Well, what a few weeks it’s been. I have learned a lot already–about outpatient counseling, carb counting, insulin, and even a bit about myself. Let’s start with my first week of rotations:
Monday: Orienting. Chaotic. Most of the day involved explanations, introductions to supervisors and systems, and a fair amount of confusion on everyone’s part. The day concluded with a brief meeting with the RN who supervises the Diabetes Center–where I would be completing my Endocrine/Diabetes rotation, and 1 week of outpatient.
Tuesday: 9 hour day. Got to meet my RD preceptor who I knew I’d get along with famously (I rarely meet an RD I don’t like…). I got to sit in on her 1:1 appointments, and observed a “Diabetes 101” 4 part class taught by the RD and another clinical team member. This class was the fourth of a four part series, and it was great to see the participants graduate at the end of the evening with confidence in their ability to own and manage their disease!
But finally sitting at home around 10pm, I found myself seriously questioning whether I have what it takes to get through this, and hoping for a better tomorrow.
The day was challenging for a number of reasons, but a major hurdle I’m running into is the lack of understanding it seems people in other disciplines have as it relates to dietitians, dietetic interns, and our level of competency. Although I have an assignment which involves me teaching a nutrition education class (for which tonight would have been a PERFECT opportunity), the RN supervisor overseeing me stated she did not feel comfortable allowing me to teach, and that she felt I was there more for observation than participation/practice. I can’t blame her–she’s just not been told what a dietetic intern does, and that we are here to get hours in SUPERVISED PRACTICE. It has become frustrating on a number of levels, but I imagine it’s a taste of what some Registered Dietitians face on a daily basis. I do hope our reputation in the medical field is improving–we’ve worked hard to get here!
Wednesday: What an improvement! This day I got to have some actual patient interaction, and felt that I did relatively well. I worked with the Physician’s Assistant/Certified Diabetes Educator who does more of the medical side of diabetes education. I got to act as a true “RD-in-training” whenever her patients had a nutrition-related question. I felt needed, competent, and believed-in. My mood only started to decline once I realized how much work there was to do, and how in deep I really am.
Thursday: Similar to Tuesday, I got to mainly shadow the RD. I wasn’t able to jump in and do any 1:1 counseling on my own due to the supervisor’s wishes. But we found ways for the RD to assess my abilities, and I am meeting my competencies for the rotation.
Friday: For the final day of the week, I took a break from the Diabetes Center and reported to the main hospital across the street: Alta Bates Summit Medical Center – Ashby Campus in Berkeley. I met briefly first thing in the morning with the Food Service Director who greeted me with a bubbly sense of pride that I couldn’t have needed any more at that point. We discussed some basic logistics–what I needed to know to survive the day. She then sent me off to the diet office where I met the nutrition assistants. Throughout the day, I shadowed, asked questions, and saw the world of Alta Bates Med Center through their eyes. I got to meet the team of clinical dietitians at this campus, as well, who will be leading me through much of my clinical rotation.
The last part of my day went from 2pm-4pm, and gave me chills… LITERALLY! I observed and assisted in tray line, which lasts about 2 full hours, and actually takes place in a REFRIGERATOR. Temps in this room are very close to 40 degrees Fahrenheit. My hospital works on a cook-chill system: the food is prepared then frozen at a main kitchen, plated in tray line, and then sent off to wherever it will be served (if trays are going to a campus away from the main kitchen), and reheated immediately before serving. It’s a system I’ve learned about many times, but have never seen in live action.
Here is a flow chart that outlines the steps of the cook-chill system in comparison to a more common cook-serve system (Original link to diagram found here).
Cook-Chill [Yellow] v
^ Cook-Serve [Green]
So the tray line takes place in a cold environment so that there is no chance for food temps to reach the danger zone: 40-140 degrees–the window in which bacteria thrives. This tray line ends up providing meals for patients at the campus I’m primarily working at, in addition to the campus nearby which houses our psychiatric and residential eating disorder treatment programs–they produce HUNDREDS of trays! It was really something to witness… These hours served as a highly valuable learning experience. I’ve always found that when employees thoroughly understand the inter-workings of an entire SYSTEM, and not necessarily just the requirements of THEIR jobs, it allows all employees to perform their jobs at a higher level–even if all of the positions do not seem to cross paths directly.
After that week, I was beyond ready for a nice long weekend. Saturday I got to spend connecting to my Jewish heritage, as I participated in a Yom Kippur fast. Once we hit sundown, it was bagels and lox until our bellies stretched to capacity (and beyond), and some of us even may have had to undo a top button…
Sunday was a bit more fun–got to attend a concert we had been looking forward to for months (The Slackers, for any ska fans out there), and spent the day in beautiful Santa Cruz.
The instant serenity-inducing beaches of Santa Cruz — No filters needed here.
We rode that pirate ship ride that goes back and forth at the Boardwalk… It remains terrifying, in case you weren’t sure.
The Slackers put on a seriously entertaining show, per usual.
The week began again far too quickly, but I jumped in with all the enthusiasm and vigor I could muster. My second week in Endocrine allowed me to hone some of the skills I was merely introduced to the week prior. Week 2 felt more hands on, as I felt more comfortable providing input during patient sessions, and knew which questions to ask both patients and practitioners. I also got to write my first very own chart note! I had the opportunity to attend another Tuesday night diabetes education class–this week was part 1 of 4, so it had a different feel to it. These participants were likely newly diagnosed, or just newly motivated. A lot of emotions filled the room that night–from excitement and enthusiasm, to denial, to fear, to confusion and unknowing. It was refreshing to realize I wasn’t alone in having those feelings ;-). By the end of the class, it was great to say goodbye while hearing the joy in the voices of some as they said “I’ll see you next week.”
Friday involved another diet office training. I got to meet a few more team members, and learned more about the management side as I shadowed the Patient Services Manager for the day.
The week wrapped up nicely, and I embarked upon the social weekend I had planned for myself! Met some great new people, and attended the last Movie in Dolores Park of the year before the weather turns cold (because it’s been just a blazingly hot summer here in San Francisco–oh wait, no it hasn’t).
I am now beginning week 4 of my internship: Patient Services and Clinical Nutrition Management. Check back at the end of this week to see how it shapes up!
In the meantime, be kind to yourself–I know I’ll be trying :).
*Note: Most of my pictures within posts at this time are not necessarily going to be dietetics-related, as I am waiting on permission to use pictures I take at my rotation sites on my blog. So enjoy my personals! And check back–hopefully I can utilize the professional ones!