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.