Every morning when I walk into the hospital I see a marble bench that contains freshly baked loaves of bread. Each loaf is wrapped in a paper bag and has a tag on it indicating which area of the hospital it is intended for. Typically they go to staff or doctor’s lounges. As people come in for the morning, they stop by the bench, grab the loaf for their area, and head to work.
I don’t know if I’m more amazed by the delivery of fresh bread to the hospital, or the fact that no one seems to be tempted to steal one of these loaves. They look and smell so good. What a great way to go to work!
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.
… I wouldn’t have no sight at all, to paraphrase an old Ray Charles tune.
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.
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.
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
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.
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).
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.
Emily and James and I set out this morning on a mission. We were on day three of our transportation shortage, and rations were starting to run low. I decided to ask Emily and James if they were up for the challenge of the 8 kilometer round trip walk through the Altmühl Forest, down into the valley, and back up to make a trip to the nearest grocery store. As usual with youth, what they lacked in comprehension, they made up for in enthusiasm. Regardless, the walk turned out to be an extremely beautiful walk through forest, along fields of corn, hay, and barley, and down through a wooded river valley. Complaints were few, but questions were plentiful.
While on our walk, not more than a kilometer from home, we stopped at the side of a local farmer’s field to examine the grain. My experience with homebrewing helped me realize it was a field of 2-row barley. This particular type of barley is commonly used as a base malt when brewing German beer, but it can also be used for other purposes. We each grabbed a stalk of nearly ready grain, and would pick seeds and munch on them as we walked.
On our way back from Riedenburg, we walked by another field that was growing 6-row barley. This kind is particularly suited for animal feed, and we could see why. The kids noticed the seeds were more plump, softer, and had more of a flavor to them. We enjoyed our walk, our snack, and four hours later, we found ourselves back home with a backpack and two bags full of groceries.
I’m terribly proud of those two kids for making that whole journey with me, but I am even more amazed at the incredible surge of energy they seemed to have when they got home. They started running around, wrestling each other, and generally wreaking havoc. It was a good opportunity to send them over to the spielplatz to burn off more steam. We’ll see how they sleep tonight.
I know most of you reading this blog are struggling with overwhelming, oppressive heat right now. We hope you all are staying cool! After having had beautiful weather the first five days here, we have had rain and cold the last two. But last night we had a wonderful surprise that heralded the end of the rain, and hopefully the return of nice weather. Here are a couple of photos that captured the end of last night’s storm.
The best (most accurate, or believable) translation for the following picture will win serious props on this here blog. Alright people, fire up your Wernicke’s areas and leave your best translations in the comments section. And don’t use Google Translate, because I’ve tried that.
One of the more surprising findings for me on this trip has been James’ growing love of Bavarian White Sausage, or Bayerischer Weißwurst (pronounced VICE-vurst). Almost every time we go out for lunch, he asks if they have it, and will easily take down two of these sausages without batting an eye. Of course he always has to share with his little brother, Henry, who loves it, too.
Weißwurst is a mild-flavored sausage that, so I’ve heard, is one of the first sausages that Bavarians will feed to young children because of its mild taste. I’m not sure, but I think it’s mostly veal and pork with very few seasonings. And it has as distinct white color which gives its name. It is mostly a morning food, not to be eaten after noon. It is usually served with a pretzel and a Weißbeer (for the adults, anyway).
But more interesting is that there is clearly a right way, and a wrong way, to eat this particular sausage. And not only is the right way the socially approved way, but it may ensure that you actually enjoy the sausage, rather than hate it, like I originally did.
The issue is the sausage casing. Unlike the brats and hot dogs that we are used to in America, Weißwurst has a tough, thick casing that is unpleasant to eat, and tough to chew (though some Bavarians do eat it this way, it is not the norm). The casing should be peeled off, by hand, and the meat eaten with sweet mustard (preferably “Händelmaier’s süßer Hausmachersenf“) using only your fingers, no fork. Alternatively, a hole in the casing can be made at one end, and the meat “sucked out” through the hole.
When I visited Germany right out of college with my friend, Will. I remember sitting in the Marienplatz in old town Munich and ordering a weißwurst for lunch since I had never had one before. Not knowing much about it, other than it looked like a white brat, I starting cutting it with a knife and fork, thinking that this particular dining establishement had messed up the sausage since the skin was so tough. I choked down half of the sausage before I couldn’t stand eating it anymore (solely because of the skin) and thought it was a big bust. I probably offended everyone around me with my clear breach of weißwurst etiquette.
But now, I have to admit, James is right. Bayerischer Weißwurst is pretty darn good, once you know how to eat it. While it is not common to find in the U.S., there is a great Bavarian sausage maker outside of Madison who makes traditional weißwurst, as well as other traditional German foods. You can check out their website here. And they ship anywhere in the U.S.!
And if you want to learn more, or just like watching videos of moderately goofy Germans who don’t speak terribly good english, check out the video below of Mr. Perkins showing you how to prepare and eat, weißwurst. Prost!
I mentioned our Ferienwohnung in the last post, but I didn’t really explain what it is. Ferienwohnung is the German word for a “holiday flat.” We are staying at the Ferienwohnung Grünauer with sweet Emma as our host. We are basically living in the lower level of her house. We have two bedrooms, a living/dining room, a small kitchen, a bathroom and a water closet.
James ceremonially christened the bidet in the bathroom before we were able to explain to him what it is. He came into the living room where Sarah and I were sitting and said, “Mom, the toilet is like a sink or something.” We immediately figured out what had happened. The kids still aren’t exactly clear what a bidet is for, and we’re okay with that.
Our Ferienwohnung is located in the village of Obereggersberg, near Riedenburg, Germany. It overlooks the Altmühltal (Altmühl valley where the Altmühl river runs). Obereggersberg is a small collection of houses and Schloss Eggersberg (the local provincial palace, now a hotel, restaurant, and wi-fi hotspot). There are no real businesses here, other than a few Ferienwohnungen, and if you want to go shopping you have to travel the 3km to Riedenburg.
So when we got here our kitchen was stocked by Frau Petri. She brought us milk, bread, snacks, tea, coffee, and various other sundries. Our host, Emma, told us that the local bakery would deliver fresh rolls to us every morning. We just needed to tell him what we wanted. And sure enough, every morning (except Sundays) there has been a cloth bag hanging on our front door with five or six fresh rolls. Brekfast is always a treat!
We’ve also discovered that just down the street is a Kinderspielplatz or kids playground. They have some swings, a slide, a sandbox, and some sort of seated zipline thing that even the kids love doing. It says it’s for kids 12 years and younger, but we’re definitely young at heart!
