Moving: All to come, All that is left behind

Moving is hard work.  Organizing your entire life into tiny boxes is not fun.  Hauling boxes to moving trucks, moving containers, or USPS is exhausting.  But honestly… the really hard work comes in the weeks preceding the move and I am not talking about boxes.

My last Memphis sunset as a resident

Many people tried to warn me of moving to Memphis last year.  “The crime is terrible, the racism is substantial, and the city is fragmented, poor, and unhealthy.”  Yep, after one year, I agree.  But guess what?  All of these undesirable characteristics exist in practically every city, just to a greater or lesser extent.  I have found happiness here, as well as equality and cultural richness.  Ultimately, however, I did not find my future employer and now must depart this Mississippi River city.  

Hugging Strangers

In 2006 Oprah conducted an interview with Juan Mann, the founder of the “Free Hugs Campaign.”  Free Hugs is a campaign that started when Juan Mann came back to his home country of Australia, walked through the Sydney airport unaccompanied with desires of embrace or friendly recognition; he felt alone and hopeless.  Instead of rolling in his own sadness, he acted (proactivity, one of my favorite characteristics) and did this:

“I'd been living in London when my world turned upside down and I'd had to come home. By the time my plane landed back in Sydney, all I had left was a carry on bag full of clothes and a world of troubles. No one to welcome me back, no place to call home. I was a tourist in my hometown.

Standing there in the arrivals terminal, watching other passengers meeting their waiting friends and family, with open arms and smiling faces, hugging and laughing together, I wanted someone out there to be waiting for me. To be happy to see me. To smile at me. To hug me.

So I got some cardboard and a marker and made a sign. I found the busiest pedestrian intersection in the city and held that sign aloft, with the words "Free Hugs" on both sides.

And for 15 minutes, people just stared right through me. The first person who stopped, tapped me on the shoulder and told me how her dog had just died that morning. How that morning had been the one year anniversary of her only daughter dying in a car accident. How what she needed now, when she felt most alone in the world, was a hug. I got down on one knee, we put our arms around each other and when we parted, she was smiling.

Everyone has problems and for sure mine haven't compared. But to see someone who was once frowning, smile even for a moment, is worth it every time.”

I empathized with his feeling of loneliness and of reward.  The Oprah interview touched my heart in some confusing way that made me want to emulate his goodwill.  I was a (back-to-school) student at Georgia Institute of Technology at that time and with the recruitment of a friend, I embarked on my first Free Hugs afternoon.  Still don’t know what I’m talking about?  Here, watch this video:

A coffee a day makes a registered dietitian?

At the end of the day on July 19^th, I was officially unemployed.  My dietetic internship was complete, I was a few weeks away from eligibility to take the Registered Dietitian exam (paperwork, etc), and I had a lot of studying to do BEFORE I would be prepared.  Alas once again I was a student with no job and at that moment, no credentials.  In the words of Scooby doo, “Ruh roh.”

After a few days of non-sense and reclaiming my house after 4 weeks of disorganization madness during Staff Relief and Graduation week, I embarked upon the daunting task of studying.  The RD exam costs a few hundred dollars to take it and I only intended to take it ONCE.  Each Dietetic Internship program (in my case, the Memphis VAMC) is ranked by multiple components, including the first-time pass rate of its graduates.  The Memphis Director let it be known that thus far she had a 100% success rate (against a national average of ~82%) and that she Would. Not. Accept. Anything. Less.  Fear tactic.  It totally worked.  That, and I am very thrifty.

Dietetic Internship Graduation! Week 41 of 41!

DIETETIC INTERNSHIP: Week 41 (of 41)

Graduation Week: Week 41 - THE LAST WEEK!!!

It felt like Staff Relief would never end but hallelujah it did and the last week of this Dietetic Internship has finally arrived!  Graduation week!!  This week spilled over with presentations, final training, and paperwork; no work days were completed in less than 10 hours.  To make this week even more memorable, on Tuesday morning I received a rather peculiar email; a fellow dietetic intern colleague Nick also received it verbatim:

“You provided patient care to a patient that has since tested positive for tuberculosis.  You provided patient care to “Mr. TB” on xx/xx/xx date, and have been exposed.  Please arrange to go to Employee Health as soon as possible to be tested for TB.”

Nick & I both received the email while in the office together.  I heard an awkward chuckle at the workstation behind me.  I read the email without fully comprehending it, then re-read it.  Before I realized it Nick & I were already in harmony through grunts and “uh huh,” logging out of our computers and nearly galloping to Employee Health!  As a reminder: TB tests require a small amount of innocuous TB strain to be injected to your forearm and then the ‘test’ is read 48-72 hours later.  Later that night I was at home regarding my forearm.  Not only had the area swelled, but also it was bright red with clear edges.  OH MY!  UH OH!  I was SURE I contracted TB!  To make matters worse, NPR was airing weekly stories on TB from across the globe.  I knew one thing: This was bad, BAD.  Like isolation and sequestration for months or even years, bad!

The Blackberry Walk

 Most days after work I exercise.  Before I moved to Memphis, I was a bike commuter for two years in Athens, GA, climbing 6-9 miles of hills daily in weather ranging from 19°F to 92°F.  I got used to it, donning a ski mask and windproof gear in the winter, and buckets of sunscreen in the summer.  Honestly, I really liked the sweatiness, but I liked even more the constant physical activity in my day.  Since moving to Memphis 9 months ago, my days have been starkly different.  Out the door by 6:30 am, I hop in my car for a 16-minute highway commute.  I hate car commuting.  Hate it, hate it.  No exercise.  Wasting fossil fuels.  Consequently I became a car-driving gym-goer.  This habit has manifested itself at other times in my life and usually works away from the monotony eventually.  For example, for nearly 4 years I minimized all gym appearances, except during bitter winter temperatures, in favor of rowing on the Chattahoochee River for Georgia Tech.

I Love Memphis graffiti art

Now back in the gym trying my best to maintain healthy compliance, I despise the reliance on a commute.  Alas the weather has finally turned beautiful again, encouraging strolling a few times per week after work; I happily abandon the gym in favor of power walking.  Mapping out a three-mile loop from the VA Hospital to downtown Memphis and back, I stay challenged and sweaty.  On my second walk one 87°F afternoon, I discovered a wild patch of blackberries about 2/3 through that made my heart scream and shout with excitement.  In an abandoned driveway/parking lot between two buildings, a 100-foot length patch of weeds, vines, and bushes grew.  As I sped past the lot a few lone blackberries sparkled in the sun, grabbing in my eye.  Whoa!  Before I knew it, I was near skipping down this lot, popping berries in my mouth as my eyes jumped through the vines.  (Note: I LOVE BLACKBERRIES!).  What a treasure trove!

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.

Specialty 2-week rotation to Florida!

DIETETIC INTERNSHIP: Weeks 36 & 37 (of 41)

Alternative / Specialty rotation in Gainesville, FL: Weeks 36 & 37

Hi ho, hi ho, it’s off to Florida I go!  My Dietetic Internship included a 2-week “Alternative / Specialty” rotation at a facility outside of the Memphis VA Medical Center.  It is the intern’s responsibility to seek out the location, find the contact information, and secure this bond.  What. A. Chore!  I wrote, I contacted, I searched for names, numbers, friends or family with whom I could stay for two weeks.  Honestly, it was all a bit stressful and at one point, I questioned why I was not just looking around Memphis and consequently happily sleeping in my own bed.  BUT.  My Internship Director kept telling us that often individuals find full-time employment at their Alternative Rotation site, and I wanted to make a thoughtful decision. 

Oak tree canopy

After a lot of contacts, I very happily secured a contract with the Gainesville, Florida VA Medical Center.  A long time ago (when I was a student at the great University of Florida), I made best friends-that-became-my-family in High Springs, FL, about 25 miles away from the hospital in Gainesville.  They accepted me for two weeks, as well as the VAMC.  Done!  Next step:  Drive.  It is a LONG way from Memphis to Gainesville, specifically nearly 700 miles!

Diabetic spirits

DIETETIC INTERNSHIP: Weeks 33 & 34 (of 41)

Intensive Diabetes Management: Week 33

Pediatrics: Le Bonheur Week 34

What type of pills would you like to take?

Let me be honest.  I didn’t take many (personal) notes during the above-named rotations.  I toiled, but I left significant lacunae in my bank of memories.  Here are a few memorable moments:

Intensive Diabetes Management was primarily outpatient driven and functioned like playing a game of Magnum PI crossed with Dr. House.  Patients come in reporting high and low blood sugar extremes with seemingly perfect compliance to medication and insulin.  Dietary compliance?  That is always questionable.  I saw patients with blood sugars ranging from 30 to 460 daily, and supposedly taking the correct dosage of insulin.  Riiiiiight.