Officially official

So I'm very happy to be officially a full-time employed RD! Just wanted to send out some wishes to all of the newly started dietetic interns in all the programs around the United States. It will be a fun-filled, grueling year, but I've said it before and I've said it again...I can't imagine going into any position without having the experience.


Since my last post, I've been given the title of an "employee" at U of M Mott Children's Hospital. I've spent a lot of time covering the PCTU area (Pediatric Cardio Thoracic Unit) while the usual RD in that area works on some research. It's one of the most difficult and challenging areas but I know it's the area where I most welcome the experience, because it will only help me extend my knowledge. 


I've also spent a lot of time in an area that I didn't spend any time in during the internship - pediatric surgery. A lot of the kids in this area are from MVA's (motor vehicle accidents) and are in the hospital long-term. Another big population in this area are bowel surgeries for Hirschsprung's disease, diverticulitis, pancreatitis, etc. I really like this area, as I feel it somewhat relates to the PICU area and that it requires a lot of nutrition support. The dietitian in this area also helps with the pediatric surgery outpatient clinic.


For my position, if no one is gone, I am general help with the team, especially when the hospital census is so high. What's going to be cool in this position as well is that I may have the opportunity to be a preceptor! For example, if the person I'm supposed to cover that day is also scheduled with an intern - I'd be the one to take over. I find that so weird. I suppose I should get used to it though...


Anywho, in the meantime, I'm officially a resident of Ann Arbor and it's wonderful. I finally have my own space and I must say that it will never be taken for granted after spending a year living in other people's houses and basements. I can decorate if I want, leave my bed messy if I want, turn the music up as loud as I want, and go to bed when I want (with it being quiet). 


For any of those starting internships and weighing the option of commuting or moving to the area, they both have their pros and cons. While I did save a lot of money by commuting and living with family rent-free, I do feel as though I missed out on a lot of opportunities to become closer to other interns and experiencing the local atmosphere (especially that of Ann Arbor). But I underestimate the expenses of the extra time, money, car trouble, and not to mention gas. Remember in one of my first posts how I mentioned I'd spend ~$1500 for gas? HA. That definitely didn't happen. I'd say I spent twice that. But in the end, as far as my bank account, I came out ahead (just a lil, though). 


Making pros and cons lists have become my new favorite thing. Ha.

Change of life plans!

So...you know how the last post said that I'd be a traveling dietitian? Well, I lied (kinda)! 


Turns out that fate took it's course and I ended up being offered a permanent pediatric clinical dietitian position at Mott Children's Hospital! So this girl is setting up a few roots in Ann Arbor. I'm more than excited/stoked/relieved. After much thinking about which position I'd rather have, I had to put it into perspective. 


- I've been traveling from room to room, house to house ever since I left home after high school.
- Both positions are float positions (basically), but at Mott, it'll be purely pediatrics!
- I'll be able to get involved with projects and committees at Mott, make a name for myself.
- I'll be able to establish myself an address, a group of friends, and a room of my own.
- I'll be closer to home, and be able to make future plans, as I know I'll always have weekends off.


So, it took some thinking, but in the end, someone gave me a great piece of advice, she said: "I know neither position is your dream job, but which one will get you there faster?"


No. Brainer.




Oh, and not to mention, I passed my RD exam yesterday! So happy that it's over. Surprisingly a lot more difficult than I anticipated, but I passed and I'm all done, nonetheless. So now, with my free time, I'm doing a lot of reading, relaxing, and soaking in feeling of accomplishment...because I simply have no other place to be, and nothing else better to do.


Well, until I go back to work on Monday, anyway. 

Rewind and review.

Ok, ok, ok. I know, I know, I know. I haven't written on here for over a month and it's completely my fault!

But, the good news is that I successfully completed my internship, $4,500 in tuition and 1,560++ hours of free labor later. Our graduation ceremony was very nice and relaxing, my family really enjoyed it and it came and went so quickly, it seemed.

Following the graduation ceremony, I left for a family July 4th weekend party in which I went golfing and enjoyed the sunshine and lack of responsibilities, assignments, and places to be. Then, the following day was my birthday in which I turned 23! Jeez I'm getting old...hehe.

Then, the day after that, I started my new job as a temporary clinical dietitian at Mott Children's Hospital. Basically, in all reality, I'm doing exactly what I was doing during the internship, but now just getting paid. I'm covering RD's who go on vacation, take a day off, or who are on maternity leave. It's a nice variety and I've covered multiple positions including PICU, transplant, cystic fibrosis, among many others.

Needless to say that I'm still living in my extended family's basement. But, that will all soon change because...

I got a (permanent) big girl job!

This "Will Work For Free" blog must now be renamed. I got a position as a clinical resource dietitian for Sodexo. Basically, I'll be traveling all over the East/Midwest in Michigan, Ohio, Pennsylvania, West Virginia, New York, and many other states covering for RD's who go on long vacations, maternity leaves, or if someone suddenly leaves and they need someone to fill in before they hire a new person.

BUT - the cool part is, is that I can travel for as long as I'd like. The position is permanent and full-time within Sodexo, but when I'm ready and there's an opening in an area I like, I can apply, interview, and (hopefully!) secure a position in one particular hospital. Then, I no longer travel. It works out perfectly as I'm young, not too much holding me down, and I have wanted to travel for a while. Even better - I'll be getting paid to travel.

That adventure starts in late August. But for now, I'm still putting in my last two weeks at Mott Children's and studying for my RD exam. A few girls from the internship have taken it already and successfully passed, which makes me feel a little better. Of course, no matter what, I'll be freaking out the day of the exam.

So, hopefully all of those who were accepted to an internship are gearing up (or have already started?) for their internships. It was a really long, strenuous, stressful, but extremely rewarding year, and I can't imagine going straight into an entry-level position without doing an internship first. Good luck!

But, seeing as how I'll have a little extra time on my hands while I'm on the road, I've decided to keep blogging from my new position as I travel. Although the title of my blog will need to be changed...

Endless consults and what's next!

Today was a busy busy day. Every year, about this (exact) time, the medical school interns graduate. This means we get a new batch...and they are all so excited and anxious and ready to change the world of medicine. But, this means that I'm getting consults for some rather interesting things. Such as a patient vomited after a feeding, when in reality, after speaking with parents, it was normal spit-up. Or that a patient had decreased intake a day before being admitted to the hospital, when in fact they had meningitis.


After looking back at the internship, if I could offer any advice to future interns and/or students...is to not lose sight of the basics of nutrition. Like serious basics. I'll take it back to the beginning. We have a new dietetic technician (DT) at the hospital who is new, younger, and has a good nutrition background. The DT's at the hospital are the ones responsible for inputting the calorie count information, computing the total calories and protein consumed, then relaying that information to the proper RD.


I got a page regarding one my 5 year old patient who is admitted for a bone marrow transplant, saying that she ate 320 calories and 90g of protein. Before you think that it's weird for a 5 year old girl to consume 90g of protein (which is a) true, b) more protein than I consume), what's the first thing that's wrong with this picture. It's so easy that it's difficult to see...


4 calories per 1 g protein. The most nutrition math out there. 90g protein = 360 calories. Not to mention the patient had only consumed 4 rolls with butter, 3 Andes mints, a handful of Goldfish crackers, and a candy necklace. I know, I know. I might just be ranting here. But it's the basic knowledge, but when it becomes a deciding factor if a patient needs to be put on TPN (which brings a wide variety of risks and possible complications), it makes a big difference. 


Whew! Off my soapbox.




So what's next in store for me? Well, since I ranted a bit above, I suppose I'll just make an easy list:

• Graduate on Friday!
• Celebrate my birthday with family and friends on July 4 (yes, that's really my birthday!)
• Start my new job on Monday, where I am now, filling in for RD's who go on vacation
• Summer bucket list
• Skydive
• Run/train this summer for the Chicago Half-Marathon
• Buy a new wardrobe (I still wear clothes from middle school!)
• ...more to come later J

Well, here it comes...1 full day left! Yayyyy! 

Wait...2 days to go...what?

Finally...down to the final couple of days. I started this countdown on September 8, 2010, and it was a whopping 296 day countdown. I'd love to say that it flew by, but it really didn't. I felt each day, each rotation, each evaluation, each project. I'm incredibly ready to be done.


But, looking back, there's no way that I can imagine going straight into an entry-level position without the internship. The things that added on to what I learned in undergraduate work are astounding. Even though the last post was discouraging to me, I haven't cried since then (luckily...knock on wood). The fact that I had one of the most difficulty staff relief positions was initially daunting, but now that it's completed I can say that I was shoved into the pool, and I learned how to swim (well, tread water well, anyway). 


As far as my staff relief, I'm down to the last two days and hopefully my BMT patient load will go from 2 patients to 1. I'm really hoping that one of our patients will be able to go home while I'm still here. She's been in the hospital for over a month now, battling gastrointestinal graft versus host disease (GVHD). She has a horrible history of chronic diarrhea (over 3 liters a day), cramping, and not being able to eat anything. We have her back on a pretty bland diet of crackers, rice, plain chicken, plain cereal, lactose-free milk, etc. Hopefully she can keep up the good work and get home! Plus, she invited me to her graduation/celebration-of-being-out-of-the-hospital party...I felt honored.


The general service is booming as usual, but nothing insanely outlandish that would be worth putting in the blog. Mostly just kids with fevers, urinary tract infections, rash, monitoring, etc. The kids on that service just blaze in and out faster than I can keep track. There may be a few consults here and there for nutrition-related things, but more along the lines of kids being picky eaters and/or having food allergies. 


So what's next for me after Friday? You'll have to wait for the next post to find out - as for now, time for bed! 

First time tears

Well, I made it 98% way through my internship without crying at work, but yesterday was a rough day and I just broke down. Staff relief is the most beneficial, yet grueling and challenging rotations. Especially when I have such huge shoes to fill and I don’t have the extensive experience under my belt. As I’ve said, I’m doing my staff relief in the pediatric bone marrow transplant position. The lady who normally covers this position went on vacation, so she’s not even in house for questions, as the case usually is during staff relief. So I’m truly doing this by myself.

The usual BMT RD is an amazing woman who knows pretty much everything about BMT and TPN: the medications, interactions, new therapies, what to do when this or that happens, when to start something, when to stop, how to teach, where to be, who to contact, etc., etc. She’s been doing the position for 10-20 years. I’ve been doing this position for two weeks. The second I got to work yesterday the phone rang, and it was another BMT team member.

We’re trying to cycle a patient’s TPN down so she can go on day passes, and hopefully eventually go home. The problem was, was that she was going to get an ECP treatment yesterday, that caused a 4-hour break in the middle of her TPN. From what I was told from the woman covering me, is that on days of ECP treatment, just run it as a 24-hour cycle and then resume normal TPN cycles the next day. So there was some debate about what to do, as we can’t just “make up” lost time by running a TPN faster. If you do this, it makes the dextrose enter the bloodstream too quickly, which can cause high blood sugars, or even collapsed veins.

It wasn’t really an issue, as I stated that I’d work on the issue and find a way that we could make everything work. What made me upset is that the staff member then asked the person who is signing my notes, and eventually called the lady I’m covering, who’s on vacation in California. I just felt as though 1) I wasn’t being taken seriously, 2) I was making huge mistakes, 3) that now my preceptors/other RD’s think I have no idea what’s going on, and 4) that my recommendations weren’t being trusted.

And for the first time in my internship, 9 ¾ months through…I cried at work.

But…I got through the day, I found a TPN schedule that would work and wouldn’t be a setback. My preceptor backed up my recommendations, and I got a morale boost from the MD. They reassured me that I’m doing fine. Today went better, as luckily the patient has no upcoming ECP treatments.

And…that I only have 7 days left. YES.

BMT, head pus, and modified goeckermans, OH MY!

Ugh. I'm getting SO close to being done! Today went much better than last Monday, and even had more to do than last week. I had 3 clinic patients, 2 BMT patients, and a handful of general pediatric patients. 

That's what I like about this position. I have a few patients who I see on a regular, daily basis. But then, I have a handful of patients that are on the general service and are in for a multitude of reasons such as dehydration, feeding problems, moderate injuries, or monitoring. There was a couple crazy admits this weekend, though. 

Such as...one of the patients was jumping on a trampoline with a friend when his friends teeth went through the back of his head. He went to an outside hospital to get staples in his head to patch it up. Well, the wound got infected and he was sitting at a race track over the weekend and the wound burst open and started pussing and bleeding everywhere. SICK! Needless to say he's here getting a strong antibiotic course and making sure that his head heals correctly.

Then, another patient was admitted for an intense skin treatment called a "modified goeckerman therapy" for severe eczema. It's for people who have chronic eczema or psoriasis. It's a week-long hospital treatment that involves the little boy being put in a spacesuit looking contraption. It pumps the suit full of moisture and chemicals that relax and soothe the skin. It will hopefully be a long-term solution for the skin. But this little boy has it worse - he has multiple food allergies including milk, soy, peanuts, and beef. But, he also doesn't like fruits, vegetables, orange-colored foods, or odd-shaped foods. Unfortunately for him, there's not much that I can do, especially since he's not being admitted for anything nutrition-related. But, I'm trying to help the parents find a multivitamin that's red colored (because that's the only color multivitamin he'll eat), and especially one that doesn't contain any of his allergens.

Did I mention that it's only Monday?

10 days!