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Monday, April 8, 2013

Patient tears

Here we go again with more patient and Dietetic Internship adventures at the Memphis VAMC!
(Blog post for Weeks 1, 2, 3 can be read HERE)

DIETETIC INTERNSHIP: Weeks 4 & 5 (of 41)
Week 4 - Outpatient at the hospital
Week 4 ushered in a similar, but slightly different patient: Outpatient at the hospital.  Just as if you might go to the hospital for appointments with your cardiologist, have blood drawn at the lab, etc, you would also see your Registered Dietitian.  

I am coming to (quickly!) learn: Every rotation has new challenges.  This one started with 2 enormous assignments that took about 40 hours (outside of work) to complete, teaching a food demo, co-teaching a cardiology healthy living class (cholesterol focus), and a truckload of online training courses due this week. Oh, patients, too.  Let’s not forget about them   And a presentation on Friday.  To top it off, a fun transition from an 8:00am start time to 7:00 am.  I like getting up early.  I don’t like the loss of an hour change!

Some highlights from this week:

Patient 1
On Wednesday morning, my patient was an 86 year old man that had never had a visit with an RD.  He was progressively gaining weight, particularly in the past few years he had put on significant weight, yielding uncontrolled diabetes mellitus, high blood pressure, and high cholesterol.  I started with the basic appointment questions, and quickly surmised that something was amiss.  I probed.  I gently questioned.  My empathetic connection has always been well-oiled and running, and soon this gentleman was in tears.  As was I.  He had terrible, unabashed tears.

A few years ago, this man turned to food as a coping mechanism, specifically binge eating, after his daughter had a double mastectomy.  He had embraced her devastations as his own, blaming himself for the outcome of breast cancer and double mastectomy.  At some point, he had read that sugar is the root of all evil in breast cancer, essentially that excess sugar causes *all* breast cancer.  He knew that on multiple occasions in the past, he would drop by his daughter and grandson’s house, bringing gifts of a couple cases of soda (her favorite) and some other sweet treat.  He was being thoughtful, and now, he cursed his thoughtfulness, and himself, as wreaking this havoc upon her.  He went on to tell me that he turned to food as his method of coping with his guilt and pain.  (This is NOT an unusual coping mechanism response.)  He binge eats at home, he goes to buffets by himself and eats 5 or 6 plates of food.  To top it off, he was aging, and slowly his closest friends were dying.  Socially, his support network was quickly shrinking. He was lonely and guilt-stricken, feeling as if he were dying inside, and that he had a hand in nearly killing his daughter.

His tears flowed freely, and despite my best efforts, mine did as well.  Obviously the standard question-answer-counseling appointment schedule did not occur.  We fleshed out his pain, his guilt, and the etiology of each.  Another appointment was made, as he told me, “This is the first time somebody paid any attention and listened.”  That just further broke my heart.

Patient 2
After double checking the medical chart, it was confirmed that I indeed had a female patient.  It is not common to have a female patient, and can be exciting and nerve-wracking.  In just a few short weeks, I have already come to know and expect male interactions.  This lady was also my same age.  In addition, she had a flag on her record for suicidal ideations, all of which were unusual to me.  Needless to say, I had started to develop a little bit of anxiety at seeing her.  After fetching her from the waiting room, her warm smile quickly put me at ease, and the next 45 minutes were relatively easy going.

I had other patients this week, but these two were the only that really stood out.  It is interesting how easily patients can pry into your heart, or under your skin.  I welcome the feelings of being in touch with my fellows.

Week 5 - Offsite: Church Health Center
During this week, my rotation was off-site at a local community center and clinic, the Church Health Center.  The CHC provides affordable medical services, and health and wellness services for the working un- or under-insured.  At a community center, my responsibilities varied widely from the traditional hospital experience.  I taught a big cooking class; on the menu: Traditional hummus & Black-eyed pea hummus.  Yum!  The participants are amusing, to say the least, as they playfully grumbled and harassed each other during class, and reluctantly tried this "new" stuff.  I made some converts!  (PS- Email me for an easy recipe!)

One very interesting patient experience: I had my first nutrition appointment with a Spanish speaker--- I speak French, not Spanish.  She spoke Spanish, not English or French.  Working through a translator was a new and interesting experience!  Oddly, I understood way more than I thought, and often responded (in English) before the translator translated the Spanish!  I am not sure of its overall effectiveness, but I think there is plenty of potential.

(Blog post for Weeks 1, 2, 3 can be read HERE)

"Approach love and cooking with reckless abandon."

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