Dietetic Internship: Week 16

I’ve now completed 12 out of 14 weeks of my clinical rotation….just letting that sink in for a minute. I spent the first four days of this week at the big main hospital in Asheville with the metabolic support team of dietitians and pharmacists. “Metabolic support” is really just a fancy term for enteral nutrition and parenteral nutrition…which are just fancy terms for tube feeding or IV nutrition. Ideally I would be able to see this at the hospital I’ve been at, but we really haven’t had too many patients that have had to be on either EN or TPN! The hospital I’m usually at is a smaller branch under the big, main hospital I was at this week, so any high-trauma cases that we receive that would necessitate EN or TPN would typically be sent off to the main hospital for more specialized care.

EN and TPN are formulas that enter the body through either a tube in the nose, directly to the stomach or small intestine, or through an IV line. These formulas contain protein, fat and carbohydrates, as well as essential vitamins and minerals to ensure patients are getting the appropriate nutrition needed. I essentially think of them like baby formula, but for adults…and children.

When determining how much of a formula a patient needs, you have to take into consideration their specific needs and calorie goals. That results in calculating out the exact volume amount required to provide all of the calories and nutrient a patient will need. This was always the part I wasn’t good at, so I was super nervous going into this rotation Monday morning. I never felt confident in my ability to calculate a tube feeding or TPN feeding in undergrad. Even after having a refresher class earlier this year, I still felt uneasy. I’m one that learns best by doing and experiencing, so the hypothetical situations we were thrown in the classroom were great, but just weren’t enough to make me feel competent.

The metabolic support team was comprised of four dietitians and a pharmacist. I bounced back and forth between two of the dietitians this week, and they were both awesome! They took it slow to start off, but also weren’t afraid to throw questions at me and ask for my input at the same time. They were patient with me as I grew more proficient at calculating formula goal rates through the week, and offered me advice and encouraging words all throughout the week. Each day I left feeling a little bit more confident in myself, and eager to get back the next day to improve even more. That sounds cheesy, but it’s true! They were a joy to work with, and made learning in a new and unfamiliar environment fun.

They also made sure I got to see as many different procedures related to metabolic support as I could, including the placement of a feeding tube, as well as a metabolic cart study. The environment was so much more fast-paced than I was used to, but I loved every minute of it! The days flew by, and it was the end of the week before I knew it. I was surprised at how much I enjoyed this rotation. I typically enjoy outpatient areas of the field more, where I get to work with patients that are relatively healthy and willing and able to talk and discuss their health and nutrition. This rotation was on the complete opposite end of the spectrum – many patients were intubated on a ventilator and heavily sedated, making conversation virtually impossible. I never thought I would enjoy patient encounters like this, but it was definitely eye-opening, and I certainly have a new appreciation for this side of the field. I also think I’m opening up to it due to the fact that I feel sliiiightly more comfortable determining needs and calculating tube feedings 😉

So that was Monday through Thursday, and Friday we had our monthly didactic class. This month we had a dietitian from Davita come and speak to us. Yes, the same Davita that I was at last week! It was a different dietitian that spoke to us, though. It was interesting to see another dietitian’s experience with renal nutrition. While much of it was review for me after my time spent there last week, I did pick up some new information as well! The speaker was entertaining, captivating, and easy to listen to, making it enjoyable to hear about PTH, phosphorus, potassium, and albumin again 😉 The remainder of the afternoon was spent going over projects for the end of the year and discussing spring rotations!!!! I still have my community rotation and food service rotations left, but will be done on May 5^th!!! Crazy!

This weekend was my first one spent in town without any plans, and it felt GREAT. I’ve had a blast visiting friends and family in other cities, and having friends come visit me, but boy did it feel good to have a free weekend, Unfortunately, that free weekend was spent poring over a case study presentation that is due in a little over a week. The end of the year pressure is certainly starting to kick in, as I’ve got what seems like a mound of assignments to get through before our last day on December 7^th! I’m trying to stay sane and take a little time each evening for myself. If you feel like I’ve been a little MIA on the ‘gram lately, that’s why! I hate that I haven’t really kept up with everyone as much as I wish, but after spending all day and afternoon on the computer or working on projects, the last thing I want to do is stare at my phone…I’d rather stare at the back of my eyelids!! I promise I’m keeping up with y’all as best as I can, and read and greatly appreciate all of the sweet comments I receive on my ‘grams that I post. Y’all are truly so awesome, and I’m incredibly thankful for the amazing support system that I have in y’all. Hang with me the next couple of weeks, and I’ll be back in full force (hopefully!) come the middle of December!

Have a great week!