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So ready for 2021

December 27, 2020 No Comments

With a name like 2020, this year really had the potential to be great. In some ways, it really was. A global pandemic brought people together on a scale that I have not seen in my lifetime. Scientists were able to make an extremely effective vaccine within a year! (They were able to move forward so “quickly” because many of the barriers that usually hold up vaccine development were lifted.) The social movements in the United States and around the world brought necessary awareness to society and will hopefully continue to bring on much-needed change. We’ve seen our lives completely turned upside down and people continue to persevere.

Hopefully, we all get through this experience with a greater appreciation of community, value for our health, and a sense to try to be better in this world. It’ll definitely be a year I don’t forget and will be telling my children and grandchildren about.

From last year’s Christmas and honestly my favorite video of my niece.

Svikki MD

Change is coming to my work schedule…again. If you’ve been following along over the past several weeks (thank you!), you will have noticed that I was reducing my clinic hours to make more time for the volume of patients in the hospital. This week, I finally had to make the move to focus primarily on hospital work.

It was getting to be too much trying to be in two places at once. There was plenty of work that needed to be done in the hospital. I’d have to jump over to the clinic in the afternoon to see patients. That also required time, follow up, and brainpower. I felt like I had to compromise my full commitment to either one side or the other.

Consequently, I spoke with the office manager and laid out observations I had made over the past three months. Physicians and nurses alike seemed frustrated. Doctors in the office were interrupted while with their clinic patients due to calls from the floor nurses. The floor nurses were having a hard time getting timely responses from the clinic docs. The doctors didn’t have time to take on admissions because they were busy in the clinic. However, bigger hospitals had to make room for more acute care patients. Clinic volumes were down so they didn’t really even need me in the office. The mid-levels had nearly empty schedules while they packed my 2.5 hours full.

So, moving forward, I will be solely in the hospital seeing patients and trying to keep our swing bed census around 10 patients. I’ll work in the clinic if many providers are out. However, I won’t have a clinic schedule per se.

Holidays in the Hospital

With the mid-levels out of the office for the holidays, my colleague and I were actually pretty busy in the office on Wednesday and Thursday morning. After the clinic closed Thursday at noon, I headed over to the hospital to see my 9 patients. A couple of patients were discharged home in time for the holidays.

I opened up my gifts on Christmas Eve while FaceTiming with my family. I’m pretty used to working over the Christmas holiday, but I’ve never had a Christmas where I wasn’t physically around my family. Thank goodness for FaceTime because it honestly didn’t feel lonely despite being alone.

Christmas day, I was back in the hospital seeing patients while wearing a light-up necklace my mother sent me. I’m all for bringing a little joy to patients stuck in the hospital for a holiday. My colleague invited me to have lunch with his family. The food was delicious and it was nice getting to know his wife and daughters. It was only the second time since moving here almost three months ago that I have socialized with anyone outside of the hospital setting. My colleague does wood work and made me this bowel from some local wood! I love gifts with a purpose and memory attached to them.

Hopes & Dreams

With a new year only a couple days away, I think most people become sentimental and plan for the future. I am no exception to that. Pre-pandemic, my years were filled with travel, concerts, adventures and so much fun. I’ve made a few videos over the years reflecting back on the previous year with travel videos and pictures.

Despite the global pandemic that changed so much and forced us all to slow down in our private lives, I was still able to do a few things. Pre-covid in the US, I was able to attend my Aunt’s birthday in Germany and sang a set for all her guests.

At my Aunt’s Birthday bash just before Covid hit in March.

I returned to the States to immediately start working in Flu clinics and on the COVID floor as one of the first residents to do so in our hospital. COVID changed how we celebrated our graduation from residency but we made the best of it. The late summer allowed for a brief window where I was able to visit family in Germany and take my little sister on a trip to Italy for a few days. I returned from there to move across the country to South Dakota to start my life as an attending physician.

Photoshoot with one of my best friends in Hamburg in March

Working in healthcare and at times being over-worked in healthcare, I am still very grateful for the fact that I am out here every day helping patients and have a job to go to. I have so much respect for people to go around. To the people who have been working from home for the majority of this year. The utmost respect for the (mainly) mothers that have been keeping a household running, childcare managed and continue to work through it all the best they can. I have so much respect for the teachers who are working crazy overtime to try to continue to educate our future generations. Respect is also due to all the frontline and essential workers. My gratitude goes out to all the people who have been physically distancing, wearing masks, washing their hands, making personal sacrifices, and just being respectful of other people’s wellbeing.

Italy with my younger sister in September

2021

A change on the calendar from one year to the next doesn’t automatically solve all of the problems faced in 2020. Actually, it does nothing of the sort. But it feels like a new beginning. There is so much potential for this specified timeframe of a year to be better than the previous 365 days. Many things indicate positive change: the vaccine rollout, a new administration, and continued knowledge/experience gathered about the challenges we face. On a personal level, I will hopefully be able to safely celebrate a few weddings in 2021. Our family is expanding in size in multiple ways. Although I don’t think we will get quite back to the lives we would like to fully in 2021, I do believe we will be making big strides in the right direction.

At one of my best friend’s sister’s very, very intimate wedding in May.

I hope everyone has a safe New Years and continues to be safe, conscientious and loving.

mfg

Happiness, Locum

Frohe Weihnachten

December 20, 2020 No Comments

Happy 4th Advent!

Svikki MD

Things are busy but well in the hospital. We kept our census at the hospital max or just grazing by it all week. We aren’t quite as COVID heavy as some of the surrounding hospitals but we try to offload the bigger facilities with better capabilities and care for less acute cases.

I felt a bit like a zombie for half the week. I didn’t sleep very well Monday night on Tuesday. Tuesday is my call day and I was woken up 5 times throughout the night about an admission of an acute care patient who was pretty sick but due to multiple factors, the patient stayed at our facility. I was woken up 7 times throughout the night about this patient the next night. So, after three consecutive nights of horrible sleep continuity and no chance to catch up during the day,… I looked a bit like death. Luckily, I had the patient stabilized enough by the next night that I didn’t receive any calls from the hospital throughout the night.

It really gives me an appreciation for all the rural docs out there who constantly manage their patients in the hospital and can be called at any time. Not too many jobs that essentially keep you on the clock 24/7. It also made me miss residency hour protection and resident wellness. There are unfortunately a lot of residency programs that still don’t prioritize resident wellness. My residency was amazing at this and I would’ve been given the option to go home after that 2nd horrible night and probably would’ve been sent home even if I didn’t want to after that third night.

I’m gonna get dark and real for a second

A friend of mine recently posted that she was headed into her third 28-hour shift in less than two weeks without a day off. Medicine needs to change its culture of abuse of doctors. You wouldn’t want your pilot telling you at take-off that they haven’t slept in over 24 hours. How is that ok for doctors. Its torture. And there is plenty of data to show that medical errors increase significantly after a certain length of shift. We strive to practice evidence-based medicine, it’s time we live by that too. You aren’t a big shot because you work non-stop. It’s irresponsible and torture and the industry needs to get with it. Physician burnout and suicide is very much real… things need to change. And not just for residents. Attendings need protection too.

Christmas Traditions cont.

Ok, back to some fun Christmas things!

Weihnachtsbäckerei – Christmas bakery

Of course, people bake cookies with their kids here in the USA too. The types of cookies vary some. The thing I instantly have to think of when it comes to baking Christmas cookies however is a song! It’s called “In der Weihnachtsbäckerei” (In the Christmas Bakery) and is a song I listened to so much as a child while baking with my Oma and Great-great-aunt. Rolf Zuckowski is famous for his albums of children’s songs and it seems like he has a yearly performance of this song on TV. Take a look!

My mom was so great to send me a package with her homemade cookies. I’d be lying if I said they weren’t already half gone! Maybe next year I can share some of her recipes when we spend Christmas together. That way, you can make your own little taste of Germany!

Weihnachtspyramide – Christmas pyramid

This is a traditional decoration from the Erzgebirge region in Germany.

This form of folk art goes back as far as the Middle Ages and uses wood to make pyramid structures showing imagery from Christianity or nature. The windmill at the top is moved by the rising heat from the candles. This lets the motives move within the pyramid. It’s a beautiful sight when it’s up and running. My Opa would always set one up in the living room and I remember watching the little figures go round and round in the glistening lights of the candles. I can’t wait to celebrate Christmas in my grandparent’s house again. I know exactly where the Weihnachtspyramide is stored.

You can also find huge Weihnachtspyramiden at Christmas markets! Like this one below in Hannover.

Christmas itself … we do things a bit different

In Germany, Christmas is celebrated on the 24th of December – Heiligabend (Holy Night). Presents are usually opened that evening. We have always done it that way in our household too.

On the day of, we’d usually spend the day doing normal things. Since we had a bit of a hobby farm, my mornings were often spent taking care of the animals. My parents would start preparing and cooking dinner hours in advance. Dinner usually consisted of a duck/goose prepared by my dad and yummy German sides the vegetarian of the family could eat including Kartoffelklöße (potato dumplings) and Rotkohl (red cabbage). As the parents cooked, the kids would get ready for dinner by putting on something nice. The older we girls got, the more time was spent on hair and makeup.

We’d all sit together and enjoy our dinner. Afterward, we would often play board games together… just to draw out the suspense to opening Christmas presents a little more. When the time finally did come, we would gather around the couches by the fireplace and my mother would distribute the presents. After all the gifts were opened, we’d spend the rest of the evening preoccupied with our gifts before going to bed.

Celebrating on the 24th meant that we had to be pretty darn patient to see our friends again during Christmas break because they would be celebrating Christmas the next day.

In Germany, December 25th is considered the 1st holiday day and December 26th is the 2nd holiday day. In many parts, both days are considered official holidays so many people don’t have to go to work and shops are closed.

Christmas 2020

As with every year since graduating medical school, I will be working Christmas. During residency, I often offered to work Christmas because my older sister was a resident too so we would usually find one evening to coordinate as our Christmas evening. That then allowed me to take New Years’ off and do something fun for a few days. This year, I will be on call throughout the holiday as well. Once again, I’ll be taking New Years’ off. This will hopefully be the last year I work Christmas for a while. This year, I didn’t mind working because I knew I wouldn’t be traveling home. Starting next year, I want to properly spend Christmas with my family again. Being a locum physician, I have a much better chance at making that happen too.

I wish you all a Merry Christmas and Happy Holidays! Please be smart, be safe, and be kind to one another,… maybe a little extra this year while we continue to take this pandemic seriously.

mfg

Happiness, Locum

Glühwein & Kartoffelpuffer Please!

December 13, 2020 No Comments

Time really flies when you’re busy! How is it Sunday again already?

Svikki MD

I’m slowly morphing into a hospitalist. My clinic hours are now reduced to 1 PM-3 PM daily. The rest of the time I am in the hospital seeing my patients. I’ve asked for a small office to be put together for me. I didn’t want to keep occupying the nurses work stations and also needed my own space to be able to dictate and work without nursing bells constantly going off. Having an office on the floor will allow me to be close to the patients and nurses though. In all of the hospitals I worked at in Germany, the doctor’s office was on the floor with the patient rooms.

During residency, our office space was in the office building next to the hospital. That creates a lot of distance between you and your patients and staff. During residency, we’d often only be on the floors to pre-round and rounds with the attending. We would manage everything else over the phone or computer from our workroom throughout the day. That made it feel more like an office job than a clinical one. So, I am happy to be getting a little space on the floor to be amongst the action.

My census has remained pretty stable at 7-8 patients. A few of my swing bed patients feel more like acute care patients with things that have come up throughout the week. Having sufficient time in the hospital has made these changes very manageable however.

More Christmas traditions!

It finally started to snow a bit again yesterday. I find snow totally appropriate in the middle of December and welcome it. Having my tree up since last weekend and turning it on first thing when I get home has been really nice.

Christkindlmarkt – Weihnachtsmarkt

If we weren’t in a pandemic and I wasn’t in South Dakota, I’d be spending my evenings or weekends visiting the Christmas market! Germany is going into a new, stricter lockdown which probably won’t leave much room for Christmas markets this year. And honestly, it’s ok,…we can go one year without. Living in the USA, I’ve gone many Christmas seasons without visiting one and I have survived. It’s for the greater good.

Historical background

The forerunner of the Christmas market as we know it was Vienna’s December Market in the middle ages. It was first recorded in 1298, when citizens were granted permission to hold a Krippenmarkt during Advent. Open-air winter street markets were associated more specifically with Christmas in Germany, with the first Christkindlmarkt taking place a century later, in 1384. This was in the eastern hilltop town of Bautzen, Saxony. These early markets started by only selling meat but evolved to provide other everyday purchases, and eventually seasonal treats, decorations and crafts – accompanied by singing and dancing.
The Guardian – 11/29/2018

Growing up in Wisconsin, my family had the annual tradition of us all packing into the Suburban and driving to Chicago to visit the Christkindlmarkt there. I believe it’s the biggest Christmas market in the US with authentic German/Austrian/Swiss vendors. While living in Germany, we would go to the Christmas market so often after work and on the weekends. We would go to different towns to check out the different markets! Besides browsing the stands for little gifts or ornaments, there are a few must consume items.

Glühwein – mulled spiced wine! Makes you feel warm and happy inside. The non-alcoholic versions are pretty good too. It’s not just about the contents of the mug but very much about the mug itself. You pay a deposit on the mug that you would get back if you give it back. We would collect a mug each year to take home. During Medical school, we collected the glass mugs and played Glühwein-Pong with them.
Kartoffelpuffer – potato pancakes! Greasy hot potato pancakes topped with sugar and dunked in apple sauce. I am a HUGE lover of potatoes in many forms, Kartoffelpuffer is high up on the list as one of my favorite.
Crepe – very thin pancakes! Although French in origin, these are often found on Christmas markets as well. You can get them sweet or savory. I’m an all-year-round crepe lover and it’s a must when visiting France, but during Christmas market times, it’s an easy and fast snack to eat between Glühwein.
Do you have any favorites when visiting a Christmas market? Let me know what they are in the comments section below!

Family Photos

Our family didn’t do the typical American Christmas holiday card. We did however, often try to come up with a reason to dress up pretty extra for Christmas. We had a year were we all dressed up as “royals” and another year we had a Christmas Prom theme, complete with pine tree and ornament corsages and boutonnieres. As children, we’d usually be put in matching outfits for a picture. I definitely plan to continue this tradition one day with my own children.

I’m going to head out on a little walk before snuggling into a warm blanket on my couch, lighting three candles on my Advent wreath, and watching a Christmas movie. I hope everyone is staying safe this holiday season! I’ll be back next weekend with more German and family Christmas traditions!

mfg

Happiness, Locum

Getting into the Spirit of Christmas

December 7, 2020 No Comments

It’s officially December and thus officially one of my favorite times of the year! Although Christmas looks much different this year around the world as years prior, I am still doing what I can to make it feel like Christmas time around me.

Svikki MD

My new schedule at work with hospital work in the morning and clinic in the afternoon is working out much better than what I was doing.

Inpatient

I had 8 of the 12 admitted patients on my census this week. I admitted three of them on my call day Tuesday. That was a busy day… I didn’t leave the office until 10:30 PM. My new schedule allows me to sit in on the regional hospital capacity calls. I hear about the patient numbers in the surrounding hospitals are, how many COVID patients each location has, and what the capacity of the facilities is to admit patients. In such a rural area, it’s nice to have an idea of just how hard it will be to transfer a patient if need be.

I also get to meet with the case manager, physical therapist, occupation therapist, pharmacy and nutrition daily and go through our census. I feel much more connected with the hospital staff now.

Outpatient

Now that I am only in the clinic for half a day, my schedule tends to be pretty full with patients. I still see a lot of the walk-ins (a lot with respiratory complaints), pre-operation evaluations and hospital/ED follow ups. I only have a few patients that I am following on a more regular basis. Being a locum physician that plans to switch locations every 6 months or so, I won’t ever have a whole lot of continuity with patients. That is something I’m giving up in such a setting. I quite enjoyed many of my residency patients, knowing I’d see them every couple months.

Vorweihnachtszeit

I mentioned “Vorweihnachtszeit” in a previous post when I experienced South Dakota snow for the first time. It means pre-Christmas time in German. Germans have many beautiful Christmas traditions. Let me share a few with you each week leading up to Christmas! I will preface this by saying that my family is not very religious or churchgoers. I like to say I grew up culturally Christian. Both Germany and the area I grew up in Wisconsin were mainly Christian and thus we celebrated many of the Christian holidays. As I’ve grown, traveled, and met many wonderful people and cultures, I have begun to celebrate other holidays from different religions and cultures with my friends.

Adventskalender – Advent calendar

An advent calendar comes in many forms and makes the countdown to Christmas fun every day! They were first used by German Lutherans in the 19th and 20th centuries. You can buy them pre-filled and quite inexpensively, filled with chocolate or other sweets. My favorite kind, however, are the homemade ones!

As a child, we had a large rectangular cloth that hung from the wall that had 24 little hoops on it. My mother would fill various treats or small gifts into little bags and hang them on the loops. Each day, one of us four children, would find the right number, untie the treats and share amongst the siblings.

A few years ago, my aunt made me an advent calendar by clipping little bags to a wire with numbered paperclips. I can’t wait to have kids to make advent calendars for!

Nikolaustag – Saint Nikolaus Day

December 6th is a day to celebrate Saint Nikolaus the Myra. During his lifetime (born 270 AD), he was known to have worked a lot of wonders. Nikolaus was known to be especially warm-hearted and helpful towards weaker people. He was known as a strict yet fair person (sounds pretty German to me lol). He would ask children if they had been good during the past year. If yes, they would receive a small gift. If not, they didn’t receive coal but rather were threatened to be put in a sack and carried away (…I don’t believe this actually ever happened and remained a threat).

Nowadays, children place one of their shoes or boots in front of the door on the night of December 5th to awaken the next morning to it being filled with treats, small gifts, and fruit! And yes, us greedy little kids would always look for the biggest, tallest boot we owned to put out. Again, can’t wait to have kids to continue this tradition!

Adventssonntag – Advent Sunday

The four Sundays leading up to Christmas are considered Advent Sundays. Certain branches of Christianity consider the six Sundays leading up to Christmas the Advent time. For most of Germany however, four Sundays are included. Sometimes, like this year, the first one actually happens in November. Last Sunday, November 29th, was the first Advent.

Many households will have a wreath adorned with 4 candles. Every week, an additional candle is lit. Traditionally, you might have friends and family come over for mulled wine, cookies, games and spending time together. During medical school, my friends and I would often take turns hosting the others.

As a young child living with my grandparents in Germany, I would grab a box filled with small Christmas decorations and adorn the wreath. While at the cabin last week, I collected branches from pine trees that had been cut down and made a wreath of my own out of them. I added four candles and some small ornaments and now diligently watch it when it’s lit because it looks like a fire ready to happen. LOL

My Weihnachtsbaum

I’ll talk about German Christmas trees specifically in a future post, but I did want to share the little tree I bought this weekend. I actually could have gotten a permit to cut down a tree in the Black Hills. That just seemed like a few too many steps for me this year… I’d have to buy a saw for starters. So instead, I went to Lowe’s and bought one. Remember the sweet St. Vincent de Paul Thrift Store deal I talked about two weeks ago? The box of Christmas decorations for $10? They finally had their moment.

I didn’t have my own tree during medical school but I always came home for Christmas. When I lived in Miami, I was surrounded by lit up palm trees. I never had a tree during residency. So, I’m super excited to have one this year. In the future, I hope to have my tree decorated with more personal items, but this will do for this year.

One thing I love: Clearly Christmas time. And not the commercialness of it all. I love the hanging out with friends and family part, the decorations and traditions. The gifts are just a bonus.

One thing I ate: Christmas sugar cookie… and the season is just beginning.

One thing I’m grateful for: Traditions. They make me feel connected to my family and friends despite being hundreds if not thousands of miles away from them.

mfg

Locum, Mother Nature, Travel

Exploring Pahá Sápa

November 29, 2020 No Comments

I know I am not alone in having spent the last week much differently than I thought I would. Here’s to hoping everyone stayed safe over the Thanksgiving Holiday. I know it was hard not doing the big family gathering. My family did not get together from various states to celebrate together and that sucked. But it was the right thing to do. As I try to make the best out of every situation, instead of a party of 10+ people, I spent the holiday with one very good friend of mine.

But first, I had to work Monday and Tuesday. I was on call both days… my 4th and 5th days in a row.

Svikki MD

As my hospital census keeps growing, I needed to restructure my schedule. It was no longer feasible for me to have an open clinic schedule from 8:30AM-5:00PM and manage a hospital census of 6+ patients… at least not without spending every waking minute in the hospital. A reason I chose locum work was to avoid that very scenario.

Going forward, my mornings will be spent working as a hospitalist and my afternoons will be spent in the clinic. This will allow me to completely focus on the hospitalized patients and I’ll be able to round with the nurses and ancillary services. I look forward to seeing how this works. Depending on needs in either the in- or outpatient worlds, I’ll adjust accordingly.

Pahá Sápa

Pahá Sápa is Lakota for “Hills that are Black” aka the Black Hills.

The Black Hills National Forest is located in the western part of South Dakota and extends into Wyoming. The area is considered sacred land by many Native Americans.

For a bit of orientation, here is a closer view of the Black Hills with some key locations marked:

Deadwood

My friend and I set out on our adventure Wednesday. The first stop was naturally Deadwood! As I still don’t trust most people to follow hygiene recommendations, we didn’t go into any restaurants or casinos in Deadwood. We did walk the historic main street. We also found a fun wood carved chair to sit in and be the biggest tourists.

Custer

I rented us a remote cabin near Custer for 4 days. We arrived in the dark but we could feel we were in the beautiful middle of nowhere. The cabin was GORGEOUS! My favorite part was definitely the fire place in the living room. Our hosts had a pecan pie waiting for us. It was much bigger than it needed to be for two people but I wanted a cabin that actually looked like a cabin (lots of wood), was remote enough to escape artificial lights to view the stars, and had a fire place. This place checked off all the boxes.

Crazy Horse Memorial

Our Thanksgiving day was jam-packed. Our first stop was Crazy Horse Memorial. I had stopped by many years ago while on a two day trip to the area with a friend, but we didn’t really experience all there is to see at the location.

The story of the memorial is fascinating. Once it’s finished (not likely in my lifetime), it will depict Crazy Horse, an Oglala Lakota warrior, on his horse pointing to his tribal lands. A Lakota elder named Henry Standing Bear commissioned Korczak Ziolkowski to sculpt the memorial. He wanted his people to have a memorial of one of their heroes.

Korczak devoted the rest of his life to the memorial. His wife Ruth joined him and their 10 children all pitched in too. Korczak turned government funding down twice because he did not trust the government and feared they would overturn the memorial’s plans. After Korczak died at the age of 74, his wife Ruth took over as CEO. She made the decision that Crazy Horse’s face should be completed first instead of the horse’s face as Korczak had planned. She felt this would increase tourists visiting and thus increased income to fund the project. Ruth died in 2014 and her daughter Monique became CEO. She works with three of her siblings and three of the Ziolkowski grandsons.

The Memorial and so much more!

The grounds also house the Indian Museum of North America, the sculptor’s studio, a restaurant, a gift shop, the Native American Educational & Cultural Center, and The Indian University of North America.

It is a great place to learn more about some of our Native American brothers and sisters and appreciate all the beautiful art they create.

Mt. Rushmore

Four white males carved into the face of a mountain in one of the most sacred places for some Native Americans,… surely not without controversy. My friend and I stopped by the monument to take a picture and were then invited to hear a 30-min lecture about the controversies surrounding the monument.

The concept of a memorial at Mt. Rushmore originated from Doane Robinson, a South Dakota historian, who thought carving figures into a mountain would attract tourists to South Dakota. Originally, South Dakota figures like Buffalo Bill Cody, Meriwether Lewis, William Clark and Red Cloud, a legendary Lakota leader were considered. Robinson commissioned Gutzon Borglum to sculpt the memorial. Borglum wanted to memorialize “the founding, expansion, preservation and unification of the United States.” Thus, he picked Washington, Jefferson, Lincoln and Roosevelt.

Rose Arnold Powell and First Lady Eleanor Roosevelt wrote to Borglum and advocated that Susan B. Anthony is included in the memorial. Borglum cited lack of rock and lack of funds as the reasons why this was not possible. His main rationale, however, was that it didn’t fit his artistic vision… (eye roll).

Besides the obvious lack of representation in the figures carved, the mere fact that it was carved into the mountain in Native American sacred land makes it plenty controversial in my mind. Nonetheless, we visited and were able to learn about these various aspects and have a discussion about a monument that clearly isn’t going anywhere and does have a story to tell. It also fulfilled its intended purpose of increasing tourism to South Dakota.

Custer State Park

After viewing monuments, we wanted to view some wildlife. We drove the Wildlife Loop through the park and the name did not mislead. I even had a friendly stand off with a Bison. Since I didn’t intend to have my rental car damaged, I backed up slowly and we eventually parted ways peacefully.

The friendliest creatures were definitely the formerly domesticated but now wild donkeys. They enjoy a good ear rub and are not shy to pop their heads in and say hi!

Thanksgiving Dinner for Two

After all of that, we managed to cook for three hours to prepare a delicious vegan Thanksgiving dinner with a little (a lot) of help from Purple Carrot.

Friday – a day of rest

Since Thursday was so jam-packed, we decided to enjoy the cabin and surrounding land and just stay there for the day. We explored the quartz and mica on the hills and wandered through the forest. I collected pine cones and cut-down pine tree branches. Hopefully, I’ll be able to make wreaths out of both of those things.

Badlands National Park

Before having to leave me, my friend and I set out to see the Badlands. The landscape is pretty wild and seems like the perfect filming location for a Star Wars movie. We drove Badlands Loop Road (Highway 240) and stopped at various viewing points to see bison, big-horned sheep, and the silly prairie dogs.

I was sad to see my friend leave. Since I’ve been in South Dakota, I have had no physical contact with people beyond professional contact at work. I also haven’t spent time outside of work with anyone because of the pandemic. My friend got tested before coming to see me. We are both really cautious about the virus so I waged the risks and benefits and came to the conclusion that it would be relatively safe for us to spend several days together. Facetime gets close but it definitely doesn’t replace the feeling of a hug.

One thing I love: Looking at the stars on a clear night in a remote place.

One thing I ate: the delicious vegan Thanksgiving dinner pictured above. I’ll talk about purple carrot in more depth sometime. For those who don’t know about it, its a vegan meal kit delivery service and a life saver for me!

One thing I’m grateful for: my friend for coming to see me and my family for having made the decision to cancel this year’s gathering. Everyone’s safety and health will always come first. That didn’t make it any easier that it didn’t take place, but sacrifices must be made. I’m grateful for all the people who worked this holiday. I’ve missed many holidays myself due to work and will likely miss many in the future. I hope people who aren’t accustomed to missing holidays but did the right thing and missed out this year, can find some comfort in knowing they were not alone in doing so.

mfg

Locum, Mother Nature

Speared Fish & Sweet Deals

November 22, 2020 No Comments

I’m on call all weekend and it’s actually been a bit busy. But I definitely wanted to keep up with the weekly post. So let’s dive in!

Svikki MD

Outpatient

We were very unstaffed from a nursing standpoint this week. The nurses that were there rocked it though and got us through. I probably saw the most patients this week since starting work. It was a mix of interesting cases and a lot of COVID.

Inpatient

I spent Thursday in Rapid City working with a hospitalist who has been taking care of COVID patients for the past 5 months. We reviewed treatment protocols, his experience with patients, the patterns of decline/improvement he has been seeing with them and discussed safe patient scenarios to keep at my hospital in Deadwood (and when to transfer). I’m very grateful they were willing to let me come and discuss with their doctors. There is also more awareness for them now that we will be admitting COVID patients.

Call

I’ve been on call for 4 of the last 7 days. That lead to a few more admissions to my inpatient panel. Between seeing them on the floors and seeing patients in the clinic, this week has once again flown by.

I’m getting used to constantly being on call for my own patients. Late night and early morning phone calls don’t surprise me anymore.

Spearfish

I live in a town called Spearfish. The town symbol is exactly what you might think it is…a speared fish. Exhibit A:

Spearfish is a quaint community with the main street filled with restaurants, bars, and shops. The public library is a block off of the main street, just next to the police station and fire department. There is a community bank up the road. It reminds me a bit of a larger version of the town I grew up in. However, unlike Muscoda Wisconsin, you don’t have to drive a mile before you hit your grocery store, fast food restaurants, and the local hospital.

The surrounding land is pretty flat and sits adjacent to the Black Hills. Someone recently mentioned to me that there is a recreational path that runs through Spearfish. This seemed like a safer option for me to explore than finding trails in Spearfish canyon without cellular reception. You never know, something could happen and no one would be able to find me.

Spearfish Recreational Path

I’ve spent the last two weekends exploring the rec path. It’s a concrete path that works it’s way through meadows and woods. The people are friendly and almost everyone you cross paths with smiles and says hello. I’ve been doing a power walk/jog combo for the 3.5-miles back and forth. The trail itself is much longer than that. It feels great to be outdoors and amongst nature. I’m interested to see how well maintained the path will be when we start having snowfall again.

Along the trail, there is the D.C. Booth Historic National Fish Hatchery. It’s free to enter. According to their pamphlet:

Created in 1896 to propagate, stock, and establish trout populations in the Black Hills of SD and WY, D.C. Booth Historic National Fish Hatchery is dedicated to fish culture and resource management. After a very successful fish production history, the hatchery’s current mission is to help preserve the U.S. Fish and Wildlife Service’s historic and cultural heritage.

I took a walk around the grounds for a bit and checked out the fishies from below in the Underwater Viewing Windows area.

Although there are many, many trails in the broader area, the rec path seems like a safer alternative for the time being. The weather has been fairly sunny recently and the temperatures tolerable with a fleece while working out. I don’t think it’ll be long though before I switch out the sports shoes for the snow boots again.

Hey Macklemore, can we go thrift shopping?

I love thrift shopping. It’s something I learned to love from my mother. In big metropolitan cities, I shop for clothes and shoes and in smaller cities, I check out the thrift store before buying items new if I can. The environmental impact our consumer society has on the planet has not gone unnoticed. Also, I will save money any day I can! Most (if not all) of my Ralph Lauren sweaters, J. Crew jeans shirts, and Gap turtle necks are thrifted. I usually can’t find pants for my long legs but I have issues with that in regular stores too.

When I first arrived in Spearfish, I noticed the kitchen was missing a few essentials I needed for meal prep. I found most of them in good condition at the St. Vincent de Paul store a few blocks away. When I needed winter gloves and some shopping totes for groceries, St. VdP had me covered. My greatest deal I’ve made so far was yesterday.

I won’t be home for Christmas

I’ve decided that if I am going to spend Christmas far away from family and friends, I’m going to decorate my apartment this year and have a Christmas tree. I stopped by St. VdP to look for decorations. They currently have a deal going where you can fill as many Christmas decorations into a box as you can for just $10! I filled up on ornaments, beads, lights, stockings, a snowman mug for hot cocoa, two decorative small trees, and a Christmas tree stand. All for just $10. I felt like a rock star. Now I just need to find a tree. When the Christmas season is over, I’ll repack everything and donate it back to St. VdP. So, it’s really more like a $10 rental fee.

I’ll show you the tree once I have one and it’s decorated

If the other items I purchase during my time here are in good condition when I am ready to leave, I will donate them back. It’s an earth-friendly, wallet-friendly alternative to Amazon Prime.

It’s almost the most wonderful time of the year!

One thing I love: Pre-Christmas season….it’s so close, I can taste it. Literally, see the next section.

One thing I ate: Lindt Lindor White Peppermint Truffles. That melting white chocolate with the refreshing taste of peppermint…I’m in trouble.

One thing I’m grateful for: the invitation I received to have Thanksgiving at my colleague’s house with his family. Although I declined because I already have plans for myself that day, I truly appreciated the thought of inviting me to their family time since I’m out here in South Dakota alone. That being said, please remember, a Zoom Thanksgiving is better than an ICU Christmas. Please only celebrate with your household or core group of people. Our healthcare system can’t handle much more and I want everyone to be as healthy as possible.

mfg

Herstory, Locum

Déjà vu & you do you, boo

November 9, 2020 No Comments

This past week flew by. I was nervous it might not due to the election but work definitely kept me busy. But first, can I just say how relieved I am that Joe Biden and Kamala Harris won? I’m only a permanent resident and thus can’t vote. I don’t want politics to be a big part of this blog (although it is important everyone is informed and engaged in politics), but I do want humanity, respect, love, and trust to be the bedrock of everything I do. To see two people with similar values win this election gives me hope for the next 4 years. It feels good.

Svikki MD

Clinic

My patient numbers continue to increase in the office. Unfortunately, the number of patients with COVID symptoms continues to climb as well. It’s no surprise, one look at the numbers in South Dakota explains the trend. This week felt as though more severely sick people were coming in though. The day I had call, I was presented with two clinic and two ED patients for possible admission. I sent two home, I admitted one, and one needed to be transferred to a facility with ICU capabilities. It feels like March 2020 all over again….but only for me. I seem to be the only person in my hospital who has experience with the virus.

Flash Back to March 2020

For those who don’t know, when COVID started showing up in Youngstown, Ohio, I volunteered to be one of the first providers to work in the designated Flu clinics. Anyone with respiratory complaints was no longer able to see their PCP and needed to be seen in the Flu Clinic. We didn’t have testing supplies for the first several days. Things were changing on an hourly basis. We didn’t have tests, then we did, but only a limited amount. At first, we had enough PPE to change between each patient. Then we needed to start wearing the same PPE for multiple visits. It was hectic but I liked working in that environment.

Two weeks later, I started taking care of COVID patients in the hospital. The hospitalists were overwhelmed with the number of patients. Two other residents and an attending headed to the floor every day to take care of the patients as best we could. We knew a lot less back then and we were using different medications than are used now. So much was unknown (and still is) but we showed up and did what we could. Who got better and who died hardly seemed to have a rhyme or reason.

By the time May rolled around, we were back to our residency rotations. The only major difference was telemedicine visits in the clinic and having to wear a mask and shield when seeing patients in person.

Back to the future

So here I am now in South Dakota. I can see the number of cases presenting to the clinic and hospital on the rise. The big difference to Ohio however, is that I don’t have the same capabilities here like I did there. I have no ICU located two floors down, no second ICU close by, and no Cleveland or Pittsburgh nearby.

The closest hospital is only a 20-minute drive away and does have an ICU but they are hardly taking patients. Rapid City is on diversion. We are sometimes looking to different states for help. This will be an interesting winter, and not in a good way. But I am not surprised we will go through this. What do you expect if the majority of people walk around without masks, the Sturgis motorcycle rally took place and people were partying at Halloween parties last week? I do not sugar-coat it when patients ask me if this virus really is as dangerous as people say it is.

Hospital

About half of the census in the hospital this past week was mine. Mostly swing beds, since they stay for weeks. I did have the first COVID admission of this hospital. They did really well and were able to go home yesterday. Today was my first day in 20 days that I didn’t have to drive to the hospital to see patients.

Svikki Hobbies

I have so many different hobbies and interests it is sometimes hard to adequately devote time to one of them. As much of a nerd as I am, I like to give my analytical brain a rest from time to time and jump into more creative activities. At times I’ll combine the two. I often drew throughout medical school, especially anatomy class, to solidify the knowledge.

When I was packing my suitcase for South Dakota, I ended up packing a duffel bag full of artsy things; paper, water colors, brushes, pens, charcoal, and pastels.

Childish innocence

I often feel that as people get older, they get more and more hung up about doing something really well or not doing it at all. I’m definitely guilty of this. The innocence of a child not caring about how perfect the end result will be but enjoying the process of creating is something I actively try to return to. When people started telling me I have talent, it became harder to just create for fun because I felt a pressure that the end result needed to be good. It needed to validate their former praise. This feeling often stopped me from starting something because I knew I didn’t have the free time to devote to perfecting it. Once I started realizing that, I actively started just drawing at random times and random things, just for the sake of doing it.

The opposite of praise can be debilitating too. As a child, I was often told, “you can do so many things…but somehow no one in your family can sing, including you.” I didn’t formally try. I didn’t join the choir. But I LOVED to sing. I know a ridiculous amount of lyrics and my favorite part about driving a car is the fact that I can sing as loud as I want and no one hears me. From time to time, in different parts of the world, I would partake in karaoke. It’s almost frowned upon to be too good at karaoke. It “ruins” it for everyone else so it’s a safe environment. But that’s the wrong way of looking at it!! Do you like singing? Then sing! Who cares if it’s not always on key? You aren’t trying to win Idol, you are just enjoying singing.

How things have changed

Last year, while sitting around with some people and a ukulele, I started singing some songs. The guy with the ukulele has a band. His band played at my aunt’s birthday earlier this year and I was invited to be a surprise singer for a couple of songs. This was the first time I was going to be singing in front of a crowd with the expectation that it was going to be good. It was so much fun! I’m still not looking to perfect my singing but I more confidently singing out loud now having overcome the comments of my childhood.

Click here to see a video of me at my aunt’s birthday!

My point here is that I want everyone to find joy again in enjoying things you like without the pressure of it having to be good! So many people are in quarantine or partial lockdowns. If you feel like doing something or trying something new, just do it! Don’t let the need for perfection ruin the process.

Here is a sample of some of the things I’ve made over the years. My dream is to one day have a studio room where I can have all of my supplies and just go and create.

One thing I love: group chats! Although my family is spread across the globe, my little sister in Austria kept us all on top of the latest updates regarding the election.

One thing I ate: a pecan caramel cinnamon roll from a bakery down the street from the hospital owned by the mother of one of the nurses. The proximity is dangerous.

One thing I’m grateful for: Biden Harris 2020. Thank goodness.

mfg

Herstory, Locum

Scenic views, Svikki’s origin, & the scariest Halloween

November 2, 2020 No Comments

I just got back from a 3.5-mile hike in the Black Hills. The weather did an about-face over the past week and there was a high of 60 degrees Fahrenheit today with a beautiful sunny sky. I wasn’t going to let that opportunity pass by. I didn’t see another human being the whole time I was out there. It was just me, the forest and the wind. At one point, I caught myself singing “Colors of the Wind”.

Svikki MD

The other Family doc was out of the office this week. They have been in the area for decades and have a well-established panel of patients. I was on call four times last week. Between covering the other doc’s messages and prescription refills while on call and having quite a few of their patients stop by for same-day appointments, I was pretty busy last week.

Clinic

I am currently still seeing mainly same-day appointments as patients are establishing care with one of the other providers when able. It’s only fair to the patient, I’m only around for 5 more months. The same day appointments have led to some pretty interesting cases. I’ve called up other specialists more than once last week. Although our clinic only has Family Medicine and Internal Medicine physicians, I can find most other specialists either in Spearfish (20 min drive) or in Rapid City (50 min drive).

My instinct to call the specialists turned out to be right every time. Sometimes, I feel doctors are afraid to ask for help because they think they should know how to manage it themselves. I see no shame in consulting a colleague who has more expertise on a subject… at the end of the day, it’s best for my patient’s care and my ego can take it.

Hospital

I took over several of the other doc’s admitted patients while they were on vacation. Consequently, I had a different swing bed patient to check in on every day. My second to last clinic patient on Friday ended up needing admission. That bought me my second weekend in a row going in on the weekend days as well for acute care visits.

On call

There were a lot of call shifts last week. Two docs were out of the office which left me and one of the internists to cover the call schedule. Luckily, the nights were quiet. During the day, however, I was covering calls, prescription refills, and patient messages which kept me busy between clinic visits.

So why Svikki?

I wanted to use this week’s post to explain why my site is called Svikki. Most people know me as Viktoria or Viky or Vik. Only a few people call me Svikki…well, really, it is only my aunt and uncle that do. I have used the name for my social media handles ever since it’s creation though. My aunt is the one who came up with it many, many years ago.

My aunt is a master of fabric crafts. Her quilts are prized possessions in our family. Her basement has a room filled with fabrics, a fancy sewing machine, and colorful creations on the walls. One of my favorite things to do when visiting is hanging out in that room with her. She had fabric tags made for me that say “Svikki” on them so that I can sew them into the things I make. If only I wasn’t hundreds of miles away from my stored things, I’d be able to show you what they look like.

I’ve also used “Svikki” in art work I’ve made for my aunt. For example, this painting I made based on a 1950’s Zwicky Ad. I replaced the cat in the Ad with one of my aunt’s favorite cats she’s had, Pauli. He was a pretty cool cat.

Happy Halloween

Halloween is one of my favorite holidays. I’ve always been in awe of the annual parties Heidi Klum would throw. When I moved to Germany for medical school, I started hosting Halloween parties of my own. Halloween really wasn’t that big in Germany. It came as no surprise to me that for the first year, I saw a lot of your classics: witches, mummies, ghosts. The people kept on raising the bar year after year though and there were some really impressive costumes over the years.

I would start grocery shopping a week in advance of the party because I would bake so many Halloween themed treats. I’d decorate the apartment for days. Every year was unique and so much fun. Each year the party grew in size and popularity. I love hosting parties and seeing others get invested in the holiday brought me so much joy.

Working in Miami for a year, Halloween was a particularly fun time to be there. I had partied in Miami during Halloween before. However, working there with a crew of super fun people and dressing up for themed nights took it to another level!

The scariest Halloween yet… 2020

Sadly, I spent this year’s Halloween on the couch watching a movie. I’m sure I’m not alone in this. Unfortunately, I also am aware that many people were out celebrating this year. Trick or treating can be done in a safe, pandemic aware fashion, but what truly scared me, more than any scary movie could, is how many people I know went out to clubs or house parties to celebrate.

I TOTALLY understand wanting to dress up and head to the club for a night of fun, but people, we are in the middle of a raging pandemic. Many sacrifices have been made, many get-togethers canceled,… I understand. But last night probably should’ve been another one of those sacrifices. We aren’t ready for that yet,…not safely anyways. It scares me to think about how many more cases will be fueled by this. It scares me to think about my fellow health care workers and myself who have put their own lives at risk to take care of Covid patients.

The ICUs around the country are filling up. The USA does not have the capacity like some other countries do in terms of ICU beds per capita. Even less so in rural areas like Deadwood, South Dakota. Yet, the people were out last night. I don’t want to be mad at people because I know people have sacrificed a lot and want to go back to how life used to be. However, today’s decisions carry much heavier consequences with them currently. I can only hope you are spared but I can in no way guarantee that. So please, stay healthy, stay kind, stay strong, and be considerate of your fellow human beings.

One thing I love: scrolling through old pictures on my hard drive. I’ve had so many fun times in my life and time-traveling back to those times brings me a lot of joy.

One thing I drank: Hot apple cider. It’s that time of the year and I can’t get enough!

One thing I’m grateful for: my friends and family sending me packages. I LOVE getting (and sending) mail. From winter care packages to edible arrangements. Thank you! <3

mfg

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