Clinical Nutrition · Life

a day in the life

I get asked very frequently by people who are interested in becoming dietitians or who have no idea what I actually do, “So what does your day look like?” For some reason, it’s always a challenge for me to describe my day. Usually, I try to explain that every day is different, but it’s also the same. Confusing? Basically, what I mean by that is that the work flow of every day is the same, but either my patients are different, or the needs of my patients that I’m following consistently are different.

On Friday I paid extra attention what I ate to outline what my day actually looks like. So here’s Friday, from the beginning to the end ūüôā

6:00 am- Wake up, get ready, pack up my lunch.

6:40 am- Out the door, drive to work. I’ve started taking the more scenic route to work because it really doesn’t take any longer and Oregon is beautiful. Plus I get better gas mileage when I’m not driving fast on the highway.

7:30 am- Arrive at work, clock in, get coffee from the cafeteria, heat up my breakfast.

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Last week I ate quiche for breakfast, so I didn’t eat until I got to work. Sometimes I eat on the road, it all depends on what I’m eating. I was HUNGRY by the time I got to to the hospital! Sometimes if I’m hungry before I leave I’ll eat at home. It all depends on the day.

7:45 am- Screen all the new patients in my units. I’m currently doing maternity leave coverage for the Intermediate Care Unit (IMCU) and the Neuro/Trauma Care Unit (NTCU). Once I have the new patients screened, then I build my list for the day and determine how many patients I have, and if I need any help.

8:00 am- Start my chart reviews and start prioritizing patients. I always see my nutrition support (enteral and parenteral nutrition) patients first and start off with a chart review in my office. Then later during the day I’ll do initial assessments and the after that, my follow up assessments. Once I finish my chart review, I head out to the floors to talk to nurses/see my patients.

10:00 am- Snack time!

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For some reason I wanted something sweet, so I went down to the cafe and bought this cereal. I snacked on it as I charted on some of my nutrition support patients.

12:30 pm- Lunch time! The RD crew always eats lunch together, which I love. It was nice on Friday so we ate our lunch outside.

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I buy my lunch about once a week at work. To me, the menu items are really affordable for what we get, but I know some people think they’re a little pricey. I usually go for one of the made to order entrees, and Friday just happened to be taco salad day! I had chips on the bottom, a pile of lettuce, shredded chicken, cheese, olives, jalapenos, salsa, and a pile of guac. I’m not a salad person at all, but I love taco salads!

This lunch was super filling and kept me full for a few hours. Lunch was full of lots of laughter on Friday, I just love my coworkers. Although it may not always be easy to work on a team, I’m lucky that there is a solid group of us that consistently collaborate, respect each other, and have each other’s backs.

1:15 pm- Return from lunch. Friday was a busy day, I didn’t actually get to start on my initial assessments until after lunch. My usual routine is to do a chart review, write down some key details, and then go speak to the patient.

One of the big roles of RDs in the hospital is identifying malnutrition. We no longer use BMI or labs like albumin as a marker of malnutrition, but instead we identify it by weight loss, poor intake, and a nutrition focused physical exam (NFPE). My initial assessments always include these components. I find myself asking “were you eating normally prior to admit?” “have you had any recent weight changes?” and “what is your usual body weight?” alllllll day long. I have learned that it’s important not to ask leading questions (“weight changes?” vs “weight loss?”) since the role of a clinical dietitian is often confusing for some people. Rapid weight loss paired with poor intake in the presence of an illness is not a good thing, and I find myself explaining that all the time to patients. I found that if I ask about weight loss, it’s mistaken as me suggesting that they need to lose weight. In the hospital, I want to see my patients maintain their weight!

I also do non-invasive NFPEs with most of my patients to assess for any muscle or fat loss. I typically looks at their clavicles, scapula, triceps, neck, and temporal muscle to determine if there is any wasting present. I’m getting much better at the NFPE, it takes a lot of practice to know what you’re looking for.

4:00 pm- I would normally be leaving work, but Friday was extra hectic, so I was still working.

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I ate my snack and continued to chart away! I had some canned tropical fruit (pineapple & papaya) with fresh strawberries.

5:15 pm- Finally able to leave work! Drive home.

6:00 pm- Arrive home. Immediately pour myself a glass of wine because of the chaos of the day.

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Not a huge fan of this sangria, but it’s not bad.

6:45 pm- Dinner!

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Cooked Trader Joe’s mini ravioli’s and mixed them with spinach & feta chicken sausage, white beans, and spinach that I had sauteed. Topped with cheese & pepper.

7:15 pm- Clean up from dinner and relax. I worked the weekend, and Friday was actually my Monday, so my evening consisted of catching up on Grey’s Anatomy (um, what is happening this season!?) and going to bed early.

9:15 pm- Bed time!

 

Clinical Nutrition · Life

6 Month Job Update + Life Lately

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Wednesday was officially 6 months at my clinical dietitian job at the hospital and 10 months ago today I had my first day at the hospital as an intern.

Time. Flies.

I just read back through my 3 month job update¬†and it’s absolutely insane how much I’ve grown since then! I still learn something new every day and know that the learning never stops, or at least it shouldn’t! ¬†I’ve also become much more detail oriented and haven’t had any more incidences of accidentally missing someone or something important. I truly think sometimes it just takes making mistakes to learn.

In November I had the opportunity to apply for a full time position that would include my own area in the hospital. Unfortunately, I didn’t get the position. I feel really fortunate because as much as I really wanted the position and my own area, I’ve been able to see the positives of continuing to float and spend time building skills in different units with different types of patients. Plus the girl who got the position was more than deserving of it. She was a classmate of mine in undergrad and a fellow intern last year, so I’m excited to see her succeed as a young RD and be rewarded for all her hard work.

3 months ago I had just started working in ICU and since then it’s become more of a regular unit for me to work on. We have 7 full time RD positions that split the ~15 units of the hospital, but 2 of those RD positions cover ICU. ¬†The ICU is a 30 bed unit and one RD covers 19 of the ICU beds and the other covers the remaining 11 beds plus the 18 ICU level bed on the cardiovascular care unit (CVCU). Those ICU patients on CVCU are mostly open heart surgery patients or those with serious cardiac arrest that has required CPR and left them with potential brain damage due to lack of oxygen for a period of time. For the most part, the ICU level patients on CVCU don’t require nutrition intervention but there are always a few that are having a difficult recovery and are requiring tube feeding.

In the last few months I’ve covered the ICU + CVCU position¬†a lot. The position may have a lot of beds, but the RD rarely has more than 10-12 patients on their list, which is manageable. I’ve really grown to love the critical care setting which is funny because as an intern I was totally and completely terrified by ICU. It amazes me how much knowledge I have now compared to then and how comfortable I am with more complex situations. I still find myself asking for help pretty frequently but I’m more confident making simpler decisions on my own now. I cover ICU for ~2 weeks in February and I’m really excited! But also a little nervous!

Anyways, I still completely love my RD job. I love the hospital and I love my coworkers and I love helping my patients. Yesterday I had 6 educations, which is a lot, and every single one of those patients was super excited about nutrition. Yesterday was definitely the exception since nutrition is often not the favorite topic, but it was so nice to spend time helping my patients set goals about their health and see them so genuinely motivated. I was so busy yesterday and stayed almost 2 hours late, but those educations made every single second worth it!

As for my January so far:

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I successfully donated blood for the 8th time last week and I’m now officially a gallon donor. If you can give blood, please do! It’s so important and only takes an hour of your time. Go to the Red Cross website to read about the eligibility criteria and find a blood drive near you!

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I bought these beautiful Alex and Ani bracelets for myself as a late Christmas present and I am obsessed. Don’t mind my dingy looking lab coat sleeve…

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I got to spend time with some church friends on Wednesday and play Clue and drink tea. It was a rager! Haha. But seriously, there is nothing more fun that bundling up on a cold winter night and playing a classic board game!

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My BirchBox¬†(<–referral link)¬†subscription continues to be one of the best decisions I have made in the last 6 months. I love opening these every month! Plus I’m obsessed with the “Let’s Do This” slogan for 2015.

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This Buzzfeed quiz had me laughing so hard. I literally just told someone the other day that I could never be vegan because I love cheese too much. 035

This is how my day started yesterday, with my coffee leaking everywhere. I got to work to find a puddle of coffee in my cupholder. Only on a Friday…

Hope you all have a wonderful weekend!

Clinical Nutrition · Dietetic Internship · Life · Weekly Recap

Week 38 Recap

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I can’t believe I’m actually saying this but….I’M DONE WITH MY DIETETIC INTERNSHIP!!!!

I literally cannot believe this moment has finally arrived.  I woke up on Friday morning and it felt like Christmas morning, I was so excited! Finishing this internship was also ten times better than finishing a school year, or even college in general, because there are NO FINALS! All I had to do was show up, work a full day, and I was done!

This week was a rollercoaster, just like all the other weeks. I was doing my second week of clinical staff relief at the same city hospital that I did my 10 week clinical rotation at.  Monday was a little more insane than usual because I had to fit in an hour and a half appointment to fill out new hire paperwork and do my drug test, etc.

That’s right….I’m going to be working at the hospital I was interning at!

I was offered the job about 6 weeks ago, but until recently all I really had was a contingent job offer. I completed all my requirements for employment there and now that I’ve finished the internship the job offer is officially official.

It really threw a monkey wrench into my Monday to have to take time to complete all of those appointments, but luckily my awesome preceptor was there to take some of my patients for me.

I know I still have a long ways to go and I have so much to learn, but I feel really confident that I’ll be a successful dietitian at the hospital. The team of dietitians there is so incredibly supportive and caring that I know I’ll be well taken care of while I’m training.

I’m not sure what exactly I’m allowed to call myself during this awkward inbetween period. I signed a paper from the Commission of Dietetics Registration that says I won’t call myself “Registered Dietitian Eligible” and I know I’m not really supposed to call myself just a “dietitian” so hopefully my new boss can provide me some direction with that!

I don’t start working until July 14 so I get a two week break before I jump head first into a job! I’ll essentially be scheduled per diem, but I’ll be training full time and likely will be taking my test shortly after my training period, since it’ll probably be around 6 weeks. So all my plans about being able to study full time this summer to prepare are gone!

I’m driving home tomorrow and I’ve loaded up the Inman’s Review Course CDs onto my phone to listen to while I drive. I have intentionally not been studying at all because I was overwhelmed enough with the internship and staff relief, so it’s kind of scary to realize now is the time that I actually have to start studying and I can’t avoid it any longer.

Immediately after finishing up at the hospital on Friday I drove down to Eugene to meet up with one of the other interns and we took off to the coast to meet up with three of the other interns for a camping trip! It wasn’t real camping because we stayed in a yurt and therefore had electricity and real beds, but after an exhausting week it was close enough to camping for me!

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The weather ended up not being half bad. It absolutely poured on Friday night but then after that it cleared up on Saturday and we even got some sunshine in the afternoon! It was a really fun trip but I am beyond exhausted now. I got home a little before 1 this afternoon and it’s taken so much effort to unpack and do laundry and deal with all of that. I also have to pack again for 2 weeks at home. I’ll be making the 10 hour drive tomorrow morning!

Now that I’m done with the internship I’m not sure what the blog is going to turn into, but I’ll post while I’m home with my next plan for this site!

Clinical Nutrition · Dietetic Internship · Life · Weekly Recap

Week 37 Recap

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Well, I can officially say that I survived my first week of clinical staff relief! It was the most exhausting week I think I’ve ever had as an intern but it was so great to know that I¬†am¬†capable of being a dietitian and I really have come such a long way this year.

I got to the hospital at 7 AM on Monday morning and immediately felt very overwhelmed. ¬†The hospital I’m at has 6 RD positions and for staff relief each of us interns get assigned a position to cover. ¬†I’m “RD5” for these two weeks, meaning I cover the med tele floor, inpatient rehab, and general surgery. I’m really thankful that I spent my 10 weeks at the hospital so late in the year because I didn’t need a refresher on how to screen my area for patients and I was aware of some of the major changes that have been made with the work flow of the positions.

I started by screening my area and realized that not only did I have quite a few patients on my list (I had around 10 every day this week), but a few of them were VERY messy patients, meaning I would need to spend some time on them.  One of them was even a possible TPN which nearly put my anxiety over the edge.

Don’t worry though, I survived ūüôā

Although we were covering areas, the dietitians that normally work those positions were there and available as resources.  When I was there strictly as an intern I asked a lot of questions without putting that much thought in beforehand.  This time I tried to take a different approach and I really thought about things before I would ask a question.

By the end of the week I really feel like I got settled in and I know next week will go a lot more smoothly. ¬†I’m actually kind of glad I had such complicated patients this week because it was good to have to work through those scenarios but to still have a preceptor there to guide me. ¬†All our notes still have to be cosigned and I did have changes made to about half of mine, but I think my notes improved as the week went on.

Another huge accomplishment: I finished on time every day! I think this is especially important because I need to know I can step into a clinical dietitian position and be able to handle the workload and not have my employer on my case about overtime.

Last night, after an exhausting week, we got to celebrate with a little graduation reception. ¬†Unfortunately, most of the preceptors didn’t show up, but I had a lot of fun with the interns and some of their boyfriends/husbands. ¬†Plus our director was there and she is one of the most entertaining people I’ve ever met.

We all gave each other little awards and I got the one above.  Future interns out there: this is an excellent idea for an end of the year get together! We all nominated each other for awards (we had no guidelines so some of the nominations were hilarious) and then had a voting process. At our last class day we all drew names out of a hat and that was our intern that we had to create an award for. It was all a secret so yesterday we presented each other with our awards and a little gift and we spent the entire time cracking up. We read all the nominations before we presented the awards so that made it even better.

I can’t believe I only have a week left! My post wrapping up the internship will be a little delayed since all of us interns, minus 2 who can’t make it, are going on a little beach trip starting immediately after we finish on Friday. ¬†I am really looking forward to it because this has been an¬†insane 10 months! After that I’m headed down to California for a little two week vacation to visit my family.

So many exciting things on the horizon!!!!

Clinical Nutrition · Dietetic Internship · Life · Weekly Recap

Week 33 Recap

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Week 33 is done and my 10 weeks at the city hospital are over!

Let me tell you, nothing this week went as I planned it would. Nothing.

I woke up on Monday morning with a full blown cold, not just a sore throat or some other indication that I was getting sick, a full blown cold.  I absolutely freaked out on Monday morning when I realized I was sick because my case study was this week and I felt like I still had a lot left to prepare for it.

I was back in ICU this week with a different dietitian and we were also responsible for the Cardiovascular Care Unit (CVCU). ¬†My previous experience in ICU made me think that it was going to be a busy week and since I wasn’t feeling 100% I was nervous. ¬†Thankfully, it was the slowest week we had since I started there in March and I actually got to leave early every day.

In hindsight, I probably shouldn’t have kept up with my normal social activities this week. ¬†I just have the hardest time saying “Sorry guys, I’m sick,” when I just have a cold. ¬†I also know that if I’m not feeling well the best thing I can do is distract myself but often times that leads me to feel even more exhausted later.

By the time Thursday rolled around I still had a full blown cold and I had to give my case study presentation at the RD/DTR meeting after lunch. ¬†I don’t know about anyone else, but I feel like every time I give a presentation I just totally black out and have no recollection of what actually happened during the presentation. ¬†Almost everyone had really great reactions to the presentation so I knew I had done something right!

I literally cannot believe I pulled it off being so sick. ¬†The group of RDs and DTRs that I had the chance to work with were all so incredibly supportive and I felt very comfortable giving my presentation to them. ¬†One of the DTRs even told me today that I didn’t seem like an intern giving a huge presentation to them, I just seemed like another RD presenting some useful information I had found.

Best. Compliment. Ever!

I’m so excited that I will be back at the hospital for 2 weeks of staff relief! ¬†I think it really hit me today that even though I have learned an incredible amount in the last 10 weeks I still have so much more to learn! ¬†I have my RD exam study guide and I’m going to bust it out soon and really get serious about learning what I know I don’t know.

Since it’s a 3 day weekend I plan on relaxing and letting my body heal. ¬†I have totally fallen off the exercise wagon, for obvious reasons, so I’m hoping to get in some kind of mild, low intensity workout tomorrow since I won’t have work. ¬†As someone who really relies on working out 3-4 times a week both for weight maintenance and energy, this week has been really hard. ¬†Obviously rest has been necessary this week but I’ve found myself just laying around so much doing nothing and more than once I thought “I could be at the gym right now if I felt better.”

I guess I learned this week that I really do like going to the gym and I enjoy working out a lot. ¬†Part of that might be that it’s the only time I allow myself to read for fun on my Kindle, but I have to find motivation somehow ūüôā

Anyways, I hope everyone has a wonderful 3 day weekend! I have watching Frozen on my agenda (since I still haven’t seen it!) and trying to work my way through the pile of magazines that has accumulated that I haven’t had time to read.

Fingers crossed I wake up feeling better tomorrow!

Chocolate · Clinical Nutrition · Cookies · Dietetic Internship · Life · Running · Weekly Recap

Week 30 Recap

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I feel like all of my weeks are busy but this week was way busier than most of them are!

On the bright side, there are only 8 weeks left and then I’m done…which is both terrifying and incredibly exciting.

This week started like almost all my other ones do, work for 8 hours and then go to the gym before going home. ¬†When I got to the gym on Monday I changed into my workout clothes in the locker room and then right as I was putting on my shoes the power went out….

Now, Corvallis is a special place.  When we get power outages, they are going to last a few hours.  Not the 10-15 minute max ones I used to experience as a kid in California.  I ended up heading home and going on a run instead since I was already in my workout gear and determined to get a workout in.  It was a beautiful night and the weather was perfect for a short 4 mile run.  I had to snap some pictures while I was running but in no way to they do this state justice!

Anyways, I started this week in ICU on Monday and Tuesday and then on Wednesday I started in intermediate care (IMCU) and neuro-trauma (NTCU). ¬†My preceptor on Wednesday was actually one of my TA’s from undergrad and it ended up being a lot of fun working with her that day. ¬†It was kind of a transition to get away from critical care but we still had some tube feeders so it wasn’t a complete shift away from that kind of charting.

Thursday I got to attend the Oregon Academy of Nutrition and Dietetics conference in Portland.  Dietetics is a very small field, the national group, the Academy of Nutrition and Dietetics, only has a little over 75,000 members.  Of course, not every dietitian is a member, but that is still a small group!  It was great to have the chance to get together with 200 other dietetics professionals and talk about our field.

Dietetics really does offer a very unique set of skills and dietitians are trained to do a job that no one else can do.  It was great to hear dietitians talk about how we can promote ourselves and protect our careers and spot in healthcare, especially since there are so many pseudo-nutrition specialists out there who are attempting to offer our services with minimal training that would allow them to do so.   Part of claiming our place is making the public aware of who we are and what we are trained to do.

No one would take medical advice from someone who isn’t trained in medicine, or financial advice from someone who isn’t trained in finance, so why take nutrition advice of any kind from someone who isn’t¬†specifically¬†trained in nutrition?

It’s something I’ve honestly never understood and diet is linked to so, so many preventable diseases that is absolutely blows my mind that the public is either uninterested in the expertise dietitians can provide or they’re willing to take advice from the media, which is advice that is rarely backed up with evidence based research, and take it without question.

I could go on, but I’ll step off my soap box now….

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We also got to present our internship research project in the form of a poster at the OAND conference which was pretty neat.  A lot of the dietitians were really interested in what we found during our focus groups and were excited to see that we were working with the college population. It was really cool to see my name on a poster!

Thursday when I got home from Portland the weather was incredibly beautiful (around 85 degrees!!!!) so I decided to go on a long bike ride since I just really didn’t feel like going on a run. ¬†I rode my bike all around Corvallis for around 45 minutes and then did some Nike Training Club workouts when I got home. ¬†If you’re looking for some workout inspiration, I highly recommend the NTC app. ¬†The workouts are killer!

Much to my displeasure, I had to return to the hospital on Friday to finish off the week.  I was actually working with one of the younger dietitians and we ended up encountering a very complicated patient.  A doctor was interested in starting peripheral parenteral nutrition (PPN) on a patient I had been following all week and it was something neither me or my preceptor had encountered outside a textbook.  It was an incredible learning experience and a great chance for me to get used to communicating with doctors and pharmacists.

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Since this week was so incredibly busy and hectic, I spent my Saturday night making cookies instead of doing anything exciting.  I am pleased to report that for the first time EVER I did not over bake my cookies and they are still soft today!  I went with the classic Nestle Toll House recipe and used chocolate chunks instead of chocolate chips.  It was an excellent way to end the week!

 

Clinical Nutrition · Dietetic Internship · Life · Weekly Recap

Week 29 Recap

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It’s Saturday night right now and I can honestly say that since I woke up on Easter morning my life has been non stop for this entire week!

Of course, Easter was a wonderful way to start the week. ¬†I went to church, hung around after for breakfast, worked on a study guide when I got home, and then went with my roommate to her parent’s house for Easter dinner and an egg hunt. ¬†All together it was a great day and it was great to be able to spend time enjoying myself AND still prepare myself for this week of rotations.

Oh, and my Easter started with this breakfast:

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Pumpkin pancakes, eggs, hashbrowns, berries, and of course, coffee.

I wish I could eat breakfast like this every day!

Anyways, I spent this week of my hospital rotation in the intensive care unit (ICU). ¬†It was….an experience. ¬†I’m actually still going to be in there on Monday and Tuesday and I’ll have another week at the end of May so I’ll have 4 weeks total of experience in critical care (ICU and NICU) which is¬†way more than I originally was scheduled to have.

I can’t decide if I really like critical care or not. ¬†One of the aspects of critical care that I really enjoy is how incredibly detail oriented it is. ¬†I really love details and I love tracking details. ¬†The critical care dietitians use what the hospital has named “visual management tools” (which is really just a fancy name to justify using a paper to track information instead of relying solely on the electronic medical record), so every morning starts with an in depth chart review of every patient the dietitian is following, usually anywhere from 7-12 patients.

They track everything from lab values, medications, and GI status (if they have a distended abdomen, are nauseous, etc.) to the amount of urine that is coming out of their foley catheter, the rate their tube feeding is running and the total amount they have had in a 24 hour period. ¬†They use the information they collect to make a snapshot of how the last 24 hours has gone for the patient and then decide what they want the patient to work on that day. ¬†Sometimes it’s increasing a tube feed rate, changing a tube feed formula, encouraging them to eat by mouth, or a number of other things.

I would say recognizing the big picture of what is happening with a patient is essential regardless of where in the hospital they are, but because of the critical care atmosphere it seems to be much more the focus of what is happening.

The entire care team rounds together every morning and it usually takes around 2 and a half hours to get to all 30 rooms on the floor and talk about what’s happening with each individual patient. Luckily, the dietitians only have to round on the patients they are following, which isn’t everyone, so it doesn’t take much more than an hour total. ¬†It’s so cool to see how everyone really works together as a team in the ICU and respects each others disciplines and opinions on the patient’s care.

The one thing I don’t really enjoy about the ICU is the lack of patient interaction. ¬†Many of the patients are intubated and sedated and are obviously in no position to be interviewed. ¬†A lot of time family is available but depending on the status of the patient and their outlook the families are often very emotional, distraught, and overwhelmed. ¬†To a lot of people it’s a very scary moment when the dietitian comes in and tells them that their loved one is going to start getting a tube feed. It takes a lot of explaining and educating the family about how a tube feed is incredibly beneficial to someone in the ICU who has a functioning gut and how it can help with their recovery in a tremendous way.

I love how important nutrition is in the ICU and how everyone values it as much as medicine, but it’s hard to have to read about the tragic events that have landed the patients in the ICU and even harder when you come in in the morning and realize the patient you spent an hour charting on the day before has passed away. ¬†Sometimes even the entire care team giving 110% to a patient isn’t enough to stop the inevitable.

I think I’ve learned more this week than I have in a long time, not just about nutrition, but about life. ¬†I’ve seen people get better, I’ve seen people die, and I’ve seen about every phase in between.

I feel very fortunate to be healthy, happy, in school, and moving forward with my career!