!” “Wie bitte?” I give up. Address. “Yeah so the street is…” and she said a complicated name. “Could you spell that?” “Wie bitte?” You’ve got to be kidding me. Examiner: “Ok, time’s up. What do you think she has?” Uh-Oh. The address is not complete. I didn’t have time to do the examination. I just know she’s got a hole in her guts. At least that. “I believe the patient has an upper gastrointestinal bleeding due to the AINS she’s been taking… without any protection whatsoever. She complained about nausea and melena. It is likely that she has another condition too, but at this moment I believe it is important that we take care of the bleeding.”  They smiled. Yeah, fine, I screwed up. Just give me the thing for the Arzt-Brief. They gave me two sheets of paper and sent me to the other room.

I went to another room. I was done in 12 minutes… I kept thinking about my future PKT in Hannover. The weather is so beautiful. Such beautiful weather in Hambuuurg… Just 20 more minutes and I’m done. Hmmm… what exactly were we doing during our neurosurgery rotation… hmmm… nothing. I can sense that now. Life’s unfair. I had studied so much internal medicine, although I don’t like it… Ufff… A little surgery, gym or even gastro would have been nice. Oh well… Hannover here I come.

Ok. The examiner came. He was smiling. I’m not sure if he was being friendly and encouraging or if he knew I’d f***ed up. Whatevs. Cheers you.

We went in. “Please report to the CA.” “Ok… Herr CA, do you have some time for me?” “Of course. “We have a new patient called…” I see their eyes rolling as I’m speaking. They don’t like it. But this is the structure we learnt during the course. What else could I do? Or perhaps…? Well, I’ll fail anyway. Might as well just spare them the suffering. “And the examination was also performed. Right now I find the bleeding of utmost importance. Endoscopy. Biopsy…bla bla bla… There was a case of gastric carcinoma in her family history… one should bear that in mind, too…” “Dr, the patient complained of back pain. You’re just telling me about this bleeding.” “That’s exactly the point Herr CA. After we’ve stopped the bleeding, we can take care of the rest. She’s had this pain for over a week now. If it were that bad, she would’ve come sooner. The bleeding. Now.” Must be taken care of man. Roll with me. … You’re not rolling with me. “…but it might be that I got it wrong. And that is why I am here. To discuss the case with YOU. What do YOU think Herr CA?” There you go. Enlighten me. He wasn’t expecting a question. Oh well. Might as well just have fun with it… I’ve failed anyway. “Dr I believe you’ve only found half of the diagnose.” No worries. Half works. We’ll make that 50-50%. So what does she have? “Would you ask the patient once more how the pain began?” Man, I do not know the answer. Herniated disk… They said no. Ok. I asked again. She said the same things. I stared at the CA. “So?” “So… the patient is rather old. It could be that there’s an underlying osteoporosis. And then even minor trauma could lead to a fracture.” The all nodded. “So what’s your proposition?” “You mean for the diagnose or as therapy?” “Diagnose.” “MRI. Perhaps a myelography, just to make sure there aren’t any worse damages…?” Who knows these things?!?!? I just kept talking and talking and talking. At least that I could do. Cause I don’t give a f*ck anymore. I’ve failed anyway. No address, no examination, and no even clue what she has. And no clue what they want from me. “And what diagnoses would you write for the colleagues in radiology?” Nothing. That’s their job. I ain’t getting paid double. “Spine fracture.” Or whatever they call it in German. “So what did you discover during the neurological examination?” My face said it all. I see it on his face that he’s read my face. Dude, no, why would you ask that. “Herr CA, to be honest, it was normal by me… perhaps some other colleague could do it once more…” I just wanna get out of this place. I don’t want to discuss reflexes right now. Then the other examiner said: “okay so regarding you bleeding.” Why… thaaaaank you. Someone who gets it. “Explain to the patient about the endoscopy.” No problem. “Good. Here are your ten words now. You have 5 Minutes.” The words were easy…  Strumektomie, Paraneoplasia, Atelektase… and the rest I’ve already forgotten.  3 Min. Done. They asked what I’d like to do next. “Sleep. And starting tomorrow… travel.” “And regarding medicine? “Gyn. I’ve done some Hospitation. That’s something for me.” Not such cases!!! “We wish you the best of luck.” “Thanks. Bye.”

Out. Freedom. Herr Karbownik was waiting for me. “So? How was it?” “Not good.” “A catastrophe?” “Yeah.” “Have a seat please.”… I’d rather go to Congo, but ok, I’ll sit. “Tell me how it went.” Why? I’ve failed. I let everybody down. I told him everything. He listened. Good. Done. “Dr C, once more. The Arzt-Arzt Gespräch.” “What? Again? Everything?” “Mr K kept asking me questions, but everything was already starting to mix up in my head.”

We went for a walk. Herr Karbownik was telling me about the buildings. “This is that and this is that… “I let Certa down. They offered me Hospitationen. And still… I was a catastrophe.

Herr Karbownik reads my blog. He knows about “Heimat” and Tim Mälzer. We went to a restaurant. “Do you know where we are?” “…no…” he showed me a picture. OMG. BULLEREI. We are at Tim Mälzer’s Restaurant. Holy sweet… Herr Karbownik said I should eat a lot because I’d lost calories with thinking. Nope. You’ll see it tomorrow. The waiter brought a plate with cheese pearls and chive. Gooood. Cheese.

We had some Burrata. With cherry tomatoes and rucola. My Lord. Oh, my. Herr Karbownik won’t eat any of it. He keeps thinking about something. Probably about my exam in Hannover. “I’m sorry Herr Karbownik.” “Why? We haven’t got the results yet.” Yeah, but I know already…

Then beef shoulder with apple tart and pumpkin-puree (I think). Wow. Perfection. The meat was just like butter. So soft… oooh… why do I love food so much…

And two types of fries… Röstli and regular…

But I deserve none of this. I am sorry Herr Karbownik. You’re trying to help me and… I’ve failed you.

I don’t want to write any more today. See you guys at the PKT.

VIPs… I’ve let you down. Sorry. Really. But I was right, see?


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