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Sunday, March 31, 2013

Coffee IV & Earwax

Alas my 10-month Dietetic Internship has finally commenced! (Oct 2012... I'm just a tad late in postings!)  My applications were due back in Feb 2012, and I was matched April 2012 to the Memphis VAMC.   Master degree + thesis + graduation, followed by a 3.5 month journey to South Africa, and I have finally installed myself in The Bluff City!

DIETETIC INTERNSHIP: Weeks 1, 2, & 3  (of 41)
Weeks 1 & 2 - Orientation & Training

The first two weeks of a much-anticipated start date were significantly less eventful than expected....

The entirety of days 1 & 2 were consumed by an all-facility orientation for all new Memphis VAMC employees.  Every single person that steps through the door as an employee is required to attend (endure) a 2-day orientation of a revolving door of speakers on various topics:  IT Security, Privacy, Confidentiality, Biosecurity, Parking, the 5-foot greeting rule, Ethics, etc… 

It was boring, it was tiring.  Occasionally some doctor’s pager would sound and everyone would whip around, lusting that it he who was needed to step out of the room.  Who knew sitting in a chair listening to   people talk could be so exhausting!?

When day 3 came along, we were each singing, “Freedom!” as we skipped past our orientation room.  For me and my fellow 7 other Dietetic Interns, little did we realize that we were merely changing the location of our 8-hour/day lecture routine.  Eight days remained of clinical nutrition-specific training.  We had quizzes, lectures, lectures, and more lectures, and an occasional leg-stretching break.  Some lectures were beyond disgusting (staging pressure ulcers), some interesting, some very repetitive.

As expected, I survived fully intact, albeit a little hyped up on excessive caffeine consumption!

Week 3 - Outpatient: Community Based Outpatient Clinics (CBOC)

During each rotation, an intern has a Preceptor, which is like a combination mentor and boss.  My very first rotation was outpatient:

My preceptor told me, “You are supposed to see 2 patients per day.”  I about fell out of my chair in shock and horror!  REAL? LIVE? Patients?!  Oh my gawd!  To accompany the patients, one must also chart. Charting = So confusing (at first)!

Two patients does not sound like much at all, but for a first timer clinician learning how to read a patient’s e-chart, all of the background medical information, hypothesize the best areas to prepare for patient-instruction, and come up with a plan for the 1-hour appointment?... Wowzer!  Of course, the patient has not even arrived yet, and you’ve already prepared for 2 hours, but he/she may have completely different ideas and needs about this dietitian visit!

In addition to in-person outpatient visits, the VA CBOCs have "TeleHealth" appointments, which is basically a Skype (i.e. video conferencing) call.  Not all clinics have adequate needs to staff some medical specialists, such as pulmonary or oncology doctors, or registered dietitians. 
My Preceptor & I had 4 TeleHealth appointments one morning with the Tupelo, MS CBOC.  During appointments:

Patient 1:
**Patient sticks his finger in his ear, pulls out finger and examines the earwax stuck to it.  Uses other hand to remove and flick off earwax.
Apparently he has NO IDEA that we can see him on video, too!

Patient 2:
**  Preceptor asks, "Do you know why you are here today (i.e., why your doctor asked you to see a Registered Dietitian)?  “I guess it is because I got dia-BEET-us.”

Patient 3, with wife:
**After discussing dietary habits,  it was noted that the patient/family prepared fried foods/meals at least once per day, sometimes up to 3 times per day.  In response to a suggestion of reducing the fried food consumption in favor of boil/broil/roast/grill, "If we don’t have any fried food, well I just don’t know what we’ll eat around here!”  She meant that.  For me, this is called Job Security.  

After this week filled with half a dozen patients, I have looked back and laughed at myself and at some patient comments.  This could be a "Patients eat the darndest things!" episode!  I had some highly motivated patients, 1 patient cry, some talkative, some completely disinterested in (because their doctors made them come), and some very friendly.  It was a grab bag every hour!
My initial nervousness has mostly abated, and I've moved onto anxiety-free appointments.  I am not nearly as organized as I would like to be during appointments, but I know that this comes with time and experience, and I’m willing to put in both to become a good practitioner.


  1. Jessie! I miss you. We should meet up and share in our VA experiences...I've been doing chart abstractions at the Bham VA. I remember vividly one patient telling his nurse, "This doughnut IS my diabetic diet."

    I'll be thinking of you whenever I run into those little gems! Hope all continues to go well.

    1. Aerin! Oh my, oh my, for some reason I am NOT at all surprised! I have more VA stories to come - please keep them flowing, too! The patients seriously crack me up sometimes!
      PS- Birmingham & Memphis are not very far from each other... ;)