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 :)