Week of October 22nd 2018- Trauma Dietetic Internship Rotation (A Very Apt Name)

Another ~fabulous~ heartbreaking week during this dietetic (nutrition) internship. My internship partner, Gia, and I are in the middle of clinical rotations at the moment. This week we have trauma! (In all forms of that word…)

Monday, October 22nd– Evaluating patients in an Intensive Care Unit (ICU) for the first time

First day at the new hospital. Quick rundown, when I say this is our Trauma rotation I mean we are evaluating patients with physical traumas. This could be due to a car accident, gunshot, stabbing, fall from stairs, severe burns, or something similarly damaging. So… real sick patients. Most can’t eat by mouth, so they are tube fed (to their stomach or intestines) or fed through a tube to their veins (IV). I say this often, but I’ll keep saying it: if eating well is important in healthy people, it’s that much more important for those who are sick. The sicker they are, the more important nutrition is.

This day we evaluated two patients in the intensive care unit (ICU). They were unconscious (due to sedatives) and it was my first time evaluating a patient this critically ill. It wasn’t so bad though. I just had to calculate their tube feeding/IV feedings and make sure they were getting the proper amount of calories, protein, carbohydrate, and fat. I hope they are doing okay.

Tuesday, October 23rd– Calculating Diets Manually. Geez, I Appreciate Technology!

Today we were assigned two patients on the intermediate floor. Since these were still trauma patients, they were still in pretty bad shape. Stab wounds don’t heal overnight, you know! Well, most patients on this floor are on tube feedings, but the ones we were assigned were eating by mouth. And, since they weren’t so sick as to be sedated, most were awake and conscious. My patients both required an interview and diet calculation. The interview depends from hospital to hospital, but tends to be something like this: Do you have any history of disease like diabetes, or high blood pressure? Have you had any recent changes in weight? Are you experiencing any gastrointestinal (GI) problems like diarrhea, constipation, nausea, or vomiting? Do you have any difficulty chewing or swallowing? Are you allergic to any foods? Are there any foods you don’t like?

Welp, I asked those questions to the patient then was told to calculate their diets. At the other hospital where Gia and I did our first clinical rotation, we had an excel sheet that adds up the calories and macronutrients (carbohydrates, proteins, and fats). The dietitian at this Trauma hospital that we are working under (our preceptor) wasn’t having it. Nope, she said we had to do it by hand. How? Using basic nutrition facts.

A portion of bread (for example, a slice of bread or 1/3 cup of rice) has 15 grams of carbs, 3g of protein, and 1g of fat. Carbs have 4 calories per gram, proteins also have 4 calories per gram, and fats have 9 calories per gram. So, add up the calories per each (15g carbs*4 plus 3g protein*4 plus 1g fat*9) and you get the total calories for that food item (81 calories in the example). Or that’s the idea (because not all slices of bread are made equally). Welp, we had to do that for the whole day. Figure out how much bread, grains, meat, milk, and whatever else our patients should eat in a day. All on a sheet of paper with a pencil. Man, technology is nice.

Wednesday, October 24th– Will my heart turn to stone, or will it shatter?

Several happenings today. We got assigned three patients. I got one from the ICU and two intermediates. One diet calculation. That wasn’t the problem. I’m not a licensed dietitian nutritionist yet (that’s why I’m doing this internship to be able to take the licensure exam). BUT, I care about my patients. I want to do things right for them. So, I ask questions. I had a patient with diarrhea. I had some options as far as supplements that would help alleviate it. I’m an intern. I’m supposed to be learning. So, the dietitian preceptor asks me which supplement I’m going to use. I don’t know. I tell her I’m stuck between two. And she briefly explains them when I can’t.

Then she asks me again. I still don’t know. I guess. Wrong guess. Now, she asks me what dose (how many supplement packets per day) and if I wasn’t sure which supplement was best, I sure don’t know how much to give! I told her it depends on how severe the diarrhea is, and I don’t know the starting dose. Blah, point is she tells me to look it up. I do. But now I’m angry. I understand she was trying to help. To get me to learn this on my own, but that’s the frustrating part. I thought I wasn’t on my own. I thought she was supposed to teach me. I don’t need her to look things up. If that was the point of the internship, there would be no internship. It’d be pointless! It feels pointless…

After this day I get back to my apartment and sing on the couch for about two or three hours straight. I’m just trying to cope. Then I call my dad to coordinate the finances for next week’s rotation which is out in the sticks (a city about an hour and a half away). I end up talking to my mom afterwards and completely break down. I tell her about all the struggles fighting for the well being of my assigned patients and how there’s only so much I can do. At the end of the day, the decision is my dietitian preceptor’s. If I can’t convince her, I have to live with a choice I don’t agree with. Sometimes this is minor, but other times it’s not. I was doing okay as I told her these things. I was angry, but okay. Until I told her about my patient at nutrition support last week. The one I evaluated then he passed away that same day. I was sobbing. That still hurts. It was just a conversation I had with him and his family, but it hurts.

Thursday, October 25th– Last day at Trauma

It was a short rotation. Just four days, and today we spent the day with a speech pathologist. Why? Well, because you need to be able to swallow to eat which means we should know a little bit about that. It was okay. Brought up a few past demons. But that wasn’t the worst. It upsets me to no end when medical professionals have little or no bedside manner. I originally wanted to be a nurse. In high school, when I started learning about medicine, I learned it all in the point of view of a future nurse. It’s nothing complicated. At least I don’t think it is. I’m talking about saying hello to the patient when you walk in their hospital room. Not shaking their leg or talking excessively loud to wake them up so you can ask them your questions. It just bugs me. And the thing is, it’s been a similar experience with all of the health professionals I’ve worked under in this internship.

When the work day ended, Gia and I went to the health department to get some materials for tomorrow. I have no idea what we are doing tomorrow. All we were told is that we will be in charge of running an information booth focused on nutrition for older adults. Today, someone mentioned patient/participant evaluations or interviews. What? Ugh. I have no idea. But, that’s nothing new in this internship. We stopped by the grocery store to pick up snacks for the week then headed back to our apartments. Since then I’ve been a little piggy trying a little of all my snacks and watching YouTube. My newest obsession is watching stand up comedy. *sigh* A girl can dream!

Friday, October 26th– Internship Director Called Gia and I Selfish

Didn’t sleep. I had to work on an assignment for the internship. So, I stayed up all night to complete it and pack. Today we had an activity planned in the next town over. So, Gia, her roommate Uuie and I got to the department of health at 6:40am in order to print off our assignments and leave at precisely 7:00am. The nutrition activity we had was setting up a nutrition information table with food models and MyPlate (the nutrition guide for healthy eating from the United States. Go to MyPlate.gov for more information). It ended a lot earlier than I thought. 12pm and we were loading the department’s van to go back. Except Gia and I had planned to stay. Our rotation for the coming week is in this town and we don’t have a car. Well, we let our internship director know this morning. I’d forgotten to let her know beforehand.. She was livid. She didn’t tell us to go back with the other interns to the department of health. Instead, she told us to call her at 2pm.

We did. Or, Gia did. I’m grateful she spared me of the director’s scolding. The director told us it was incredibly selfish and wrong, the choice we made to use a department vehicle for our own gain. (The department of health driver took us to the town in the department van.) I didn’t think it was that serious, but from what Gia tells me, the director was more than serious. My take on that is she should have told us to go back. She could have done that. We would have gone back. Lost the money we’d put down on the Airbnb for the weekend. I just wanted to get away. I hate my life here and more at the apartment I live in where everyone hates each other. One weekend. I wanted one weekend away. But that was selfish. Sorry director.

I slept from 4pm to 11am. Don’t want to be awake.

Saturday, October 27th– Boring day at a new Airbnb

I woke up at 11am, but we had to be out of this Airbnb by 1pm. Gia and I ate leftovers from lunch yesterday and grabbed our stuff. The hosts gave us a bag of bananas and then a ride when they saw us waiting in front of their place. We were taken to a nearby plaza where we waited at a Burger King until the other Airbnb was ready for us to check in. There we unpacked and worked on homework. Boring day. I can’t fully enjoy this week after being reprimanded by the director. I’m tired of being corrected and made feel small.

I did research for a grant proposal for an organization I was a part of during university. It would be amazing to give back to that community that helped me so much. If only I could get through this internship.

Sunday, October 28th– Mosquito War and War Movie

Woke up at 7am because I was itchy. Did I mention this new Airbnb only has one room and one bed? Gia didn’t want to sleep in the same bed but changed her mind for some reason. Probably because I told her I hadn’t planned on high blasting the A/C (there’s only one A/C unit and it’s in the bedroom). She’d planned on sleeping on the couch, but I get very cold easily and really hadn’t even planned on turning the A/C on. Whatever. Point is, she caved and slept on the bed with me. I passed out, no covers. Woke up to mosquito bites. Left the bed so I wouldn’t wake her as I vigorously scratched them. More mosquitos in the living room.

Woke Gia up to get the duvet she was sleeping on top of. Covered myself in it like I was hiding from the bogey man. Heard the little monsters buzzing around my duvet shelter, just waiting for me to come out. It was so hot under there. I popped one arm and my head out. Five minutes and four bites on my arm later, I’d had enough. I went to the tiny room and blasted the A/C. Didn’t care that it woke Gia. I covered myself in the duvet and watched YouTube in that frigid room. Effective. Peaceful.Then we went to the grocery store to buy some food and for me, some bug spray. UGH. There’s more of them now. I can’t think like this. And Gia thinks I’m crazy because they don’t like her blood. They usually don’t bite me. …this just proves showering is a bad idea.

I tried to work on my assignments; I really did. Kind of… I just don’t want to. I’m interested in the grant, but I don’t feel like working on it. It’s a lot of work and I’m stressed with all the other assignments we have to complete. Ehh. Gia and I watched a movie to finish off our stressful weekend. It’s a long movie, but I think it’s motivational. Unbroken follows Olympic athlete  “Louie” Zamperini through his experiences during World War II such as being adrift at sea for over a month and his time in prisoner of war camps in Japan. It’s gives me the feeling that if a fellow human can live through that and defy his circumstances, how can I not get through this? It’s just an internship. This isn’t war. I can do this. Or, if I can’t, I’m going to do my best and die trying. (Hopefully not die… though sleep deprivation and stress are serious issues.)

Note:

I drew the featured picture on Friday as Gia and I waited for 2 ‘o clock to strike in order to call the internship director. Any Doctor Who fan will tell you that Oods are creatures who literally hold their hearts’ in their hands. I feel like that now. And in the sketch, I’m trying to shove my heart back in. It’s not working..

Week of October 15th 2018- Nutrition Support (Beware of Burnout)

My life is stress. I know this. I feel like I should be prepared for this. But no matter how much I’ve lived through, I feel as though I’ll never be ready for what lies in front of me. Maybe I never will be. I definitely wasn’t ready for this week.

Monday, October 15th-First Day at a New Hospital- Nutrition Support

New rotation! Another clinical area, this time Nutrition Support. For those who are new to my blog, I am doing a dietetic internship with the Puerto Rico Department of Health. This consists of completing assignments from the Health Department itself plus going to different hospitals or community locations to experience a week or more in about 20 areas over the course of one year. Each rotation has its own dietitian preceptor that is in charge of us. They essentially guide us in that area and give us more assignments/ work to complete for them.

This preceptor had us define 36 medical terms that relate to nutrition support. Nutrition support is exactly like it sounds. When a person can’t eat in the traditional way (by mouth) hospitals support their nutrition by feeding patients via a tube to their stomach or intestines or through a vein (using an IV or catheter, basically a tube attached to a vein). There’s much more to it than that, but I hope that gives y’all an idea.

Our first day we turned in the vocab and saw our dietitian preceptor do patient rounds. 11am, we were on our own. We were given a patient to do a case study and that was it. No further instructions.

Tuesday, October 16th- Learning TPN Calculations?

So, we got all of Monday to work on the case study. After a while we went to ask the preceptor for further information on how to do the case study and she gave us our patients’ laboratories and told us we needed to interview the patient. My patient (which I essentially got randomly, since we didn’t get much information about who was whom) was so ill, even the preceptor didn’t go evaluate him. She told us he was on death’s door, and wasn’t about to go in and ask him how he was doing. …great.

Today the preceptor dashed through an example of a TPN (Total Parenteral Nutrition) calculation. This is the math a dietitian does to figure out how to “feed” a patient through their veins in order to meet their total needs for the day. My internship partner, Gia, and I had done this during our general clinical rotation at another hospital, but were both completely confused by the end of her “teaching” us.

So, after going to see the daily patient rounds it was about 11 am and we got the rest of the day (until 4:30pm) to work on our three calculations that were part of our homework. We spent the day puzzled trying to figure out how to calculate things the way the preceptor did. I was sleep deprived. Don’t remember from what, but I was running on about two hours of sleep and couldn’t think enough to figure out the math. Gia went to ask the preceptor and came out even more confused.

Wednesday, October 17th- All Nighter for Nutrition Support Homework

What did we even do at the hospital today? I don’t remember. So, I’ll tell you about something that I didn’t mention about Tuesday. At the beginning of patient rounds, our dietitian preceptor turns to me and Gia and, almost like an afterthought, says something along the lines of “Oh Laura, your patient died”. … Okay. That was it. Then we went up to see the day’s patients. When we were in the hallway that led to my deceased patient’s room, the preceptor mentioned the family was still there as the medical staff were preparing his body for removal. …Alright.

I didn’t say anything. Later, the preceptor told me the nurse she works with had told her to give me a new case study, but she’d decided not to, because that’s part of life. That’s what happens. At that moment I said, “Yes, I know. He’s my third.” That I know of, he’s the third patient that I evaluate that I later learn has passed away. Even though I just had a conversation with them, it’s an odd feeling to know that one day you were talking to someone trying to help them eat/ get better and the next… there’s nothing to get better. They’re gone.

Thursday, October 18th- All Nighter for Department of Health Assignments

Since this week we had a meeting at the Health Department on Friday, our rotation at this hospital was cut short. This meant all of our assignments were due on Thursday. I typed up those calculations we didn’t really figure out how to do, the case study that we were also not 100% clear on, and the summary of an academic article about TPN. Gia and I worked on it all night. I was able to sleep one hour before waking up at 6am to take the train to the hospital. That hour was glorious. I felt renewed.

After presenting our case study and turning in our work I’d planned to sleep about 5 hours to then finish another case study I had to present during the meeting on Friday. I felt awake though, so I didn’t sleep. I worked on the case study and told myself I’d finish by midnight and then I could maybe sleep two hours before working on a grant proposal that was also due on Friday. Nope. I barely finished the 20 page case study and power point presentation that went with it by 6am. I didn’t take mindless breaks. I laid on the cold floor to wake myself up. I was running on an hour of sleep. But I finished my terrible work. I didn’t even get to begin the grant proposal.

Friday, October 19th- Presenting Clinical Case Study

6am. Meeting started at 7am. Printer issues. Chaos. I presented with a shaky voice and without an idea what I was saying. It was disastrous. At one point the director of the program (I was presenting to her and my fellow 9 dietetic interns) asked me a question and I was so tired, so beaten, that I responded the truth. She asked me why I’d decided on some supplement for my case study patient and I said, “honestly, because my preceptor told me to.” This was my first patient. Ever. This was during my first day at the general clinical rotation way back in September. I listened more to my preceptor than to myself. She’s the one with the experience. She was supposed to guide us. *Sigh* Trust no one. Make your own decisions.

Saturday, October 20th- Sleep Blissful Sleep!

I fell asleep at 8pm and woke up at 1pm today. It was so needed. When I woke up Gia and I went grocery shopping. Mostly ramen. Both of us hardly ate this week. That’s not okay. Hardly any sleep or food plus a ton of stress meant we were working ourselves empty. I didn’t even have pasta at home and subsisted mostly on ramen.

Luckily, this hospital feeds its employees and for the four days we were there, they fed us too. That was the majority of our food. Even there, I’d only eat a scoopful of rice or the meat. Because of the stress, I just wasn’t hungry. I bought a cookie and it tasted bland. Things were getting bad. My body didn’t care much for food. To avoid that, I bought pasta and tortillas. The most basic of foods for me. The easiest filling things to eat. I don’t want to go through a week like that again.

The rest of the night Gia and I worked on a powerpoint presentation and handout due on Sunday. Yes, our preceptor for the next week told us it was due on Sunday. …Okay. So we got it done, because I really don’t want another week like this one.

Sunday, October 21st- Catching Up on Priorities

Woke up at noon and then went to the store to buy some ink. Gia recently has printed a lot of my assignments because I’ve been having issues with the printer at my apartment. So I felt like I owed her. After that we wandered around the mall. I bought some food, but since I’d made an effort to have a filling breakfast (eggs and apple juice) I was stuffed. Gia put the fries in her bag and I did the same with my chicken nuggets. We wandered some more when I saw that the flower stand was there. (I posted a picture of the flowers I bought from there on instagram a few weeks ago. Links to my social media below!) Today I bought some yellow daisies before returning to our apartment complex. Gia went to her apartment and I to mine. Since then I watched a bit of YouTube and began writing this blog post.

Oh, and that grant proposal I didn’t finish? It’s due in two weeks now. Catch is, passing grade is an 85. This week is another intense rotation: Trauma (aka, critically ill patients). Plus! Gia and I were just notified on Friday that we will be going to another city (about an hour and a half away) this coming Friday to put up a little information booth about nutrition for older adults. OH! And! Next week our (five day) rotation is in that city. Ah! And we don’t have a car. We might just stay from this coming Friday till next Friday when the rotation there ends. But… how will I turn in the grant proposal? (It’s due as a hard copy.)

 

Who knows?! Isn’t life fun?! I should be going crazy, but I’m taking everything in stride. Either I can get through this internship or I can’t. Simple as that. I’m going to do what I can, because I can’t do more than that. If my best is enough, great. If it’s not, then I wasn’t meant for this. That’s okay. There’s much more to life than a  single career path.

Take care, friends. Eat well and sleep. Nothing is worth your health. I learned that this week.

Week of October 8th 2018- WIC Rotation (I Don’t Want to Step Into Another WIC Office Ever Again in my Life)

Monday, October 8th- Avoiding People During the Three Day Weekend

It was a three day weekend. Why? Who knows? It’s Puerto Rico. I’m just going with it. It’s good though. I got to laze around Friday afternoon, Saturday, and Sunday. Usually I pull myself together just enough to do my laundry on Sunday and get ready for the next day. I didn’t have to do that this weekend, but on Sunday I did have to finally crawl out of my cave of a room (my roommate was gone for the weekend, so it was glorious). Some other interns wanted to meet up to talk about rotations we’d been to and for general advice. I’d already promised I’d go, so I wrestled on some jeans and a bra and marched over to the little grocery store eating area where this meeting took place.

Really, I’d been essentially in hiding since Friday afternoon. I would sleep early (10 pm-ish) and get up early (7 am-ish), solely to avoid people. …Having my own room would be a disaster. Anyway, my roommate, Axyl, finally came back today, so no more hiding. Today, I did laundry, cleaned my side of the room, and worked on an assignment. Oh, and I brushed my hair. That was nice. Tomorrow begins our individual rotations at WIC. Mine is out in Santurce (the next town over, you could say). Bright and early at 7am. ~Yay.~

Tuesday, October 9th- I was told we’d talk about assignments today, then got berated for not having said assignments done before today. What?!

First day at WIC. I arrive for the preceptor (dietitian supervising me) to berate me for not working on the assignments sooner when she herself had not mentioned them and when I asked her the week before (Friday, I believe) she told me I did not have to complete anything by Tuesday and that we’d talk about that then. UGH.  She could have said, I have no more information for you, have at it, and I would have finished it by the time I arrived today. UGH.

So, I spent the day freezing in the exaggerated A/C and working on assignments. I saw her interview a patient and that was my day. Better than Wednesday where I spent it looking up options if I were to quit this internship. I found a variety of universities with pretty much open admissions to Master’s programs. So, maybe it wasn’t entirely counterproductive….

Wednesday, October 10th- No Motivation, Just Sleep

I went home as usual from the WIC office. A bus ride and train ride. Approximately an hour trip. And I watched You Tube for a bit, until I got sleepy. I decided to take a nap before working on my assignments. My roommate came into our room, made a comment about me being lazy. I decided to prove him right, and slept. 8pm-ish, I slept until the next morning. I didn’t see the point in being awake.

Also, I did not work on my clinical case study or grant both due next friday, or on my clinical binder due this friday, or even on the WIC assignments also due this Friday. Those assignments were: a 15 minute long presentation, a case study, a short article, a facebook post, and a bulletin board. None of it. I worked on none of it. I slept.

Thursday, October 11th- Why can’t people talk right?! Be straightforward!

Dietitian preceptor tells me to focus on the case study, that I have to have that done by today, when I had asked her on Tuesday when I had to turn all of the assignments in and she’d said on Friday. Liar? or Spazzy? I don’t know. She also told me I’d be observing a class led by another WIC dietitian at 9:30am. But! At 9am, she tells me in a failed nonchalant way that well, I was supposed to give the class, but since my powerpoint isn’t finished…

Hold up! She had NOT told me my powerpoint was due today! To make things worse, she’d told me to focus on the case study! But double wait!! I did have my powerpoint done!! Well… a rough version, but I wasn’t going to tell her that. I said, “Oh, but I am finished with my powerpoint.” Real nicely… So, she gives me 15 minutes to set up in the conference room, and now I’m supposed to present my presentation to the WIC participants. That’s crazy! But I did it, and she criticized my powerpoint for having too many words on it. UGH.

Friday, October 12th- Got an 83% on my Evaluation for WIC. Failing in my Internship Program is 79%.

Welp. Since I did not get to finish my case study, hadn’t done my clinical binder, or any of the other WIC assignments (the article, Facebook post, or bulletin board) I did them this morning. And I mean this morning. I started 9pm on Thursday and worked straight until 6:30am when I took an Uber to the WIC office. I kept working at the site. I finished everything but the bulletin board by the time I was in the office. So, I focused on that. (Picture featured above)

Yeah, there were a couple grammar errors. Yeah, the dietitian nit picked me on stuff that was directly from the Academy of Nutrition and Dietetics (the most official and correct source as far as nutrition goes) then dropped it when I told her where I got the information from. That’s ignorance! Why is it wrong when I say it, but okay when it has the official Academy seal?! It’s the same information!

Anyway, she evaluated me and told me my bulletin board was my best assignment and that it’s understandable since I have a problem with the language. URHROIHSFUSA!!! WHAT?! Excuse me?! They were grammar errors due to a time crunch. Don’t push your judgemental view of foreigners on me! That made me angry. As one of my strengths she did state the fact that I am in control of my emotions and that she could never tell if I was upset. GOOD. Because I was. Constantly!

She also said I lack leadership and confidence because I have a quiet voice and refer to the computer questions a lot during patient evaluations. DUH! I don’t work for WIC!! I don’t know the questions! And so what if I have a quiet voice!! UGHGHHGHGH. That also made me angry.. More strengths she stated is that I was very cooperative and took criticism well. Ugh. I went home and caught up on sleep. 8pm to 12pm on Saturday, I slept.

Saturday, October 13th- Karen. Stop Reading my Blog.

Karen, a fellow intern, whom I told not to read my blog, does read my blog. Sorry I can’t tell you guys about my weekend. If she had respected my wish for her not to read this, I would feel open to sharing. But, I don’t. K, you’ve broken my trust (again), but I won’t sink to your level. You will remain anonymous here. But I’ll never believe you if you say you don’t read this. If you want to know what I say or write about you behind your back, ask me. Because it’s the same things I say to your face. The only thing I haven’t had the heart to tell you to your face is how your terrible spanish grammar makes me cringe. That’s it! Everything else, you know. So stop snooping around and get your own life.

Sunday, October 14th- Another Day I won’t Divulge because Karen Reads my Blogs

It was a beautiful weekend and I found hope about staying here. How? I won’t say. Why? Karen. K, butt out of my life. I don’t want you in it.

So what if I’m on my Period? Yeah, I said the P word!

Nausea, abdominal pain, dizziness. Concerning right? Until I tell you it’s due to my period. Which I wouldn’t. Because it’s not professional to talk about such things. So what? I have to do my work as if I’m not a second away from puking all over it?

On my last day of clinical rotations a week before writing this, I got my period. I was gulping down tons of warm saliva, nauseous, and seconds from vomiting. I felt the world shift as I viewed patient files; I rocked back and forth quietly groaning as my uterus shed its lining and I did this all in (literally) bloody tights. (My dietetic internship hospital uniform requires a skirt and skin colored tights.) Oh, and on an empty stomach, since I was so nauseous that I couldn’t get down more than a spoonful of soup and a couple swallows of water.

Even though there’s an explanation for symptoms like nausea and abdominal pain when it’s due to a woman’s period, those symptoms are concerning and important to be addressed! YET! Women are expected to do the same good job she usually does when she’s not in pain and bleeding as when she is. AND, she is not to mention these extra obstacles. Because it’s not professional. It’s too personal. Unwanted information.

But I wanted to mention it this day. I’d had a situation before when I’d told a boss I was on my period (I asked to go home early before I felt obliged to puke on a customer) and she looked horrified I’d brought up such a hush hush topic. So, this day I simply told the preceptor (the dietitian that was supervising and evaluating my work at the hospital) that I had been nauseous and dizzy all day. I told her the nausea was normal. Then she asked if I’d been to a doctor yet. When I said I hadn’t, she suggested my dizziness could be due to the stress of being in this dietetic internship.

(Sarcasm)~Isn’t it great that ailments can be from physical or mental origins? Isn’t that fantastic?! Even better is the fact that society judges mental ailments.~ If I have a “legitimate” reason for being nauseous like, let’s say a stomach virus, then yeah, I’m sick. Stay home. Blah. But if I’m nauseous because I’m nervous (say before a big speech or exam). No mercy. I should get over that. And, of course, not mention it. That would make me seem weak, soft, not put together. Not competent.

And, just as bad, if I’m nauseous because I’m on my period (a physical origin! The uterus shedding its lining!!) in that case I’m not supposed to let anyone know about it either! I’m expected to keep quiet and pretend nothing is wrong when I’m (literally) bleeding!

 

Why?

 

Why does our society value the physical and cast aside mental and women’s physical issues? Why? Those matter too. Those have important implications. They are barriers. Why are physical ailments excused from going to work or school, but mental and women’s physical issues expected to be worked through and not spoken about?

I finished that day at the hospital early. Got all of my patients evaluated. In pain, bleeding, hungry, nauseous, and dizzy, I finished. The preceptor just saw that I finished. That’s all that mattered to her. That’s all that matters to society.

But, remember, that having a mental diagnosis or being on your period are on the same level as a physical illness. Treat it as such. They aren’t anything to be ashamed of. So, talk about them like you would about breaking your arm or getting a cold. Unapologetically, because there is nothing to apologize for. And when you get your usual load of work done, be proud.

Breaking my dominant hand affects my ability to write. Why wouldn’t I be proud of being able to write legibly with my dominant hand being broken? Likewise, being depressed or on my period affects my work (motivation and execution). Why wouldn’t I be proud of being able to get through my usual workload for that day?

Even if society won’t give you that credit, give yourself some credit! You deserve it! Keep fighting anything in your way. I don’t know you, but I’d be proud to know you aren’t letting anything get in your way of your success. 🙂

 

Weeks of August 27th to October 5th 2018- Why I Haven’t Daily Blogged in Over a Month (With Audio)

Above is an audio recording of me reading this post. About 7 minutes. Not perfect, but I hope some of you enjoy it. 🙂

My goodness! It’s been too long! I truly hope everyone is well. So, what have I done for the last …erm… lemme check… month and a half? Nothing much. Except begin rotations in my dietetic internship and question my life, but that last part is normal. I’ve gotten angry, I’ve, recently, made crying a part of my weekly routine, and I’ve felt incredibly worthless and insignificant. I could tell you guys why, but that’d take at least three blog posts. So, I’ll recap in one long post.

 

Rotation 1: Elder’s Center (Community Nutrition)

It was okay. As my first rotation, I was ready for nothing and had no expectations. My internship partner, Gia, and I were told to write up an intake form and then were expected to complete the assessments and evaluate the elderly participants. I’d done this once. With a college student. Very different. We ended up doing the evaluations together (Gia and I) and got upset at each other for it. It was the first time we had to collaborate on something like this and, well, there were kinks.

Later on that week we were also instructed to give a presentation on MyPlate to a different Elder’s Center. After lots of activity/interactive ideas were tossed because the event would be to 100+ people not 30, like we originally thought, Gia and I spent a whole afternoon making a ginormous drawing of a sample MyPlate. It came out really well! And I loved having an excuse to draw. Gia doesn’t share my interest in these creative arts but partook in the merry poster making regardless. 😊

This week was all about learning to work together and hitting some bumps along the way. (Side note: The way home was about 2 and a half hours by bus and train. All but maybe one day we also met up to work on assignments together for the next day, spending a grueling 12+ hours with each other daily. We’re friends, but phew! that was trying!)

Rotation 2: General Clinical Dietetics (Clinical Nutrition)

*SIGH* It’s been eternal. I hope to give y’all the short version. First week was general orientation and review. That was nice. I was positive. I didn’t mind having to calculate diets and tube feedings or evaluate case studies. It was kind of nice. Made me feel smart.

Second week. General medicine for me, surgery floor for Gia. First two days the dietitian who we are with (from now on called our Preceptor) is super helpful and goes with us to do the interviews with actual patients. Third day she let’s Gia loose. AKA alone. Good luck doing patient interviews with a whole two days of experience! …that was sarcasm. I was terrified, and the preceptor could tell, so she went with me one more day. After this we were on our own looking at patient files (yes, they do paper filing here) and interviewing patients.

Third week. Oncology floor for me, general medicine for Gia. Our preceptor tells us we should be much faster and, in not as many words, better by now. She asks back any question we ask her and is generally unhelpful. I understand the tough love bit. Haa… do I understand it… But! It wasn’t helpful here. These are people’s lives! I mean, I’m not going to kill anyone by giving them more kale than they need, but you feed someone with diabetes a strict diet of bread and sugar I bet you there’s going to be some health implications! This stuff matters. I don’t want to play with people’s health.

So, I’d ask anyway. Only to hear that the preceptor had told Gia that we should study more and look things up (by this she means on the internet). Why would that ever be my first choice, when I have an experienced dietitian right in front of me who is supposed to be helping me gain clinical knowledge?! I already studied. Or at least that’s what my Bachelor’s degree says. I know, I know, lifelong learning. There is no end to learning and studying, at least not if you want to stay relevant and competent, but my point stands! Our preceptor blocking herself off from being an accessible, trustworthy source only instilled distrust in me.

I will admit that by her asking so much of us, I am much more conscious of every patient file, medical history, lab value, and most minute details (I’m only human), but it also instilled that nagging insecurity and distance from her. Which maybe is for the best, because I guess I can get that experience and clinical knowledge on my own if I work in a hospital for years. (Which, at this point, isn’t likely.)

Moving on, fourth week. Surgery floor for me, oncology for Gia. Preceptor expects us to be, essentially, fully independent. She doesn’t even take Gia to her new area! My heart breaks and I (finally) cry due to the rotations. Arguably, our jobs as dietitians matter in every floor of the hospital. Healthy or not, but especially if not, it matters what we put in our bodies. But in surgery? It could be the direct link between someone developing holes in their intestines or bleeding internally. Serious stuff depending on what surgery or health complication the patient has.

I couldn’t handle it. And that’s why I began writing the Why I’m Not a Doctor series on this blog. I couldn’t handle me, basically a dietitian in training, having to go teach patients what diets they have to follow for the rest of their lives. And you might say, “yeah, yeah, diet shm-iet”, but if someone had a kidney removed, or part of their intestines removed, you better bet it matters what they eat! Teaching them what that should be is crucial!

I don’t feel nearly qualified enough for something that important. But I went in there and taught (read: gave handouts to) several patients with truly life altering surgeries and broke soon after. I wanted to be better for them. I wanted to be as knowledgeable as they deserved and I know I could be in time, but I’m not now and I don’t know when the next time someone who is knowledgeable will help them. It hurts to want to help, but not be able to. At least not to your fullest extent. Plus, one of the patients I’d evaluated the week prior in oncology died this week. So, you know, EMOTIONS.

Now it’s week five. We have to do something called staff relief responsibility. Essentially do the work of a dietitian on the floor we chose for that week. AKA exactly what we’d been doing, but alone. (The preceptor still checking our work and signing off all of our evaluations and diet plans, of course) Soooo, yeah, pretty much the same thing. I chose general medicine (anything to get out of surgery) and Gia, who I think is completely insane for this, chose surgery. Neither of us wanted oncology which happens to be the floor our preceptor is in charge of when she’s not teaching interns.

I’ll miss our little study room reserved for us interns and some of the sweet patients who I hope are doing well in their own homes instead of the hospital I met them in. There are many things I won’t miss. Hopefully the rest of the year (internship) is not as emotionally grueling, but I doubt it.

 

Either way, it’ll make for some interesting stories.

Stay healthy, my friends.

 

P.S. And yes, that was the short version. I warned y’all!