Dietetic Internship: Week 13

Monday, October 19, 2015: Today was abnormally slow in that we really didn’t have a whole swarm of patients to see like we thought we might for a Monday. I only saw 3 patients, so I had a good amount of time to work on some assignments for our didactic class. We had a case study and presentation due, as well as an outcome measure assignment and collection of ADIME notes. The worst part is compiling it all into word documents, which was what I was doing today. 

Tuesday, October 20, 2015: Another slow day! We saw a couple inpatient consults, made rounds with the hospitalist, and had an outpatient appointment with a client to discuss their diabetes management. In my down time, I was thankfully able to knock out a lot more of my case study and collection of ADIME notes. I spent some time preparing for a couple days spent with the dietitian at the cancer center tomorrow!!! I’m super excited, but also a little intimidated as I don’t really know what to expect. The RD sent me a few articles to review before I show up, so I’ve been poring over them. I think I mentioned that last week, though?..

Wednesday, October 21, 2015: oh my goodness, oh my goodness, today was AWESOME. Today and tomorrow will be spent with the oncology dietitian at the main hospital in Asheville instead of my teeny little sister hospital. I had to be there bright and early (well, dark and early…) at 6:45 for their 7 am morning rounds, which turned out to be a lot different than the usual rounds I’ve experienced at the hospital. The rounds at the cancer center are actually called cancer conference, which are essentially the same that I’ve seen once or twice at my normal hospital. MDs review a handful of patients, their diagnoses, pathology of the disease, and their course of action or plan for treatment. Today most of the cases were breast cancer. Afterwards, we saw patients! I have to rave about the RD’s relationship with each patient — he (yes, he! a male!) truly connected with each one and made them feel like a rockstar, personalizing and tailoring care for each patient, meeting them where they were at. 

He was also considerate enough to take the time to walk me through literally everything that goes on there. He made sure I had a basis of knowledge right off the bat so that I could keep sooomewhat up to speed throughout the next two days! I got to see all around radiology and watch a treatment, observe him talking to patients while in the process of receiving chemo, watch the SLP (speech language pathologist) administer a fiberoptic swallow evaluation (SO COOL), and make a trip to a local camp for survivors to direct “nutrition jeopardy”!

At the beginning of the morning I was super overwhelmed and felt extremely incompetent. I mean, I’m not exaggerating when I say I truly think this dietitian actually knew EVERYTHING….and I knew….nothing. I had to really take a step back and remind myself that he had been in this specialized field for 12+ years, umm DUH, of course I’m not going to know everything he does. After that little reminder to myself, I relaxed a lot and found myself to be more at ease the remainder of the day. With that all I have to say is: just because you think you are dumb, doesn’t really mean you are dumb!!

Thursday, October 22, 2015: Back again at 6:45 this morning for day 2! Today’s conference focused more on GI and pelvic cancers such as prostate, pancreatic, and bladder cancers. We later saw a couple patients with cancers ranging from ovarian, esophageal, breast and lung cancer. 

I think one of the most interesting pieces I took away from this rotation was that treatment can be very site specific. Certain sites affected by cancer pose more of a “nutritional risk” than others, depending upon how that organ works in the total body system, or upon how treatment will affect it. For instance, those with cancer of the GI, head and neck, lung, rectal or esophageal sites will likely need increased energy needs compared to those with breast cancer (typically speaking, though every patient is different!! obviously!). I also had no clue that chemo can lead to increased protein build up, which eventually breaks down to uric acid, which in high levels can lead to gout. However, patients can be prescribed a medication to manage uric acid levels. 

I always learned in undergrad that wounds require a looootta protein to heal properly, and I finally had the opportunity to actually see that put into action today! A patient had surgery to remove a mass in his lung, resulting in a rather large wound on his chest. He was following his protein recommendations well and adequately meeting his needs, and it showed! We saw pictures of his wound taken both directly after surgery and then again two weeks later, and the healing and repair was amazing. Just goes to show how important nutrition really is, which I love 🙂

Overall, I had a FANTASTIC time with the oncology dietitian over the last two days. I learned a lot, and truly came to understand the world of cancer a little bit more. I can’t imagine facing the diagnosis of cancer, but these patients were some of the most resilient I’ve yet to see. Their level of motivation, determination, and persistence was moving. The dietitian reminded each patient just how much of a rockstar they are, typically ending each appointment with a fist bump – hah! I came to realize that nutrition therapy in this realm of the field is very much focused on managing symptoms that are a result of medication side effects, ya know, all the nausea, vomiting, diarrhea. I was so sad to leave this afternoon!! The passion that the dietitian poured into his work was infectious. Everyone I had run into over the last two days had nothing but high remarks about him, reassuring me that “you’re with the best in the field right now, soak it up!!”. Needless to say, there couldn’t be a truer statement.

Friday, October 23, 2015: Back to my little hospital today to round out the week. I expected every bed to be filled this morning, but it was almost empty! Praises! This might sound cheesy, but I took a lot of that infectious passion from yesterday into my patient interactions today and felt SO much better about not just how I was performing, but also about the care I was giving. So often I think I feel rushed by patients, thinking they don’t really care what I have to say. Today I tried to turn the conversation more towards them, talking about what interests them while still gathering the information that I needed. And I mean, this isn’t a new concept to me at all… I noticed this same switch in counseling skills while working with WIC as well, and I think it’s a sign that I’m finally really getting into the groove of things and feeling more comfortable and confident in my ability. PRAISE HANDS EMOJI. It’s always a great confidence booster when your preceptor tells you “thank you for your great, hard work today!”.  It’s also great when the weather is perfectly sunny and breezy, the drive back to town is lined with mountains and trees at the peak of leaf-changing, and you get a gel manicure for 20% off. So basically, Friday rocked. Hope yours did too!! 

Saturday, October 24, 2015: I woke up at the crack of the dawn to make a quick trip to Hilton Head to celebrate my great aunt’s 94th birthday with my cousin, Lee! (Hey, Lee!!!) We had such a blast treating our little Gran to a lunch of fried chicken livers and Pinot Grigio, an afternoon overlooking the ocean on the back porch, happy hour with more Pinot Grigio, and an entertaining dinner at her apartment’s dining room. 

Sunday, October 25, 2015: I made my way back to Asheville a little before noon, and ended my weekend with a dinner date at WIcked Weed with Alexis (ahemm, @restoring_radiance) and her friend, Molly!! It was the perfect way to wind down, and I couldn’t have asked for better company! After following each other on Instagram for about forever, it was so much fun to officially meet up in person, and it felt like we had known each other for forever. We ended the night with an unintentional gift-swap of wild friends peanut butter and other goodies, because great minds think alike 😉 

Hope everyone had a wonderful week + weekend! If you’re ever in the area, don’t be afraid to shoot me a message on IG, here, or my email! I’d love to meet as many of y’all as I can, makes my life exciting!!