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Just Keep Swimming

For those of you who don’t have young children, this title is a quote from the movie “Finding Nemo” that I thought was appropriate for this post for two reasons. First, in the movie when things get difficult, Dory (the blue fish) says, “Just keep swimming, just keep swimming…” I’m certainly not complaining, but lets just say that the first week of school was an adjustment for everyone.  Secondly, we have had some of the most beautiful and hot weather of the summer. During a whole week of sunny, 80-degree days, we spent a lot of time in our swimsuits.

By the creekWe went one afternoon to the local, outdoor swimming complex. We have been there twice before, but this time the kids found some friends from school to play with, which was great. We spent another afternoon at our little creek down the road. It’s small and shallow, but still cool (okay, cold), clean and refreshing. There are rocks for throwing and a rope ladder and swing.

Over the weekend we took an day trip to the town of Murten. It is a fantastic, medieval town a little west of Bern on the Murtensee (Lake Murten). We swam in the lake, Lake Murtenwhich was some of the warmest water for swimming that we’ve found in Switzerland (though that’s not saying much!). We also played at a park near the lake, watched the ducks and the fish, walked through the town, and Emily and I walked along the top of the ancient wall enclosing the old city. We forgot the camera, but I snapped a few shots with my iPhone.

On Sunday, we slapped our suits on once again, and headed to the Aare river. We biked further down the crowded trail along the river past many beautiful outcroppings until we found one that was not claimed and had some nice shallow places for the kids to swim. It’s beautiful, and fun to watch all the swimmers and rafters floating down the river. Joe jumped in again (this time without his glasses) and glided a little further down the river, enjoying the view of the blue water flowing off to the horizon with mountains in the background.

We’ve been told that this kind of weather is rare in Switzerland, so we plan to continue enjoying it as long as wek can!

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The New Job

Thursday, August 18th was my first day of fellowship. If you have read any of the information from the About section of our website (particularly this page which explains why we moved to Switzerland) you know that I will be spending the next year studying treatment of adult and (some) pediatric forms of hip disease. Switzerland, and the University of Bern in particular, is a world leader in the understanding of hip disease. I won’t bore you all with the particulars of why and how, but let’s just say it is an honor and a privilege to be here.

Bern, a city of several hundred thousand people, houses at least six hospitals and over 60 orthopaedic surgeons. The Inselspital (German for “Island Hospital” – read more about the hospital’s history here) is the main university hospital in the city. Just like in the United States, most university hospitals are tertiary referral centers. They get the most complicated cases and the sickest patients. They are also hotbeds of research, both clinical and basic science. The difference between Switzerland and the US, however, is that university hospitals leave all of the “bread and butter” cases to the surrounding institutions. If you’re healthy and need a total hip, they won’t take you at the university hospital (whereas, in the US they will gladly take you, especially if you have insurance).

So that makes residency education different as well. In Switzerland, residency training takes 6 or 7 years on average, and is less organized than in the US. Their residents are required to do one year of training at a university hospital to sit for the boards. Most residents spend the other 5 or 6 years in the community hospitals doing general orthopaedics. A few residents, however, choose to spend the majority of their time at the university hospital. These are generally residents with a particular area of interest and, perhaps, a desire to enter academic medicine. The other major difference here is that residents are restricted to 50 hours of work per week, where we allow for 80 hours in the US (but stay tuned for changes to that rule).

So my first day at the Inselspital was most excellent. I was instructed to find my way to the Orthopaedic offices by following a red line on the floor until it took my to the #5 lift. I got there, and when the lift opened, it revealed a box that was roughly two feet by two feet. The gentleman in front of me got in, turned to face me and looked at me like, “Well? Are you getting in?” so I squeezed into the box next to him, turned around, and watched as one other person climbed in next to me. Suffice it to say, it was quite a tight fit, and I’ve never felt closer to my coworkers. Since my arms were pinned to my side I leaned over and hit the button for floor E with my nose. When the door opened at my floor I burst forth from the box like a greased Scotsman out of a ventilator duct.

After that I followed the signs to the Orthopaedic clinic. The clinic offices were very nice… small, but very functional. I found my way to the morning conference room and sat in a chair in the back. People began to file in and I smiled and greeted them if they addressed me. The first part of morning conference was a lecture on periprosthetic infections. While this topic is dry when presented in English, it is even more difficult to tolerate in German. Add to that the European’s general distaste for air conditioning and Bern’s current heat wave, and it was a struggle to stay awake.

Following the lecture there was a routine “sign out” conference. Just like every other program I’ve ever visited, a portion of the morning was devoted to reviewing yesterday’s admissions and planning treatment options on difficult patients. And to drive home the point that medicine (especially Orthopaedics) is mostly the same everywhere you go, even though sign out was conducted in German, I clearly heard one of the staff physicians describe a particularly bad elbow fracture as being “all f*****d up.” In English. Forget Esperanto, swearing is the universal language.

Following morning conference I met with my fellowship mentor, Professor Dr. Klaus Siebenrock. He is chairman of the department and leader of the Hip, Pelvis, and Tumor team. We chatted briefly about expectations for the coming year, potential research projects, and surgical opportunities. We also chatted about my name since he comes from the Black Forest region of Germany, where the name Schwab is stately, if you’ll tolerate a pun.

Then we went to the operating theatre. The Inselspital seems to be under perpetual construction and one of the newest completed portions of the hospital includes a set of operating suites for orthopaedics. We dressed for surgery, he introduced me to a number of surgical staff, and we went to work. The cases were great, the people were very friendly, and I ended the work day with a good feeling about the coming year.

To make the day even better, I had a text on my phone from Sarah saying that she and the kids were in Bern, at a local library, and that we should meet for dinner. We met in the beautiful, and bustling, Kornhausplatz, where the kids quickly spied a McDonalds. We have been eating so much European food lately that Sarah and I agreed the kids deserved a little taste of home. And McDonalds was a good reminder how bad home can taste sometimes. So three Smurfs™ Happy Meals™ later, we took the kids home on the train. It was a great end to a great first day.

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Back to School

Today was the first day of school for Emily and James. I got to accompany Emily to school for the first period of the day. The classroom had small desks with students’ names on them, hooks out in the hall for jackets, a chalkboard at the front, and generally could have been mistaken for any elementary school Emily at her deskclassroom in America, or anywhere else. However, there are a lot of differences, some small and some huge, between school here and what we are used to back home.

For starters, the calendar is very different. With a short, 6-week summer break, school starts in mid-August and goes through the first week of July. But, there are several long breaks throughout the year: fall break (3 weeks), winter break (2 weeks), sport break (1 week to go skiing), spring break (2 weeks), and Whitsun week.

The grade levels are different, too. Last year, Emily was in 1st grade and James was in Kindergarten (K5). Here kids don’t start in elementary school until they are 7, so Emily is in 1st grade again and James is in Kindergarten again at a completely different school dedicated to Kindergarten. There isn’t much academic learning in Kindergarten here, mostly just playing and working on social skills. So, the curriculum is going to be fairly easy compared to what the kids have done back home. However, since everything is in German, including talking to their friends, their brains are constantly on overdrive and they are sure to learn a ton outside of the curriculum itself.

There are no school buses in Switzerland. Children have to get to school on their own, and in a small town like Münsingen, that means walking. So, there are throngs of kids walking Ready to walk to schoolthe streets in the morning without supervision. In fact, James and all the kindergarteners were given reflective sashes to wear while walking to school and Emily was given a bright yellow hat that says, “Back to School! Watch Out for Kids!”

There are no school lunches in Switzerland either, so all of the kids walk back home at 11:50am for lunch. And then, depending on their age, they walk back to school again by 1:30pm for the afternoon periods. However, in Kindergarten and 1st grade, school is only mandatory from 8:20-11:50am. Emily and James both go back to school on Tuesday afternoons, and Emily goes back every other Monday. But, that means my kids are home all afternoon 3-4 days a week!

Then there are all the small, interesting differences that I started noticing when I went shopping for school supplies last week. The primary item Emily needed as far as school supplies I am used to is called an “Etui.” It is a small, highly regulated zipper container with pencils, eraser, sharpener, colored pencils, ruler, markers, ink, and a few other things. All the kids have one that they use from 1st grade through high school. Then, there were some other things on the list, including a toothbrush, water bottle, “house shoes,” black ballet-style slippers, and a gym bag with gym clothes. We bought everything not knowing exactly how it would all be used, especially the odd assortment of shoes.

On the first day of school, we learned that children do not wear “outside shoes” into the classroom. They change into their “house shoes,” which are usually slipper-like shoes with rubber soles that are kept at school. Also, they change into gym clothes (even in 1st grade!) and they don’t wear tennis shoes for gym, but rather special black slippers. And, every other week for gym, Emily gets to go swimming!

All of these differences are neither good nor bad, they are just different. My only hope is that my kids have a good year and, as I wrote on Emily’s “school spiral project” this morning, “I hope you learn a lot, make many friends, and have fun!”

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Without hindsight…

… I wouldn’t have no sight at all, to paraphrase an old Ray Charles tune.

Aare - Bern
The Aare River flowing through Bern

You see, Sarah and I have had this desire to swim in the local River, the Aare. We have wanted to do this since before we were in Switzerland over a year ago. We watched Rick Steves show us how people just jump right in, float along, and get out somewhere else down the river. To us, this was THE DAY. We were finally going to get our chance.

The Aare is a relatively fast moving, freshwater river that flows from a glacier of the same name in the Bernese Alps. It expands into Lake Brienz, then flows past Interlaken into Lake Thun, and courses north from Thun, past our small village of Münsingen on it’s way through Bern. It eventually meets up with the Rhine river near Koblenz, Switzerland. This makes it the longest river to arise and end in Switzerland. It is some of the bluest, clearest water that I’ve ever seen, and every year, thousands of people swim, paddle, and tube in the Aare. In fact, one could even jump in at Münsingen, and ride it all the way to Bern if they wanted. We did not do this.

Aare - Münsingen
The Aare flowing past the village of Münsingen

We decided to take the kids down to the river, throw on our bathing suits, and each of us (Sarah and I that is) take turns jumping into the river and float for a few moments before coming ashore and rejoining the family. Emily was there ready to cheer me on. James was snapping countless photos on our camera. Sarah had the camcorder in hand and was catching every second. And Henry was busy throwing rocks in the water. It sounded like a great idea, and indeed it was, except for one small problem…

So I admit… I forgot to take my glasses off before jumping in. As I hit the ice cold water, I thought to myself, “did I take my glasses off?” I reached immediately to my face as I went underwater and felt a moment’s relief when there were no glasses on my face, “aahhh, I DID take my glasses off.” This feeling was immediately replaced with one of dread: “No you didn’t, you moron, you could see fine before you jumped in.”

In fact, you can see the complete stupidity for yourself in the video below, intended to capture a moment of extreme pleasure while communing with nature. It really just shows an idiot, jumping into a fast moving freshwater river, with his glasses on. So while hindsight is usually 20/20, it is rarely, if at all, comforting.

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Small accomplishments, big mountains

The early part of this week was a bit slow. After waiting a week for the local bike store to open, it was closed again on Monday. So, we went there bright and early on Tuesday morning, only to find out that he didn’t have any used kids bikes. He told us those are pretty hard to come by. He did, however, have a cheap used bike for an adult, which we bought and immediately took to the grocery store to pick up several heavy items we’ve been needing to tote home.

The kids’ spirits were a little crushed. The weather wasn’t helpful either (cool, cloudy, and a little rainy again). But, on Tuesday night there was a beautiful rainbow right over our house and our luck began to change. Wednesday morning, Joe went into town with Emily to go to Bern and to find the hospital he’ll be working at. Right outside a shoe store by the train station, there were two used kids bikes! He bought them, and by that afternoon the kids were riding two wheel bikes with no training wheels. There were a few bumps and bruises along the way, but they are both doing great.

Thursday morning we woke up to a beautiful day for the first time in a while, and decided it was time to get to the mountains. We took the train to the city of Thun (only 10 minutes from Münsingen), which is a beautiful city on Lake Thun. Then we took a bus, a funicular, and a cable car to the top of the Niederhorn. The view kept getting better and better the higher we went. This really is a beautiful country!  At the top there was a restaurant and an area for the kids with a zip line, dragon slide and sandbox.  Most stunning playground location I’ve ever seen.  After making it down the mountain, spending a little more time in Thun and getting home in time to make supper, we realized how lucky we are to live in such a beautiful place.

Don’t miss the photos of our first mountain adventure.

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We made it to Bern!

Our accomplishment for the weekend: taking the whole family on the train into Bern. That required several smaller accomplishments like getting my passport pictures for my train pass, buying train passes for me and the kids, and getting the whole family to the train station on foot at a reasonable time.

Once we got to the city (only 8 minutes on the express train), we walked through the old town to one of Bern’s best known tourist attractions: the bears. The city (and Canton) of Bern is named after “the Bear” and displays a bear on its red and yellow coat of arms. So, for many years there has been a bear park (“Bärengraben”) in the city that houses three bears. The best part of it is its location and beautiful view of the Aare river and the old town.

On the way there we walked quite a long way through the weekend outdoor markets, past the beautiful old church (Munster), the city’s clocktower (Zytglogge), and under the arcades past many high end shops. The kids are conditioning their Swiss walking legs, and they did great. But, after lunch by the Bärengraben and climbing up and down about a hundred steps around the bears and down to the river, we decided to take the tram back through town to the train station. We were home for nap time, and spent the rest of the weekend relaxing at home. But we can officially check off one more item on our to do list: visit the city of Bern (check)!

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Living and Learning

In our first five days, we haven’t gone further than a couple of kilometers from our house. The reasons (or excuses) are that I haven’t gotten my train pass yet because it requires passport pictures, which I also haven’t gotten yet. Also, the train station is just far enough away to make it a challenging, though doable, walk with all the kids. Ideally we would all have bikes by now, which is how everyone gets around here, but the bike store is closed until next week because the owner is on vacation, and Emily and James don’t know how to ride bikes without training wheels anyway. So, at this rate, we won’t be going anywhere for several more weeks.

Fortunately, within our very small radius, there are two creeks, a swimming complex, the kids schools, and several neighborhood families with kids. Also, our shipment from America came, so the kids have at least a few more toys to play with. After over a month with just the items in their backpacks, it was like Christmas in August.

Our first week in Switzerland has been a balancing act of failure and success. If you define failure as doing something wrong, then that happens several times a day. In fact, the first time we do anything, we inevitably do it wrong. For example, every time we go to the grocery store, which Joe and I have been taking turns doing each day, we do something wrong: going through the express lane with way too many items, bringing up more items than I had the cash for (they don’t take our credit card), not having the right coin to unlock the grocery cart, etc. (Incidently, since we don’t have bikes yet, we also have to carry all of our groceries home over a kilometer in our backpack and grocery sacks, which makes me feel like I did a 250 rod portage in the Boundary Waters!)

We have also failed to get Swiss phones, internet access, or a bank account, some of which require a residence permit that is going to take a couple of weeks to secure. I got lost with all three kids trying to walk to a nearby playground. Oh, and I fried my hair straightener by plugging it into the wrong electrical converter.

Compared to our failures, our successes seem trivial. But you have to count all the small accomplishments that we take for granted back home. Like understanding a conversation with neighbors on the street (check), cooking a meal with no recognizable measuring tools and instructions in a different language (check), and figuring out the school supply lists (check).

The kids start school a week from monday(!) and it feels like we won’t have done anything. But, then again, we have moved to a new country, and I guess that counts for something.

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We have arrived, again!

In case we didn’t make this clear two weeks ago, traveling with three young kids is extremely challenging. We had a difficult day of driving in an overstuffed rental car filled with kids and luggage (and kids sitting on luggage). We made it to Bern, Switzerland and stayed one night in a crowded hotel room with one kid on the floor, and one two-year-old that doesn’t know how to fall asleep without his pack-and-play (which was wrapped in several layers of plastic with several other items and strapped to the top of the car — oops). No one got much sleep, tempers flared, and I wondered several times, “why are we doing this again?”

However, the next day, we drove to our new home in the town of Münsingen. After going through everything with our landlord, a 32-year ex-pat from Connecticut, we were even more overwhelmed and exhausted. But, we had arrived!

There are several things about the house that are fantastic. The yard is a beautiful, relaxing space surrounded by lush greenery, flower gardens, a koi pond with a bridge, candle-lit patio, two fire pits, a bench swing, a ping pong table, fresh raspberries and black berries, and a vegetable garden that has already been planted with lettuce, beans, tomatoes, rhubarb, radishes, and peppers. It will be a bit of work to maintain, but we love spending time and eating meals out there. The house also has plenty of space, including a guest suite with a room and bathroom that closes off from the rest of the house. So, if anyone is thinking about visiting us, come on over!

Also, our neighborhood is great. We are near a creek and in walking distance from everything we need. There are lots of kids here, and Emily and James immediately befriended a family across the street. We were fortunate to arrive on August 1st, which is Swiss National Day. The first night, though we were too exhausted to try to go to the celebrations in the city of Bern, we learned that the tradition for most Swiss families involves setting of lots of fireworks in the streets. We joined the families outside our house where the kids all had a blast setting off over a hundred fireworks of all sizes. The next day, the kids played together again, and we all went to the local swimming pool complex in the afternoon. Even though it has only been a couple of days, we love our new home. Already the challenges of getting here seem like a minor hurdle compared to the incredible experiences ahead of us.

NOTE: No pictures this time. We won’t have real internet access until we get our residence permit, which may take a while (I’m sitting in a Swisscom store right now). But we’ll post when we can.

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Heading to Switzerland

For those of you playing along at home, we will be leaving Germany today and heading to Switzerland. Tonight we stay at a hotel in Bern, and tomorrow we hopefully move into our permanent home for the next year. Tomorrow is Switzerland’s national day so we will be greeted with parades and fireworks.

Unfortunately it does mean that for the next few days, at least, we will likely be without reliable Internet access. For those of you who have been kind enough to email or Skype us with your comments, we will be hard to reach over the next few days. We’ll post an update as soon as one is available.

Wishing you all well as we roll into August!

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Beer

Reinheitsgebot - German Purity Law of 1516
Reinheitsgebot - German Purity Law of 1516

How could I possibly spend any time writing on my travels in Germany without mentioning the beer. Germany is so steeped in beer culture and brewing tradition that it is impossible to escape the connection between German Brewing, and German People. Land has changed hands, laws have been written, monarchies won and lost, all on the backs of the brewers, and the beverages they create.

I’m no beer historian, but I do know that the region of Germany that we are currently staying in has been involved in a significant portion of brewing history. Nürnberg, in the 13th century, had laws forbidding the use of certain grains in beer. And of course, the German Purity Law of 1516 (or Reinheitsgebot) was signed by Duke Wilhelm IV of Bavaria on April 23, 1516 in Ingolstadt, Bavaria. This law stated that “no longer any materials for beer brewing will be used other than Barley, Hops and Water.” Even the Germans were not aware of the necessity of yeast until Pasteur’s work in the 1800s.

Sunday in the Biergarten
Sunday in the Biergarten

But more than the contribution to beer history, Germany is extremely liberal in how it allows and facilitates the consumption of beer. Beer and beer mixes (Radler and Ruß being among the most popular) are frequent lunchtime beverages. There is not only a Biergarten on every corner but there are two in-between. They are outside of town halls, next to churches, and you can assuredly find a beer at the local Sommerrodelbahn (kids playground with alpine-style roller coasters). Open bottles of beer can be carried on the street, enjoyed on the subway, bus, or tram, or sipped on a park bench. There has been some proposed legislation of open container laws, but none of the Germans I spoke to thought it would go anywhere.

Helles Beer
Joe drinking a Helles beer

Ordering beer in Germany also takes some practice. In America, you might ask what they have “on tap,” or look for a beer list. You expect to get a list of labels: Miller, Budweiser, Schlitz, etc. In Bavaria, you order a type of beer, and they bring you what they serve.

Common types of beer that you may order would be Helles (German for “bright” – a light colored lager beer), Dunkel (dark), Bock (generally a stronger lager that varies in color depending on the type of Bock it is), Weizenbier (sometimes called Weissebier, or Hefe-Weizen – a wheat-based beer). And then there are the different sizes; the most frequent sizes are listed as 0,3l (0.3 liters), 0,5l (a half-liter or ein Halbes in German), and 1,0l (a full liter, or ein Maß in German).

Radler
Löwenbräu's Bottled Radler

And then there are the beer mixes (gemischt). The Radler (German for “bicyclist”) is a combination of beer (usually a Helles), and lemon-lime soda (like Sprite; in German weißes Limo). It is supposed to be mixed 50/50, but I’ve found that men seem to get 60/40 beer, and women get 60/40 soda. Maybe it’s just my imagination. The Radler is a favorite summer drink amongst travelers and, not surprisingly, bicyclists. There is a version in Northern Germany called, I believe, an Alster. The Ruß (short for Russian) is similar to a Radler, but instead combines weiße Limo with Weizenbier.

And the local Getränke-Markt (drink store) sells a wide selection of biers, sodas, etc. in crates, usually containing 20 0,5l bottles. Crates can be bought whole, or you can make a crate containing different drinks as well. And don’t forget to save the bottles as your local liquor store will take them back, send them back to the brewer, and refill them. No wasting glass here.

So for better or for worse, beer is plentiful here. And generally speaking, in Bavaria, if you sit down at a Biergarten or Gasthaus and order “ein Bier, bitte,” you will most likely get a half-liter of a Helles-type beer.

But regardless of what you get, it’s going to be darn good.