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.

Levitt Shell & Cotton

Cotton blossoms in Henning, TN

A funny thing happened as I drove out to Mud Island one late Saturday morning: I saw things flying through the air everywhere, like great big allergens just waiting to cause a giant sneezing fit.  My afternoon plan was to sit outside at a café, read, study for the RD exam, and have a cold drink.  With my allergies, this plan suddenly seemed impossible…  However, I wondered, “Why did I not see all of this air debris at my house 13 miles away?”  I can thank the Mighty Mississippi River for my answer, and more specifically the barge traffic upon her.  It is cotton season, and all of the large and small flying puffs was cotton blowing off of the barges!  Thankfully I successfully sat outside for over 3 hours, with only one incident of cotton inhalation, momentary watery eyes, and a fit of sneezes.

Memphis has a great “shell” in midtown, Levitt Shell, an outdoor amphitheatre.  Young Elvis Presley took the stage here on July 30, 1954, in what historians have called the first-ever rock ‘n’ roll show.  Built during the Depression, it served as an orchestra performance venue in the 1930s and 1940s.  Today they put on more than 20 free summer concerts for the people of Memphis.  On this same Cotton Saturday, I packed up my bamboo mat and headed for a seat on the grassy knoll for my inaugural experience.  I was greeted by 5,000 other Memphis residents, many packing picnic gear and adult beverages.  The Memphis Dawls played, backed by various string players, and the Memphis Doctors Dance Band. They sang and played fun toe-tapping current tunes and covers from the 1940s.  Halfway through the night, dusk started to approach everyone embraced the relaxation and entertainment.

Memphis: World Championship Barbecue Competition

Friday

What a riotous event!  Sheer gluttony!  A weekend dedicated entirely to … BARBECUE!

After work on Friday, I quickly headed to the Mississippi River in search of myoglobin-outlined perfection.  After a 10-minute weaving search for free parking, I stepped out of my car… into what seemed like a meat smoker of goodness.  ALL of Downtown Memphis: Smelled. Like. Barbecue.  WOW!!  I am not kidding. 

You should know that I only eat meat a few times a week for health and ethical reasons– but when I do eat meat, it is often barbecue driven.  I love barbecue.  (I also love pattied sausage, but that is for another post.)  This new downtown aroma smelled like heaven! 

When it comes to barbecue, I have always been a lover, but I have my preferences.  I have never been a huge fan of ribs; they just haven’t had the right taste and texture for me; I am more of a pulled pork kind of girl.  Well all of this changed on Friday & Saturday... 

Welcome to Memphis in May  2013 World Championship Barbecue Competition!

Creative BBQ team names!

Thousands of competitors are on ‘teams’ that complete for various BBQ categories from ribs to whole hog to best tent (see categories and winners here ).  Each team has a ‘tent’ for cooking and, most importantly, for partying.  Team sizes range from 5 to 50, and tent sizes are up to 2 stories tall!

Tell Me What You Eat

DIETETIC INTERNSHIP: Weeks 31, 32 & 35 (of 41)

Foodservice Systems:  Weeks 31 - 32
Culinary : Week 35

Where do Registered Dietitian’s work?  As of Oct 2013, there are approximately 89,000 RDs in the US and abroad, the vast majority of which (~70%) are employed in a clinical field (healthcare in hospitals, long-term care facilities, etc).  The other main RD fields are foodservice systems, and school foodservice.  Research and community dietetics round out the list.  Unquestionably, the preponderance of public opinion associates RDs commonly with “food” only despite its low occupancy.


     As soon as I utter the words “Dietitian,” most people:
             a) pat their belly or hips, grumbling out regrets regarding dietary intake;
             b) recall what was consumed at the last several meals; and/or
             c) silently, yet assuredly, bring food and weight to mind.
     It has not taken long to recognize this repeating response. :( 

Breastmilk, fiber, and fried rice

DIETETIC INTERNSHIP: Week 30 (of 41)

Women, Infants, and Children (WIC):  Week 30

WIC = Women,Infants, and Children.  Yep, that is all I saw this week during my week at WIC.  WIC serves the financially underprivileged through a nutrition commodity program.  Directly, no money changes hands, only vouchers and education.  Registered Dietitians play essential party to this transaction as the nutrition expert for the pregant and post-partum woman, and the growing infant or child.

In the weeks leading up to this week’s rotation, I was slightly apprehensive.  My assigned WIC clinic was at one of the least desirable shopping malls in South Memphis, known for its crime and tumbling desirability.  Yes, there was Macy’s, Sears, and close to Graceland, but the area has fallen from grace, and several armed security guards roam the corridors.  Two local friends warned me to not stay in the area after dark.  During my lunch breaks, I frequently exercise-walked the thoroughfares and browsed the shopping selections.  I unearthed several bargains, but constantly looked over my shoulder.  During one lunchtime saunter, my security was infinitely unmitigated as I spied one security guard plugged into the wall, focusing intently on his charging cell phone.

Going Back to School

DIETETIC INTERNSHIP: Week 29 (of 41)

School Food Service:  Week 29 - Memphis City Schools

Who remembers what it is like to be less than 10 years old?  What about in high school?  How did you respond in ‘social interactions’?  What did you like to eat?  When did you like to eat?  How much?

What an interesting change of pace to transition from medical maladies to school food service this week!  For one week my mind reverted to sophomoric ideologies and preferences; it was tougher than I remembered!  One day I worked as a Lunch Lady at an elementary school (what fun!), and one day at a high school (a bit nerve-wracking!).  Going back to elementary school was so much fun!  Not only were the cafeteria workers friendly and welcoming, the kids were hysterical.  I walked around talking to them about their favorite foods, favorite snacks, encouraging each to try different foods on their trays… generally forming a personal Inquisitorial Committee.  Before leaving the cafeteria, several kids insisted on sharing their love with me, passing me through lots of hugs, and “I hope you come back!” salutations.  The high schoolers, on the other hand, were not nearly as lovely.  It did not take long for me to read through the words and body language of the kids, recalling the constant turbulence of emotions.  I left that afternoon SO thankful of my age and perspective.  (That was a first; I usually lie about my age! J)

The Old and The Restless

DIETETIC INTERNSHIP: Weeks 26, 27, & 28 (of 41)

Vacation!:  Week 26

Geriatrics & Palliative care: Weeks 27 & 28

These next two weeks were filled with the old, the very old, the young old, and the very sick.  I spent two weeks alternating between Geriatrics (>65 years old, often inpatient 4-6 weeks for rehabilitation) and Palliative Care (less than 6 months to live).  I was full of emotions before this rotation began, knowing my past may interfere with my present.  Daily, valetudinarians dominated my workload, and I wobbled between emotions.

My past includes my father, a Veteran, who passed away at home 8.5 years ago.  He peacefully and painfully died at home, aided by personal administration of palliative sedation.  Any time some of these words are spoken within my earshot (particularly “palliative”), or in regards to a young individual, (my father was 54 years old), my nose begins to tingle and flare, my eyes open widely, instinctively searching my surroundings, reflective of my minds speeding thoughts and connections.  This rotation not only posed professional challenges of a new patient population and goals, but also of managing my own reactions.

Sight, Smell, Texture, & Feeling

DIETETIC INTERNSHIP: Weeks 24 - 25 (of 41)

Spinal Cord Injury: Weeks 24 & 25

The Spinal Cord Injury (SCI) population is a very unique group that ranges from tetraplegia (formerly known as quadriplegia) to paraplegia, with various stages of injury severity (complete v. incomplete) and mobility.  For example, an incomplete tetraplegic patient may walk with a cane or walker, but a complete paraplegia may not be able to turn him/herself in the bed, nor sit up.  Much of this has to do with injury severity.

I spent two weeks working with inpatient and outpatient SCI patients.  VA SCI individuals are frequently inpatient for extremely long durations; I visited with patients that had been inpatient for over 6 months or more!  Many SCI patients are quite healthy in mind, but uncooperative in body.  The injuries that resulted in SCI are far ranging, from a 32 year old enlisted officer that went butt over teakettle while mountain biking, to an older man that fell out of the top bunk of his prison bed.  One can only imagine that compliance to medication, which includes nutrition, is just as varied.  With some near complete immobility, nutrition is the #1 form of medicine… or the #1 form of disease.  

I had a blog post published nationally under the VA!  Read the original here, or below:

Every Body, Every Day: How to Get Fit

May 9, 2013 by Jessie Furman

How many times in one week do we hear about exercising? Eating right? Losing weight? Keeping our heart healthy? Many have heard and understand that exercising is beneficial for health; however, there are often many questions about exactly how much exercises is needed, the benefits to activity, what qualifies as exercise.

What does it all mean?

If your doctor told you that doing one thing for approximately 30 minutes per day, 5 days per week would significantly reduce your risk of:

Early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, breast and colon cancer, falls, depression.

Would you consider incorporating it into your life? It would cause no harm, only benefits, including health and financial gains. Would you do it? By now it is no surprise that this 30-minute per day “thing” is Physical Activity!

Watch this video, it is worth every minute:

How much?

Some physical activity is better than none.  For major health benefits the CDC , the American College of Sports Medicine, the U.S. Dept of Health & Human Services, and the American Heart Association recommend that adults:

The Administrative Side

DIETETIC INTERNSHIP: Weeks 20 - 23 (of 41)

Management: Weeks 20 & 21
Professional Development: Week 22
Research: Week 23

The Registered Dietitian’s exam includes various managerial topics, from theory (Maslow, Herzberg) to application (human v. technical v. practical skills).  In a pair with fellow intern Nick, we spent two weeks working with two different managers:  the Chief (of Nutrition & Food Services), and the Clinical Manager.  The tasks ranged from disciplinary proceedings meetings to face-time-only-required meetings to rudimentary analysis of current Clinical Dietitian medical chart documentation.  Meh.  While many people at my age are ready to progress beyond the day-to-day operations in their respective career and move into management, my feelings are slightly ill timed.  I suppose because the dietetics fields is a career change for me, I am entirely interested in solely patient care at this time.  Or perhaps I just want to stay away from financial analysis any time soon!?!  Regardless of sentiment, I like healthcare!

Hair Shopping

When I travel or move to a new place, I am a Tourist, Explorer, Dweller, and Shopper.  When it comes to shopping, my favorite way to spend time and money are at grocery stores and farmer’s markets.  I know, I know, the stereotypical female gods now scream blasphemy as clothes nor malls have entered this favorite list!  Alas, one of my favorite (economical) shopping centers in Memphis has a Kroger, Wal-Mart & Goodwill; I usually park in the middle and stretch my legs walking the parking lot between the stores.  

Yesterday after work, I parked in my standard mid-spot, and walked the 7 or so minutes to Goodwill.  Just as I was about to enter I heard, “Excuse me! Excuse me!”  I assumed directions were needed, but instead was met with a much different non-interrogatory response.  “You are simply beautiful!  Beautiful!” exclaimed a smiling older man.  A childish smile embraced my face. J

Tagxedo & Chasing Jessie awesomeness

I found this great website that allows one to customize a (pre-loaded) shape with words, colors, font types, and themes!  What is the standard shape representation of dietitian?  An APPLE, of course!  Here is the Chasing Jessie (Dietetic Internship only) word art!

Make your own at Tagxedo.com :)
(It is legitimate, this is not a spam posting!)

Rock On: The Kidney Stones!

DIETETIC INTERNSHIP: Weeks 18 & 19 (of 41)

Renal (Kidney) Disease

The renal world (i.e. kidneys) poses a lot of complications for patients in many arenas, from medication management, coordination of many healthcare specialists, and very importantly, drastic nutrition alterations.  Unless you develop some form of kidney troubles, most people have no idea what the kidneys do, where they are located, or how many we have?...  (Psst!  In general, your two kidneys are located in the back of the abdomen (see a picture here), working hard all day long to filter blood (remove waste products, create urine), maintain fluid and electrolyte balance, and secrete hormones to control blood pressure!)  Everything you know about healthy eating recommendations is (nearly) reversed in kidney disease.  Let me explain...

Standard healthy eating advice:

Eat whole grains, buy wheat bread instead of white, brown rice, not white!  Eat more fruits and vegetables!  Consume low-fat dairy 3 times per day!  Limit your sodium intake!

Oh wait, you have chronic kidney disease (CKD) and/or on dialysis?  Screeeeeech!  Cancel nearly ALL of those recommendations!