Category: Orthopaedics

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.