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!
Friday, July 31, 2009
Thursday, July 30, 2009
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!
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...
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.
Almost the end.
What a day. Today I have had quite a few challenging heme/onc cases. My most difficult case was a young man with AML who currently has GVHD of the gut/skin/liver, a pneumothorax, decreased urine output, potential liver failure, and BK virus in his brain. The patient's MD indicated he has never seen a patient with BK virus in the brain. I know the medical team is similarly overwhelmed with how to manage the patient. Anyhow, he is on TPN, which was actually discontinued yesterday due to fluid overload. His triglycerides and lipase are elevated. The current debate is whether or not to remove lipids from his TPN. The TPN pharmacist said lipase is not needed to digest IV lipids, but if his TG are super elevated that may be a reason to discontinue lipid administration. The patient is intubated and sedated and has a number of other medical complications that are too complex to explain at this time. Anyhow, from a nutrition perspective, we are currently waiting for the TPN orders to be reinitiated and then we will restart his parenteral nutrition. His labs will be measured again before writing the order. Today his potassium was elevated, and he had diarrhea. Complex. Diffcult to treat, but much more difficult to observe. The most challenging aspect has been juggling what to focus on with abnormal labs, diarrhea, liver failure, fluid overload, etc. All nutrition efforts seem contraindicated....
Well, tomorrow is officially my last day. Still cannot believe this summer has passed so quickly. I have learned a ton and feel much more prepared to enter the field. Exciting.
Rachael
Well, tomorrow is officially my last day. Still cannot believe this summer has passed so quickly. I have learned a ton and feel much more prepared to enter the field. Exciting.
Rachael
Radiation/Oncology
Today is my second to last day at CMC. I have been covering an entire unit this week. Luckily it hasn't been super-busy! My unit is a general medical floor where most of the patients are geriatric. Many are hospice, comfort care or waiting to be placed in a nursing home. For the most part I am ordering supplements or just "following-up as needed" since many are NPO due to unresponsiveness.
Yesterday, I spent the morning with the Radiation/Oncology unit. I shadowed a few outpatients with cancer through the process. My first pt was a lady newly diagnosed with pancreatic cancer. She was first assessed for a process called 'gating' where they tape a small rectangular block onto the abdomen while she lays down on a CT scan table. The purpose of this block is to measure the wave of her breathing. Once they get a steady pattern of breathing measured, she was moved to another room with a similar set-up. This time they performed an actual CT scan. The gating process is used in patients where they think that the tumor experiences a lot of movement due to breathing. Gating allows the radiation to be applied in a more specific manner, targeting the tumor as it comes away from the body, to try and limit the amount of radiation that is applied close to the chest cavity. Once this was complete, the patient was free to go - but not before she was permanently tattooed with four black dots on her abdomen so that her radiation could be applied more precisely each time she comes in for treatment. I never realized how demanding a radiation regimen was. Pt's come in 5 days per week for about 2 months.
Yesterday, I spent the morning with the Radiation/Oncology unit. I shadowed a few outpatients with cancer through the process. My first pt was a lady newly diagnosed with pancreatic cancer. She was first assessed for a process called 'gating' where they tape a small rectangular block onto the abdomen while she lays down on a CT scan table. The purpose of this block is to measure the wave of her breathing. Once they get a steady pattern of breathing measured, she was moved to another room with a similar set-up. This time they performed an actual CT scan. The gating process is used in patients where they think that the tumor experiences a lot of movement due to breathing. Gating allows the radiation to be applied in a more specific manner, targeting the tumor as it comes away from the body, to try and limit the amount of radiation that is applied close to the chest cavity. Once this was complete, the patient was free to go - but not before she was permanently tattooed with four black dots on her abdomen so that her radiation could be applied more precisely each time she comes in for treatment. I never realized how demanding a radiation regimen was. Pt's come in 5 days per week for about 2 months.
Last day
Today is my last day and yesterday was the last day working with patients. This summer has been a great learning experience. I now know way more about TPN and diabetes than I ever expected. Overall I realize in a hospital always expect the unexpected. I hope everyone had a great summer. See everyone in a few weeks!
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