Fourth Week - Back home

The weekend - The north of Portugal

I spent the weekend seeing the north part of the country with the friends that I recently made. No more being ditched for me. We set off by train to the town of Valenca after finishing with our duties at the hospital, where we met up with another student who was from the area and was home for the weekend. The train ride was about 3 hours long and passed through amazing country side and towns with unique names like Tropha, and Nine. We got picked up at the station and made our way to the historic fort and old town over looking the river Mino and Spain. After walking around and exploring, we had dinner with some of the famous green wine of the region. We then headed to the town of Malgco where our host was from.

The Valenca Fort

The next day we explored the tower of Malgaco after an amazing breakfast of coconut pastries before heading to the town of Moncao. There I sampled the refreshing drink of panache (a mix of beer and 7up). However, I later found out that it kind of girly. Oh well. We visited some of the winyards on the way back to Valenca for our evening train back to Porto.

Since we had some time before the train, we crossed the historic bridge built by Gustave Eiffel into Spain and visited the town of Tui. You can definitely tell that you are in a different country. Tui is part of the Santiago Pilgrimage Route, and the main attraction in the area is the old Cathedral and Monastery. After a short visit and some touristy pictures to prove that we went to Spain, its almost time for the train and we head back across the bridge.

Spain !!!

We arrive in Porto around 10 pm, and after dropping off our luggage at my dorm at the Campanha station, its the prefect time for dinner and some going out Portuguese style. We didn't stay out like true Portuguese though, until 5 or 6am, since we had plans to visit the Geres national park and do some hiking.

Miklos, the Hungarian student, had reserved a car for us at the airport at 9. We meet at trinidad station at 8:30 and take the metro to the airport. There was a great deal from europcar where we could rent one for 20 euros for the day. We set off on our journey to the park. This was without maps though, perfect for traveling in a foreign country. There was a park office in the town of Braga, so that was our initial destination. After a few wrong turns we made it to Braga. Now to find the park office. The website said that it was 500m from the train station...hmm better just park and head to the city center. After a epic breakfast of baked apples and some touring, we find the tourist office, who has no idea about the park office but we did manage to get some maps. We walk towards the train station, and after asking some people, we learn that the park office is closed on Sunday. Oh well we head on to the park and plan to figure it out once we get there.

Baked Apples with a View

Luckily my phone gets 3g with the Portuguese SIM card so we use google maps to get us to the park. After gathering some supplies at the town of Geres in the park, we start driving into the park. We decide, instead of doing a 3-4 hr loop, to drive along the park road and stop when we see something cool, which was a frequent occurrence.

The best was a climb down a cliff to a series of pools and waterfalls with ice cold water. After surviving a picture for facebook, we continue through the park and enjoy the vistas.

Vistas of Geres

Next on to the town of Parvoa de Varzim, a beautiful coastal resort town north of Porto. We arrive in time for sunset; however the whole town in shrouded in a dense fog. After getting dinner at a local restaurant we drive the car back to the airport and head our separate ways for the night.

The Short Week:

Monday I arrive after rounds, since I met with Dr. Basto in the AM. I find out that patient, that has been on the service before I started, with endocarditis who started having GI bleeds last week had her colonoscopy. It turns out that she has 2 large masses in her colon, one of which is partially obstructing the lumen. Pretty bad news for a such a nice lady. On a brighter note our lady with the stroke seems to be improving.

That afternoon, after taking the opinions of all of the girls on the team, I head out to finally go buy my interview suit. After 2 hrs of indecision, I manage to pick one that fits well and is well priced.

In the evening, I go back to the hospital to meet with Dr. Basto to go have dinner at his house. The food is amazing, and his family is very nice. Multiple courses of appetizers, main dishes, and desserts, all followed by Port Wine and expresso.

The next 2 days go by pretty fast. Our new admits leave on the same day. I spend the afternoons spending time with my friends and the Portuguese med students. We check out the Cleirch tower and just relax in the city.

The Tower

On my last day, I say goodbye to our patients and the team. I shared some of the Indian food snacks that I had brought from the states with the team, which they really enjoyed. We have a final dinner at night, and go for a few drinks at unique bar by the university downtown. It turns out that it was Bastian's (the german student) birthday a midnight...happy birthday. I get back pretty late just in time for a few hours of sleep before leaving at 6:00 am for the flight back to the US.

Home at last after barely making the connection to Chicago in Madrid. At least I knew kind of where the signs where this time.

Final List of Do's and Don'ts

1. I definitely over-packed. DO NOT bring dress clothes or dress shoes. It is perfectly fine to wear jeans, tshirts, and sneakers to the hospital.

2. Do bring snacks. They come in handy for those times between coffee breaks and to eat on the first few days while learning the city.

3. Do get a metro pass. It is valid from the 1st of the month to the end. You will get the form from Sophia the Erasmus student coordinator at the hospital on your first day

4. Do explore the city. The city center near the trinidad or aliados metro stop. Take the yellow/red tour bus on a weekend to see the sites

5. Do make friends. The Portuguese med students are all very nice and eager to show you their town. Also make sure you go to the meeting organized by Sophia to meet the other visiting med students

6. Do explore the rest of the country via the train system. www.cp.pt

7. Do try to learn some Portuguese before hand. This is something I wish I had done, but was able to pick up a good bit while I was there

8. Do bring your stethoscope, pocket medicine and white coat. Even though the Portuguese med students get a long coat.

9. Do Not fly though Madrid if you can avoid it

10. Finally, do have a fun time.

Third Week

Its been a busy week and weekend. The great late summer/fall weather continues to hold out.

Friday evening I went with Dr. Basto and his son to the Soccer Match. Portugal vs. Iceland. Portugal needed to win the game to continue qualifying for the EuroCup. It was my first soccer match and was a great time, especially when Portugal won 5-3. Goalll !!!

After the First Portuguese Goal of the Game

Saturday I decided I needed to get out of the city and see some more of the country. Portugal has a great train system and its really easy to travel around the country. Check out www.cp.pt for booking.

So where to go?.... I decided on a day trip to Aveiro, a small town south of Porto about halfway to Lisbon. According to the interwebs, its also known as the Venice of Portugal, so I thought why not check it out. The trains were super easy and there was a 30 min express train from Campanha. I took the 11:30 train after getting in my sleep requirements after the game. As I take my seat, I hear an older couple speaking English. I turn around and ask if they are from the US. Turns out not only are they from the US, but from South Carolina. It was great to meet some other southerners, and kind of random. We talk during the ride down about med school and their lives. They offer to buy me lunch in Aveiro...sweet. We explore the town and canals together. The lady keeps making me stop and take pictures for my mom. They had to be back in Porto earlier so I head to the tourist office to see what else there is to see. Turns out there are walking tours for 5 euros and they will do one for a single person. Turns out the guy runs it as a small business out of his house and whenever someone wants a tour the office call him up to come. Since I had walked around the city, I pick the salt making tour. Aveiro is also where all of the salt comes from in Portugal. The tour consists of a walk out into the marshes and the salt farm with various evaporating pools. A great idea for a nature lover like me. After the windy and salty tour, I head back into town, walk around, and have dinner before taking the train back to Porto.

Canals in Aveiro

So once again I am supposed to meet up with another erasmus student on Sunday after his meeting. He is not sure when it gets out, and will plan on meeting me out in the city. On the list for the day go visit the stock exchange palace and explore some more. I arrive there 15 mins before the next English tour, perfect timing. The palace is extraordinary, however they don't let you take pictures inside which is a bust. After the tour, I decide to get some lunch. I walk by this restaurant which is in a courtyard and has a menu displayed. Frango Asado Sandwich which is a grilled chicken sandwich, perfect for lunch. I start walking to a table when this sweet old Portuguese lady hands me a menu and grabs me to come with her. It turns out the menu I was reading on the street was for her restaurant, which is also in the courtyard and consists of a few tables and chairs. The place where I was going to sit is a large corporate place that built their restaurant in front of her's. When I order the sandwich she tries to explain that they are out and do I want grilled chicken with potatoes instead. All I understood was they are out of potatoes. We try to figure each other out for a few minutes, me in English then broken Spanish, and her in Portuguese. Her daughter eventually comes over and explains. The food is good, but as usual not spicy enough for me. Good thing I brought Tabasco from the US.

I spend the rest of the day walking along the river and then across into Gaia, this is after watching some of the Portuguese youth jump from the bridge into the river for fun a few times. Once in Gaia, there are a bunch of street vendors selling crafts. Great place to get gifts. I spend the evening just relaxing on the river and having dinner and drinks before heading back. However, it was odd that the waiter asked if I was eating lunch at 630pm. Turns out dinner is much later here in Portugal and people generally stay out late after since most people don't have to go to work until 10. Doesn't work so well when you have to leave for the hospital at 7:30. I never did meet up with the other student, guess I got ditched again.

JUMP!!!

The work week went by pretty fast. We had a lot of new admits this week which made things interesting. I even got to take the H&P for one of them since she understood English. The Portuguese med students would translate for me to help out. I also did my first successful ABG on one of our patients this week. All of the patients are really nice, and I have picked up enough Portuguese to say hello each morning, ask if there is any pain (useful for physical exam time), take a deep breath, again, and see you later.

On Wednesday, I got out to dinner with the Team. They used to have group dinners all of the time, but this was the first in 6months. Perfect timing for me. I spend the afternoon with Flavio, the Portuguese med student on my team in the city checking out Servalles, a contemporary museum with extensive gardens. It's free with a student ID, but we had to take the bus there which is the only downside. We talk and walk through the gardens where I proceed to pick oranges off the tree and eat them, as he tells me, "you are going to get sick." I also eat some chestnuts that have recently fallen from the tree. Luckily I didn't get sick. We leave and meet up with some of the other visiting med students that I meet at the meeting last week for a few drinks and go back to get ready for the 9pm dinner. I am going to meet Flavio and the med student from the team next to mine at the hospital and we will carpool to the restaurant. I get out at the hospital, and oh great. The phone wont make calls or let me text, and gives me some recording in Portuguese. Luckily after walking around aimlessly I see them in the car. Turns out the phone is out of money, guess I should not have sent all of those international texts.

"You are going to get sick"

On thursday, Flavio has to leave to go to the azores since he is a TUNA, the med school boys singing group/frat. No wonder all of our patients are in "love" with him. I meet with the other visiting med students, Bastian and Miklos, after work to get some lunch and hang out, and we make plans for the weekend to do some hiking and see some of the towns up north. Friday goes by pretty fast in anticipation of the trip.

Second Week - Obrigado !!!

The weekend:

I spent most of the weekend exploring Porto. I had bought tickets for one of those open top two story tourist tour buses from the Porto Visitors Office for the weekend. It included 3 different hop on hop off bus routes, short river cruise, and a trip to one of the wine cellars. Great way to see the city in a weekend. The plan was to meet another visiting student I had met at Casa De Musica metro station and then take the tour bus to the beach and walk along the coast to the river at 11, so I gear up and take the metro there. However, his phone is off and I cant find him any where. Its 1130; guess I got ditched. (It turns out he went out too hard on Friday and didn't wake up) More on the Portuguese Nightlife in future posts. I find the stop for the tour bus and it happens to come with in a few minutes of me finding the stop, a good sign since they run every hour. I climb up top and enjoy the view around the city to the beach. I get off at the first stop along the coast and take in the view and the sea air. There's so much to do; scramble on the rocks, check out the tidal zone, walk along the board walk, eat at the many cafes there. I pretty much spent the rest of the day walking along the coast towards the river, where I hop back on the bus at another stop. Which takes me towards the city center and Gaia, the town across porto with all of the wine cellars. Perfect evening for an early dinner and river cruise.

The Portuguese Coastline

View From The River Cruise

After the fantastic day at the coast, I take the bus back to Aliados (the main promenade in Porto) to catch the metro. As I get of at trinidad, I decided that now would be a great time to get my monthly student metro card. They close at 1630, and its 1600 plenty of time. I go in to get a ticket for the number being served system and they cop handing them out says that they are closed. I would soon learn why they where "closed."

I return the next morning at 10:00 when the metro office opens to get my pass. Already at number being served at 130. My number is 239. I'll wait it out. It should go fast right? I would get my pass, then get on the bus and do the other tourline up to the port and check out some wine cellars in the afternoon. I should have left and done my tour or gotten lunch, 2.5 hrs later and a few levels of angry birds, finally its 239. Make sure you have the following to get the card....the form from erasmus, a copy of your passport (luckily I carry one around instead of my passport here, and a small picture). No one told me about the picture, and there was no way I was going to wait in line again. Luckily the lady was able to use my picture of my NC drivers license. Thank you NC.


Now, back on track. I decided to reverse my touring plans and go back to Gaia, have some lunch and tour a wine cellar with some sampling for Port wine, and then take ride around on the other line to the port and old fort.



The Calem Wine Cellar (above)

The Private Hospital:

On Monday, I was scheduled to visit the private hospital, Hospital Cuf. It was built last year, and looks like everything is from IKEA. It offers the same services as Hospital Sao Jao. However, the difference is that most of the patients that go to the private hospital have private insurance that covers the cost or they pay out of pocket. While the care at the public hospital is mostly free, patients have little choice in who they will see and there is often a delay for surgical procedures. I meet with the doctor from the private hospital at Hospital Sao Jao who drives me to Hospital Cuf in the morning. There I meet the rest of the team consisting of two medical students Andre and Luiz, and two other attendings. The med students here also rotate at different hospitals since the main one affiliated with the med school can't fit all of them. Andre and Luiz show me around the hospital while the doctors finish up their morning work. I see the cafeteria with a view of the Atlantic Ocean, the ED, the wards with patient rooms that are nicer than the place I'm staying, and the ICU. We have one patient in the ICU that we are seeing. She was a lady who had a knee replacement and who subsequently had bleeding after PT and needed to get 4 units of blood and be monitored. At this hospital the internal medicine doctors take care of most patients after surgery. They also are responsible for the patient no matter where they are in the hospital, ICU or the ward. We also have a new admit to work up on the floor. I go with Luiz and Andre to take the history. What I gathered from the Portuguese history and physical was: fat, fertile, and forty with right upper quadrant abdominal pain....gallstones. We go back and present to the attendings who discuss the case. That's essentially it for the day there after taking care of the rest of the work, I have lunch with the attendings. One of whom drives me back to a metro after a brief car tour of the city.

ICU in the Private Hospital

Back to the ward:

The rest of the week goes by pretty fast at Sao Jao, since Wednesday is republic day, and it's a day off. I am back with my team, and we have some new patients and some that leave. I found that, unfortunately, the 103 year old lady passed away over the weekend.

This week most of our admits have psyc or social work issues and thus have interesting HPI's, like the 75 year old lady who was found by neighbors in her house walking around while her daughter was unconscious and unresponsive and her husband on the floor, dead for 2 days.

My favorite patient this week is an 89 year old lady that was transferred to our service from neuro ICU. She suffered a MCA territory stroke and had partial hemiparesis of her right side. However the only word she could say when we first examined her was, "Obriagado," which means thank you. Luckily, her speech has gotten better over the week and she can move her leg. The plan is to have her evaluated for rehab once the nurse in charge of rehab gets back from vacation on monday.

Having been around the city over the weekend. After work most days, I decided to venture out on my own and go back to some of the places I have seen. I walked across the top of the Ponte Luis Bridge linking Porto to Gaia, which was a great experience. I went to a couple of cool coffee and tea shops with the other med student on my team, Flavio.

I also met the other erasmus medical students this week. We had a small orientation meeting organized by the hospital and med school. Even though I am only here for a month, it was nice meeting the other students and making plans to hang out later.

First Week

Arrived in Porto at last !!!

It was hectic week getting here. I just had finished my rotation at Johns Hopkins in Baltimore and was scheduled to fly out Monday morning from NC. Just enough time to finally spend a few hours with my best friends, who are now residents at JHU, drive down to NC, do a month's worth of laundry, re-pack, and head out on this adventure.

The flight from NC to Miami went pretty smoothly. However the main flight from Miami to Madrid could have been better. I was the genius who picked a seat online that ended up having some component box under the seat in front, which took up 1/4 of my leg room. Great for an overnight transatlantic flight. Should have consulted seatguru.com.

I also ended up sitting next to a nice Spanish lady who proceeded to tell me her whole life story in Spanish after she took 3 Xanax, and I told her that I knew "poco espanol. "

The flight took off an hour and half late first due to lack of fuel and then maintenance issues. Slightly unnerving for a transatlantic flight. I finally managed to get to sleep dreaming of ending up on an island in the middle of the Atlantic and the TV series LOST.

When we got to Madrid, I was given a priory connection slip to help me get to my connection to Porto faster, since the flight was scheduled to leave in less than an hour. It would have been useful if the gate agent told me where to go instead of saying, "follow the signs." What signs? Turns out that I have to get my passport stamped in Spain, not Portugal. Something to keep in mind for those of you in the future, you get your passport stamped as you enter the EU. Then I had to change terminals and redo security. Whew...made it to the gate drenched in sweat, and the plane is still there.

I slept most of the short flight, and things are starting to look up. While waiting for my bags to come out in the porto baggage claim (yes they made the short connection time as well), some workers from porto tourism come give us welcome bags with a map, list of things to do, and a hat. Nice...The porto airport is very nice; pretty much walked through customs and there are signs everywhere on how to get to the center city. My counterparts that went on this rotation before all took the metro to world spru (the dorm that we stay in). However, I took a cab, which cost 20 euros to get from the airport to the front door of spru. I did this because I had packed a carry on, my unc messenger bag with the lovely 8lb UNC laptop, and a 36 in giant suitcase that my parents had gotten to travel to India. No way this was going to be an easy feat on the metro. More on if I over-packed to come ....

The drive from the airport was nice. My cab was a Mercedes Sclass sedan; the driver had a radio station that played a mix of red hot chilly peppers to "somewhere over the rainbow." It was nice to see the landscape around city, which was interesting since the trees/forest is similar to NC, but with palm trees mixed in. Made it to the dorm and checked into my room around 3 Porto time, which is around 10 eastern time. Pretty much just settled in and got ready for my trip to the hospital in the AM.

I left the dorm in Campanha at 700 with the hopes to arrive and meet Dr. Basto at 830. The nice part is that the dorm is attached to the station so there's a walk along the building and then down an elevator and metro. I stood in line for to buy a card and just stuck some money in the machine and hoped it was enough. I took the train from Campanha to Trindad (equal to metro center in DC for those of you that are familiar with that system) and went down the escalator where I saw signs for the train to Hospital Sao Jao. The trains come pretty quickly so you don't have to wait that long for the next one. Made it to the hospital lobby in 30 minutes. Its only 730. Guess I'll get some coffee from the cafe that they have and play some angry birds on my phone.

Note for future students: I have AT&T, so was able to buy a package before I left that would let me make calls but will still charge per minute for emergencies, but I can also send 200 text messages to the states, so I have been using this to communicate back home. You will also get a SIM card here from the ERASMUS coordinator in the hospital, just make sure you bring a spare phone that has been unlocked by your carrier to accept foreign SIM cards.

The Hospital on my first day

I meet Dr. Basto and go to his office. We discuss my plans and some things to do in Porto before taking me to meet my team, Med B on the women's floor. The Hospital was built in 1959 and they are working on renovating most of it (mainly a major work in progress). By some glitch my attending was out this day and so as a back up plan, I spend the day with Med A. The team is very nice and we round on the patients and wait to discuss with the attending in the late morning. A team consists of the attending, an internal medicine resident, and 6th year (final year) medical students who essentially function like interns. A typical day is from 8 - 2ish. Plenty of time to go explore the city/recover from jet lag.

Second day. I meet with Dr. Basto again, after only getting lost in the hospital once because a door was closed that was open yesterday, and we go meet Med B, which functions essentially the same as Med A. One of the major differences that I see between the US system and here is the number of patients on a team and the amount of time spent talking with them. The nurses also play a very integral part in the patient's care. We stop to update the nurse taking care of our patient on the plan multiple times.

Day 3. Its Friday...Friday...Friday...Friday....tomorrow is Saturday... Today was a little different since our attending had to leave at 830 to take care of something with his car. To be honest, I wasn't sure really what he said. Everyone understands or speaks English in the hospital but sometimes things get lost in translation. Our resident had also worked overnight in the ED as a consults person. Here the system is that there is a resident in the ED that sees all of the consults and decided to admit them or not. The ones that are admitted go to whichever team is next to take a patient. So each morning you have to check in the log at reception to see if there are any new admits for your team. Anyway, as I come in, the nurse rushes in and what I believe tells the resident to come quick. Our 103 y/o lady with CHF is tachypnic and has a fever of 40 C. She was doing so much better yesterday and actually answered our questions; now florid sepsis. We start her on high flow oxygen and fluids. She had gotten abx last night...so now we wait. In the mean time the med student and I go see the other patients, who all also have low o2 saturations, which means I get to perform an ABG. Pretty exciting AM in the hospital. Things quiet down after the coffee break with the other med teams, and I head out around 1. I stop off in the city center to visit the porto tour office and have some lunch. I have a pretty exciting weekend planned. A hike along the beach from matoshinos to foz where the river meets the Atlantic on Saturday and then one of those open top bus tours of the city on Sunday.

The Busy Streets of Porto