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.