June 8th: Today we got a day off from the hospital to have a tour around Oursense and go to a private spa with hot springs! The tour was given by a tour guide and we were shown many main points in the city both today and historically. We walked around town and were shown different popular shopping areas, one of which was the marketplace. The marketplace consisted of one larger central building surrounded by many smaller, individual stands selling various items. One thing I thought was weird is that the fish was stored on ice and was out in the open as opposed to being behind clear glass or plastic case. After that, we went to Las Burgas, hot springs that are in the city of Ourense – they are VERY hot. They also have mineral properties that can resolve certain skin conditions. While we were there and the tour guide was talking, people would come and fill up containers of water to take home and quickly run their hand through the water and rub it on their skin. After that we went to the main cathedral in Ourense (Catedral de Ourense). I’ve never seen a more beautiful church ever! The tour guide said it was also used as a fortress because Ourense is so close to the border of Portugal. After a group lunch, we took the “spa” train to a private spa with hot springs! As a rule, we could not take pictures of the spa because it was private, but the surrounding area was beautiful! The hot springs also contained the same mineral properties that the tour guide talked about in Ourense (the surrounding area of Ourense also has a very large number of natural hot springs). We were allotted two relaxing hours in the spa; after which we reluctantly left the spa, but we all had very smooth skin!
After returning from the spa, one of the things I had for dinner is what I would consider the Spanish equivalent to mozzarella sticks; they were called “triangulos quesos” and were served with a very sweet tomato and pesto sauce. Yum!
June 9th: Today at the hospital was the first day that I did not follow the doctor I’m shadowing this week into the OR; instead, she was seeing patients today – and she had approximately 56 on her list! The way this was set up was very different from the U.S.; all the patients (a lot of them) waited in a large waiting area and waited to be “buzzed” into the doctor’s office based on their number (it reminded me somewhat of being called at the deli line). The patient enter the doctor’s office, a room with a desk, computer, chair for the doctor, chairs for the patient and guest, and an examination table. The doctor sat on one side of the desk typing notes while talking to the patient who sat on the other side of the desk. More often than not, the patient would then be examined for whichever urological ailment they were in the office for. The major thing that was very different from the United States is the time that the doctor spent with each patient: sometimes it was as little as about five minutes with almost none lasting longer than about twenty minutes! This goes back to the differences between Spanish and American health care systems; health care is “free” because it’s included in people’s taxes. Which leads me to the feeling that more people go to the doctor more often which leads to many patients to be seen. I believe there may have been one other doctor tackling the list of the 56 patients for the day, but I’m not exactly sure. All I know is that I saw a lot of different patients in the span of time I was there. The number of patients I saw today was much larger than the number of patients the internal medicine doctors I shadow back home see in a day. My doctor was extremely busy today and therefore couldn’t translate what was going on after she saw each patient, but from what I got out of the conversations (which were very fast – too fast and complicated for my years of high school and one year of college Spanish to comprehend everything), the majority of the patients did not have an issue, it was either more of a check-in or because an issue they thought they had. Of course, there were a few that I saw that did have a problem. During an endoscopic check for bladder cancer in one man, the doctor did find cancer and it was actually that patient’s second time having bladder cancer.
While I did not get the “thrill” of being in the OR today, I learned many valuable things today, most importantly the differences between Spain and America’s health care systems and what that translates to for everyday patient care. It also put some things in prospective: I tend to get annoyed when the doctor is late for my appointment or I have to wait, but the people in Spain wait a long time to see the doctor for just a short amount of time, nothing compared to some of my very long and thorough doctor visits when I’m sick. Also, today was important because it highlighted that medicine isn’t all exciting surgery; sometimes you need to meet with nonsurgical patients, even if the length of the list is intimidating and you’d rather be in a surgery.
Later that evening, we had a group dinner with all the fellows and the site coordinator to talk about our day. Also, it was one of the student’s birthday! So of course, we all had a celebratory glass of sangria!
June 10th: Back to the OR! Today I got to see three procedures! The first was an endoscopic procedure to get a sample from the kidney (through the urethra, bladder, ureter, to the kidney) to check for kidney cancer. The second was to break up a kidney stone; it was really amazing to watch the laser break up the kidney stone so it could be pulled out of the patient, I actually got to see the kidney stone – strange to think that such a little thing can cause so much pain! The next patient also had a kidney stone; however, the ureter was very narrow in this patient and the doctors had to put in a catheter-like tube to enlarge the ureter so they could go back in and remove the stone at a later date. This was my last day in Urology, even though my doctor said I could come back anytime I want; while I did enjoy urology and all the surgeries I got to see, I should give the other specialties I’ve been assigned to a chance too! After leaving the hospital late in the afternoon, I treated myself to churros and chocolate (probably my favorite thing that I’ve eaten so far) and a late siesta which was much needed after this busy week.