Long overdue update!

Hi everyone, it’s been awhile!  Sorry for the massive delay, I had some things distracting me along with working longer hours during my 7 weeks of pediatrics.

I really enjoyed pediatrics–the peds dietitians are so much fun and working with kids/teens was really rewarding.  I did 3 weeks on the general peds floor, 1 week (plus a few extra days during holiday coverage) in the peds ICU, 1 week in the neonatal ICU and 2 weeks of peds outpatient.  The first week or so was pretty tough because, as many of you know from clinical and lifespan nutrition, everything is different and much more involved with kids!  I was kind of dreading peds because I remember struggling over pediatric case studies in undergrad.  I’m not sure what was harder though, the class case studies or real patients–real patients have more problems and their status may change quickly but at least there is usually more info available and of course practice helps… But anyway, long story short I enjoyed the pediatric floor and the ICU.

Surprisingly, I enjoyed the NICU too.  I don’t think I’d set out to become a NICU dietitian but if the opportunity arose then I would definitely consider it.  I think I was lucky though because that week we had an awesome Attending (they rotate every week so it’s the luck of the draw) and the dietitian I worked with that week was fun.

As for my 2 weeks of out patient, let’s just say each day was a whole new experience.  I worked with 5 different preceptors over 8 days basically in a different clinic each day (sometimes 2 different clinics per day) so it was a little chaotic.  I went to pulmonary, GI, weight management (both over- and underweight), infectious disease, feeding clinic, endocrinology and more that I can’t recall right now.  Let’s just say I enjoyed some more than others…  I though weight management was fun and enjoyed getting to spend 30-40 minutes talking to the patients.

I was actually sad when my time with peds was over, but now I’m working with my favorite group of patients–Oncology.  I love Oncology-it’s so rewarding and so involved.  When I was in peds I tried to work with as many of the oncology patients as I could and now I’m enjoying the adult population.  I am hoping to find a career in oncology (peds or adult) so I’ll have to look and see what’s out there.

Sorry for the long overdue and brief post, I will try to post updates more frequently.  Good luck to everyone applying, the deadline is quickly approaching!

Clinical recap

Oops, It’s been a long time since I’ve updated this blog. I’ve been a lot busier since moving on to clinical and I’ve kinda let this slide… Anyway, here’s an update on the past 5+ weeks.

I started clinical with a two week rotation through renal transplant and general medicine. I’d say it was 90% renal (+a multitude of complications) and maybe 10% general medicine. It was a tough area to start in but I’m glad I did because I’d rather tackle the tough stuff first. My first patient on my first day of clinical was a total train wreck, end stage liver disease, end stage renal failure, a post-operative ileus (his GI track temporarily froze up after surgery) and he had a few other issues going on. It was intense! But I love intense so that was great.

After a great 2 weeks on the floor, I moved on to a 2 week ICU rotation with some liver transplant patients mixed in there. That rotation was awesome, lots of tube feedings and I was able to observe a donor nephrectomy (the kidney donor’s surgery). I had to stand for over 4 hours in a freezing room but it was totally worth it to watch the doctor pull the kidney out of an incision just large enough for his hand and arm to pass through.

After the 2 weeks in the ICU I moved on to a week of out patient renal clinic, which I surprisingly enjoyed. I didn’t realize I’d like giving educations all week but it ended up being lots of fun. At first I was intimidated to give educations to patients because I wasn’t sure I could remember everything I needed to cover and do so in a cohesive manner but I’m getting more comfortable with them and have begun to enjoy doing them. I’ve given educations to adults on post-transplant nutrition and food safety, type 2 diabetes, weight loss (for kidney donation eligibility) and heart healthy eating.

Now I’m in a lengthy (about 2 months) pediatric rotation so I’m spending more time educating parents on how not to starve their children and am learning to do newly diagnosed type 1 diabetes educations. Everything is more complex and intense in peds… so of course I love it! I’ll admit that today I wanted to pull my hair out after spending over an hour trying to calculate a crazy tube feed combo only to find out that the doctor had changed the concentration of the formula earlier that morning without recording the change… which would have made it much easier to start but at that point I had to re-calculate everything and wanted to scream. I also had to learn how to dose vitamins, which is totally new to me. One great thing about peds is that the doctors not only listen to the dietitians but they rely on them (and the dietetic interns to some extent) because doctors know very little about nutrition therapy and it is very important in peds.

Anyway, I know this is a brief summary of the past 5-6 weeks so if you have any questions I’d be happy to answer them. Enjoy the holidays and good luck with internship applications!

Changing Course

Wow, It’s been a while since I’ve updated this blog. These past two weeks have been crazy-busy!

I am happy to report that I finished food service management last Friday with a bang. We executed our Halloween theme meal and it ended up being a great send off. The last 2 weeks of food service management included lots of final planning for the meal, including taste-testing recipes (yum!), forecasting portions, tons of advertising, costing and decorating. We had such great reviews after the taste-testing that we didn’t change any of our recipes for the final event. Our menu included the following:

Grill special: Sweet potato fries

Hot Entrees: Butternut squash ravioli in a vodka sauce or penne with pumpkin and bacon served with roasted root vegetables or chicken tamales served with Spanish rice

Salads: Waldorf salad

Soup: Tuscan pumpkin-white bean soup

Desserts: Dirt cup caramel and chocolate apples, pumpkin and pecan pie and chocolate cupcakes with pumpkin cookie

Beverage: Apple cider

The actual meal went really well. We drew a huge crowd and had the cooks running back and forth to make more food. People were still talking about it today so it must have been good!

We also organized a hospital-wide pumpkin carving contest and a department-wide costume contest. We had a huge turn-out for the pumpkin carving contest with 23 entries and tons of creativity. Unfortunately, our costume contest didn’t go as well with few employees actually dressing up. Those that did looked amazing though. The judging of this contest was also interrupted when a county health inspector showed up and all of the managers and staff went running. The kitchen turned into chaos at that point and our final wrap-up meeting was canceled.

Tomorrow I start clinical. I’m starting in renal transplant so it’s kind of an intense start, but I’m excited about it. I’ve been working through my pre-rotation assignment and still feel unprepared, but I’m sure once I get there things will click.

Weeks 4 & 5

Sorry for the lack of posts, this week has been a little crazy, but good.

Last week was a lot of fun. Our rotation was patient services and we did a lot of activities that will hopefully have an impact on patient satisfaction. One day we went up to one of the floors and passed around surveys and spoke with patients about how they liked the food. I really enjoyed having a chance to talk to patients since I feel they are the whole reason we are there. We inputted our findings into an excel chart to assist our preceptor with continuing to follow the satisfaction scores on that floor.

We also put together and led 3 in-service trainings on the hospital’s renal diet. Two of the in-services were for tray line employees and one was for the diet assistants who take patient menu choices. I think all 3 in-services went well—our presentation looked nice and I think we delivered it well. The majority of the audience members seemed engaged and we had a few great questions at the end.

We also made an employee of the month poster board so the food and nutrition department can start recognizing an employee of the month. That was a fun project and hopefully will serve as a fun way to motivate employees.

This week has also been a lot of fun. We’ve been learning the ins and outs of tray line and have really been getting a feel of the kitchen environment. Our big project this week has been an audit of tray line, food temperatures and the overall kitchen environment. Monday I jumped in and helped serve the ground and pureed diets. It’s not easy to make a ground meal look appetizing so I give those guys credit! Of course the audit included multiple taste tests, which we definitely didn’t complain about. Well, maybe with the exception of the ground and pureed foods, for some reason I have a hard time getting those down. Must be a texture thing. Overall though the food looked and tasted good. The main problem we found was in temperature control. It’s really hard to plate and deliver 300-400 meals without having problems with temperature control. We’re presenting our specific findings to the kitchen supervisors tomorrow and have lots of ideas to help remedy this problem.

We’re also going to present our findings from today’s hand washing audit. Let’s just say some employees need a reminder about proper hand washing guidelines and procedures. I think this is something that should be regularly revisited during in-service trainings at all kitchens and restaurants because it’s so easy for someone to over look and yet so important.

I can’t believe I’m finishing my 5th week of food service. Only 2 more until clinical starts. Time is flying!

Motivating Day!

It was great to see everyone at the internship fair! I hope you are all motivated for applications now. It’s definitely stressful but you can do it.

I’m really excited after today’s classes on enteral nutrition therapy. I love calculating tube feedings and can’t wait to try them on real patients. I can definitely see myself becoming a CNSD (Certified Nutrition Support Dietitian) during my career.

The dietitian who taught one of today’s classes is our trauma dietitian. I would love to have a job like hers. I actually wanted to be a trauma surgeon throughout my 4 years of pre-med and I am thrilled to learn that there are career opportunities for dietitians in trauma units. There’s just something I love about the unpredictability and severity in trauma cases. And, as a bonus, dietitians don’t have to be on call unlike trauma surgeons (not to mention avoiding the years of medical school +residency +fellowships required to become a trauma surgeon). I’ll have to wait until this spring to do my rotation with that particular dietitian, but I will get plenty of experience with tube feedings in other rotations prior to that—hopefully in about 4 weeks!

Monday classes are also great because they shorten the work week. It’s especially nice to break up some of the food service management with clinical classes.

Tomorrow should include a couple of meetings and an overview of the rest of what we’ll be doing the next 3 days. I have no idea what we’ll be doing the rest of the week, but I think it’ll include assisting with an employee in-service training. That should be fun.

Thanks for all of the great feedback about the blog. I’m happy to hear people enjoy reading it!

Meetings, Meetings, Meetings

One thing I have learned from this rotation is that management means lots of meetings. I don’t know how these managers have time to get the rest of their jobs done! We seem to have at least 2 scheduled meetings and numerous impromptu meetings throughout the day. This week has been a little more relaxed schedule-wise with a nice 9am start time. I am so happy to be able to stay up past 9pm since I don’t need to be up at 3am this week. Aside from the meetings we have been working on small assignments such as thinking up ideas to revamp the clinical nutrition department website and assessing employee productivity. Nothing stressful and it’s all a good learning experience.

We’re also making progress on our Halloween theme meal. Right now our menu includes butternut squash ravioli in vodka sauce served with roasted root vegetables, chicken tamales (also served with the root veggies), pumpkin Tuscan white bean soup, Waldorf salad, pumpkin-bacon pasta salad and tons of Halloweenish desserts. We’re designing our menu and theme around the history of Halloween to go beyond the usual pumpkins and witches. If everything goes as planned the staff should be executing our meal on the 31st, which is also my last day of food service management (!).

Sorry there’s nothing too exciting to report at the moment. I guess I better enjoy the calm before I start clinical (or delve deeper in the theme meal and community project planning) because I know the interns working on the floors don’t have much downtime.

Food Prep

This has been a long and interesting week. I’ve been in the production portion of the food service management rotation. I’m beginning to see that managers have insane schedules! We start at 5:30am and often don’t leave until after 3:30 pm. The production manager we’re working under this week usually arrives around 5 and doesn’t leave until the evening, not to mention working weekends or other odd hours when needed. Wow.

We helped out in cold prep today making sandwiches and salads. Helping prep food was fun and made the morning go by really fast. Before I knew it it was 8:30 and time for a break. I love it when time flies like that.

We also were given our 2 major projects for both the food service rotation and rest of the year. One is designing a theme meal in the cafeteria for Halloween and the other is a community education project that will include all of the interns and hopefully some staff (if we do a good job recruiting help). Add those on top of the regular rotation schedule and other internship projects and commitments and I’m definitely going to be busy. This is what I signed up for though so I’ll find a way to juggle it all :o)

I did get to go to a telecommunication lecture on safe enteral feeding practices. Can you believe that there have been instances where a nurse administered a tube feed intravenously thinking it was a parenteral formula? Aren’t parenteral formulas clear? Tube feedings are definitely more brownish and thick. Crazy.

Tomorrow I’ll be working with catering, which probably means helping prep more food. Hopefully that means the day will fly by again and then I can enjoy a relaxing weekend.