Last week at High Point but the end is not quite here

I finished my last at High Point last week. I was able to focus on oncology and rehab patients all week, which was definitely a treat given they were the patients I most enjoyed working with. It was a bit of a slower week, so I was encouraged and able to spend more time with each patient. Mostly, that meant spending time listening to them tell me about their lives and histories whether it had to do with their eating habits or not. It was great, and I loved every minute of it! One patient spent spent over 45minutes telling me stories from his WWII days in Europe. Not only was it fascinating, but low and behold I learned about where some of his eating habits came from! I am more convinced than ever that the power of listening has the ability to heal...or at least make people feel a whole lot better.

I start a one week rotation this week at UNC tomorrow focusing on inborn metabolic disorders. I feel like it will be a complete change of pace in many ways yet should also be very interesting. I am looking forward to it!

goodbye CMC Union

I left to go out of town the day after my clinicals finished, so I didn't get to write my last post until now. My last two weeks at CMC Union were a very good experience for me. I was on staff relief both weeks, and it was the first time that I really began get to know the patients on the floor. Before I just usually went with whichever dietitian had the longest list, so I rarely followed up on the same patient that I had already seen. Staff relief was a great way to see the parts of clinical dietetics that I enjoyed and the parts that were not my favorite.

I was sad to leave the dietitians on my last day because they were very good to me all summer. One of my favorite parts of the summer was interacting with them every day. Overall it was a great summer!

Ending on a High Note

My last week of staff relief definitely had its ups and downs, and I was pretty much exhausted for most of it, but it was a great week in the end. I followed several patients over the course of the week, and it was great to get to know them and help them. I did a lot of instructions, and most of my patients were remarkably receptive, making the experiences really positive. (However, I did learn that you should NEVER calculate someone's energy needs on the fly because it is way too easy to make a mistake, and then you have to go back looking like an idiot.)

I heard some interesting food beliefs from several people: 1) when you add salt during cooking instead of at the table, it doesn't add sodium to the food, and 2) sea salt has less sodium and is better for you than table salt.

The exception to my feeling of being able to help everyone was my very last case: a woman with a h/o severe hyperemesis gravidarum. As I dug into records from previous admissions, it became clear that there isn't much we can do for her - jejunal feedings and TPN have both failed in the past, and she ultimately had to terminate a pregnancy. I spoke with her briefly to let her know that the RD's would follow her and give her all the help possible, but really, this woman just has some tough choices in front of her.

Overall, this has been a really challenging but educational and rewarding. I will really miss the RD's at Rex - they were so helpful and fun to work with. They've all been very supportive, including Lyn (the demanding clinical nutrition manager), who went out of her way to compliment me on Thursday. I'll take that as an H.

pickled pigs feet!

Today was my last day at CMC and it was definitely bittersweet! I was almost trapped there due to an overturned tractor trailor that spilled pickled pigs feet all over the lone road that leads to the hospital. Luckily they were able to clear most of the mess in time for my departure.

It's really a relief to be finished, but I'm definitely going to miss the dietitians that I worked so closely with. They were all really great teachers - always supportive, encouraging and patient with me, and willing to answer any questions I had, despite being very busy. This whole experience has been a very positive one and Cayuga was a perfect environment for me to learn and develop professionally. Today the dietitians and nutrition assistants even threw me a good-bye party complete with an AMAZING flourless chocolate cake and presents. It was really hard to leave!

goodbye!

i just have to say that i'm actually a bit overwhelmed that tomorrow is our last day at unc. i've been on staff relief as well, like sarah mentioned...covering peds this week because a peds dietitian is away getting married. it's been a great but definitely busy week. i honestly don't even know what to write right now. (haha) i think i'm just realizing that this is all the training we're going to get (if we choose to go the clinical route).
anyways, i think the highlight of this week was my cute baby girl with curly curly hair, who is always alone in her room. i'm drawing a blank but i think she was born with a defect where her esophagus and stomach are not connected. so, this sounds crazy, but they are "stretching" her esophagus and literally just waiting until it's closer to the stomach so they can surgically connect them. so anyways, I stepped in to check on her tube feeding and she was awake, crawling around her crib so i stuck my finger in to just say hi. she grabbed my finger and wouldn't let go...so we ended up playing together for awhile. totally not nutrition related i guess, but it was just a nice feeling to see that the nutrition she was getting was giving her the energy to be happy and moving around again.
anyways, hope everyone has a great rest of summer! woo!

4 hours left!

I'm working a half day for my last day, thus the 4 hours left. I am ready for Nashville, TN.

I spent the first 3 days of this week at UNC with a wonderful RD named Jennifer who works as a ketogenic diet dietitian on M/T and helps with other specialty areas on W. And I got to spend a bit of time with Sarah and Diane and hear Caroline's case study. On M/T we basically focused on one patient who was a 1yo little girl with severe seizures. Her mom desperately wanted to try the ketogenic diet and fully believed in its healing potential. She was on top of things. She read a whole book about the diet, constantly stayed at her daughter's side taking care of every need, bought the highest priced scale available to measure out formula and make different ketogenic recipes, and was willing to try anything Jennifer recommended regardless of the cost. I should mention that this mother was obviously not of a high SES and wore tattered clothing each day we were there. What a beautiful example of unselfishness she provided as she gave up everything to take tremendous, compassionate care of her little, suffering baby.

On W, we also saw a 17yo boy with CF who was on TF at night to help meet his needs. I never realized how annoying TF can be until he started talking about it. He said it makes him sick to even think about the formula being pumped inside of him, so he has to do it at night. But he rolls over a lot and pulls out the tube from the site, so his bed gets all soaked with formula. And his site leaks a lot, and he says that the acid leaking from his stomach burns his skin. Awful. I should have just recommended Cook Out milkshake TID (which would only have met 1/2 his calorie needs unfortunately).

I am about to burst with excitement about being finished. I will definitely be sad to leave all of my new Fayetteville friends though. A tear may be shed...

ICU

It seems like I will be tackling a pretty interesting case tomorrow on my last day. An ICU patient came in today with a complication of a gastrostomy. He had an exploratory surgery of his stomach that somehow went terribly wrong. He has a hx of throat cancer so he already had a PEG tube placed. Somehow the patient perforated his stomach and tore his esophagus while vomiting, so his PEG isn't usable. Now instead of the normal port on his PEG, they somehow attached a tube and it runs out of his stomach, to the outside of his body and then back into his jejunum. I guess that plan was to feed him through that, but since he perforated his stomach, they aren't feeding his gut at all, obviously. He was started on TPN today, but he has a pretty poor prognosis. His stomach contents leaked out into his abdominal cavity and possibly into his lungs. Looking back today I can't even imagine how I would have felt seeing this kind of case when clinicals started, and it makes me realized how far I've come. I'm hoping we can make some appropriate recommendations for the patient tomorrow.