"Alright, you've seen it once, next it's your turn."

That one little sentence seemed to be the phrase of the week during my time at the Savonlinna Central Hospital. Although that didn't actually happen, it didn't stop all the anesthesiologists, surgeons, and nurses from teasing me that next I'd be doing their job.

My time in the Operating and Anesthesia Wards was a little different that I expected, and a lot better! I will admit that I wasn't entirely sure I was going to like it--after all, my two days in the OR during my Medical-Surgical Rotation was more than enough for me. It seemed too repetitive, not very interactive, and something where you spend a lot of time just waiting. I'm so pleased to say that I had no idea what the OR is like in Finland, but I was happily surprised by it. Here are a few reasons why.

1. The nurses

Ok, so in the OR, there are several different types of nurses. There's the scrub nurse who assists in the surgery and there is the circulator, who runs and maintains the flow of the OR. She also prepares the patient for surgery. Here in Finland, there is another type of nurse, the Anesthesia Nurse. Basically, she maintains all the anesthesia during the procedure and ensures that the patient remains stable. She can give medications to maintain the blood pressure or heart rate, and can turn up or down the gas depending on the patient's carbon dioxide and brain wave levels.

I was so happy when they assigned me to an anesthesia nurse for the two weeks. I don't particularly find the other two areas on the OR interesting (sorry!), but I loved the anesthesia side. I really loved our critical care/ICU rotation last semester, and this was the closest I got to something like that. I learned about the ventilators, and helped ventilate patients manually before and after intubation. I got to look and assess the stability of the patient and determine if they needed any type of medication (diazepam, heart rate, blood pressure, pain med, ect). I learned a lot about the anesthesia medications and side effects, got to practice those IVs, and was asked lots of critical thinking questions like, "what next." I loved it.

All of these nurses were very welcoming to me, even if they didn't speak to me in English. I found them to be a little shy at first, but then soon warmed up to me as I spoke with them. They were very knowledgeable and so used to having students that I found I got lots of practice. Two nurses even let me stick them with IVs multiple times so I could practice. After that I nailed every IV I tried (and I got to try a lot!)

Shameless selfie...not in a warehouse, just the locker rooms!

2. The surgeons

The surgeons were very welcoming as well. I noticed that once I was introduced as an exchange student, almost all of them opened up conversation with me, invited me to watch closer, ask questions, ect. The nurse commented that she was impressed, because many students have a fear of interacting with doctors and surgeons, feeling intimidated, so they don't. I can be, but they were all so easy to talk to and when I showed interest in what they were doing, they were eager to show me what they did. I even got to cut into a gallbladder to look for stones after they removed it! It was very exciting. I saw a c-section, hip/knee replacements, the gallbladder surgery, breast removals, cancer ablations, spinal surgery, ear/nose/throat stuff, plastic surgery, ect. So many different things. It was from a surgeon who first told me "Now you've seen it once, next it's your turn." Yeah. Definitely. NOT.

On a personal soapbox and going back to what I said earlier, I don't believe that nurses should fear doctors. My nurse said that she has noticed that many Finnish nurses still feel that way towards them and that they don't feel like they can approach them, challenge them, or make suggestions. This is something I feel like is even among us in the States, a little bit. I feel very strongly that there should be open communication and mutual respect for the different professions, because they are very different and have different focuses.

Day Surgery...

The windows from the OR look out to the beautiful lakes!

3. The anesthesiologists

Here the anesthesiologists start the anesthesia (intubation, gas, medications), monitor that the patient is stable and then move on to the next patient, leaving the nurse in charge. These anesthesiologists also were very nice to me and let me do a lot. One of them let me intubate several times! He was standing over my shoulder telling me exactly what to do and helping me do it right, but still, it was very exciting! He also taught me about the post-op orders for medications that he gives, and asked me lots of questions to help me see what might be needed. I assisted with spinal anesthesia as well, and with epidurals and ventilating patients again. After each anesthesia (spinal or general), every single anesthesiologist said, "You've seen me do it, next I won't need to come, it's your turn." Every single one!

The challenges: 
Now, I did really enjoy this rotation, I learned a lot and saw some really cool stuff. There were, of course, some challenges though.

1. Medications.
Ok, did you all realize that we use different medication names? Most of the time, the generic name is the same, like diazepam or propofol or fentanyl. But of course all the trade names that people use in daily life are very different. I was lost the first day trying to remember all those trade names for Finnish meds. Thank goodness the BYU College of Nursing made also made us learn generic names! I didn't realize it would come in handy. But also, for example the generic name for Acetaminophen (Tylenol) is different every where else except America. We call it acetaminophen; everywhere else calls it paracetamol. It's the most basic medication you learn in nursing school, and they all looked at me funny when I said I didn't know what it was. It's hard to remember that you actually are knowledgeable and skilled when basic things like medications are different.

These are also how most of the US medications come...

And these are how Finland's come...there's a slight difference in preparing them. 

2. Method/Measurements.
Of course they use Celsius and the metric system. We also actually use those in medicine as well, so I'm sort of comfortable doing calculations and stuff and knowing what the normal weight/temp would be. But then, they have different scales for levels of hemoglobin or blood sugar. Those are also very basic things we learn in nursing school, but here I felt like I didn't know anything because they asked me if it was normal, and I had to say I didn't know.... Equipment is very different, all supplied by European companies for the most part, so the IV sets were different, the monitors in different languages, the pumps very different. In a way it's like relearning everything. I just had to remind myself to be patient and humble and willing to learn. THAT is hard. NaCl (Sodium Chloride) is actually called Natrium Chloride...easy to see why, but it's those little differences that make you stop and think again.

3. Language
Once again, the language barrier is difficult. I have to admit I didn't think it would be that much of a problem before coming. I think my clinical instructors here were wise when they put me in anesthesia, because you don't really talk to the patients except before and after. Do you know how awkward it is when you know people are talking about you (I can follow conversations that much) or around you, but not be able to add in? It's hard to feel part of the group too when you are sitting there. I do try to make conversation, but many times when I try to talk, they are shy and uncomfortable and start looking for my nurse to translate everything they want to say. Many people have told me that they were taught so much about grammar in school and less about conversation, so they are afraid of making mistakes when they talk. I honestly don't care about that. I just want to feel like I can be apart of the conversation, greet patients, make small talk, help the patients not feel awkward when the nurse talks to me and directs me in English. That has been the most difficult thing. Especially since I'm a very social person and want to talk to everyone!

I think I will not take for granted those situations where I understand and can follow the conversation. I think I will think and feel differently when I have a patient that doesn't speak my language. I think I will be more understanding, empathetic, and more willing to find alternate methods of communicating because I do understand what it is like to be talked around or not talked to. And as a healthcare provider, I don't feel like we should ever let our patients feel that way. They have a hard enough time as it is being sick, dependent, and many times helpless. I don't want to add that other feeling as well.

Whew. What a soapbox. If you actually made it to the end of this post, congrats! I really only expect my fam bam to stick it through :) But I'm always happy when others are interested haha. I didn't get to take many pictures while there, so sorry about that! Just know, most of the hospital looked just like ours do. Stay tuned for latest updates this week about my new clinical rotation!

In the meantime, enjoy this beautiful view of the lake!