new years eve

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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2014: Year of the Trailblazer

2013 –

I can’t say you and I didn’t have our moments. You certainly didn’t make things easy on me. Over the last year, there have been some major peaks, coupled with significant valleys, each accompanied by imperatively important lessons to be learned.

This year I’ve seen what makes me tick, what makes me smile, what makes me giggle until I cry, and what makes me cry until there’s nothing left to do but laugh.

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I’ve learned that most of the time I’m bubbly, but it doesn’t mean I don’t also feel anger. And I’ve learned that I love Star Trek, and I’m totally ok with it.

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I’ve found that I love myself more when I’m sober than I thought I ever could. And I’ve learned that one should be ridiculously, laughably, wildly in love with his or her own life — and even more important, I’ve seen how within my control that is, and have had to remind myself multiple times that this control ironically often comes from accepting the things over which we have no control.

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2013 in summary – I moved to the city of my childhood dreams; landed jobs I never thought I was qualified for (and did just fine); matched to a dietetic internship, solidifying my plans to become a registered dietitian, and met clinical cases I thought I wasn’t capable of solving (sometimes excelled, sometimes looked utterly foolish, but after all I turned out ok); I cried a lot, laughed a little bit more, moved on from a wonderful relationship that had run its course, letting go of someone I loved deeply, learned to handle my emotions without alcohol to numb them, and determined who some of my real friends were whether I was ready for it or not.

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Oh, and finally got to try poutine (Canadian french fry dish with cheese curds and gravy goodness that has been on my bucket list for some time).

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(It was delicious, of course)

All in all, 2013, it’s been REAL. No other phrase seems quite as fitting. And to your successor, 2014, I say BRING. IT. ON. I’m ready, and can’t wait to dive in, blazing my own pathway from here to Happinesstown. I am open and ready to receive the bliss I deserve. Let’s do this!

Don’t Waste the Night Away: How to Avoid Over-Drinking this New Years Eve

Typically my first tip for avoiding that dreaded fallin-down-slurred-speech level of drunk is pretty fool-proof: offer to be the designated driver. This works for me, becaue of a) the law, and b) it’s sometime easier to follow a rule I’ve made for myself if  others will be impacted by my decision not to follow it. However, I feel that New Years Eve is only part complete without a sparkly beverage in hand. Here are some tips that have worked for me in avoiding the slop.

1) DON’T DRINK

As fun as it is to attempt moderation, it’s not a reality for all of us at this juncture in time. If you feel the need to go sans alcohol for the night, but fear your ability to stick to it, drink something like sparkling water (or even the infused ones are pretty good), or a diet soda with a lime. I find that drinking something that feels almost cocktail-esque fills my need to over-indulge in the real stuff. 7Up and OJ is also a favorite of mine!

2) STEER AWAY FROM SHOTS

When ingesting shot after shot, our bodies have zero time to alert us to the fact that we’re tipping over into schwasty territory. Try to stick to mixed drinks if you’re drinking hard alcohol.

3) STICK WITH BEER, YOU’RE IN THE CLEAR

If you’re just learning how to moderate your drinking, sometimes it can be extra challenging to follow a loose set of guidelines that tell you to “not drink TOO much, just a little.” When I first began my journey into moderation, I found it very useful to cut out hard alcohol for a while. Beer and wine will at least show you you’ve had enough through signals other than the swirvs—once you feel full, it’s hard to keep drinking! Eventually you’ll be able to figure out ways to slip it back into your life in moderation. A plus to drinking beer—hangovers are far less severe without the use of those high-sugar mixers.

4) H2O! (…and other virgin bevs)

Alternate between alcoholic and non-alcoholic drinks throughout the night. This will force you to shoot through your alc more slowly, and if you’re spending the evening at a bar, you’ll save money too! Having your non-alcoholic drink be water is probably your best bet, as it’s important to stay hydrated. However, I know it’s often difficult to pull off once others around you have lost their inhibitions, and may want to push alcohol on you. It’s easy to disguise a non-alcoholic beverage, using some of the ideas in Tip #1 (you can throw a lime in almost anything, and ask for it in a high ball glass or tumbler, and trick most people… ;-)).

Also, in any situation involving drinks—ALWAYS be sure to stay hydrated, and eat properly leading up to drinking (well, ideally, all the time…). Drinking on an empty stomach typically ends… not well.

Everyone have a FANTASTIC New Years Eve. Have fun, and remember that a good evening is a waste if you can’t remember it :).

See you all in 2013!