Week 15

This was my last week with the sports dietitian at UH. This rotation flew by! Part of it was because it was only 4 weeks instead of 5 weeks like my clinical rotations were. Time also went by fast because there were lots of things to do and I felt pretty busy most of my time here. I absolutely loved this rotation. I'm sad it was so short and I have to move on.

I created some more educational materials. Allison and I also experimented with shake recipes. I've been making the same ones pretty much every day: vanilla peanut butter, chocolate peanut butter, and a fruit one. This week we made some pretty yummy ones: butterfinger, cookies 'n cream, and snickers. It almost made me wish I was on a weight gain regimen haha. We ran to Sam's Club again. I always love the outings! I've also been helping Allison hand out pre-practice snacks to the football team, as well as travel snack bags/meals for away games. I really enjoy the personal interaction and talking to people so I love stuff like that! That's another reason why I liked doing the bod pod assessments. I got to talk to a bunch of strangers while they waited for their turn to take the test. (I'm also that weirdo that starts conversations in checkout line at the store).

I also sat in on a counseling appointment with Tara. One of the track coaches wanted Tara to meet with one of the sprinters about weight loss after doing her bod pod assessment. Tara even let me create the sample menu for the athlete. It was fun! Now if I could just get Tara to take me to her appointments with the Rockets...

Since it was my last week, I was mostly just finishing up projects and helping Allison with new things that came up. I really just can't get over how fun this rotation was! Even though I had some pretty long and early days, I loved it. Definitely encouraged my plans to be a sports dietitian in the future.

I also had the best ending to my last week! Confession, I don't love Halloween. It's pretty much my least favorite holiday. The Saturday after my last day at UH was Halloween. Instead of finding something to do that I wasn't all that excited about, Ashlee and I went to the UH vs Vanderbilt game. Ashlee also did a sports rotation at UH athletics during our internship. Allison hooked us up with tickets and sideline passes for the game! We had good seats and spent some time watching from the sidelines. Allison also showed us around the locker room and we helped her set up halftime snacks for the team! It was so much fun! Even though I couldn't go to a BYU game this year, it was at least fun to be able to see some college football live.

The view from our free seats!

Ashlee and I on the sidelines with Allison

Week 14

My time at UH is halfway done! Since I don't remember the specifics for each day, I'll just talk about my week as a whole instead!

I'll start with a fun thing I did this week. I joined the CPSDA! That stands for the Collegiate and Professional Sports Dietitians Association. I took advantage of their cheaper student rate while I was still an intern. I'm just trying to take advantage of everything that might help me become a sports dietitian.

I created more educational materials this week. I've also been helping Tara with a few projects in the cafe, like taking inventory and ordering. I figured I might as well put my food service background to good use. I ran to the store with Tara one morning too. I did more Bod Pod tests this week for the track team and to finish up baseball. It's so funny to see the difference between the different athletes. The baseball guys didn't care of anyone watched them take the test. They'd strip down to their spandex pants and just all hang out in the bod pod room and make fun of their friends while they were in the machine. The girls would make sure no one else was in the room, close the door, and didn't want anyone watching them. In order to reduce surface area for the test, they weren't allowed to wear jewelry during the test. I had to ask so many boys to take jewelry off. Felt weird to ask. I think every other girl had a belly button ring too. Those just seem like they'd be painful. Overall I think my favorite question was from a guy on the track team. He seemed super nervous for the test. After I explained how it would work, he asked, "is it going to fill up with water while I'm in there." I tried so hard not to laugh. No wonder he looked terrified!

We had another intern meeting with Claudia. We talked about resumes and caught up with everyone. It is definitely convenient to already be on campus for these meetings.

My big project for the week was a cooking demo for the track team. I planned the recipes, created handouts, and basically did it all by myself. It was a lot of fun! I went shopping with some donated HEB giftcards from the cafe. I went to an HEB close to UH. Tara told me I wasn't allowed to go to the HEB on Scott street because I'd get shot, so I went to a different one. When I first pulled up, I didn't want to get out of my car though because the entire parking lot was covered in crows! I felt like I was in "The Birds." It was super creepy. The store was pretty deserted since it was early in the morning. I did keep running into the same fireman who flirted with me on every other aisle while he shopped with his fire department.

I ended up doing two back to back cooking demos. The first was for a group of women's sprinters and the second was for men's/women's throwers from the track team. Let me complain for moment about this. The track coaches tried to cancel the second cooking demo the day of, which is super rude. Allison told him no, they would have to come. Then, the coach pops his head in during my first cooking demo and says, "we canceled that for the thrower right?" I told him no, I was still planning on it because they didn't give us enough notice. He said, "well I canceled it this morning." I told him I've been planning this for at least a week and did my shopping 3 days ago. He felt like an idiot and they came. It all worked out, but I swear men just think food appears or something.

We did the same recipes for both groups. My goal was just to choose easy and healthy recipes that a college student might actually make. First I made a salsa chicken in the crockpot. It was an easy recipe that even hid some veggies in it. We also made a black bean salad and a healthy dessert! The dessert was called banana peanut butter smudgies. You basically mash up a ripe banana with peanut butter and freeze it between two graham crackers. It's like a healthy ice cream sandwich! It went really well. They seemed to really like the recipes and I got a lot of really good feedback in the days following from the athletes and coaches. And now pictures because that's why people like these blog things right?

My grocery store haul 

The sprinters enjoying the recipes

The throwers

All ready for the cooking demo

The yummy food!

Everybody loved it!

Week 13

Confession: I'm writing these posts in retrospect. I've already forgotten so much, but I hope that I can remember all of the important things.

Monday:

I started the day with making shakes again. I think this will be pretty routine. I don't mind! I enjoy experimenting with the recipes. I also helped Allison prepare mealtime educational materials. Football always eats lunch and dinner together and Allison really wants lots of educational materials around in the dining area. I'm becoming very familiar with Microsoft publisher and the laminating machine.

Tuesday:

Another day, another morning of making shakes! Remember how the old dietitian resigned? Today her temporary replacement started! Tara used to be the sports dietitian at UH and they brought her back to fill in part time until they hire a full time replacement. She's really cool! She has two cute little kids and she also works part time for the Houston Rockets. More than anything, I feel like my internship has been good for networking. Allison mostly just handles football and volleyball, so Tara will run the cafe and handle all of the other sports. Football is definitely the most demanding, and the most fun I think. If football likes what you do as a dietitian, you're pretty much guaranteed to keep your job for a while. I learned how to use the Bod Pod machine today. In Tara's words, "a monkey could run that machine." No pressure, right? The Bod Pod is a machine that is used to measure body composition. It tells you your percent body fat, how many pounds of fat, etc. It calculates this based on your height, weight, and how much air you displace in the machine (picture below). Running the bod pod machine is kind of hilarious. It really is super easy to use, thank goodness. I guess I am at least as smart as a monkey after all. What a relief! All of the athletes that were being measured today were from the baseball team. I have to calibrate the machine, weigh the athlete, and then they sit in the machine for 2-3 measurements. All they have to do is sit as still as possible while the machine takes the measurement. There's even a panic button in there if you get claustrophobic. Luckily no one had to use it while I was there. The machine uses your body surface area in its calculations so the goal is basically to be as close to being naked you can be while actually having clothes on. They even had to wear one of those spandex Under Armour skull cap things. Of course they look ridiculous while they're sitting in there. It kind of looks like they're preparing to blast off into space. Lots of snapchats and pictures were taken by their friends. What do you expect from a bunch of college age boys? Working the bod pod made me feel old. I had to get all of their information including their birth dates for the records. I'll say it again, time is so weird.

The Bod Pod Machine

Wednesday: 

Allison and I started the day by making a run to Sam's Club. She needed to buy more snacks to prepare for the football game this coming weekend. I love food shopping, so I was happy to come along with her. We also bought some new breakfast items for the weight gain football guys. Below is a picture of most of our cart while loading it into the cart. I had fun maneuvering it around the store and I only ran into Allison once! I did more bod pod tests today to try to finish up baseball and made some more weight gain shakes!

Thursday:

Besides smoothies, I also helped a student athlete with one of her projects. She and her group were assigned some kind of marketing project and their idea was to create healthy lunchable type items to sell in vending machines. I spent some time putting together a list of ideas. I honestly don't remember what else I did this day, but I'm sure it involved creating some educational materials and laminating them :) 

Friday:

The end of another week! Crazy! It's been fun to be at UH while their football team is undefeated. They've had such a great season! Everyone around the athletic building just seems really happy and pumped. I wish BYU played UH in Houston again this year. I could definitely go to that game! Unfortunately I won't be able to go to a single game this season. Still depressed about it. I didn't stay as late I normally do today because I had to go help set up for the young single adult conference at church this weekend. I somehow got roped into planning the games for tonight. I'll be glad when it's over. Luckily they'll be playing the BYU vs Cincinnati game on a projector during the evening. That was the only reason I agreed to come/help. :)

Week 12

This week was the start of a new rotation. This rotation is the one I have been most excited for! I'll be working with the sports dietitian at the UH athletic department for the next month. Being a sports dietitian is my current dream job, so this rotation will be perfect for me. I'm excited to learn a lot and see what it's like.

Monday:

I came to UH at an interesting time. The current sports dietitian has recently resigned and her last day of work will be tomorrow. I'll be spending most of my time working with Allison. She's an intern with the athletic department. She's an RD, but she's trying to get more sports related hours in order to become a sports dietitian. I'm really grateful that she was willing to take a dietetic intern, otherwise I wouldn't have gotten to do a sports rotation. Since it's my first day, I spent some time orienting myself. They also just opened up a new cafe for the athletes. It literally just opened today. I think I came at the craziest time possible, which I think means I'll be really busy so that's good news! I spent some time today analyzing some data from surveys Allison had given the football team. It mostly included questions about their eating habits and preferences so that she can better provide meals and snacks for them. There is also a group of about 10-15 football players that need to gain weight (per the coaches/strength and conditioning). I worked today on compiling their preferences for special weight gain snacks so that Allison and I can put together special snack bags for them a couple times per week.

Tuesday:

Another thing that we're doing for the weight gain guys is making special weight gain shakes/smoothies. Each shake has about 1000-1200 calories. Some of the guys drink 2 per day. I spent some time in the weight room this morning making the shakes with their fancy blenders. I also started making some educational materials today. I'm making snack posters that show examples of different calorie level snacks. It's like making educational materials for children really. The less words and more pictures, the better. I'm also worked on the cost/nutrient analysis of the special weight gain snacks and shakes. There's also a supply closet with all of the snacks and Gatorade shakes that are for football. I took some time working on inventory in there so we could order more.

Wednesday:

I don't know if I mentioned that I'm going to be grading papers for an undergraduate professor at UH because I'm not busy enough...Really I'm doing it because I'll actually make a little money doing this. This morning I met with Carla quickly since I was already on campus. She's super nice! She'll be a fun professor to grade for. A big project I'm working on for Allison right now is making travel books for football with information and tips for eating on the road. Mostly it involves a lot of laminating since the content is already done. Ah the life of an intern. We also had our intern meeting with Claudia. I like getting together with the other interns. It's always fun to hear how everyone's rotations are going.

Thursday:

I had a day off. What? Today was game day and Allison was at the hotel with the team all day and didn't need any help. Since they haven't hired a new dietitian yet, I just had the day off. Can't complain about getting a little break.

Friday:

I spent most of today finishing up the travel books. Mostly I just like working and talking with Allison. She's really cool and knows a lot about sports nutrition, even though she's still learning herself. I can't believe I've already finished one week here! I'm only here for a month and I know it'll just fly by.

Fun Facts from my First Week:

• The parking situation at this rotation is sketch. No other way to describe it. UH is not in a very nice part of town and since I'm on campus, parking is a nightmare anyways. I don't have a parking pass which further complicates things. I park on the side streets by the McDonald's next to the athletic building. No worries it's just in the third ward of Houston. There's really interesting people that live there, roaming dogs, condemned/abandoned buildings, and piles of trash in the streets. Seriously considering purchasing some pepper spray. I try to avoid coming and going during the dark hours.
• The dress code for this rotation is the best. Just when I thought it couldn't get better than wearing scrubs at Ben Taub, I start this rotation and get to wear workout clothes every day. 
• Being at UH is weird. Let me tell you why. Their mascot is also the Cougar! It's so weird to hear people saying "Go Coogs" in the hall. And yes, that is how they spell "Coogs," with two o's. Who does that? BYU's got it right with the "Go Cougs." Also one of UH's colors is red. I had to go out and buy red shirts to wear for this rotation. True blue fans don't own red. It just feels wrong. 
• I love football snacks. I have access to free snacks in the cafe and Allison's office all the time. It's awesome. I'm currently obsessed with the dried tart cherries. They're like candy!

It's going to be a great month!

Week 11

How the heck is it already my last week at Texas Children's?! Time is so weird.

Monday:

Today I was in the NICU with Laura. We attended rounds as usual. Laura is hilarious and I'm glad I got to spend some time with her my last week. Today was also the best day ever. I took my fate into my own hands. My interest lies in sports nutrition. Dream job? Division I collegiate sports dietitian. Think about it....Awesome job, right? Unfortunately it's not an "entry-level" position per se. Anyways, back to my day and my fate-taking. Roberta Anding is a very well known sports dietitian in the world of sports dietetics. She worked for the Texans for 12 years, works for the Astros, Rice, and Texas Children's. She is awesome and knows a lot of people in the field. I wasn't able to have a full day with her due to scheduling conflicts. Instead, I set up a meeting with her during lunch to ask her some questions, talk, and mostly just meet her for networking purposes. I'm thinking long-term here people! She was the coolest. Seriously. I'm convinced she knows everything. She answered A LOT of my questions about how to get from my current state to my dream job. She gave me very specific suggestions and names of people to get in contact with. It was so fun to talk with her. I think (hope) I made a good impression? It definitely made me more excited about all of it and the possibilities. I wish it would have worked out to spend more time with her while I was at TCH, but I'll take what I can get.

Tuesday:

Today I was back in the NICU with Laura. Just the usual preterm baby stuff plus more practice calculating infant TPN. I've also been working this past week on finishing up my case study presentation. I spent a lot of time working on some calculations on my case study baby's feedings. I wanted to show the changes in his feeding regimen. It changed slightly pretty much every day.

Wednesday:

Today was (surprise) not in the NICU! I would've been in the NICU all week, but my schedule has changed a little bit because of scheduling conflicts, dietitians having babies, dietitians finding new jobs and leaving, etc. Today I was in the allergy/immunology clinic with Lin Lin. A huge perk of today was free breakfast and lunch. I seem to end up in the clinics that have catered food all the time. Not complaining! I've always thought allergies were interesting because my brother was born with a ton of them (thanks Nick!). I'm glad I got to spend a day with Lin Lin learning more about allergies. It was all really interesting. I also learned about allergy tests where they place a sample of the food being tested in a patch directly on your skin. I've always done the skin prick tests so I thought that was interesting. None of the tests are 100% accurate, so that's reassuring...

Thursday:

Today was another day in the NICU with Amy, but more importantly it was my case study presentation! Unfortunately I had to change venues because the room they usually use was already booked. The room I actually presented in wasn't as convenient, so not as many dietitians attended. It was a smaller, more intimate group to present to, which is fine with me. I think it went really well! I got really good feedback on my evaluations and the dietitians seemed interested, especially the ones that aren't regularly in the NICU.

Friday:

My last day! I spent my last day with Nidia in the NICU, which only makes sense since she is my main preceptor. We attended pediatric grand rounds, which is a lecture that they do once a month (don't quote me on that time frame). This one was by a physician from Stanford University's Center for Allergy and Asthma Research. She was actually a double doctor (MD and PhD). Pretty cool, right? It was really interesting, especially after being in the allergy/immunology clinic earlier in the week. We also attended NICU rounds and went over my evaluations. Long story short, everybody loved me :) Crazy that I'm already done with all of my clinical rotations! Some of the other interns haven't even started their clinical yet. I really enjoyed Texas Children's, and I'm especially glad that I was able to complete my clinicals at two completely different healthcare environments. Here's to the next rotation! Oh, and some pictures :)

My ID badge that I had to return for security reasons or something like that...

Me in front of the hospital! It was so nice outside on my last day!

Week 10

Week 4 at Texas Children's. The end is starting to feel a little more real. Two weeks is nothing! I'll be done here before I know it.

Monday:

Today I was with Shelley. She covers the pediatric respiratory care unit. I believe it's a step down from the ICU. Don't quote me on that. She also works with a lot of developmentally delayed kids. She is really friendly and bubbly. She is so good with the kids! I went over the competency since it was a new specialty. It's so interesting to learn all of the differences between the different types of patients. Depending on the patient's medical problem, history, and current medical picture, it changes how you estimate their needs and even which weight you use to calculate. I think the best take away from my clinical rotations is developing my clinical judgement. There are so many things to learn from textbooks and the classroom, but until you put things into practice, you really don't understand how all of that knowledge applies to patients. You're probably thinking, "Duh Megan. I could've told you that." It just makes sense, right? Shelley's also really good at helping me feel involved and answering my questions. Definitely enjoyed my day with her!

Tuesday:

Today was another day with Shelley! She's still fun to work with on day 2, so that was good :) We attended rounds for her patients. I think I like rounds at Ben Taub better. It's either because they were more interesting, or there were more young, attractive residents leading rounds. We'll never know for sure...We also did mid-upper arm circumference on one of Shelley's patients. We were pretty sure her recorded weights were unreliable, so we decided to take some measurements of our own to determine how malnourished she was. It was really sad how tiny she was!

Wednesday:

I was back in the NICU today, but I was with Lindsay. There are seriously so many different dietitians in this hospital. I'm positive I won't meet all of them before I leave. We attended rounds. I always add to my list of "words I've never heard of" while attending rounds. The physicians are always throwing around procedures or disease names that are unfamiliar to me. I also got some more practice calculating baby tub feeds/TPN today. It's insane how tiny the numbers are for those premies. I also learned that my case study baby had a seizure over night. He just can't catch a break!

Thursday:

Today I was with Luci in the outpatient special needs clinic. Outpatient always seems a little slower paced to me, which can be nice sometimes but is usually more boring to me. Luci was fun to work with and answered a lot of questions I had. I've enjoyed working with (most of) the outpatient dietitians, but I don't know if outpatient would be as enjoyable for me. I suppose I'd enjoy it more if I had a relationship with the patients. Plus, I haven't been as involved in the assessments for outpatients, so I guess it makes sense that I haven't liked it as much.

I also ended my day by going to another high school football game. I know, you're thinking I'm a weirdo, but these games are community events! Plus, it was homecoming so I went with all of the Weaver's. There are so many traditions around the homecoming game. It was fun to watch them from the stands instead of on the field with the marching band.

Friday:

I switched things up again today, surprise...surprise...Today I was with Suzie who handles the lung transplant patients. Again, another really fun dietitian to work with. I feel like a broken record, but I like most people I guess. Ask anyone and they'll tell you I love talking to strangers and meeting new people. Some people might call that weird, but I call it fun. I've also really enjoyed being able to see how nutrition interventions change between all of these patient populations. It keeps me on my toes and always learning.

Another week done! After I was done at the hospital, I met up with Ashlee, also an intern. We met up at the Memorial City Mall, which was awesome! It was fun to walk around the mall and relax after another week. It's a pretty nice mall! They have an ice skating rink and some cool stores. We had to walk through the American Girl Doll store of course. It made me wish I was a kid again! We headed from the mall to a Malaysian restaurant in China town where a bunch of friends from church were meeting for the monthly restaurant rush. They choose a different restaurant every month. It's a pretty fun idea! I even ate a tiny octopus. I wouldn't recommend it.

Week 9

Can't believe it's already my third week at Texas Children's! By the end of this week, I'll be more than halfway done with my rotation here, and then I'll be done with all of my clinical. Time really is flying.

Monday:

Today I was with Libby in the Cystic Fibrosis clinic. She is super nice! I really liked working with her. Cystic fibrosis is a genetic disorder that causes the production of really thick mucus. This mucus affects a lot of important organs and glands (lungs, intestines, pancreas, etc.) This disorder especially affects the lungs. These kids get this thick mucus in their lungs, which increases their susceptibility to infection. Nutritionally, a lot of these kids are underweight. The mucus coats their intestines or affects the enzymes that help digest their food. As a dietitian, your job is to pack as many calories as you can and help keep these kiddos healthy! It was sad to see the families with multiple children affected by this disorder in the clinic. One of the patients we saw was the recipient of a Make a Wish trip to Disneyland! Her prognosis wasn't good, but it was so cute to hear how much fun she had on that trip.

Tuesday:

Today was a NICU day with Nidia. I was able to update my flowsheets on my case study baby. I chose the baby that was more of a "classic preterm" infant. The other baby started developing some other medical issues that would've taken away from my prematurity research. I attended rounds with Nidia. Rounds are interesting in the NICU. Some days we just round with one attending physician. Other days we round with the attending, residents, and nurse practitioners. The NICU is also huge and there are multiple different teams rounding all at once. It's all kind of a blur! Today we went to intestinal rounds. All of the dietitians rounded with the team that sees all babies with intestinal disorders/problems. Today I was able to spend some time researching for my case study presentation. Nidia has lots of great resources from her nutrition fellowship with Baylor.

Wednesday:

Today I switched gears completely and spent a day with one of the eating disorder dietitians. Texas Children's has outpatient dietitians that meet with eating disorder patients, but today I was with one of the inpatient dietitians. All of her eating disorder patients are admitted to the hospital. Pam is really good at her job and is really an impressive dietitian. This was her last week of working at Texas Children's before she left for another position, so I'm really glad I could spend a day with her before she left. We helped some of her patients fill out their menus for the next few meals. We also helped some of the patients plan meal ideas for when they discharged from the hospital. We attended an interdisciplinary meeting with the physicians, psychologists, etc. that work with the eating disorder patients. That is a whole different world. I think it's really interesting, but I don't think I could work with eating disorders long term. It'd be really hard! I don't think I have the right personality for it.

Today was our weekly (more like every other week) intern meeting. Instead of having a meeting, we all went to a really good pizza place with Claudia (our program director). It's fun to see everybody outside of meetings and internship business. The pizza was really good too. You can't beat when your program director pays either :)

Thursday:

Today was another day in the NICU! I spent the day with Amy. It's been really fun to work with so many different dietitians. I love meeting people and talking to strangers (weirdo, I know) so I've really enjoyed getting switched around! My case study baby is on one of Amy's team. Interesting development with my case study baby. He started developing meningitis! So sad! His list of complications keeps getting longer and longer. The other baby that I almost chose ended up being totally fine and is just a "normal" preterm infant. Funny how it turned out opposite of what I thought. Should've expected that, right? It just gives me more to research and learn I suppose. Today was also journal club. I think the dietitians do journal club about once a month? I may have made that up. From what I understand, journal club is when one or two of the dietitians give a presentation on a certain topic. It's informative and helps the dietitians earn continuing education credit. Today's journal club was on all of the different types of milks there are! Cow's, almond, soy, hemp, coconut, etc. There are so many different milks! It was interesting to have them all compared and learn more about them.

Friday:

Today I was with Monica. She works with the cardiac patients. A different specialty means another competency. I'm getting quite the collection of good information. Nothing too crazy this day. I really liked working with Monica! Can't beat a good Friday to end the week! Officially more than halfway done with my rotation!

Week 8

To be honest, I was a bit disappointed with my first week at Texas Children's. I think I had built it up in my mind too much and it ended up being a really different week than I expected. I also was surprised by how much I liked being at Ben Taub, and I was a lot more sad to leave than I expected. Luckily my second week at TCH was much better than my first and I'm starting to really enjoy it.

Monday:

I got the day off for Labor Day! So much for the "interns don't get holidays or breaks"...I actually wish that I could've come in to get more hours, but since I don't really know what I'm doing at this hospital it didn't make sense to come in with the "skeleton crew." Not the best learning opportunity when the staff is so few in numbers. So, instead I slept in and enjoyed my day off!

Tuesday:

Today I was back with the ketogenic diet dietitian. I was supposed to be with a different dietitian who also covers these patients, but she was sick today. She taught me some more about the ketogenic diet as well as the low glycemic index diet and their uses with her patients. We saw the patients she had scheduled for the day and I finished up a chart note from the MDA clinic on Friday. Apparently outpatient dietitians have up to 5 days to finish charting on their assessments. I don't know how you're supposed to remember stuff from 5 days before, but it's nice to have some extra time if your work load is really heavy.

Wednesday:

I switched things up today! I was with Kari who is the dietitian that works with all of the bariatric patients. She sees patients pre and post bariatric/weight loss surgeries. It takes a lot for pediatric patients to qualify for bariatric surgery. We're talking severly morbidly obese kids who often also have significant cobmorbidities of being overweight. It's so sad so see such young kids already in danger of high cholesterol and blood pressure. A lot of insurance companies require these kids to go through about 6 months of a supervised weight loss program in order to qualify for the surgery. Kari helps with the nutrition counseling portion of this. She also helps kids post surgery adjust to their new lifestyle. Obviously if you had your stomach surgically shrunken, your portions are going to have to significantly decrease. Kari makes sure these kids are receiving all of the vitamins/minerals/etc. that their bodies need after having their GI tract altered by surgery.

I also attended a presentation in the NICU. The physician's presentation was titled, "Neonatology Physiology Lecture Series-Cardiac Surgery." I like attending these conferences. There's always a ton of information! The NICU is so foreign to me. It's nice to be able to gain more medical background on these patients. Plus, you can't beat a free lunch! It's the little things when you're an unpaid intern.

We also had our weekly intern meeting on campus at UH. We finished up the last few pathophysiology presentations. I've enjoyed these, especially since I've been doing my clinical rotations. I have definitely seen quite a few of the diseases in my patients.

Thursday:

Today I was with Brittany, the dietitian that covers the bone marrow transplant patients. She was really nice and so fun to work with. Brittany and I reviewed the competency and were able to see some of her patients. Her floor is really neat. It has special air filtration and is more strict on its visitor policies. Most of the kids aren't allowed to leave the floor after they receive their transplant. Their immune systems are so suppressed that any kind of infection could be really harmful. A lot of the kids on her floor have ALL (acute lymphoblastic leukemia). I learned a lot about pediatric cancers while with Brittany. It was kind of sad, but the kids are so cute! I also received more information on 2 different babies in the NICU. I'm deciding which one to follow for my case study. Both are very premature and have their fair share of medical complications.

Friday:

Today was another day with Brittany. In addition to seeing her patients, I also attended a lunch conference in the NICU on Midgut Volvulus. Basically this means that the infant's intestines have become rotated because of a malrotation during formation. It was really interesting. I'm always learning about things I've never even heard of before in the NICU. Brittany and I also practiced calculating TPN for her kiddos. You can ever have enough practice with TPN, that's for sure.

After my rotation, I went a football game at my high school alma mater with some good family friends that I've known since kindergarten. It was so fun (and weird) to be back at my high school. It was a fun way to mix up the week! Can't beat those Friday Night Lights!

Week 7

I'm finally starting my second rotation! This is the second part of my clinical rotations, and I will be completing it at Texas Children's Hospital, which is also part of the Texas Medical Center. Unfortunately I couldn't trick security into giving me a discounted on site parking pass. Instead I will park at a $1 lot by the Rice football stadium and walk a mile to the hospital everyday. Here's to hoping it doesn't rain too much...

Monday:

First day at a new place is always exciting! Texas Children's is a really nice hospital. There are fun colors everywhere and lots of fun displays (trains, artwork, etc.). Definitely a change from Ben Taub. It helps distract from the depressing part of working in a children's hospital for sure. I spent my first day with Nidia who will be my main preceptor while I'm here for the next 5 weeks. My schedule is full of a wide variety of specialties, but Nidia will be my main contact and the dietitian I will spend the most time with. She is one of the dietitians in the NICU (neonatal intensive care unit). Nidia's background is really impressive. She did a special nutrition residency in the NICU through the Baylor College of Medicine. She knows a lot about NICU nutrition. She gave me a tour of the NICU. It's divided up into different levels and pods based on the severity of the baby's condition. She even let me chart on my first day, and we reviewed the NICU competency and infant formula calculations. Overall, a good first day!

Tuesday:

My second day was with the outpatient GI dietitians. I spent my morning by myself reading through the competency for gastrointestinal patients. Each specialty at TCH (Texas Children's Hospital) has its own "competency." This is a packet of information compiled by the dietitian with a case study/quiz at the end. It's great for learning, but boring when all you do is work on these for 3-4 hours...Later in the morning we attended the Houston Pediatric Nutrition Group meeting. The physician's presentation was titled "Nutritional and Microbial Therapeutic Interventions for Inflammatory Bowel Disease." It was a very interesting presentation. Inflammatory bowel disease include things like Crohn's disease and ulcerative colitis. The doctor covered the manifestations and origins of disease as well as nutritional therapies. We also got free lunch, so I can't complain about that! We saw a couple patients in the afternoon, all of which were related to childhood obesity. We went over a lot of healthy food options and eating strategies for portion control. These type of pediatric assessments definitely require a lot of family involvement.

Wednesday:

I was with the same GI dietitian again today. I spent my morning alone with my competencies and readings again. Super exciting...Today was the obesity clinic day. When patients come into the clinic, they're seen by the nurse, doctor, dietitian, etc. Everyone just takes turns going in the patient's room. I also saw a patient with one of the other GI dietitians. It's been good for me to see different dietitians' counseling styles. It's nice to pick and choose the things I like as I develop my own style for assessments.

Thursday:

Changed things up today and worked with the ketogenic diet dietitian. The ketogenic diet is intended to help control seizures in patients with epilepsy. The diet is high in fat, provides appropriate protein, and is very low in carbohydrates. It intentionally places patients in a state of ketosis. It was really interesting to learn about. The patients on this diet are very closely monitored. They come in for frequent doctor appointments and blood/urine tests. Want more information? Look up The Charlie Foundation.

Today Nidia also gave me information on two babies in the NICU. I will choose one of them to complete a case study presentation on. One has more complications than the other, and I'm aiming for more of a "classic preterm infant." I'll decide soon-ish :)

Friday:

Friday I was with the ketogenic diet again, but today we were covering the muscular dystrophy clinic. Muscular dystrophy basically causes progressive muscle loss and weakness. From a nutritional standpoint, this is concerning when it comes to digestion, swallowing, etc. We want to make sure the kids with feeding difficulties are receiving adequate nutrition.

My first week was okay. A little slower pace than I'm used to after being so independent at Ben Taub. I'm gathering a lot of good information from the competencies and readings, but I'm hoping my interactions with patients will increase. I guess the disadvantage to seeing such a wide variety of specialties is that I won't be able to go into as much depth. TCH will be a good learning experience and has a lot more resources than Ben Taub. I'm glad that I have the opportunity to complete my clinical rotations at two different hospitals. I think my internship should be all about gaining exposure and learning as much as I can, and I think my schedule will provide that!

Week 6

I've been slacking on this blog. Hopefully I can remember everything that has happened! This was my last week at Ben Taub.

Monday:

I spent today with Alix in the Surgical Trauma ICU. We went over a lot of the nutrition protocols and research that guide her practice. One of the main things that some of the research shows is that if enteral feedings are initiated within the first 24-28 hours in the ICU setting, the outcomes are much better. The patients in this ICU are pretty interesting, and by interesting I mean crazy! One of the patients was described as "pedestrian vs. train." Another patient jumped off of a balcony and fell 40 feet. There never seems to be a lack of gunshot wound patients at Ben Taub either. Reading patient histories was definitely interesting. Alix and I headed to the ICU for rounds with the medical team. Right when we were supposed to start, one of the patients decided to code. He originally came to the hospital to have his appendix removed and ended up going into septic shock. It was an exciting start to the day. While the medical team was working on the coding patient, Alix and I practiced some TPN calculations and went over nutritional implications of common medications used in the ICU. I assessed/wrote a note on a patient that was in a really bad car accident. He hit a pole and it took prolonged extrication at the scene to remove him from his car. I learned a ton today from Alix. She recently took her exam to earn her CNSC credential, which means she is a certified nutrition support clinician through ASPEN (American Society for Parenteral and Enteral Nutrition). She is really up to date on research. Gross fact from today. Alix and I were in the ICU to give the medical team our recommendations. While I was standing about 5-10 feet away from one of the patient's beds, the patient coughed and I simultaneously felt something land in my hair.....eww....The patient's trach was uncovered. He managed to cough up something through his trach and have it land perfectly on my head. I was definitely excited to go home and shower.

Tuesday:

I was with Alix again today in the ICU. We spent some time going over more ICU information and nutrition support. So many notes to take...This morning started with another patient coding. Two days in a row! This patient coded about 5 times overnight and ended up passing away. We also went over cultural/religious implications in end of life care. There are so many things to consider. Alix helped me practice TPN calculations a lot more today too. Today I assessed the patient that coded the morning before, as well as some other patients on the floors. I really liked the ICU with Alix. I feel like I learned a lot from rounds and just from working with Alix.

Wednesday:

I spent today with Esther. She's the dietitian in the NICU at Ben Taub. We spent the morning going over the guidelines used for nutrition with the NICU babies. They were written by Texas Children's Hospital for the Baylor medical staff. The NICU is a whole different world for nutrition support. We went to rounds with the medical team and saw all the cute, tiny babies. Since it was Wednesday, I had to go over to UH for our weekly intern meeting. It's always fun to catch up with the other interns.

Thursday:

Today I had to go to Texas Children's for orientation. Luckily I didn't have to go to their new employee orientation like I did at Ben Taub. Apparently I'm the only intern that Texas Children's is going to have until the spring. I just spent a few hours with a couple of the dietitians to go over my schedule and some of the differences clinically when you work with pediatrics. It was nice to meet some of the dietitians I'll be working with and see some of the hospital. I feel really lucky to be able to do both of my clinical rotations at the Medical Center. Fun fact, the Texas Medical Center in Houston is the world's largest medical center. Pretty cool right?

Friday:

My last day at Ben Taub :( I spent my last day with Kendall in the Neuro ICU. I love going to rounds with Kendall. She works with a good team of residents in her ICU. Her patients are always interesting, and I've really enjoyed the ICU environment. I was able to do assessments on quite a few patients today. It was good to be busy for my last day. I won't go into a lot of details. It was a pretty typical day in the Neuro ICU with Kendall. I was really sad to leave Ben Taub. I loved working there a lot more than I thought I would. The dietitians I was able to work with and get to know were awesome! They were so fun to work with and I learned so much from them. It was an interesting hospital for sure, but I'm really grateful that I ended up having this rotation in my schedule. Can't believe how fast my first rotation went! I finally took pictures too!

Kendall, me, and Alix. Not pictured: Carmen who had to cover at Quentin Mease on my last afternoon.

They didn't even let me keep my ID badge as a souvenir.

Week 5

I don't feel like my weeks are all that different from each other, but this week I did get to do some new things! 

Monday:

I spent today with Carmen. I like spending Mondays with Carmen because that means I get to go to the morning multidisciplinary meeting. I just like being able to get the whole picture. Also sometimes someone says something funny :) Can't beat a laugh to keep you going Monday morning. I pretty much work as "staff relief" at Ben Taub. We split up the patients, I work them up on my own, and then the dietitians check my notes at the end of the day before I sign them off. It's given me some really good experience practicing my own clinical judgement. I think that's the hardest thing to develop because you have to have experience to form good clinical judgement. Since I was with Carmen, it was the usual type of patient (metastatic cancer, osteomyelitis, tube feed follow ups). The most exciting patient was an aggravated assault with a car. Let me just say that I've seen some pretty messed up things at Ben Taub. It makes me never want to drive a car, walk down the street, or pretty much leave my house, but then I think about how boring my life would be and I get over it. 

Tuesday:

Tuesday was an early day in the Neuro ICU with Kendall. I think ICU nutrition is fascinating. It's just so different from what I do with Carmen's oncology patients. Part of the reason it's so interesting to me is that I hardly know anything about the ICU. I've learned about so many different medicals tests and standards of practice. It keeps things interesting. Probably the saddest patient situation was a guy with an accidental gun shot wound to his head. Not the type of accident I ever want to have. 

I got to go to wound rounds with Courtney. That was definitely a different experience. She goes to rounds once a week with the wound care nurses to see patients in one of the units with really bad wounds. It's mostly pressure ulcers (more commonly called "bed sores") and diabetic ulcers. I got to see some pretty gross stuff. I also got to see a little more of the patients than I bargained for. There are just some things I don't think you can un-see. The nurses examine the wounds and measure how big and deep they are. The grossest wound was this really deep diabetic foot ulcer. The patient was refusing amputation. I've never seen such deep layers of tissue so exposed. When they removed the dressing to see the wound, the worst smell instantly filled the room. It was an instant gag reflex. Courtney told me that the patient used to have maggots. I probably would have thrown up if he had maggots when we saw him. I hope he goes for the amputation. 

I also got some good practice calculating tube feeds with Kendall. The Neuro ICU is really good about following Kendall's recommendations and starting feeds early. I also got to watch the way Kendall does diabetes education with a patient in the emergency room. I'm glad I've been able to watch a few different dietitians do these educations. It helps to see the different styles they have. That way I can pick and choose which things I like from the all the different dietitians I work with.

Another fun thing we did today was a taste testing with the Neuro ICU residents. We went to their office to go over our new recs for the day and got talking about different oral supplements and tube feeds. They had never tried any of them and were really curious what they tasted like. We brought back a couple Boost products and a supplement we use for renal patients. One of the residents really wanted to try a tube feed formula that we carry. We talked him out of it since tube feeds are gross. Why would you want to taste something that doesn't have a flavor? The patient doesn't even taste their tube feeds since it bypasses their mouth. It was fun to be able to educate them on supplements in such a relaxed environment. It helps them be more sympathetic to the patients who don't like their supplements or won't drink them. One of the residents said he has Boost as his post workout drink...Too far.

Wednesday: 

Two early days in a row with Kendall in the ICU! Today was even earlier because rounds started at 5:30. It's days like this that I wish I lived downtown. I got some more practice giving education to a patient with a new colostomy. I had a few gun shot wound patients and even an inmate as patients today. Always interesting at Ben Taub. Kendall also helped me practice calculating TPN (total parenteral nutrition). I was glad we had some time at the end of the day just to work through some practice scenarios.

Wednesday is our day to meet as interns at UH. I somehow always manage to have early mornings the days I have to stay longer to meet on campus. We went through a few more presentations from our pathophysiology powerpoints that we created our first week during orientation. Starla presented on a procedure called a total gastrectomy. Basically they remove your stomach and reconnect your esophagus to your intestines. This type of procedure is pretty common in patients with stomach cancer to remove tumors or other malignancies in the stomach. I presented my slide show on maple syrup urine disease, and no I did not make that up. This disease is when a person is born with a defect in a specific enzyme that breaks down branched chain amino acids, which leads to accumulation of these type of amino acids. It causes a lot of neurological side effects and developmental delays if it's not detected and treated early. It gets its name from the sweet smelling urine of babies who have this disease. Ashley also presented on superior mesenteric artery syndrome. Don't worry, I had never heard of it either. Different things can cause this syndrome, but it results from compression of the third part of the duodenum. It causes all sorts of fun abdominal and gastrointestinal symptoms. I like meeting with all the interns on Wednesdays! It's always fun to catch up with everyone and swap fun stories from our different rotations. 

Thursday:

First off, I drove to work in a HUGE thunder storm this morning. It was the biggest storm I've seen since I moved back to Houston, and it was awesome! I absolutely love thunder storms. The rain was so heavy and had huge drops. Lightening was striking all along the highway in huge bolts that went straight down from sky to ground. It slowed traffic down to about 10 miles per hour though. Plus the roads downtown are awful in the rain. They flood so fast. But, it was such a good storm that I wasn't even mad that it made me a half hour late. 

This was my last day of the internship with Carmen! I'll still be working in the office she sits in, but I won't be working on her patients at all after today. We were at Quentin Mease today. Ashley, who I worked with there last week, left on vacation, and the dietitians from Ben Taub get to help cover her shifts. We just split up the patients and tried to catch up and also get ahead for the week. I mostly had patients on the geriatric floor. It's very different from Ben Taub since it's a rehab hospital. Nothing too critical. I think I prefer the hospital setting to a rehab hospital. I've never been super excited about long-term care type facilities, so it makes sense that I wouldn't enjoy Quentin Mease as much. I do always enjoy reading patient histories. When I read about patients who can't read and have a history of addiction to cocaine since childhood, I'm definitely grateful for the way I grew up. I did get two patients mixed up for a quick minute and scared a lady into thinking she had diabetes while I was doing my assessments. Oops! I guess you live and learn :) I also got lost taking the stairs. The elevators were being inspected and were out of use for a little while, forcing me to take the stairs. Unfortunately the stairs at this hospital don't correspond with elevator locations. Luckily I found a nice security guy to help me find my way back to the office. It kept things interesting for a little while. I also got some good practice doing diabetes educations. It was a pretty low key day.

Friday:

Fridays are always great, even if you have to be at 5:30 rounds. The Neuro ICU is so cool. The residents are always doing cool surgeries and the patients have medical conditions I've never even heard of before. I got to practice calculating TPN some more. I had a really good interaction with a nurse on the floor as we tried to figure out what the doctors wanted to do with a certain patient's feeds. She was really nice and super helpful. I also got to do an education on congestive heart failure with Kendall. It was a pretty good day, and you can't beat getting done at 2:00 on a Friday!  I can't believe I only have one week left at Ben Taub.

Week 4

I'm already more than halfway done with my first rotation! Crazy is an understatement for sure. I got to do/see some different things this week, and it was nice to add the variety to my daily routine at Ben Taub.

Monday:

Mondays are the worst, agreed? So hard to wake up this particular Monday. Not sure why, but it is what it is. I spent another day with Carmen working up her patients. At 9:30 we had to go to our weekly multi-disciplinary meeting. I think I described this before, but just in case I didn't... The residents from the different medical teams go through their lists of patients with the social workers, nurse managers, physical therapy, occupational therapy, and last but not least the Dietitian. It's a good way to hear what's going on with the patient from every perspective. It's also nice to find out which patients have plans to discharge so that we don't spend lots of time assessing them :) I also got some good practice calculating tube feeds. Alix, one of the ICU dietitians, showed us a CT scan for one of her patients. He a cocaine addict and ended up pretty much brain dead in half his brain. The CT scan was crazy! There was literally nothing going on in the scan once you reached a certain point. 

I really like working with Carmen, because she lets me work really independently and practice making my own recommendations. She pretty much just signs off on everything. I'm better at making recommendations for some patients more than others, but Carmen gives really good feed back on why she does things certain ways. My biggest problem is having enough confidence in my recommendations. I'm still too worried about being wrong. Working on it....

Tuesday:

Remember how I was so excited that all of my computer logins were up and running? Imagine how disappointed I was when it stopped working :( For some reason, the charting software had me in the system as a registered nurse again. If I'm going to be assigned the title of Megan Thacker, RN, I think I should at least get a nurse's salary. Is that too much to ask? I guess I'll just stick with my intern "salary." Who wouldn't prefer to be paid in experience? Good news is they fixed it by the end of the day.

I spent the day with Carmen again. One of the things I haven't gotten a lot of experience with yet is providing patient education. I've done a few, but Carmen hasn't be consulted for hardly any educations since I've been there. Today I watched Carmen do a diabetes education. It was nice to see how she balanced providing the patient with the information that he needed, but not teaching above his understanding level. Probably best not to overwhelm someone. 

Ben Taub sees a lot of HIV/AIDS patients. I've had so many patients that end up in the hospital because they're wasting away from AIDS. Can't say I saw a lot of that at the hospital I worked at in Salt Lake...

Wednesday:

You know it's going to be a good day when you wake up a little before 4:00 am. Mornings with 5:30 rounds make me wish I had a shorter commute. This morning was especially fun because I couldn't find my keys or ID badge anywhere! (of course they were both in a pocket in my backpack I thought I had checked a thousand times). I've become really good at "losing" things just long enough to make me stress about it. 

I enjoyed getting to work with Kendall a little more today. (she's the Neuro ICU dietitian). I mostly just enjoy being able to assess different types of patients. I also got to do two educations today: a renal diet and a cardiac diet. I don't love working with renal patients, so that education wasn't as fun for me, but it was good experience. 

To end my day, I watched a speech pathologist conduct barium swallow studies. The person eats/drinks different textures that have barium in them. We then watched them swallow the different textures through an X-ray machine. It was so cool! I wanted to watch this test because as a dietitian, we refer patients to speech therapy for any problems with chewing or swallowing. Sometimes they have to get this type of test done to determine if they're safe to swallow certain types of liquids and solid food. Sometimes the X-ray will show a person aspirating, meaning that instead of traveling down their esophagus as normal, whatever they ate or drank travels down their trachea into their lungs. The barium swallow can also show other swallowing problems. Some of the things I saw while watching the tests were liquid collecting around the epiglottis, improper movement of the very back of the tongue when swallowing, and needing to swallow multiple times just to swallow one drink of water. The speech therapist that was doing the tests was really nice. She was super helpful and answered all my questions. There was also a med student there watching so she was fun to to talk to as well. I'm glad I was able to watch these tests. Never underestimate the power of asking for things. All I did was email the manager over the dietitians and she set it all up for me! Now, what else do I want to see/do at Ben Taub.... :)

On Wednesdays, we have a standing appointment at UH to meet as interns with our program director. This was the first week we could meet because of a few conflicts on our program director's part. It was fun to hear about everyone's different rotations! We also started our patho presentations that we prepared our first week during orientation. Mag presented his on C. Diff. Wednesday was a pretty busy day!

Thursday:

Today was another early day with Kendall in the Neuro ICU, but rounds started at 6:00 instead of 5:30. Yay for "sleeping in." Kendall ended up leaving early because she wasn't feeling well. Turns out she had strep throat! Luckily I am still healthy myself. Thank you disinfecting wipes and some good old fashion hand washing. I spent the rest of my day with Carmen finishing up her patients. Since I did a longer day Wednesday, I cut out a half hour or so early today. It was nice to beat traffic and have a shorter afternoon. 

Friday:

Friday was a completely different day! I was at Quentin Mease, a community rehab hospital that is also part of the Harris Health System. They also have a geriatric floor. The best part? I didn't have to come in until 8:30 :) This hospital only has one dietitian, Ashley. Her patients typically stay for 3-4 weeks. A lot of them come from Ben Taub or Lyndon B. Johnson Hospital. Ashley assesses all of the patients at the hospital. She also does more education. I was able to observe a class that she teaches as part of a weight loss/exercise program for the patients. The class was on portion sizes. It was a pretty fun environment. Ashley knows the patients at the hospital really well since they stay for so long. It makes work a little more fun when you have a good relationship with the patients. I also got to see a patient that had transferred to this rehab hospital after a stay at Ben Taub. I knew he looked familiar, but I didn't realize I had assessed him until I reviewed his chart. I have such a good memory.... He's a sad patient. He's younger than I am and has really bad AIDS. He's super non compliant with his medication so he's ended up with toxoplasmosis in his central nervous system. A lot of the patients that come to the community hospitals don't have access to the care they need when they leave the hospital because of funding, lack of transportation, lack of family support, etc. Then they end up back in the hospital much worse. 

Ashley was really cool to work with. She's really good with her patients and they all love her! I enjoyed getting to see a different hospital with some longer term patients. 

Friday night I met up with some of the interns at a little Mexican Cantina for happy hour. Don't worry mom, I just had a diet coke and an enchilada ;) It was fun to get to know the other interns a little better over some good chips and salsa. It worked out perfectly because then I could hit a church activity afterwards before I headed back to Spring.

Fun Facts of the Week:

• They do leech therapy for patients at Ben Taub. Leech Therapy. I work in a hospital with leeches. GROSS! 
• Ben Taub has had about 3-4 people jump off their parking garage this year. I think they need better security or something.
• One new way doctors are treating C. Diff is with flora reconstitution, or as I like to call it a poop transplant. That's right, they are putting stool from a fecal donor into your intestines to try to introduce the good bacteria into your gut again. Eww.
• A nice old lady at Quentin Mease told me I have a baby face. She also told me I was cute, so I'll take it.

Week 3

I cannot believe I've already been at Ben Taub for two weeks. I'm starting to realize how fast this internship is going to fly! I'm definitely starting to get more comfortable with clinical dietetics, but I still have SO MUCH to learn. One thing I love about dietetics is how much I don't know. I'm not worried about getting bored because there's so much I can still learn. With that being said, get ready for the weekly run down!

Monday:

I spent today with Carmen again. Remember, she's the oncology dietitian and she's super cool. Basically everyday I come in and help her finish up screening and then she gives me some of her patients to work up for the day. I'm learning so much by being so independent. It's so rewarding to write up my own recommendations and actually have her sign off on them. I'm slowly building my confidence. One of my favorite assessments this day was a cute older Vietnamese man with some type of oral cancer. He and his wife were a really nice couple. Overall today was pretty typical. Nothing too new or crazy. 

Tuesday:

Tuesday was another Carmen day. Today we had some tube feeds to calculate, which was good because I need practice! I'm excited for the day when calculating nutrition support is second nature. I'm hoping that's a thing? Hopefully it can be that easy for me eventually! One of the patients had a nasogastric tube that was used only to suction things out of his stomach. I didn't know they did that, so that was interesting to learn about. Apparently in patients with bowel obstructions they sometimes need to do this in order suction things that are just stuck sitting in the stomach (fluids, secretions, etc. that can't move past the obstruction). Makes you grateful your stomach works doesn't it?

Wednesday:

Who was I with today? You guessed it, Carmen. Today was full of pretty typical patients. I did get to do my first diabetes education today. The best part? It was a patient in the Emergency Room. It's a whole different world down there! I'm not even sure how we got there. I definitely could not find my way back there by myself if someone asked me tomorrow. To get to our patient, we had to walk through the shock room where all the traumas come in. I should say traumas and dramas. There was a man in there who was not happy with the hospital policy of putting all of his belongings in a special bag to bring around with him. Carmen came down to watch me do the education. It went well, but it wasn't the best patient to do an education with. He didn't quite seem all there so I'm hoping he actually understood what was going on. It's amazing to me how some people have had diabetes for 30 years and never received proper education. Carmen had to leave a little early today for a dentist appointment, so I spent the last 2ish hours of my day with Alix, the surgical trauma dietitian. She's awesome and really smart! ICU nutrition is so different from everything else. They practice "permissive underfeeding," meaning they intentionally provide less than the amount of calories a person needs. It's really important to not overfeed in the ICU. Most research supports underfeeding rather than overfeeding. She showed me around her ICU a little bit. I also got to see her visit  a patient who had come in as a trauma and suffered an anoxic brain injury when he was extubated. (not the hospital's fault, just a freak accident. I was worried it was the hospital's fault too). It was really sad because he's pretty much just a vegetable now. Today I also got one step closer to being a self-sufficient "employee." My email account got set up! Too bad my log in still had me in the system as Megan Thacker, RN. Definitely not a registered nurse...baby steps. At the least the email was working. 

Thursday:

Thursday was a fun change of pace! To start, I had to be at the hospital a little before 6. Gross! Traffic wasn't bad at all on my commute though :) Thursday I was with Kendall. She covers the Neuro ICU. She gets all the head traumas, etc. Rounds started at 6:00 am. Besides struggling to keep my eyes open, rounds were pretty cool! Since Ben Taub is a teaching hospital, we round with residents, interns, and students, plus their attending physician. Fun fact neurosurgery is something like a 6-7 year residency. As if medical school wasn't long enough....The 5th year resident was the one reading all the medical history off of the computer as we went from patient to patient. The interns did the physical assessment, and everyone else just kind of pitched in when appropriate. There was a point when the last year resident challenged the 5th year's treatment knowledge and plan. Kendall the dietitian wrote this in my notebook after that encounter was over, "you just witnessed a HUGE power struggle. Awkward." It was awkward, mostly because the 5th year resident didn't have an answer to the other resident's question. It was early, I don't even remember what the issue of debate was, but apparently it was a big deal. I really enjoyed learning more about brain injuries, ICU nutrition, and medications I had never heard of. 

I also got to do an education for a patient with a new ileostomy. I'll save you the trouble of "googling" what an ileostomy is. Basically they surgically bring your ileum (last part of the small intestine) through an opening they create in your abdomen to create a stoma. This connects to a pouch that collects the waste/output from your intestines. Super fun right? I educated this patient on the effects of fiber on his ileostomy output, how to schedule his eating patterns, and the importance of fluid intake. It was an interesting education. It was fun to do a little more research and learn more about ostomies. I also got some good practice paging the different teams of doctors today. All the time I spent talking to strangers on the phone for my job with the outpatient weight loss program last year came in handy! Kendall said they had an intern one year that was so nervous about talking on the phone that they had to role play a ton before she would page the doctors. Thank you work experience for coming in handy yet again. The good thing about starting so early was I got to leave at 2! Woo hoo! I enjoyed missing heavy traffic both to and from the hospital today. 

Friday:

Friday I was back with Carmen. The highlight was getting some good practice calculating TPN. TPN stands for total parenteral nutrition. This means that all the calories, protein, fat, fluid are provided through a person's veins and don't use the GI Tract at all. The patient we were calculating this particular feed for had a small bowel obstruction so obviously we couldn't use their gut until that was resolved. The assessments have been really good practice. I'm slowly learning how to ask the right questions and interpret information from patients. 

Another week of wearing scrubs every day! I'll enjoy it while I can because I just found out today that I can't wear scrubs when I'm at Texas Children's starting in September. Obviously it's the little things with me :) 

Week 2

Starting Clinical

I was so excited to start with my first week of real rotations! My first rotation is clinical 1 at Ben Taub Hospital, which is part of Harris Health Systems. Harris Health Systems is a large network of hospitals, clinics, and other healthcare service locations throughout Harris County (my home county, woo!). Ben Taub is an elite Level 1 trauma center in the Texas Medical Center. Ben Taub is a teaching hospital, and is staffed by faculty and residents from the Baylor College of Medicine. They also have students and residents from the University of Texas Medical School at Houston. Ben Taub is also a community hospital. Most of the funding comes from Harris county tax dollars, followed by Medicare/Medicaid, and then private insurance, etc. Orientation told us that more than half of the Harris Health System employees are African American and more than half of its patients are Hispanic. A little different than my hospital experience in Utah...

Those are the official facts of Ben Taub, but here are the Ben Taub facts according to Megan so far. Ben Taub is a pretty old hospital, although I'm probably biased after working at the Intermountain Medical Center which was only about 7 years old. Spoiled, I know. A lot of the patients don't speak English. A lot of the patients are homeless, uninsured, and/or come from really interesting and unfortunate social backgrounds. Since Ben Taub is such a good trauma center, it receives most of the severe trauma patients in the city. In the words of my mom, "gun shots and knife stabbings." Throw in really terrible car accidents and that pretty much covers most of the ICU patients. All that being said, I am really grateful to be at Ben Taub for half of my clinical rotations. I already have, and will continue to get really good experience working with the dietitians and patients here. I'll get to see a wide variety of patients and learn a lot! 

Ben Taub Hospital in its retouched internet glory

The weekly run down.....

Monday:

I won't bore you with the details from this day, because frankly, I'd put myself to sleep. After a week of orientation at UH, I was excited to have my first day at Ben Taub. That excitement was short lived because today was a full day of new employee orientation. Imagine you're at new employee orientation for a company you don't get paid to work for. Sounds awesome, right? The employee leading orientation did remind me of a bald, slightly less thrilling version of Steve Harvey hosting Family Feud though. It might have been because he had a mustache and said that all the employees are a family. Could've helped a little bit, right? I did get to leave a little early since I'm not an employee receiving benefits, so it was nice to avoid sitting through some of the useless information. 

Tuesday:

Today was....more orientation! At least they provided some free breakfast snacks. Today was only a half day of orientation, so it wasn't quite as painful as Monday. I did get to spend the afternoon with Carmen the dietitian. I'll spend most of my time here with her. She is awesome! She's really good at her job. She handles the oncology units and a medsurge floor (basically stabilized patients that used to be traumas). Most of the dietitians at Ben Taub are really young and it's one of their first jobs out of their internships. It's really encouraging to see how capable and confident they are so early in their careers. There's hope for me :) Tuesday afternoon was a good chance to meet the other dietitians and watch Carmen do some assessments.

Wednesday:

Just when I thought orientation stuff was over, I spent Wednesday morning in computer training. It wasn't terrible. We ended up getting done two hours early, so can't complain about that! That meant I could run to the scrub store by the Med Center.

Side note: I finally get to fulfill my dream of having a legitimate reason to wear scrubs every day without being a nurse or a surgeon! I'll be honest, the scrubs are one of the best things about this clinical rotation. Who knew you could be so comfortable at work. I feel like I'm wearing pajamas all day long. Which is great because scrubs are much more socially acceptable than pajamas. They're super soft too! Okay, I'll stop freaking out about my scrubs....But really, I'm wearing them right now after "work" and it feels great.

Other side note: I will refer to most of my days as an intern at work, simply because it is easier and flows better. Remember, I don't get paid for any of my labor as an intern. Rip off? Probably. Required to be a dietitian? Absolutely.

Back to Wednesday... I got to spend more time working with Carmen today. I also found out I get free lunch and free drinks. I'll take it! I learn so much every day at the hospital, it's hard to remember which day was which! I learned a new way to calculate fluid needs that I had never learned before and is more accurate according to the dietitians here. (Nerd alert: Apparently I get excited about new formulas to calculate how much fluid someone needs in a day.) One thing I did notice while learning the best way to write chart notes was the way you have to word your recommendations as a dietitian. It's an interesting balance between making a firm recommendation and staying within your scope of practice. 

Thursday:

My first full day with the dietitian! I even got to see my first patients by myself! Nothing like jumping right in. Both were pretty similar patients, so it was nice to get the repetition. I am so grateful for my job at IMC last year. I didn't realize how helpful it would be in the moment, but I already feel so comfortable in a hospital environment and visiting patient rooms. If nothing else, that alone is so valuable to my internship already. It's been great to already be seeing my own patients. I learn so much faster by doing, so it's really helpful to just get thrown right in this week.

The dietitians in the office (Carmen's office is shared with the two ICU dietitians) have also recommended some really good research articles and other resources to find research to support our standards of care. I'm so impressed with how well versed they are in current research. One of the dietitians recently passed her test to be a CNSC (certified nutrition support clinician). I'm really excited for the days I'll get to spend with her because she knows a ton about enteral nutrition (tube feeds) and parenteral nutrition (nutrition support through an IV line). 

Friday:

I was able to work up some more patients on my own today and add to my lists of "things I learned," "abbreviations I don't know," "things to look up later," etc. Carmen is bilingual, so she had me do some of her Spanish patient's assessments and translated for me. Today was the first day that I felt a little sad working with cancer patients. It's a lot harder to work with younger patients who have families and have really progressive cancers. It also makes me really appreciate what you can do as a dietitian and I really feel like what I'm studying makes a difference. Friday was a great day and a good way to end the week!

Overall Highlights:

• FINALLY getting my ID badge and parking pass figured out with the lovely security office at Ben Taub
• Note, this was also a "low light" because of how frustrating it was
• Getting the $30 parking pass for the onsite garage instead of the $75 pass for the offsite garage with a shuttle 
• Celebrating one of the dietitian's birthdays with free Yogurtland frozen yogurt that the manager brought to the hospital
• Having good hours that help me avoid prime rush hour 
• When the dietitians told me that I'm much more prepared than they were for their internships :)
• Assessed my first (probably of many) gun shot wound patients. Welcome to Ben Taub!
• Did I mention the scrubs?

It was a great week! I'm liking my clinical rotation a lot more than I thought I would so far. I celebrated by sleeping in on Saturday :) and going to a fun beach activity with the church group of young singles from Houston. Who knew Surfside was so much *nicer than Galveston?

*key word "nicer," still not what I would call a "nice" beach :)