Halitosis, Grouchiness, and Orgasms

DIETETIC INTERNSHIP: Week 15 (of 41)
Week 15 - Psychology, Oncology, Cardiology

This is week 2 of a very wide mix of patients: oncology, cardiology, and psychiatry.  I have a personal interest in psychiatry patients, and needless to say, those conversations were *always* very interesting.  Because I do not like to poke fun at others when the handicap is not within their realm of control, I will reserve most of those interactions.  One, however, was embarrassing enough to share… (See “Friday’s patients”).  Here is a brief chronicling of my second week:

Monday's patients were mostly uneventful, but that did not last long this week...

Tuesday’s patients were generally well and good, but the last patient of the day had some of the worst breath I have ever smelled.  He recently had a severe stroke, yielding impaired speech, so I had to look and listen close.  I almost gagged as I leaned in closely.

Wednesday's patients took Tuesday's breath to an entirely different level.  

I went on "meal rounds," which involves visiting each patient on a specific ward to assess appetite and meal consumption.  It seemed every other patient room I entered smelled like rotting poo.  Literally.  Normally I try to take ample care and time with each patient, but with the vast majority making me nauseated at entry, time in each room was limited.  Retched!
(FYI: I smelled the food, that wasn’t the culprit!)

Thursday’s patients yielded relief to the stench!  I got what I asked for, no more pong, but it was replaced by grouchiness.  Serious cantankerousness.  I hadn’t noticed any change in my attitude this day, but the patients were verbally combative from the moment I introduced myself.  My last patient of the day was slated to be the worst of them all; I visited his room five times.  Yes, five, to educate him on his new medication, Warfarin, and the drug-nutrient interaction with vitamin K foods.

    First visit- He was out for a procedure.  That is ok, I’ll come back later.

    Second visit- A nurse was in the room. All I could hear was him yelling at her, being cranky, and disbelieving of everything the medical staff had implemented (medications, procedures, everything!)  (I‘ll come back later!)  At the nurse’s break station, the recent nurse arrived with sighs of his crankiness.  All of the nurse’s chimed in to recount recent interactions with him – all bad!

    Third visit- Upon entry and introduction, I greeted him sitting up eating his late lunch tray delivery.  First words out of his mouth, “Here’s another person coming in to waste their time.”  (Ohhhh, great.)  “Why does everyone come in right when I get my meal?”  I offered, ahem, insisted, that I return in 30 minutes so that he could eat in peace.

    Fourth visit- He mostly forgot why I had arrived on my 3rd visit, so we started over, him with a standard reception of baseline grumpiness.  It took me a while, nearly 15 minutes, just to break the ice of grump.  I’m not sure how I did this, but somehow I made a lucky entry into his joyful side.  He was smiling, laughing, and offering me soul food cooking tips for 10 solid minutes!  I stayed and chatted with him for another 10 minutes, and was able to cunningly educate him on vitamin K foods and Warfarin interaction to the point that he could repeat it back to me.  As I left he smiled and said, “Have a blessed day!”  

    Fifth visit- DANG IT! I forgot to ask him about vitamin and mineral supplement intake, so I had to go back.  I entered with trepidation, hoping that our shared goodwill would continue.  He was initially skeptical, but warmed up quickly to me again.  We laughed some more for another 5 minutes, more subtle education, then I slipped out.  I think he even enjoyed my company, and I enjoyed briefly eliminating his petulance!

Friday’s patients involved a few standard low-sodium diet educations, but then my visit to the Psychiatric ward for diabetes education trumped all for awkwardness.  To get into the unit, one must proceed through triple locked doors manned through video admission.  Once inside, I found my patient's door blockaded by a sleeping man, complete with pillow and blankets, at the doorstep.  This was my patient's roommate, my patient was resting inside with the door locked.  A friendly nurse opened the door for me, and I found my patient pleasantly awake, but I quickly learned, very hard of hearing.  I belted out pleasantries and education, then had him read to me some of the diabetes handout.  He painfully and slowly read through every single non-starchy vegetable on the list, then stopped suddenly and reached under his blanket.  In less than 2-3 seconds he paused, put his head back while exhaling stuttered sounds of relief and joy, then looked back at me and the handout.  Just as quickly, he resumed slowly reading aloud recommended vegetables.  What just happened??  I finally processed the events:  I was witness to a very fast and very unanticipated orgasm.  Was it me, or the thoughts of broccoli and green beans?

“Confidence is what you have before you understand the problem.” — Woody Allen