Adjusting to a New Norm

Dietetic Internship adventures at the Memphis VAMC continue! (Previous week's blog posts can be found to the left under the navigation by date headings.)

DIETETIC INTERNSHIP: Weeks 10, 11, & 12  (of 41)

Weeks 10, 11, & 12 - Nutrition Support

After 2 brief weeks with inpatient clinical dietetics, I was doused headlong into my next big rotation: 5-weeks of intensity in Nutrition Support.  Warning: This title is deceptive.  The Nutrition Support registered dietitian may cover various wards, but at the Memphis VA Medical Center, she covers ICU, Surgical ICU (SICU), and is a team member of Nutrition Support team.

The ICU patient is one of the most complex patients, and has the highest death rate of any ward, up to 20% average across the US.  The ICU is also the site with the highest number of medical errors due to the complexity of care.  This place is intense.  INTENSE.  I was turned loose as the nutrition expert on the ICU team (decisions reviewed before action, of course!) among medical residents and doctors.

Some of the first things I learned: Involvement in any ICU ward requires a mental adjustment, specifically adjusting to the high frequency of death.  The ICU death rate across the US is approximately 20%; these patients are very sick and very delicate.  This mental adjustment happened to me without having made a conscious decision.  Essentially, one must become slightly –numb—to patient outcomes, not becoming too emotionally attached to any particular patient.  It is easier when the patient is unconscious, but still not entirely feasible.  An average day can be a very somber experience.  During a 3-day stretch, 3 of my patients died.  It was not uncommon returning from the weekend off to expect at least 1 patient passing.  Such is the norm for the sickest of the sick.

DIETETIC INTERNSHIP: Comedy on Jefferson Avenue

One afternoon after work, I was greeted by a hilarious sighting.  As I walked out of the VA, I spotted an older male VA pt pushing a walker across the street back to the hospital.  How did I know he was a hospital patient?  Oh, because he was wearing only his hospital gown!  (Thankfully tied closed).  His field trip apparently had a goal in mind, as I spotted a bag of something fried under his arm.  Fried chicken, no doubt.  Oh my, oh my, men in the South! (and patients at the VA!)