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..

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