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.