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Tuesday, April 29, 2014

Dietetic Internship: Staff Relief

DIETETIC INTERNSHIP: Weeks 38, 39, 40 (of 41)
Staff Relief: Weeks 38 - 40

Finally!  The last phase of the Dietetic Internship is upon me: Staff Relief.  For three weeks, I will take over full responsibilities for one Registered Dietitian role at the Memphis VAMC, manage her floors, her patients, set follow-up dates, and complete other required RD administrative duties.  I have to see at least six patients per day, preferably 8, regardless of complexity.  Historically I have met with my preceptor each morning for her to parse out my daily patients; now I will decide and manage all 60 or so beds and determine my own priorities.  This step is like moving into adulthood.  Finally.  Undoubtedly full of challenges, too.

Alas, I did it!  I saw a WIDE variety of patients with different nutritional needs:   Bowel obstructions, Gastric cancer surgery, sudden respiratory failure and progression to vegetative state, emergency guillotine amputations below the knee because of horrible diabetes management, little old men that refuse to eat, pancreatitis, inguinal hernia repairs, and malnutrition.  I accompanied a cardiopulmonologist to the ER to watch him perform an emergency intubation.  NOTE: That is NOT a delicate procedure!  I watched a left and right cardiac catheterization (not part of RD duties, just interesting!).  I visited daily the sweetest 71-year old man w/ Parkinson’s disease that had severe GI issues and required total parenteral nutrition; he made my heart pour out with happiness and sadness simultaneously.

Overall, in three short weeks of Staff Relief, I made some interesting discoveries within myself and in this position.  (1)  I continue to fully enjoy the challenge of the complicated surgical intensive care patient.  (2) Going on daily rounds with the Director of Surgery (a wicked smart and witty woman), pharmacist, and medical and surgical residents encourages constant learning in a challenging environment.  Because VAs are teaching hospitals, the attending physicians must always be ready to question the residents, and hopefully provide a positive thought-provoking work setting.  I love this to no end.  (3) I also love being a part of the Nutrition Support Team and constantly calculating and re-calculating enteral and parenteral nutrition needs.  (I suppose characteristics from my Finance degree still linger prominently!)

Remember that “numbness” feeling one must assume in the ICU setting?  Patients die at high rate in the ICU, approximately a 20% mortality rate, and to become emotionally attached to any one of them risks regular, uncontrollable emotions yielding difficulty at objectively performing one’s responsibilities.  A person must assume not coldness but a mental distance while providing care.  (4) While I understand and have adapted to this unspoken requirement, I have realized one thing: I do not really care for it.  (5) All of the math calculations for enteral and parenteral nutrition and the challenging complexity of care do not seem to outweigh the delicate critical patients and the death rate.  I do not care for it (long-term) as much as I thought I would (short-term).  I like patients that can talk back to me, that are upright walking down the halls with physical therapy, and I suppose even the plentitude of cranky patients that give me a hard time.  I love the challenges, but perhaps the emotional disconnection is too much for my own personality.

“We are not human beings on a spiritual journey.  We are spiritual beings on a human journey.”
– Stephen Covey

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