Week 5 at Rex

On Friday, I went back to speak to the woman with T1DM who had asked my preceptor and I, "What's a carbohydrate?" during our first instruct. She was about to be discharged with fixed dosed insulin, so if nothing else, I was supposed to make her understand the importance of eating regularly to prevent lows. (That's actually why she came into the hospital, but she can't dose herself.) I felt like the whole thing would be futile when I went it, but I was pleasantly surprised. The pt was out of bed and fully alert, and she said that she had actually reviewed the info we had left with her (albeit while watching "some movie with Beyonce"... all the more funny because this is a 60-something white woman). Anyway, she was so interested and asking so many questions that I went ahead with a full instruct. I think she finally started to understand the connection between carbohydrates, insulin and blood sugar. She was even receptive to my suggestion to get measuring cups so that she can make sure she's eating the portions listed in the exchange booklet. I really hope it all sinks in this time!

I was a little thrown by a heart healthy diet instruct for a woman who had just had CABG x1 - he seemed to be doing just about everything right already! I asked him about his usual diet and what he knew about saturated fat, trans fat, etc., and there wasn't really anything I could add. So we basically just chatted about food and nutrition in general, and my only real advice to him was a balanced and varied diet ... including small portions of the pastries he thought he needed to swear off of entirely.

The nicest thing about the week was regularly getting through the workload early. When I expressed surprise about that on Friday, my preceptor said, 'When you have two people doing the work of one, of course it goes faster.' I think I'm finally getting to be a functional RD. Of course, the intimidating clinical nutrition manager has set the bar high for my performance - she said that only 1-2 interns have ever taken on the full workload of one of the RD's during their staff relief week.

Now I'm on to a week of obstetrics, which will probably be more like a week of general medicine since the obstetrics RD doesn't get many consults, so she just fills in other places most of the time.