The Diary - Turku, July 2001

So tonight, I am off to Finland. Having just completed my exams for this year, I don't want anything else but to sleep, watch films, eat and get some rest. But that will have to wait. Instead, I am on my way to some country where they speak an incomprehensible language that is not like anything I have ever seen. I will be working at surgery, but sure I know nothing about surgery. I am so much afraid that they might ask me to DO something. Moreover, I was told that Finland is terribly expensive and full of mosquitoes and reindeer. What am I going to do there? Please let it be 31st already. Being nervous from the very early morning I arrived at the airport two hours before the departure time to find out that the plane was actually leaving fifty minutes later than I had first thought. (At least I got the date correct, unlike when I went for my dermatovenerology exam on Monday only to find out that it had already been on Friday.) Finally I checked in and sat down in the lobby watching the people. They all seemed the same to me. The same short blond hair, similar faces, similar glasses. And there I was, with short blond hair, with the same glasses (actually I bought those glasses just a week ago). As I was listening to the gibberish they all spoke, I envied them; they were going home.
Once on the plane, my fears were slightly lessened by the excellent meal they served. They may speak a horrible language but sure they care about their customers. I was sitting at a window above the wing, with a fat lady sitting next to me. It made me feel a bit claustrophobic, especially when I watched the tip of the wing bend up almost a meter as we took off. But the flight was a pleasant one (just the rule saying that you fly into turbulence every time the coffee is server proved to be correct again). After two hours, we descended below the white fluffy clouds and I saw Finland. Well, I saw trees and water and I assumed it was Finland. No mosquitoes no reindeer.
The immigration officer kept looking into my passport for so long that I could almost see the "REFUSED" stamp there. Finally, he asked me what I was going to do in Finland. "Do some surgery", I replied in a matter-of-fact voice. I may know nothing about surgery, but sure it sounds good.
Once outside, I tried to make my phone work. It took me about thirty minutes and cost me a small fortune. First it didn't want to find any network. Then I sent few messages asking for a reply, so that I would know this whole thing worked. None replied. So I tried calling my brother. As with the network choosing, I knew it was possible, but I had no idea how to do it. It all seemed so easy back at home when I asked in the shop. After several vain attempts I got the call-back working and managed to call my brother. Of course, he was asleep. What an outrage! So here I am, lost in some hostile alien country, desperately trying to contact someone home, and he is asleep! I was shocked (not much of a surprise though). But at least I knew now, that the phone worked and I could send a message to my mother saying that I was not swimming in the sea but sitting at the Helsinki airport (not feeling much safer anyway). Then I went to have a look around. First thing you notice at the airport is that there are more Finns in Finland than you had previously thought. And as I learnt in one of the magazines on the plane, 75% of all Finns have a mobile phone. And I guess that out of these 75% more than 99% have a Nokia. That's the only way to explain what happened when we all got off the plane. You could hear the "beep beep" everywhere. Next thing you notice when you walk out is that although it is half past midnight it is not dark. Even if you are expecting this, it will still surprise you, when you first see it. The bus for Turku at 0:30 arrived at 0:30. I had almost two and a half hours to get some sleep. That was not easy at all, the bus was full and the man in front of me leaned the seat back, so that I had no place for my legs. Still I almost fell asleep several times, but usually I only got to the half-awake half-asleep state and then, in some kind of a myoclonic spasm, I shot out my arms and legs, hitting the poor man next to me. It was quite embarrassing so I decided I'd rather stay awake. When I got off the bus in Turku at 2:50 it was already light again, it had been dark only for about an hour or so. I was looking around to find my tutor Aino, but saw nobody. That made me a bit nervous, but then I saw her coming. Funny, until then I was sure Aino was a boy. She drove me to the student's village in her old VW Golf, driving like Mäkkinen and Häkkinen combined. Once in the students' village it took us about twenty minutes to find door 3B. I am not quite sure how I am going to find my way back from the hospital tomorrow, but I am so tired now that I don't care at all. It is half past three in the night and I am going to sleep.

July 2 2001 (Monday)
The day of the picnic

I had only three hours of sleep and then I went to the hospital to take the MRSA and VRE tests again. That was annoying, since I guess we all had that done in our home hospitals and we had sent the results with the CC as required. In the hospital I met with another girl, Laura, some Lithuanian guy called something, a Dutch girl called Marieke and maybe someone else, it was too much to remember. After the test, they wanted to show us the way to the canteen but unfortunately they didn't find it. Neither did we find my doctor. So I went to have a cup of tee in the hospital caffee. Eventually I found my doctor, he introduced me to some seven or eight other people; of course I didn't remember a single name. There were three female doctors and only one male doctor. In our hospital, there is only one female surgeon in all the surgical departments. We went for the rounds (rounds in Finnish are as funny as absurd theatre in Chinese). From time to time I could hear words like "peritonitis" or "abskes" as they pronounce it here. I tried to guess the diagnosis from the look of the patients. Two of them were so obvious that I asked the doctors. Of course, I got none of them right. After that, one of the doctors took me to the operation theatre and I got to see the first operation in my life. Amputation of rectum for adenoma recti. Dr. Grönroos was commenting what he was doing in English, except for those moments when the patient was bleeding too much, then he would switch to Finnish and I have no idea what he was saying. Standing on your feet for three hours, smelling burnt flesh and drying blood is not exactly the kind of thing you want to do after three hours of sleep. So I was glad when they closed the patient up and I got the chance to go for lunch. Lunch works this way: you stab a ticket onto a pole and then you take whatever you want, as much as you want. The only trouble is it is all labelled in Finnish, so when I tasted my coffee I found out it was some kind of beer. Disgusting! During my lunch I was introduced to another girl, a beautiful smiling blonde. Half asleep I went with Laura and Valdas (that's the Lithuanian bloke, I know his name now) to the medical school to get us cards for access into the computer room. After that, Laura drove us to the students' village. Yet another girl with the driving habits of a rally driver. Some of the zebra crossings are elevated but I doubt whether Laura knows that. Her Honda surely does, as it hit the ground every time we jumped over one. At about three o'clock I got to bed. But alas, only few minutes after I had fallen asleep I was waken up again by the doorbell. It was a girl asking for a mattress. Still half-sleeping I gave her one mattress from my room and immediately hit the bed again. the group

I had no idea who she was and why she wanted my mattress but my brain didn't work enough to ask any questions. At six p.m. we had a meeting at the corner of the hospital, so I met with Valdas at five and we got on our way. After ten minutes of easy walk we were at the hospital. Ir really is not as far as it seems. So we went to look for the post office to send some postcards and at six we were waiting at the corner. There they were: Susanna - that smiling girl I met at lunch, Laura - the rally driver, Nina - a quiet girl. Then the foreigners: Marieke - a Dutch girl on a wheelchair, Eduardo - a Spanish teddy-bear-like boy, Ruth - a Spanish girl, Valdas - my neighbour, Thomas - a Greek studying in Bratislava and I. There might have been more people I guess but it was such a busy day that I can't remember them all now. Yes, Ming and Jang. Two Chinese, both of them doctors already, she's a paediatrician and he's an intensive care specialist. evolution game

We went to do some shopping (food is really expensive - spaghetti, cheese and ketchup cost me a fortune) and then we had a nice picnic in a park. We played silly games (like evolution for example, amoeba amoeba); people watching us must have had real fun. But so did we. And we talked and talked. We learnt a Finnish song about different body parts, but I don't remember a thing. Now it is half past midnight and the sky looks like it is seven. How am I supposed to go to sleep? It is late; I am going to sleep.

July 3 2001 (Tuesday)
The day of the hospital

It is not a good idea to wait until dark before going to sleep. Fortunately I spent most of the time in the hospital with the mask on, so I could yawn as much as I liked. I first went for a radiology meeting, of course I didn't understand a thing, but at least I saw some pictures (they call 'CT' a 'TT'). At the rounds, I followed the doctors, trying to read the files; the diagnosis line is always in Latin. So I went one patient behind the doctors, looking into the files, nodding my head knowingly and not saying anything. I guess the patients must have been scared to death. But otherwise the rounds are really nice, the doctors talk with the patients much more than ours do and they also laugh much more. Maybe they are so nice people, or maybe Finnish is inherently a funny language. Who knows? This morning I asked one of the nurses for a place, where I could keep my stuff during the day. Surprisingly she didn't tell me to bugger off like most of the nurses in our hospital would have done. Instead she led me to a room with lockers and showed me which one to use. And she was smiling! Even the cleaning ladies here seem to smile at you as you walk over the floor they've just cleaned. In our hospital, they would simply shoot me. After the rounds I went to see a hemicolectomy. The surgeons talk a lot during the operation; sometimes I catch words like "peritonitis", "abscess", "laparotomia" or "ileus". But God only knows what they are really talking about. As for me, the conversation could easily go something like this:
      "Yesterday I peritonitis got so drunk, that I guess I will fall into the wound today"
      "Laparotomia? You are a drunk, look at your hands trembling!"
      "Today we'll go with my mates abscess periappendiculars perforatus for a bender again."
But it is more likely that they really talk about surgery. One of the anaesthesiologists asked me today where I was from. I told him, and he pointed at the gut and said, "This is a gut". I wanted to say that I knew that because heart surgery had always fascinated me, but I didn't dare. Under the mask and behind the glasses he couldn't see that I was laughing so he kept poking me, winking at me, saying that he was just joking. The most difficult thing seemed to be the mask. I could not get it right so that my glasses would not go all misty and foggy every time I breathed out. There must be a way to do it; most of the people there had glasses, but I was the only one to go blind with every breath. Still it was good to have the glasses on. It is easier to get the blood from the glasses than from your eyes. (Hey! I just tuned into an English-speaking radio station. I like that.) Today I met a Dutch bloke who works at the radiology department at the MRI (MK in Finnish). He says that Finnish is a very difficult language to learn, since even a little change in letters can change the whole meaning of the sentence. So one of the foreign doctors supposedly called a lady to say her husband had just died and instead of saying "I am sorry, your husband is dead." he said "I am the devil, your husband is dead." The screams of that lady could be heard all over the village. But who knows, maybe this bloke was just making it up. I wouldn't know. Ruth took that disgusting beer as coffee today, just as I did yesterday, only she made it even better by adding some milk and sugar to it. And the lady there who handed her the sugar just watched and didn't say a thing. Maybe she was just thinking, "These foreigners, they are disgusting!". Today I sent three postcards for 150 crowns. That's almost a dinner for two. They've just said on the news that American doctors implanted the first self-contained artificial heart today. Well done. The expected survival of the patient is sixty days.

July 4 2001 (Wednesday)
The day of Donna

This morning I "read" the file of one of our patients. Just by looking at her I knew she had diabetes, hypertension, thyroid dysfunction and trombophlebitis. Medi+Heli helicopter

She looked just like a patient I've seen at home who had diabetes, hypertension, thyroid dysfunction and trombophlebitis. Today I also saw the helicopter landing. It is big, red and ugly. It lands outside the hospital so that the patient needs to be taken to the hospital by an ambulance. I saw a hemicolectomy for diverticulitis, had a great lunch (some kind of fish) and then sat in the library until four, reading about pancreaticoduodenectomy. That will be tomorrow. At four I went to tell the doctor that I was going but he was already gone. Donna

Since I last saw him in the morning, I guess he thinks that I skived off right after the rounds. I'll have to speak with him tomorrow whether it is all right if I do what I want. Tonight we went with the girls to have a drink on one of the boats on the river. They are really nice. The girls. But the boats as well. Thomas and Valdas told me that there are two restaurants in the town where you pay and then you can eat as much as you want. I'll starve a little more and then I'll check it out. I guess that after that, they'll close the place down.

July 5 2001 (Thursday)
The day of the RIBS

The pancreaticoduodenectomy didn't go ahead since the tumour was inoperable. I suspected something was not going as it should when they started by middle superior laparotomy. In the books I studied yesterday, it said that you do both subcostal cuts. So I was looking forward to seeing the whole abdomen open and instead they dag into this little laparotomy and then they said it was all over. The next planned operation was a laser surgery but they did it conventionally, so I didn't see the laser in action. Too bad. In the meantime I missed the ERCPs that my doctor was doing. I at least caught up with him to ask whether it is OK that I do what I want. He said that it is OK and I guess we are both happy this way. Funny that the inoperable tumour today left the surgeons quite untouched but the anaesthesiologist was very sad. They say that if you tell an anaesthesiologist "The patient is dead.", they'll just say, "Oh, shit." in a matter-of-fact tone of voice. I guess that one should never generalise (I know this is an old joke, but still a good one). But this doctor was very nice; she was all kind and willing to explain everything about the process of putting the patient into narcosis. When I asked whether the patient wouldn't get cold during the operation, she said it was a good suggestion and installed the nasal thermometer. I felt important.
In the evening we went to a "grilli" to have a kebab and then sat for a while in "The Ribs", drank ciders (tastes awful) and listened to some jazz (sounds good). It was a pleasant evening. I also went to do some running before that. It is really bad. I wanted to run a circle around the students' village but I had not idea where to run. It felt weird running somewhere not knowing where.

July 6 2001 (Friday)
The day of the Finnish

I saw two gastroscopies in the morning, made a diagnosis from the door (wrong, of course, but he WAS an alcoholic!) Then I saw a "ruptura vulneris cum evisceratio" in a post-appendectomy patient and an operation of ileus for carcinomatosis. Dr. Laine offered me today that I could assist a laparotomy but I let Marjo do it, I wanted to see first what is actually expected from a student during an operation. Not much, I'll do it next time. If all goes well I could assist on Monday. The gastroscopies today were also interesting, but I can't tell an ulcer even when it is as big as a fried egg. My doctor, Juha Grönroos, left for a four-week holiday today, so on Monday I'll get a new one. I hope she will leave me my freedom. Today I saw the helicopter again. I heard it coming so I went outside to see how they take the patient to the hospital. Since I didn't see the ambulance anywhere, I thought I'd missed it and decided to wait for the chopper to take off. After about five minutes, the ambulance came slowly and taking their time, the doctors took the patient to the hospital. Either the patient was dead already or the Finns have seriously missed a point. Posankka

Never mind that, watching the helicopter taking off from so close was an exciting experience. It was again 30°C today (even now at quarter past one in the night it is more than 18°C) and having the helicopter hover just a few meters above my head was very refreshing. The helicopter is really ugly, and this text is really incoherent. I went running a bit again (30°C!) and ate about half a kilo of spaghetti. Tonight we went to Emmi's place. Nice little flat and about twenty people in it (30°C!) I met several new people; they all speak English so well! I tried to learn some basic Finnish phrases (thank you, Susanna) but I am so bad at this. I remember only "kiitos", that's "thank you", and "huomenta", that's "morning". And also Posankka. That is the Pigduck. I am going to sleep.

July 7 2001 (Saturday)
The day of Cutty Sark

I got up at twelve and I had a nice breakfast/lunch

(rice this time, I can't stand spaghetti any more). Laura sent me an SMS that there were no more tickets for the Ruisrock festival (that saved me 150 FIM). So I went to the hospital to read my emails and then to explore the town a little. The sun was burning like hell fire again, so I only got to the Suomen Joutsen (or whatever, it is a big ship) and then I had to turn and get home hiding in the shadows. Even though, I will be probably peeling for the next two weeks. That SJ is some kind of a frigate that anchors on Aurajoki. I took a picture of it; I'll put it next to Cutty Sark in my album. The town is really nice. Had spaghetti for dinner. Didn't see the helicopter. I am going to sleep.

July 8 2001 (Sunday)
The day when the sun came down on us

Again slept the whole morning, no lunch, and at one I was meeting Valdas and Thomas to go with some of the Finnish girls for swimming. The swimming pool was nice, they had a great slide. After Nina probed it, we all bought the bracelet for 10 FIM and then infiltrated a crowd of little children to show them the correct way to do it. After several rides we found that the best method was to ride the slide in a kind of modified opistotonus, touching the slide only with your shoulder blades and heels. That made you go so fast that you could either fly out of the slide or break your arm twice. We stayed for about four hours enjoying ourselves. I did some swimming to compensate for my horrible running discipline; I swam a little more than one kilometre and got burnt soooo bad, even though I kept applying the sun block every now and then. After the swimming, Thomas, Valdas and I went to this "endless" pizza place. For 44 marks you can eat and drink as much as you want. The food was not so good, but hey, there are times when I prefer quantity to quality. I just had a shower and treated my burns. This will be a difficult night. And tomorrow is going to be a difficult day. A new doctor, assisting the first operation in my life, and in the evening we are going to learn some Finnish dances. The sun is 140 million miles away but it can be a real bastard.

Week One