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Weeks 13-21: Cardiology, ICU, Eating Disorders, Staff Relief

It seems we’re developing a motif here, as this post will continue to cram 5+ weeks of rotations into one abridged post. But, hey, so goes the life of the dietetic intern.

Week 13: Cardiology

Cardiology was my only 1 week rotation – and man, it went by SO FAST! I do feel like the length of the rotation was appropriate, however, given the patient population. During this rotation, most of the patients I saw were status post heart attacks, CABG procedures (stands for Coronary Artery Bypass Graft, and is pronounced like the vegetable – “cabbage”), or admitted with Congestive Heart Failure (often referred to as CHF). Working in a hospital as a clinical dietetic intern for 13 weeks prior to this, I had already been exposed to most of these conditions, and I don’t feel that having a very long cardiology rotation would have enhanced my experience dramatically. I basically gained more practice giving heart healthy diet and CHF educations, which I welcome more of! My one complaint for this rotation is that it was my only week working on a unit at a different campus than my other weeks, and it was a bit challenging to get used to the different buildings, and a new set of operations in such a short amount of time.

Because the heart healthy diet is the primary need on cardiology units, I’ve created a separate post to provide an overview of the guidelines. You can view the post HERE! The rotation really inspired me to spread the word about heart healthy diets, and catching signs of heart failure, because death related to heart disease is typically so preventable.

If you are in dietetics, I welcome your feedback. And if you are just interested in learning about the diet for your own benefit or that of a loved one, please leave a comment and let me know if you found the information helpful. Questions and comments are ALWAYS WELCOME!

And after Cardiology, it was on to Critical Care!

Weeks 14-15: Critical Care

This rotation was INTENSE, mostly consisting of recommending nutrition support options. The majority of the patients I saw were NPO, so taking in no nutrition by mouth. I had the opportunity the learn about the current nutrition support guidelines according to ASPEN and the Academy of Nutrition and Dietetics, and gained a clearer understanding of what makes each formula unique and appropriate for various individual conditions.

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Lot of calculations and lab values in Critical Care…

Not only was my critical care rotation interesting, but I also felt like a very strong component of every patient’s care team. I attended daily rounds on the ICU floor in which each critical patient was discussed, and the opinion of the dietitian was typically obtained, and highly regarded – usually my recs would be implemented immediately without hesitation! In previous clinical rotations, I recall experiencing frustration when having to recommend the same diet changes multiple times, seeing no orders placed. In the ICU, I felt capable of making a difference in the care of patients, and felt truly empowered as a proponent of good nutrition, particularly as I got to watch the transformation some patients took once appropriate nutrition recommendations were implemented.

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You fellow interns and RDs feel me??

Week 16-17: BREAK!

After Critical Care, I was lucky enough to have a 2 week long break. I spent a nice chunk of that time catching up on clinical readings and assignments, but I certainly got to have some fun as well…

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Went camping…

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…in Morro Bay, California…

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…with my best friends in the entire world (my SISTERS and parents)…

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…who walked all over town with me when I just had to have some Cioppino (it was SO worth it)…

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…We even got to have a little camera fun…

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…and got so many beautiful sunsets…

Then I got to welcome 2014 with my sister and brother from other mothers in Seattle, WA and Vancouver, BC:

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…where I got to see Captain Kirk’s Chair at the EMP Museum

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…climb atop this Space Needle…

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…with THESE two…

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…clean ourselves up for a New Years Eve celebration…

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…and I even found my name in LIGHTS!

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And of course, once returning to San Francisco (<3), had plenty of time left over for tasty coffee, a farmer’s market…

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 …and a little at-home yoga :).

And it’s a seriously good thing I got so much me time over these two weeks. I was definitely going to need it entering my eating disorders rotation…

Week 18-19: Clinical Elective – Eating Disorders

In a happy twist of fate, on my very first day of interning, my CNM offered my fellow intern and me 2 options for our clinical elective: eating disorders, or NICU. I immediately jumped at the opportunity to claim EDs – although I wish I could have experienced both areas of specialty, I’m sure no one is surprised by my choice.

My elective week brought up a whirlwind of emotion, both positive and negative. But the greatest thing I took from these two weeks was that I felt right at home. It was incredible to be reassured that ED treatment and recovery is the field I am meant to be in, because of my passion, my skills, and my own personal struggle. I feel blessed to have found this so early on in my career, and am so glad to see I still feel the way I did at the start of this journey.

Most of the week involved a lot of shadowing. Given the high specialization and touchy nature of this field, at the start of my rotation it was unclear whether I would have the opportunity to counsel one on one. However, after a few days of sitting in on sessions and observation of groups, in addition to spending time note writing and reviewing the past medical histories of the patients, I was able to conduct supervised one on one sessions with a number of people. This experience was anxiety-inducing, incredibly exciting, and limitlessly humbling. I was reminded of the love I have for this field, and was also reminded that I am quite good at it naturally! But I also saw how much I do have left to learn, and look forward to the career ahead of me.

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^This is what note taking looks like in an eating disorders rotation…

Weeks 20-21: Staff Relief – FINAL WEEKS IN CLINICAL!

Staff relief… What to say about staff relief. Well, I’m sure I grew from it, and I can say that. There were also a lot of tears coupled with self-doubt and feelings of inadequacy. Not to get all negative Nan on ya, but this experience is what it is, and I’m here to share it with you.

I must say, now that staff relief is behind me, I could not be more appreciative of those two weeks. I think it is so important to have them under your belt before entering the field as a clinical dietitian. But it was TOUGH!

For those of you who are unfamiliar with the term, staff relief is the rotation that usually comes at the end of your clinical rotations. During staff relief weeks, the intern is to act as dietitian, covering a unit on his or her own. It’s really the first taste you get of working independently as a clinical dietitian.

After discussing my staff relief rotation with my internship director, I learned that my experience was atypical. This may be one of the challenges of being in a distance program – my director is unaware of how things are going unless I share the information with her. During staff relief, most interns will cover 1 unit – ICU, Oncology, Med/Surg, etc (per my director, interns typically cover Med/Surg floors). During this rotation for me, things were organized a bit differently. The dietitians from each floor would assign me about 2 patients, totaling up to about 6-8 patients per day. I found that the most challenging part of this was having to switch mental gears from oncology to critical care to cardiac to CVAs so many times per day. I feel this brought down my level of efficiency, and made it challenging for me to do a quality job while also seeing the appropriate patient load each day. This impacted my confidence significantly, and I really had moments when I doubted whether I have what it takes to be successful in the field of clinical dietetics.

The good news is, once I spoke with my director (2 weeks AFTER completing this rotation), she assured me that my experience was not typical, and that seeing so many different types of patients each day in fact WAS quite challenging. I was so relieved to hear this, and felt I could reassure myself that staff relief did not indicate that I had made a catastrophic decision in choosing to become an RD.

Let it be a lesson to me – to give myself a BREAK, and not jump to thoughts of failure so immediately at the first sign of struggle.

So, that’s a wrap for my clinical rotations! I cannot believe that one of the biggest challenges in my path toward my RD is behind me. My next post will talk about my experiences working in long term care and community nutrition. Please check back for updates soon!

And all you DI hopefuls applying through DICAS right now, you are in my thoughts as programs sift through your applications. Next will be interviews for many of you! Remember: smile, stay calm, and be yourself – you’ll do great :).

Stay happy :).

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Mac n’ Cheese Craving About MORE Than Our Lack of Will Power?

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What an interesting <24 hour span…

After a challenging but incredible day working at my new job, getting to visit some patients in the ICU, I head to my typcically oh-so-reliable vehicle (the Kia Sportage), in a bit of a rush to make it to my second job–about an hour away–on time. In the ignition my keys go, and with a clockwise turn forward, I see my afternoon flash before my eyes. Sportage was…. Dead. =’O

After a brief panic-laden call to my father, during which he told me a bunch of things that under more serene circumstances I would have already known, I called AAA, made my job aware, and awaited my knight in shining new battery’s arrival.

Battery’s replaced, I’m one hundred clams poorer, but I’m on the road. With extreme traffic (usual 1 hr drive took 2hrs), I felt my blood boiling and my mind racing with what innovative Chinese water torture method my job might use to punish me. (Side note: something I really enjoy about a commute is the time I’m forced to spend calming myself down :))

FINALLY, I arrive back into town. As I let out a serious sigh of relief, apparently, so does my rear right side tire. Tire pressure light comes on, and as it turns out, I have a flat. I decide to hold off until after work to deal with it, at which point I stop by a gas station and fill the tire with air. A large part of me knew that this likely would not fix the issue, but it was 8pm, and I needed to get home.

This brings me to this morning… Around 10am, I go to my car to drive to the store to pick up some foods for lunch (which I eat with my clients, so I am obligated to have something). Upon pulling out of my driveway, I learn that my tire is not just a bit low on pressure, but is–you guessed it–flat Stanley. Fantastic. I find the nearest tire repair store, and drive (YES, DRIVE) my poor, just barely pre-mortem vehicle about 3 miles down the road for fixin’. The man fixing my tire was incredibly nice, and when I told him I needed to be at work by a certain time, was sure to get right to it. He informed me that I had, not one but — TWO screws in my tire, and that because I drove my car there, it was incredibly dangerous to continue driving on it (even after repair) due to the damage. Now, I am suddenly in need of a new tire.

Now…. to my point in writing this post. I’m about $250 down, and in SERIOUS need of a hug. With blood glucose levels running low, and cortisol levels running obscenely high, I find myself craving… wait for it…. PIZZA LUNCHABLES. What?

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(Seriously? This sounds good?)

Then I think about it… In my early childhood, before my mother became as well-versed in nutrition as she now is, she would often feed these to us. I remembered a time with my family on Yom Kippur, a Jewish holiday involving fasting. After I had attempted to do this fast for the first time at age 6 (um, earliest signs of ED, perhaps?), and my poor growing body just couldn’t take the hunger, my mom took me out to the car, and gave me my very own pizza Lunchable that she had brought, likely foreseeing me not making it much past 11am. I think this shows that what I really needed today after this stressful experience is not highly processed, naturally stale-ish tasting fake and cold pizzas. What I really want is for my mom to take care of me, to take me out to the (functioning) car, sit with me on the sidewalk, and tell me everything is going to be alright, even though things have not gone according to plan.

The evidence is there. Cravings often have a true emotional tie within us that others may not be able to understand, and sometimes we subconsciously believe that eating certain foods will give us what we lack. So…

I PROPOSE A CHALLENGE:

The next time you have what seems like an odd craving, try to think about WHY. Was it a food your family made every Friday night? Maybe it’s the cookies Grandma would make whenever you went to her house (not my Grandma–but maybe yours did that stuff… ;))? It could even be the crappy dorm food over which you shared a number of laughs and good times with your best college pal. Then, if you’re really NOT hungry, or it’s maybe a food you’d like to avoid due to health reasons, try doing something to fill that need. Maybe you can call a family member, just tell them you miss them. Or if you’re lucky enough, go hang out with them. Maybe you need to call up a friend to hear a familiar voice. Or just go give/get a hug from someone. Does the craving go away? Do you feel fulfilled? I would love to hear any findings or feedback here!

Comment away, my dears :). To LUNCHABLES (or at least the warm fuzzy feeling they give to some of us…)!

Give Yourself LOVE

Some days, we need a little extra love… Sometimes, those days coincide with the days every loved one in your life seems to be otherwise engaged.

How do you LOVE yourself when YOU are the only one around?

It’s the End of the World As We Know It… And How Do You Feel?

Ok, I think most of us occupying the realm of sanity do believe we will live to see December 22, 2012. But that little conspiracist in me has something to say (I mean a VERY tiny voice… so please don’t judge me).

She says “Well, maybe the world IS ending tomorrow.”

And then the part of me living in reality responds. Now, while I do not believe that as of midnight my days are numbered, that little tiny voice got me thinking… If the world did end tomorrow, how would I feel? Would I feel accomplished? Would I feel fulfilled? To these questions—I say yes, I would. I feel that I am where I am supposed to be at this very moment.

But then Michael Stipe took a backseat for a moment, as It’s the End of the World dimmed, and I began to here Dave Matthews sing “When the world ends… I’m going to be there with you somehow.”

Again and again we are told that you never hear people gripping onto the last breaths of life, remarking they wished they had worked more. Regrets tend to come in the form of not spending enough time with the ones you love, and doing things that truly make you happy. Yet I never truly got it until now.

So, what I’ve chosen to learn from this experience is this: If the world DID end tomorrow, my one wish would be that I spent more time with loved ones, telling them what they truly mean to me… not so much that I don’t yet have a PhD. So today, I will begin working on making that reality, so I don’t have to worry about it for the next apocalypse.

If there’s one thing this crazy Mayan miscalculation can teach us, it’s to remember what’s truly important. When the world ends, where will you be?