Posted in My Life Now, Uncategorized

I don’t know if I can do this anymore

A few weeks ago, my watch documented that I went on a walk and burned 330 calories in about an hour. I was actually sitting in the ICU doing chart reviews on my patients for the day. The following are my thoughts I wrote after this happened.

I know anxiety and other mental health and really even just mood and mentality in general are NOT just in people’s heads. These things have physical effects. And if anything, I have the evidence that I did have noticable physical effects from it just now. And yet…

Most of the time I still tell myself I’m exaggerating. Even now with data right in front of me I’m telling myself it’s a fluke and it really is just in my head and I’m fine. Or if the data isn’t a mistake, then there’s something physiologically wrong with me and that’s all it is.

When I say this job and current phase of my life is killing me. I do mean it literally. The amount of stress, anxiety, hopelessness, unhealthy eating, lack of sleep, and insufficient exercise and negative mental environment during the majority of my day are slowly killing me. I’ve seen it in my own medical labs, in my heart rate just now, and multiple times a week when I breakdown before succumbing to sleep and repeating the whole cycle all over again.

And I know there are steps that can be taken to get out of this vicious cycle. I continue doing what I can, but every setback makes it that much harder to get up the next time. I don’t know if I can do this anymore.

You know the worst part? My job is to go up to people, people just like me, stuck in ruts and their own devastating cycles and tell them to eat their vegetables, maybe not sit on the couch after work until bedtime stressing about everything there is to be stressed about, and instead go for a walk or meal prep some overnight oats. That’s what I don’t think I can do anymore.

How do you tell someone the truth, that by not prioritizing what they eat, how much they exercise, how much sleep they get, and how stressed out they allow themselves to be, they are killing themselves faster than the cancer, renal failure, diabetes, heart failure, etc? How do you tell that to someone who knows all that and wants to do better, desperately wants to help themself, but is homeless, in prison, barely able to provide for their children if they skip a few meals, or simply has so much else vying for their attention that they do not have the mental capacity to care about the food they consume?

I’ve seen and heard so much suffering. Yet, even when I am at my best, have all the energy and drive and positivity to give my patients the care they deserve, I feel like my efforts are pointless. At the end of the day I can only hope I’ve helped the people I’ve spoken to. I’ll never know for certain. The only people I know about after an interaction are the ones who come back a week or days later, often with the same problem, and often with the same nutritional/lifestyle solution that could, at the very least, lessen the severity of their illness. Or, I know of the ones who die at the hospital with or without my efforts.

I don’t know if I can do this anymore.

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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.

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Best and Worst Experiences during Clinical Rotations in High School: Why I’m Not a Doctor Part 1

I wanted to be a doctor when I was younger, but I gave it up because I didn’t want to lose my humanity. In high school I, essentially, took a year long, intensive, crash course in anatomy and (more so) physiology. I was a sponge. I absorbed everything. (Except vitamins and minerals. Those were not interesting to me at all.) It’s amazing how knowledgeable I became from that one year. I remember sketching anatomically correct hearts and coloring them for fun.

I also remember going into clinical rotations the following year (11th grade) and feeling incredibly awkward about it. I was wicked book smart, but catastrophically inept when it came to people skills. (Still not great at it…) Which means 90% of my clinical rotations went like this:

 

Dr.:

“…and that’s what we do in [insert area of hospital here].”

Catastrophically Inept at Social Skills 17 Year Old Me:

*nods*

Both of us:

*AWKWARD SILENCE*

 

It was almost worst if the medical professional I was shadowing tried to converse with me. Most of my answers were short and direct. Example:

Dr.: 

“…and that’s what we do in [insert area of hospital here]. What area do you want to go into or what are you interested in besides medicine?”

Me:

I’m not sure yet. Um, I like to read.

Dr.:

Oh, that’s okay. It takes time to figure that out. What kind of books do you like to read?

Me:

Uh, really anything as long as it’s fiction.

Dr.*Sees I am most definitely not the conversational type*:

…that’s nice. Yeah, when I was younger [insert personal story here to fill up my silence]

 

The worst example is when I made a conscious attempt to be more conversational because I had read somewhere that it’s good to take interest and ask questions. That gets people talking according to some self help text I read. So, I mustered up some anxiety ridden courage and asked the cardiologist I was with that day a question (who, to make things worse, happened to be the father of one of the girls in my clinicals class). It went like this:

 

Dr.:

So, we evaluate patients using a stress test.

Me.: *Thinking: Don’t let the silence hang. Say something! Ask a question! Show him you are interested in the topic and want to know more!*

So… what does a stress test consist of? (…yes… I actually spoke this very formal way back then. Even around friends. It was sometime this year that I began simplifying [read: dumbing down] my speech.)

Dr.: *Stares at me for a second* *Responds in a this is completely obvious, I don’t know why you asked that question tone*

It’s a stress test. We put the patient on a treadmill and stress the patient.

Me:

*feels stupid* *silent for the rest of the day*

 

…But I digress.

Before the flood of vile flashbacks, I planned to recount my best rotation. For that, let’s backtrack a bit. In high school, I didn’t study. I just learned in class. And retained all of the information. When it came time for a test I simply reviewed (read: quickly read through) my notes from class and presto! high A’s. Here’s the best rotation I had:

 

Nuclear Medicine Dr.:

See here?

*points to a patient scan with some mass or other abnormality*

This patient had [insert some diagnosis that I’ve long since forgotten]. Do you know what [insert some medical term related to the patient’s case] is?

Me: *Enthused this isn’t a personal question and is something I can answer with much more ease*

Yeah, that’s [insert correct answer].

Dr.: *Intrigued I got it right*

Right!

*Continues discussing case* *Brings up new scan*

Now this patient had [insert some other diagnosis that I’ve long since forgotten]. Do you know what [insert some medical term related to the patient’s case] is?

Me: *Glad for another question I can answer*

Yeah, that’s [insert correct answer].

Dr.: *Very intrigued now*

What’s [some medical thing]?

Me: 

[insert correct answer]

Dr.: 

What’s [some medical thing]?

Me: 

[insert correct answer]

He was rapid fire quizzing me now and I was gaining confidence with every correct answer. A couple questions later:

Dr.:

Where are the thyroid glands?

Me: *Nervous because thyroid glands were only briefly mentioned in class. Once.*

*Hesitates then uses both index fingers to point to my throat on a fuzzy educated guess*

Dr.: *Satisfied at last, asks with genuine interest*

What area do you want to go into?

Me: *Still buzzing because I got the last question right* *Confidently answers*

I want to be a nurse.

Dr.:

A NURSE?! You have to aim higher! It’s better to struggle at something difficult than to excel at something easy. Don’t you think?

Me: *Thinking about doing very well in my regular level classes and just well in my AP and IB classes, but learning things on a much deeper level*

*Thinking about the fact that I took those higher level courses because I truly believe it’s better to challenge yourself and do okay than not to and breeze by.*

*Tentatively* Yeah, I think you’re right.

Dr.: *Gives me an encouraging look and a hint of a smile*

Don’t conform with being a nurse. Be a doctor.

 

Then he gave me his business card and urged me to contact him if I ever had any questions. I assure you no other doctor gave me their business card. Nor did I ever impress another doctor. Not surprising, since I probably said as many words to the Nuclear Medicine doctor as to all the other doctors the rest of the year combined. And no, I am not omitting his name for privacy reasons. (I’d give him a pseudo name, if that was the case.)

I actually lost his card sometime after that school year. I was not able to remember his name, let alone call him when I began doubting the whole doctor thing when I began university. Not that I would have called him anyway, because… you know… severe anxiety. I did go over to the nuclear medicine department at that hospital sometime before going off to university though. I had hoped to run into him, but I didn’t see him and I didn’t even know his name to leave a message. :/

 

If you’ve read the My Life Now section of my blog, you know that I’m here in Puerto Rico as part of a dietetic internship instead of in med school.

I’m sorry, Nuclear Medicine Doctor, high school clinicals teacher Ms. Dee, all of my clinicals classmates who expected medical greatness of me, all of my teachers that swore up and down I’d go on to excel as a doctor, my AVID teacher Ms. Dar, my parents, and myself. I’m sorry.

~*~*~

My next deterrent from medical school wasn’t the crushing fear of losing my humanity. (Though that was always present.) It was a wrong click when I enrolled to university. Come back for part two next week to read about fateful click!

Note:

Picture is of my physiology class material sophomore year in university.