Heidelberg, Awesome Spinal Surgery, Tests, and Arithmeum

On Friday I went with Megan and Austin to a place near Kaiserslautern where Austin used to live with his family. We stayed with his old neighbors, the Christmanns, who also showed us around the area and took us to a concert celebrating 60 years of Americans and Germans working together at the Ramstein base. The concert was really fun, and several times we had to suppress the urge to get up and dance. I think my favorite was the motown medley. We also had a nice time getting to know the Christmanns for the first time (for me and Megan) or visiting after many years (for Austin). They prepared a delicious dinner of Raclette, and during the meal we decided it would be fun if we attempted to speak only German. I didn't say much, but what I did say was horribly mangled. However, I felt like it was a good exercise for me, since normally my controlling ways make it so I don't want to speak unless I'm absolutely positive I can say what I want to say correctly, but this approach doesn't work well for learning a new language. By forcing myself to only speak German, I had to loosen up and try to say things even when I wasn't entirely sure how to say it. It was also nice to have cohorts so that we could all laugh together instead of feeling like everyone was just laughing at me.

The next day, after a slow, relaxing morning and saying goodbye to the Christmanns, we went to Heidelberg. The town itself was very pretty, and the main attraction, the castle was epic. We walked all around and inside of it, and saw the giant wine barrels and apothecary museum. I liked seeing all the ancient remedies and old distillation equipment. It's kind of funny to think that we still have to learn processes they were using a long time ago in modern o-chem labs, and the equipment hasn't even changed that much. The castle was really cool to see from the outside. Someone observed that it looked like Hogwarts, eliciting a small Harry Potter discussion (always welcome) and a recital of the Hogwarts school song.

"Hogwarts, Hogwarts, Hoggy warty Hogwarts, teach us something please..."

On the train back, with the trip essentially over, the stress of the imminent physiology test began to get to me, so I studied most of the way back, which helped to somewhat relieve my worry.

Narwhal horn at apothecary museum

distillation equipment

On Monday this week we got to go to the Bonn University Clinic and see some surgeries (or “chirurgie”). This was my favorite part of the week, and not just because it only had to compete with three tests which occupied the rest of the week, but because it was amazing on its own. I was with Yesenia and Lars watching the back surgery, and it was incredibly interesting. I wasn't sure at all what to expect when we walked into the operation room and there was an actual person lying on the operation table, but when they began it was so interesting I could hardly take my eyes off it. The anesthesiologist let us stand in his area and he even brought a stool over for me and Yesenia to stand on so we could get a better view of what was going on. We had to wear lead protection aprons because they were using an x-ray machine during the surgery to get a visual on the screws and metal bars they were putting in. The procedure being done was a spinal fusion of the L4, L5, and S1 vertebrae because the L5 was slipping. After the initial cut with a scalpel, they were using some kind of electrical tool that sounded and smelled like it was burning the patient's flesh, and the anesthesiologist explained that it was difficult to get through the back muscles (which he called a “filet” to compare it to the part of a pig or cow which a filet is made from) and that they needed to be relaxed. The surgeons also made comments and explanations, and occasionally even made jokes. I didn't always realize right away when they were joking because of the language barrier, but I think it helped me feel more relaxed and less queasy. Initially, watching them dig around in the patient's back did make me feel just the tiniest bit unwell, but I was so fascinated that I didn't want to miss a single second so by sheer force of will I refused to be sick and kept my eyes locked on target almost the whole time. The surgery lasted a long time, and in fact they were still going when we left, and we were the last ones to leave. For the first hour or so the surgeons inserted six screws, one on each side of the three vertebrae involved. The screws had a notch on the top, and when they were all in place there were small metal bars that fit into the notches and were bolted down. At this point we witnessed some of the guesswork and estimation of surgery, because the two screws in the middle vertebrae had to be taken out and redone because they were too far laterally. Even after this, they were a millimeter away from where they wanted to be, but the surgeons said it was ok to leave them there because later they would do a laminectomy and it wouldn't matter. Also, they had to shape and cut the metal bars that went across the top of the screws since they needed to be curved and the correct length. We got a kick out of seeing them use this huge wirecutter-looking tool to get them to the right length, and another tool to bend the them to the correct amount of curvature, which was all estimated. They also had to redo one of the metal bars after putting it in because they saw it needed to be shorter and more curved. After all this they started the laminectomy, which took a much longer time than I was expecting. They basically hacked away at the patient's spinal cord with a variety of interesting tools, including these little scissor-type instruments that would grab tiny pieces of spine which were then ripped away, like tiny ants ripping away piece after piece of a loaf of bread, and a few times they actually had tools that looked like a chisel and mallet which they used to hammer at the patient's spine. There was quite a lot of bleeding at this point, and the surgeons explained to us that there were lots of vines in and around the spine, which was where all the blood was coming from. They had a tool kind of like the one dentists use to suck up water and saliva out of your mouth, only in this case it was sucking up blood and bits of gristle, and the sound it made was pretty nasty. They also pointed out the nerve roots exiting the spine, which made me think of the picture in the textbook of nerve roots exiting the spinal cord. There were a few differences between the picture and real life; for one thing everything looked red because it was covered in blood. Even the fat, which normally looks whitish-yellow, looked red because there was so much blood around. Luckily, by now I was completely over any feelings of nausea, and in fact I kept marveling at how ok I felt. At this point the anesthesiologist also began telling us a lot of information about his job. He said there were several things he had to pay attention to, including: a general anesthetic which was a halogen and made the patient go to sleep and forget, the respirator which measured oxygen consumption and carbon dioxide output, and a liquid opioid for pain. The carbon dioxide needed to be between 30 and 40, because above 40 means they are feeling pain. At one time we saw him give the patient more liquid anesthetic and he explained it was because the carbon dioxide level was getting higher (but still within an acceptable range, he was increasing the anesthetic as a precaution). He also checked the blood pressure and other vitals with various machines, and graphed the data periodically on a paper chart. The patient was on constant IV drip to maintain blood pressure because of all the bleeding, and one time we saw the anesthesiologist use a slightly different solution, and he explained that the second one was more gelatinous and was used because the blood pressure had dropped. He also said that anesthesiologists have to pay attention to what the surgeons are doing and what is going on at all times because every patient, doctor, and surgery is different, so they have to be continuously adjusting.

The rest of the week was a stressful blur of tests, until Friday when we went to the Arithmeum. I really liked seeing all the calculating machines, especially some of the earlier ones which looked so delicate with all the gears and step drums. It was also fun to play with some of the exhibits which we were allowed to touch, punching in numbers and trying to figure out how it worked.

For now I'm just looking forward to spring break. My mom and sister are coming to Europe and we're going to Prague, so I'm really excited to see them and go to another place I haven't been yet.