BMT = BA

BMT = bone marrow transplant, and BA of course, is bad ass.

We have mini case-studies to present tomorrow on a patient we went and visited earlier this week. My patient was a woman who had just had a bone marrow transplant for her uterine cancer. She wasn't eating and the RD and I counseled her on ways to increase her intake while she isn't feeling well. Basically for this case-study is to start looking at patients, their charts, and most importantly, practicing our PES/NCP statements.

Short explanation, but the NCP is the Nutrition Care Process, and it's aimed at standardizing dietetic practices, so that they will be more highly regarded, respected, and perhaps even more covered by insurance. The nutrition diagnosis, which is different from a medical diagnosis, is aimed at quickly explaining the patients problem, etiology (cause), and the signs/symptoms (PES!). So, for my patient, her nutrition diagnosis (for that day) was...

Inadequate intake related to nausea and vomiting, as evidenced by food and menu refusal.

As for the rest of the week? BUSY! Lots of classes which cover/review bone marrow transplant, renal, cardiac surgery, gastrointestinal, estimating energy needs, enteral nutrition, and of course...dun dun dunnn....total parenteral nutrition, or TPN.

TPN is a type of nutrition that is basically elemental nutrients, such as basic dextrose, amino acids, and fat molecules that are given via IV. They give TPN to patients who may not have a functioning stomach, intestines, or bowel, and of course, these people still need their nutrients to survive. But giving a patient TPN is extremely more difficult than it sounds. If a patient with a certain, or any condition, is given the wrong formula, it could actually kill them.

So, we had our first of three TPN calculation classes on Tuesday. In this class, I learned about specific caloric values of the elements, how to calculate volumes, etc. etc. Perhaps it would be best explained with one of my homework questions...

****

#1: A pre-term infant weighs 3.5kg. The TPN order calls for 204mL at 8.5mL/hr of D18AA6 with 6g/day and 10gAA/day coinfused with 48mL 20% lipids/day at 2mL/hr. Total fluid order must include TPN + lipids + IVF = 14.5mL/hr.

Calculate total calories per day from dextose.

Calculate total calories per day from amino acids.

Calculate total calories per day from lipids.

Calculate total calories per day from TPN.

Calculate calories per kilogram in the TPN.

Calculate protein per kilogram in the TPN.

Calculate the dextrose infusion rate (DIR).

Calculate the lipid infusion rate (LIR).

Calculate the percentage of calories from protein in the TPN.

Calculate the percentage of calories from carbohydrate in the TPN.

Calculate the percentage of calories from fat in the TPN.

****

Yep...that's just one of the problems. Gotta love homework for clinical.

But, it's nice to finally be exercising my brain more and switching from a math/science/health approach versus a managerial approach. It's refreshing, and I love it. And finally, our holiday break begins tomorrow! About time...

Change? Yep.

That's about all I can say to explain today. A definite change from the last four months. I think I have had more things assigned today then I've had in a while. 

Today was a day full of class sessions that taught us about CareWeb, CareLink, policies and procedures, ABC's of dietary assessment, prealbumin measurements and uses, and many other topics. It was a lot of sitting and listening, but made me very excited to finally jump into the clinical portion of my internship.

But, I no longer like the snow. A drive back from work which usually takes about 30 minutes, took 2 hours today. It was ridiculous, and to be honest, brought me to tears. I have much to do tonight, including an online module which is taking about 2.5 hours, reviewing a PowerPoint with voice overlay, reading, and studying for a medical terminology exam that I have first thing in the morning. It definitely didn't help that I got home at 7pm.

As of today, it's a toss-up on whether or not the boyfriend and I will end up going to the Pistons game tomorrow, which makes me sad. With the roads the way they are, and our schedules, it might be more beneficial to wait and just go to another game. The seats I won are nosebleeds, and it's literally impossible to go up any higher in the arena. So, we might just wait, go when we're more relaxed and less rushed, and spend a little money on getting much better seats. Especially since great seats are only about $10-15. I did get lots of other fun, free stuff so it wont be a total bust. But still...

How many more days? 198.

Oh hey, snow

The first big snow of the season is here! Usually I am fully enjoying it by romping around outside or cuddling inside and watching it all fall, except today I had to drive back downstate in it. A two hour car ride turned into three hours tonight. But, while the trip was annoying and long, I made it all in one piece. I think Marge is being nice now because I got her fixed and ready for the winter. Marge is the name of my car, by the way.

This weekend was a fun weekend spent in Mount Pleasant for graduation! My sister and boyfriend both graduated, and I'm very proud of them both. We experienced graduation in the new CMU event center, which was extremely nice and super-new. It was nice and comfortable and temperature controlled. Not like my graduation. Which was outside. They meant it when they said, "rain or shine." Because on my graduation day, the sun did shine for a few short minutes, and the rain came...along with the snow, and sleet, and wind, and lightning, and thunder. To help us out, CMU gave us trash bags for ponchos. But yet nothing for our thousands of family members sitting in the stands, many of whom ended up getting sick afterward. But it was worth it...(right, Gram??).

While it did stink to drive home for three hours, I love the fact that I can get back to a normal schedule again! I love that I can work out before I have to go into work and actually shower before I go into work and feel presentable. I did love my PSE, though. I learned so much and loved all of my staff. As days went on, while I may have had more problems come up, I felt comfortable enough to handle them on my own and staff began coming to me with their issues, which was really neat. I'm sad that my foodservice experience is officially over (still can't believe it!), but I'm more than elated to start my clinical rotation. 

And, in five days is my winter break! Two weeks where I can do whatever I want, including sleeping in, finally...

Oh, and guess what?! 199 days...

2 more days!

Until I'm done with my PSE. Very exciting. Today started off great - as I won Detroit Pistons tickets on the radio at 5:30am! So, it looks like getting up and going to work so early has it's perks. I'm very grateful and I look forward to next Tuesday to watch them play the Atlanta Hawks!

And, by some stroke of wonder, no one called in this morning and the day kept on going smooth. Except for the stupid copy machine, which was giving me trouble and "jamming" all up for the second day in a row. Wonderful. My QA phone and pager went off a ton as usual, and I had to help pass trays, remind staff to stock their fridges, and do rounds...overall a good day.

I also got to do some more administrative duties, but because of confidentiality, I can't say. But, I will say that it definitely gave me a challenge and saw how something really happens versus practice scenarios and metaphorical situations. Same situations, but big difference in the way I felt practicing in practice sessions versus when it really happens. But, it gave me great exposure to what being a manager is really like. And I love being a manager, I love my staff, and I'm sad that Friday is my last day!

While I am sad that Friday is the official last day of my entire foodservice rotation, I am extremely pumped and ready for my clinical rotation to begin. We got the packet of information and PowerPoints that we will be going over next week, and it's about 2" thick, back to back paper. I'm really happy that we're doing a week of refreshers for ABC's of clinical practice, renal/cardiac/BMT/etc.etc. diets, and writing notes and doing all that fun stuff.

Bring.It.On.

PSE? Psshhhh...

Today = all by myself! I took over as the QA, answering all staff questions, keeping patients happy, and basically just making sure everything is running like clock work. It was a good Monday, no call-ins, only two patients to talk to regarding accuracy of meal trays, and other small issues. I think the most exciting thing that happened was that the Fire Marshals decided to drop in for a surprise inspection, and I just had to make sure that all the logistic rooms and the soiled tray carts were not in front of doors or anything. Which they never are. But, it gave me something to do.

Besides that, just getting excited for the holiday season. This includes scraping snow off my car, bundling up in my winter gear, and decorating with hand-made paper snowflakes (impressive, right??). 

I'm almost sad that my foodservice rotation is over. I'm going to miss the awesome/amazing preceptors and the fun and outgoing staff. I now know tons more than I did when I started. I had an undergrad class that was meant to prepare us for a managerial position, but I think I've learned more in the past 6 days as a (well, pretty much) manager than I did in a 16-week course. 

One thing I'm not going to miss? Shifts that start at 6am.

Week 1...check.

Week one of my professional staff experience is officially over. And I survived! Yesterday wasn't nearly as bad as Thursday, I must have paid my dues. We still  had a few staffing things to take care of with call-ins and such, but overall, not bad at all. I got more pages than Thursday, but they were for easy stuff like delivering formulas for discharge and just making sure that patients are happy. I also had to deal with a disciplinary issue so that was "exciting" to see. Not exciting about what happened, but exciting in the fact that I got to see a real case scenario of what it's like...versus the counseling practice experience we did where we had the worse case scenarios and were videotaped trying to solve them.

Week two starts on Monday and I will officially be done with my entire foodservice rotation on Friday. Next Monday begins with a week of clinical classes to get us refreshed with all of our clinical information. I also have my medical terminology exam that week so I've been brushing up on that. My life has been pretty mundane besides that. Yep.


207 days...

Eh.

Such a long week. I leave home at 5am and sometimes don't get home until 6pm. I'm so tired. Things are SO crazy. 

The PSE is nuts. For the first three days, I was with three different supervisors, which was really frustrating, as they all had different schedules and ways of doing things. I never knew what tasks needed to be done on a daily basis. But, today I was with the same person again and I got the hang of things.

Basically, the QA Supervisor does a lot with staffing, making sure the galleys on the floor are stocked and clean, making sure staff are doing OK on the floors and aren't having any problems, talking with patients who have had accuracy issues for their trays, and stepping in for positions when needed. This isn't only for galley staff on the floors, but also the B2 galley which does a lot of the call-backs for trays and making trays for last minute diet changes.

The first three days, I wasn't the supervisor 100%. Today, I was. I was handed the phone and the pager and had a pretty smooth day throughout. When 1pm hit? It never stopped. The phone was constantly ringing and my pager was constantly going off. RD's needing formula. People needing to go to meetings. Nourishments not getting there on time. People calling in and not coming to work. Trying to find a replacement. Unhappy patients. 

Extremely happy tomorrow is Friday.

Pros of having a blog:

*Remembering what I've done, kind of like keeping a diary

*Sharing my experiences with those who might be applying to a DI

*Keeping in touch

Cons of having a blog:

*Too tired to write sometimes, especially after 13 hours at the hospital

*Sometimes not much to say

*Friends/family reading the blog and not calling or writing instead

...how many days left?

Today was a day that started off unprepared. Not by me, but I surprised my preceptor by being their shadow for my PSE. Kind of frustrating, actually. But, it was nice to go through the day-to-day activities of a Quality Assurance (QA) Manager. We worked on clocking in and clocking out time for staff, visiting patients who had issues with QA, such as missing items on trays and other issues like that, and finally having a meeting with the other QA manager. Tomorrow I will be with a different QA manager so we'll see what that brings.

Something crazy is that in 9 days, I'll be done with my entire foodservice rotation. YIKES.

But, in five days I'll be back home and enjoying a fun holiday party with my favorite people. As for now, I'm working in papers and evaluations for the elevator study rotation.

Back to the grind..

Turkey day has come and gone. Nothing too exciting other than tons of relaxation, way too much eating, and dreading the drive back. It's really nice that the elevator study is finished and our presentation is done - the next two weeks will consist of Professional Staff Experience (PSE). We'll be stepping in as supervisors and basically taking over their duties. I've been assigned to the AM Galley PSE and my days will be from 6am-2:30pm. Even though it's early, it's better than sitting in an elevator for the entire time.

After that? I'm done with my entire foodservice rotation. I will have completed one of the largest rotation chunks of my internship. Whoa. Then it's one week of clinical administrative classes, a winter break, and then it will be 2011 and I'll be completing my clinicals. Whoa.

Good news is that my car is fixed and it wasn't my transmission. Phew. Still wasn't cheap, but it was about a $460 repair that will help my car last a lot longer. So maybe my first purchase after I graduate the internship and (hopefully) get a job won't be a car. If I just paid that much, I might as well drive it until it dies.

But, just like everything these days, it may be subject to change.

213 days...

5,948 huh?

Yep, something like that. The six interns (including myself) who completed the elevator data collection rode the elevator a combined amount of more than 5,000 times. Whoa.

So today consisted of organizing data and deciding what the heck we wanted to do with SO. MUCH. INFO. In a few words, we kicked butt today and got an incredible amount of work done. Best part? Knowing this information, huge paper, and millions of graphs and appendices will be put to use. Unlike undergrad, the "hypothetical" projects are no longer, everything I do in the internship - projects or otherwise - is put to use for the good of the hospital and PFANS department.

Even better, is that I get to go to see my love in a few days and go on my first Black Friday midnight shopping adventure! 

219 days...

Turkey time

Well, it's almost turkey time. I'm excited for a three day work week and being with family, friends, and boyfriend. Today was filled with driving home to exchange cars, because mine must go into the shop. It's doing this really annoying jerking thing and I'm excited to have it fixed, but nervous about what's wrong and how much it's going to cost. If it's nothing big, wont put me in harms way, and wont cause my car to die on me, I'm just going to live with it. I'm just more nervous that I'll be stuck on the side of the highway somewhere in the dark.

But I was stuck at the restaurant today because I locked my keys in my car. First time ever I've done that. And it signals that I need to get a spare set and put them somewhere easily accessible. OOPS.

Other than that, it was nice to have 2 days off in a row. The majority of the interns and I had a Thanksgiving feast yesterday. It was filled with veggie lasagna, green bean casserole (by me!), sweet potatoes, spinach artichoke dip, a spicy Malaysian dish, cranberry stuffing, and cupcakes that looked like turkeys! Pictures to come later...

 220 days...

Donor Poop

Good news? I'm done riding in the elevator.

Bad news? My body is wreaking the havoc of riding in the elevator for 64 hours. Current body temperature = 100.2 toasty degrees. These aren't glamorous elevators. They're service elevators that house biohazard bins, trash bins, and chemicals on an hourly basis. With no fresh/clean air circulation.

You better believe I took my vitamin B, C, and zinc supplement tonight. I'm not getting sick. Not now. Not before one of my favorite holidays where I'm going to want to stuff my face. And I'm going to be around family and friends who I want to socialize with and not make them sick. 

Definitely sleeping in tomorrow. What's sleeping in? 6am. That's A-MAZING compared to the 4:30am I've been getting up at lately. Tomorrow is basically like a "project day." 

Today we had our weekly intern meeting which usually is like a small 1.5 hour long class session. Today it was on prebiotics and probiotics. SUPER interesting. We focused more on probiotics and their mechanisms in the body and how they can help our clinical patients. I also learned about fecal bacteriotherapy. SO COOL, but so gross to think about.

Basically, C. diff is a big bacteria problem in hospitals lately, causing uncontrollable diarrhea (5-10 times a day!) and all sorts of problems. Well, nothing is working, antibiotics make it worse, and of course all other medications are just in and out. So what they do is take donor poop from a healthy individual and give it via enema, colonoscopy, or sometimes even through a nasogastric tube (a tube that runs through the nose and down into the stomach) to someone with C. diff or other GI issues. YEA. This way, someone elses healthy microflora and probiotics (healthy bacteria) can help someone else heal. Think of it as a temporary transplant. Haha...ew.

Some studies show almost instant results in 95% of participants. Plus no adverse effects have been found. It not only works for C. diff patients, but also people with ulcerative colitis and small GI problems such as constipation, diarrhea, and abdominal pain. 


Seriously. Google it! Apparently it was even on Grey's Anatomy once. Think of how many would volunteer, possibly getting paid, for donating their poop.


Just a little fun fact for the day.






Now for bed. At 8:15pm. True story. Yayyyy "grown-up" life.

Not. Needed.

What's not needed? Comments from our elevator riders.

I've been nothing but nice to people coming in and out of the elevators. People are becoming so familiar, because they ride the elevator so much, that I don't have to ask what department they're from. I talk to them, ask them about their day, sometimes give random facts, or just sit quietly. So, why do I deserve such comments? Some (not all, of course) people are just starting to throw out rude comments and becoming hostile because of our presence for this study.

It just seems as if other departments, besides PFANS, are becoming annoyed that we're in the elevators. Excuse me. It's not like assigned elevator usage. We're doing this for the good of the hospital. Maybe create some elevator policies so they're not so congested all the time. We're doing this so perhaps the food wont have to ride in the same elevator as the trash and biohazard bins.

But the good news is that I have 2 days of elevator riding left. 6 of 8 days - CHECK! I even have tomorrow off. Ever wondered if your battery on your iPod actually lasts at least 8 hours running continuously? It does.

Even better? Thanksgiving dinner this weekend between all the interns. But, missing someone back home gets tougher and tougher each day ♥ 226 days...

Rest.

Finally, a day off. 6 days in a row of work and sitting in an elevator was brutal. Unfortunately, it's only one day off and I will have to go back tomorrow to sitting in an elevator. Newbed it hard yesterday by forgetting my iPod but luckily I was stocked full with medical terminology flash cards. I'll have to take a medical terminology exam before my clinical rotation starts and it's been a while since I browsed through everything. Luckily it all came back pretty quick! It's crazy to think that in less than 2 months I'll be beginning my clinical rotations. I'm already more than halfway through my foodservice rotation...yikes. After this elevator study rotation, I'll do two weeks of professional staff experience. Then - it's off to clinical rotation I go! 

Other than that? Nothing new.

Brutal x2

Second day - CHECK!

Today wasn't as bad. At least I knew what to expect and planned ahead. I brought my iPod which was by far the best decision I've made all week. Instead of dead quiet and small mechanical noises inside the elevator, my head was filled with sweet jams! When no one was in the elevator I moved around and busted (small) grooves like it was a dance floor. This was the only way to keep my legs moving and my ankles and heels from getting sore.

We interns are going to write a book titled, Elevator Ergonomics.

So, most people would usually come home from an 8 hour shift of (literally) standing on their feet all day and plop on the couch and not move for the rest of the night. Not me! I had to get moving. So I went for a 4 mile walk in my most comfortable shoes. Definitely the second best decision I've made all week. I know my legs would be restless at night if I didn't. 

But, like I said, not much else going on! 

231 days...

Brutal.

Waking up at 4:30am - BRUTAL.

Riding the elevator for 8 hours straight - BRUTAL.

Feet - aching.

Amounts of data - overwhelming.

Worth it? Let's hope so.

Day 2 of 8 is tomorrow. BRING IT ON.

What else happened today? Absolutely nothing. I literally hopped on the elevator at 6am and didn't get off until 10:30am, when I had a break. Then I hopped back on at 11:30am and didn't get off until 2pm. When the elevator wasn't in use, it sat there. So I sat there, in it. I did some stretches. Walked around in a very small circle. Kicked butt in the game on my cell phone. Facebooked when I was on the higher floors and had a smidgen of service. Hummed to myself. Doodled in my notebook. Doodled on my data sheets (oops).

When the elevator was in use? I was mostly explaining why I was there, correcting the confused faces of when people hopped on and asked where I was going, I replied...

"I'm headed wherever you're headed!"

Even better was when the doors would open and people would just say, "Oh, never mind, I'll wait." I'd reply...

"Well, I'll be here all day - so you might be waiting a while!"

In which, they'd hop on, ask where I'm going, and repeat the process. Needless to say, I'm not sure anything new will happen tomorrow.

Sometimes people would get creative and say, "well, lets hope the elevator doesn't get stuck!" To which I'd reply...


"Well, I'm stuck here either way!"

I should probably clarify why exactly I'm riding the elevator for 8 hours a day for the next week and a half. Basically the department wants to know who is using the elevator, for how long, if they're locking it, setting it on manual, where they're going, and everything else you can imagine. This way, they can justify the department getting a designated elevator (or at least a designated time frame), for when the entire hospital moves to a Room Service Food Service operation.

The things I do to get two little letters (RD) after my signature...
 

232 days...

Early mornings

SO - get pumped (maybe?), because tomorrow through Saturday, then Monday, Wednesday, and Thursday of next week will consist of shifts from 6am-2pm. 

Doing what?

Riding an elevator. ALL. DAY. 

Yessir, no joke. But - it's all for good reason, believe it or not. Because the entire hospital will soon (ok, two years) be going to room service, the hospital is in limbo with whether or not PFANS will get a designated elevator to use. The hospital refused to fund for a contracted company to come in, so they use us for free labor. We are basically going to be seeing when elevators are going to have the highest traffic, who is using them, where they're going, how long it's taking, and if it's ever being held when it's not supposed to be. 24 hours a day.

So, this is our big food services management project and we'll be turning in a huge report with lots of figures and tables, so it's not as easy as it sounds. It's also not going to be easy hopping on the highway at 5am, but it's better than some of the other shifts, which the other two shifts are 2pm-10pm or 10pm-6am. Yikes. 

Our project wrap-up for last rotation went really well. We were all pretty much fried by the end of the day, even when we only had an hour long presentation scheduled that day. Everyone seemed to love hearing about all of the experiences we had and it was a very informative, fun, and interesting three weeks.

So lets just hope the next three weeks fly by just as fast. The little social life I have is gone. Good thing I had tons of fun this past weekend up at Central. Hopefully Thanksgiving will be here before I know it - that would be wonderful.

233 days...

And...my Healthy Eating Tip of the Month is now online! Check it out... 


November 2010 - Ace the Fats!

Rawr.

Again, this week is pretty laid back, at least at the hospital. Luckily tomorrow is just our rotation wrap-up session, a quick explanation from the preceptor of our next three week rotation, then off to Mt. Pleasant I go! 
 

I can't seem to catch a break otherwise.


237 days...

Today consisted completely of public speaking. Us six foodservice interns presented our literature reviews! Mine went very well, and took about 20-ish minutes, so I'm just glad it's over. All attendees (supervisors, preceptors, directors) seemed very receptive to my motivation/recognition presentation. Basically some of the ideas that I found during research or came up with myself were...

• "Strive for Five" from Aramark
• "Dollars for Scholars" from The Village at Manor Park Nursing Home in WI
• "Kudos Letters" from Sarasota County School Board
• Extra vacation time for perfect attendance at the WV University Hospital  
• "Staff Yearbook" by me! 
• "Double-Take" recognition program, by me!

 And basically just did my literature review on a study that focused that did a survey to look at what motivates employees, especially in a health care setting. It was a great experience to look further into how a study can impact a presentation, and definitely will prepare me for the clinical literature review I have to do when I'm in that big rotation. 

I'm pretty sure that the rest of this week is going to fly by. Tomorrow and Thursday we'll be doing Fire Safety/Evacuation in-services, Wednesday is more patient satisfaction interviews, or "Meal Rounds," then Friday is the wrap-up session already. Then, it will be off to CMU for Central/Western weekend. So, probably won't be much this week, but just everything coming together!

Oops

So apparently I haven't posted in a while. Oops. Nothing terribly exciting has been going on. On Friday we just had a project day to get things done. Another intern and I did a practice run of the tour for the Open House.

Speaking of, the open house went really well. There were many eager potential interns from all over the state and country. Our group was extremely quiet, so I felt as if the other intern and I were just chatting away the entire time. We would ask them time after time if they had any questions, but we just got "deer-in-the-headlight" eyes. I guess when I went to the open house a year ago now (YIKES!), I was really scared and overwhelmed as well. But, during lunch we got lots of good questions. It just helped to remind me how lucky I am to be where I am, and how grateful I am!

Then, after the open house, I did my Healthy Eating Tip of the Month board. I must say it's much more colorful now than it was before. But, you can see for yourself...

Before...

After!

That took me about an hour and then after that I hung out at some of the intern's apartment in Ann Arbor. It REALLY makes me want to move. We celebrated an intern's birthday with making homemade pizza, eating "ice-cream" cake, and drinks. Then we went out to a ritzy club and danced the night away...then, I drove back home in the morning. Guh.

But it's the last week of my second rotation. ALREADY. My literature review presentation is tomorrow, which I plan on working on all day. Such is life.

More and more room service

Yesterday was another day of supervision of trayline. Unlike the day before, we assumed more of the role of a supervisor. This meant that we had to look at a list of tasks, find out which ones were done and still needed to be done, and then go out and know who to assign them to. Then, we had to tell the staff member what they needed to do. Definitely weird telling someone twice my age what they had to do when I had been there for a week and they have been there for years upon years. But, overall a great day for practicing supervision. It's nice that the staff in the kitchen are becoming more comfortable with us being there. We're interacting more, helping them on trayline and cold production, and just talking to them. One staff member put it best, "I love coming to work, it's like one big, loving, and dysfunctional family."

Today we visited a nearby hospital, Henry Ford Hospital in West Bloomington, and got to watch a cooking demonstration and had a quick tour of the kitchen and hospital. This 24-hour room service operation is SO nice, but they only serve about 120 patients at each meal. U of M? About 400-500. They have everything made to order, nothing from a frozen box, everything from scratch. Optimistic, yes. Realistic, probably not. But, it was nice to see what other organizations are doing. The hospital was beautiful and had wonderful art. They also had a farmers market inside the hospital, which was neat. 

Other than that, not much! Just working on a literature review for foodservice, which is about employee recognition programs and ideas. Not as easy as it sounds! There are lots of options but choosing one for PFANS needs a strategic approach. More on that later...

And, Gram, probably my (only?) religious blog reader, reminded me that I didn't say anything about the salad creation/taste test results. Unfortunately, we didn't win, but another group did. They created a delicious Michigan Salad with dried berries, raspberry balsamic vinaigrette, Granny Smith apples, and sunflower seeds. It's all in the hands of the executive chef and department directors. Over all though? Amazing experience and learned so much. Even though the Michigan Salad won, there wasn't one salad that wasn't tasty!

Weird to think I'm already halfway through my second rotation...

245 days...

Supervise THIS!

Today was a day of trayline! The shift started at 6am, which meant I left the house at about 5am-ish. ROUGH. Either way, we started off the day by watching trayline do breakfast and how things work. When they were done, we checked and approved staff clock-in and then helped out with Meals on Wheels. We did sweeps of the area for quality assurance and then ate lunch.

The whole day was honestly a blur.

But, for lunch we did get to order trays and do a tray audit. Another brave intern ordered the dysphagia pureed diet. She got pureed and shaped carrots, pureed and shaped beef, really runny cream of chicken soup, custard, and pureed and shaped pears. Honestly, in all, it wasn't that bad. Definitely something I wouldn't order, but if I had to eat it, I would.

After that, we shared our regular diet trays with her! Then, it was out to trayline to supervise. We basically just walked around and made sure everyone was all set with everything and made runs back and forth between stations. We had to make a substitution because they ran out of tater tots, so we subbed mashed potatoes. Just some of the quick-thinking things that supervisors do on a daily basis. We then helped out with Meals on Wheels again, then called it a day at 3pm.

Tomorrow? Same time, same place.

But, we did get the lists of people who are coming to the open house on Saturday. I'm so excited to give tours! I know exactly how these potential interns feel, only because I was in their exact spot a year ago and just as nervous and lost. It was an awesome experience though and definitely solidified my urge to attend U of M's internship - where I am now and loving it.

Also really good to see a few Central Michigan University students on the list...although it makes me feel a little old not to recognize all the names...

Another long week came and gone. Friday was an exciting day, and quite unexpected. We started the day with a tray temp track, which was pretty easy and delicious. I had a turkey dinner at 9:30 in the morning, no big deal. After that, we headed over to another building and mannn we didn't know what we were in for.

Basically four of our precetors switched spots with us. We became the supervisors and they assumed the role of our food service staff members. Then, we had to give them oral warnings and written write-ups. And - they gave us worse case scenarios. And - they videotaped all of this! What's a worse case scenario? Outrage. Throwing the papers at us. Arguing. Excuses. Yelling. Lashing out and telling us they walked in on their husband with another man! Needless to say it was tough to keep a straight face.

But, overall it was one of the most beneficial sessions we've had so far, at least to me. When I take over during the professional staff experience and I have to discipline a staff member, I will be ready. And if anything, this experience really exemplified the dedication and enthusiasm that our preceptors have for us. They were very encouraging and while it was a funny/serious, I got so much feedback, I think I can take on this challenge if I came to it again.

All I know is, these weeks need to keep going quickly...

RD-clerk-clerk-DT-trayline

So many names to remember! RD. Unit clerk. Diet clerk. Dietary technician. They're so crazy connected and it was confusing at first. But, today we went through the flow of a diet order from the doctor and dietitian to the foodservice staff down in the kitchen. It has to go through so many channels and people before it can actually be implemented. While it is good for the diet order to be checked by so many people, it just stinks because it leaves more room for error. Although it was an overall fun and informative day. Three of we interns actually got to log in, make a fake patient, and send notes back and forth to each other like they really would in the system. 

We also walked around with the person who controls/monitors all the refrigerators and freezers in the hospital. Think about it, some floors have as little as four refrigerators/freezers, while some has as many as twelve or more! And don't forget about the super-important appliances down in the kitchens. All of these fridges and freezers have a Temperature Tracker device which sends digital information down to a computerized system. Today we met with the guy who monitors all of these and he also walked around and showed us how he goes through all of the refrigerators every day and throws away expired items. Interesting position and experience - but not my forte of career path. After that, we completed nourishment room quality assurance checks to make sure that stock is properly rotated and everything looks clean and is in working order. They do these checks once a month.

Other than that, pretty relaxing day. Just working on projects and literature reviews so my life isn't movie-worthy at the moment.

252 days...

So stuffed

Today was the food show! It was downright A-MAZING. So many vendors and so much food just being shoved at you to try. Chocolates, coffees, wines, beers, liquors, casseroles, breads, oils, veggies, etc. etc. Also, because it was technically a "restaurant show," they also had tons of cleaning products, insurance companies, equipment, and marketing products. Overall, really cool. There was also seminars about how to market your restaurant on social websites such as Twitter and Facebook, maximize your menu, and appeal to all customers. Oddly enough, we ended up staying from 10am-5pm. 

Our preceptor, the executive chef at the hospital, walked around with us for the last hour or so. This was actually really fun because he knew a lot of the vendors. Because of this, when he walked up to the vendors with us, they took more time to explain their product and how it could affect our patients nutritionally. I came home with bags and bags of loot and foods...and I think I've sampled enough beer and random food to make me float.



And of course...

Pizza crusts, mayo, coffee, tattoos, shot glasses, ice cream scoops, cook books, tortillas, bottle openers

T-shirts, informational handouts, pens, first aid kits, cleaning products, pizza cutter, bumper stickers, drink mixes

But here are some fun vendors we sampled and visited that were really delicious/cool...

• Frostyogurt (frozen yogurt products, no added sugar or other additives) 
• Zoey (new soybean oil that is non-hydrogenated, made in MI)
• Randy's Granola (made in MI, yummyyyy)
• Mama Mucci's Pasta (cheese stuffed dumpling pasta and barley mushroom risotto)
• Hacienda Mexican Foods (chips and salsa)
• Olive-it! (Garlic stuffed olives!...one of 100-some kinds)
• Saugatuck Brewing Company (hard cider)
• Chazzano Caffe (had a really cool scientific double-filter coffee contraption and espresso maker)
• Dunkin' Donuts (yumm coffee and donuts)
• Big Moe's BBQ Sauce
• Gourmet Mondiale (white balsamic vinegar, raspberry balsamic vinegar...etc. etc.)
• Earthy Delights (mushrooms, honey, tea)
• Grand Traverse Distillery (cherry vodka, made in MI)

Among many, many, MANY others! Honestly I am really surprised that I didn't get a stomach ache going from eating small samples of roast beef to pickled asparagus to vodka to smoothies to chocolate and on and on.

Today was orientation for the second set of rotations in food service. It will be dealing more with supervision, quality assurance, and making sure everything is working in good shape! Luckily, this rotation only contains one large project - an in-service on fire safety and evacuation. 

Basically, there are 9,309,481 places where a staff member might be and they need to evacuate in the UH, CVC, MCHC...anywhere! The problem is, many of the "fire boards" have maps on them that are so tiny and complex to read. We're going to simplify them and come up with neat tactics to help staff in event of fire (or panic)! 

Tomorrow is the food show!! And to make it better, it doesn't start until 10am. And even better...it's in the same town that I'm living in! NO COMMUTE TOMORROW! Yayy! A food show is basically when hundreds of food vendors come and try to promote their new products to stores/hospitals/restaurants. This means that they throw hundreds of samples at you...I love samples. I'll definitely take a picture of all the goodies I bring home tomorrow.

254 days...

Round 2

So, the next round of foodservice rotations begins tomorrow at 8am. It will begin with another meeting and I'll probably be given another folder (my folder count is up to five), and then I'm sure we'll be given more projects to complete. It's just overwhelming to know what my work load will consist of now that the first round of rotations is done. 

But, the presentation on Friday went well. A few other interns and I made a doughnut cake and the preceptors seemed to love it. Our presentation was about an hour and a half and covered all of the projects we completed. After that, we were free! So the six foodservice interns all went to lunch (well, brunch), and then it was on the road to CMU! Homecoming was fun and exhausting, but of course, I didn't want to drive back...

Homesickness sucks.

I really hope my car makes it for the next nine months, too. It's really disliking the five hour round trip drive to Mt. P and back. Weird noises. It jerks when I accelerate. Wonderful.

Well...here goes nothin'.

255 days...

Doin' work

Work, work, work is all it seems to be this week. Nothing too much to report, just finishing up projects and writing informal and formal reports for everything. Tomorrow is the big day for the taste test, so I'll report later what happens with that, which probably won't be until next week sometime. I need a weekend off, so it will be up to Mt. P for me.

3rd week, here I come!

Well, the third week has officially started. This week I have project days, or days dedicated only to finishing projects. But, that doesn't mean it'll be easy. At all.

Today was our first in-service. My partner and I actually created and held an in-service based around knife cleaning, use, and safety. It was neat to actually present to a group of kitchen staff and have them understand and (seem) interested. We learned (beforehand, of course) how to use a knife sharpener and how to cut properly, so we could show staff. Then, we had them take a short quiz and a pledge. The main problem is, is that staff are using knives for things they shouldn't be used for; opening bags, cutting open boxes, etc. So, hopefully they obtained some new information and hopefully will make changes. 

Then, the rest of the day was spent preparing for tomorrow's in-services, which are about cleaning, sanitation, and proper hand washing techniques. We made a sweet poster of how to properly wash your hands and someday I'll figure out how to post it here. That in-service is a little more formal than today's in-service. It will be held in a classroom with PowerPoint and quizzes. Whereas today was more of a short, 15-20 min class on proper knife use. 

While I do have all these project days and I do get a lot of homework done at the hospital, I come home and still feel like I have lots to do. 

So, sadly there probably won't be any updates that are too exciting this week. Just trying to wrap everything up. 

261 days...

Week 2...CHECK!

So, week two of the first set of foodservice rotations is all done. Three days this week I was up at 4am to be at the hospital by 5:30am. That SUCKED. Not only was I up super early, but by the time I was finished, I was too exhausted to work out, do homework, or anything. The thing is, is that I wouldn't have a problem working this shift as a professional, as long as it was a consistent shift. 

But, we are getting a lot done on our projects. This upcoming Friday is the big day, the "Wrap Up" day. Monday and Tuesday will consist of presenting knife and safety and sanitation to kitchen employees. Then, the rest of the time will be dedicated to writing formal and informal reports, preparing our recipe for the taste testing/judging for Thursday, and trying to scramble to get everything done. THEN...it's back to CMU for Homecoming!! Finally get to see my sorority sisters, friends, and of course, Jordan. <3

Also, some people have asked why I don't post lots of recipes and stuff like that on my blog. Well, mainly because my blog is to document my internship experience. I do like cooking and making meals, but, reading through recipes isn't my favorite past-time. How can I be in dietetics and not like looking at recipes all the time?! Because...a) I like to invent my own foods and combinations, and b) a lot of the time, the recipe calls for things I don't have in my kitchen! Which is frustrating.

Finally the weekend, time to relax and hang out at grandmas. I'm going to try and explore the area I'm living in. I want to go to the mall, but I feel like I'd just be teasing myself. I know I don't need anything, and can't really afford to shop anyway.

Rawr.

SO EARLY.

5:30am is a rough time to start a shift. Especially when you have to add an hour commute to that. Oh, and how could I forget? I'm not getting paid to do any of this!

But, today we worked in production within the B2 kitchen. We did things like portion audits and forecasting. They're having a problem with inconsistencies of the scoops using to portion out items. Things aren't being as uniform as they should, especially when patients need a specific amount of food. Why might this be? If they're diabetic, on calorie counts, or on restrictive diets. We also worked on our recipe with Chef Steve. Who is very Italian, but fun to work with. We're making a BBQ Chicken Salad with an Herb BBQ Ranch Dressing. Tomorrow we get to work the huge majority of the day with him on our recipe. I'll definitely post a picture when it's finished. 

Then, a week from tomorrow we will have the taste test. The best salad out of the other two intern groups, Chef Steve, and our group will win itself a place on the menu! Which may not be exciting to some, but it is for me. Today I finally completed the patient surveys and yesterday I finally got done the tray-tracking worksheet. It's just so many projects to keep track of and it's not only confusing but definitely hard not to catch myself getting them mixed up. It might have to do with the fact that I've been up for 13 hours already today...

But it is nice to be home early. But, that means more time being alone. Grandma always seems to be outside working on the yard or downstairs. A lot of alone time - could be good or bad. Ideally I'd love to go home every weekend but a) it's so expensive, b) I have 8 projects due in 1.5 weeks, and 3) I never seem to get anything done when I'm home. After living in the dorms for three years and then a sorority house for the last year, it's tough being completely alone for a huge part of your day. I do get a lot done, but sometimes I wonder...

But, next weekend I'll be going to Mt. Pleasant for Homecoming. And I'll be leaving the afternoon on the 15th. October 15th ring a bell? It's when all of my projects will be due! No projects for a whole weekend! What will I do!? And, the following week, our whole day is going to be dedicated to going to a food show. It will definitely be a good time, think of it this way:

Love going to Sam's Club, Meijer, Wal-Mart, or wherever and they have a product sample at the end of the isle? A food show is like a HUGE building dedicated to product samples. It's going to be better than Halloween. Any "foody's" paradise. Snacks, frozen dinners, juice drinks, alcoholic beverages...I'll definitely report on what I end up with.

Other than that, while some days are much harder than others...I'm just tryin' to live the dream...

268 days..

More, more, and some more...

Job shadowing. I feel that's all we've done lately. But I have learned a lot. On Friday, another intern and I job shadowed one of the managers in the Maternal and Child Health Center (MCHC) Room Service from 12:30pm-9pm. That was a long night. I ended up driving back up to CMU that night, hence the not posting all weekend. It was fun, but definitely didn't prepare me for today.

In which I had to wake up at 4am, in order to be at the hospital in Ann Arbor by 5:30am for the 5:30am-2pm shift. Definitely rough. Especially with the commute. This random sleep schedule and lack of sleep in general is making me sick. Runny nose, headache, being flushed. Great. Definitely sleeping in tomorrow because I have a project day; a day where nothing else is planned except the fact I have to be at the hospital, wherever I want, working on whatever project I want to work on. I can make my own hours. Yes...

Overall, the MCHC rotations went well. Another intern and I did tray accuracy audits, portion audits, recipe audits, meal satisfaction surveys, patient surveys, time sheets, planning sheets, and a bunch of random information. It was fun and it was good to see the different managerial styles of the two managers we shadowed. After my project day tomorrow, I'll have to do the 5:30am-2pm shift in the production area on Wednesday and Thursday. I just need to get on a usual schedule or my body is going to royally hate me.

The good news is that the University of Michigan Dietetic Internship open house is this month. Basically prospective 2011 interns can come and get a tour, find out more about the program, talk to current interns (like me!), and put a face-to-the-name for Joyce, the internship director. If you're interested in attending, it's on October 30, and you have to RSVP by October 15 to (click on link):

University of Michigan Dietetic Internship Program Open House

270 days...

!!!

1:15pm....epiphany...

I LOVE LEARNING.

Now I know for a fact this sounds crazy. Don't get me wrong, I had an amazing time receiving a priceless education at CMU. I had top-of-the-line professors, amazing classes, grueling case studies and research which all helped me wind up where I am today, at such a great internship.

But, while sitting in a foodservice hands-on session doing inventory, ordering, and procurement, I had this epiphany. In undergrad - all of high school, middle school, and elementary for that matter - I've been judged and graded on every single project and assignment I've ever had. Now that I'm in this internship? No grades, no judging. Just evaluating. HUGE difference. I'm being evaluated on my performance and my attitude towards the profession. And it's not just an evaluation, it's constructive feedback. Such as undergrad, I might receive a grade on a paper and the only feedback I receive might be highlighted areas where I made mistakes or failed to mention something...

And again, I'm no baby. I can take harsh criticism very well and learn from it. But, the feeling I get from preceptors, faculty, staff, and even the foodservice workers make me love learning. It makes me that more excited to go in the next day, even if it is at 5:30am. 

And it's not just those who are above us. It's the people I'm around all day: other interns. In undergrad, it's almost as if I had to compete with my classmates for the best grades and to be the best candidate for an amazing reference letter from a professor or supervisor. I had to be to class the earliest and stay the latest to make sure I obtained everything I could. I had to be involved in this, that, and everything. 

Here? All the other interns and I are on the same level. We've all worked just as hard as the other to be where we are. The only thing we have to get used to each other? Knowing we can trust each other. In undergrad in group projects, you know there would always be a leader, some good workers, and some slackers. As a natural leader, I'd always end up taking on more than I could handle, seeing as how many times if I didn't, none of the work would get done. It's tough, but nice and reassuring to know that when we do a project as a group, we're all leaders; when we are assigned something, it will get done by that person. 





Well, that was fun...

Today was another day in purchasing and procurement. We did a quick daily inventory, which would normally take our preceptor about an hour to do the entire food service program, but it took two other interns and I about 2 hours to do about 3 stock rooms. Ha! Basically it all boils down to knowing your organization. I'm sure that with more practice, other interns and I would be able to whip through inventory like its our job. Our preceptor taught us many things today, some of which include...

• Knowing your organization and inventory 
• Knowing what items are popular and move off shelves quickly, and vice versa
• Being aware of production schedules and holidays
• Seeking out competitive prices and bargaining with suppliers

This lady's been at her job for more than 30 years. She's a pro. After finishing inventory, we then went into CBORD and entered her order in and then loaded it into the supplier's website. From there, items are double checked and flagged if they seem like odd amounts (40 cases of celery). The program asks you like 1,304,239 times if you're sure you want to submit the order (duh, it's about a $20,000 bill), and that's it! But, it has many more steps than it seems, I'm just cutting it down for time, and for my Grandma's boredom tolerance (I know you're reading this Grandma Z)!! :)


Overall a great day though, just exhausted, as usual...

Officially a CBORDian

...among many others...
 PFANS = Patient Food and Nutrition Services

UMHS = University of Michigan Health System

UMHHC = University of Michigan Hospitals and Health Centers

DI = Dietetic Internship

UH = University Hospital

CVC = Cardiovascular Center

MCHC = Maternal and Child Health Center

MPB = Medical Professionals Building

HETM = Healthy Eating Tip of the Month

NSS = Nutrition Services Suite

FMS = Food Management System

CBORD = ????

Needless to say...there are lots of acronyms. Today, a group of interns and I worked with CBORD - a food management system program which it's acronym-type name stands for nothing. CBORD is where the PFANS staff set up food items, recipes, menus, etc.

Definitely more complicated than it seems.

• Every food item is linked to something
• An item must be logged and given proper names and numbers, within character limits
• Items need a unit of measure for ordering and production 
• Inventory done every day and logged, items and recipes forecasted
• Items must be logged with how much they costs and which supplier to come from
• There may be one item, but it may come in...
• 7 different varieties
• 6 different diet variations
• 20 different portion sizes
• (7 x 6 x 20 =  840 different ways to prepare one item)
• There are prep cost yields and nutrient yields to consider
• Items must be linked to specific menus 
• Nutrient information must be linked into items so they will appear in linked recipes
• Recipe ingredients must be done in pounds (1/2 teaspoon baking soda = 0.008 lb...literally)

Lastly, CBORD then prints a bunch of reports which break down the recipes for where they will be prepared, when, and who will prepare them. Reports to also do inventory, track waste, and so on...so on...so on...


Did I mention that for every food item and recipe - every single one - staff must go in and determine if it is compliant with all 110 different diets?!

 I learned a lot today. 

But, the preceptors for this session were amazing and so much fun, which made the experience that much easier. And, we got out early! But that means into bed early, as I must report to the hospital at 6:30am tomorrow. That means I should leave the house by about 5:30-5:45am, which means I should wake up at about 4:45am. 


Yay!


275 days...

And so it finally begins...

So, the rotations have officially started and it is SO nice that they have. Today our task was to do inventory, which might seem simple but it's definitely not. I worked with one of the purchasing managers and she took me through her daily and monthly routine of doing inventory. U of M has thousands of products and produce that they have, not to mention nourishments and formulas.

The manager I was with was awesome. She first let me do the looking around in inventory, counting the cases or individual boxes or flats of product, then I would tell her. Seem easy? It's not. First, everything in storage comes in similar looking boxes, especially the formulas. With those, there might be one slight number variation and it was my job to find it on the cardboard box. Then, boxes aren't always where they're supposed to be. I may have thought I counted them all, but 10 minutes later, I would find a box out of place and then have to go back and add it. To make it better, a shipment came in while we were doing inventory so we had to go back and add all of those to our list.

After I was on that end, my manager let me be the one to write. That was also neat to see because again, it's unbelievable how closely related some of the products were. One product might read "For Enfamil Lipil 1.5 RTU" and another might read "For Enfamil Lipil Unfl RTU." And, of course, those products would be right next to each other in the storeroom and on the inventory checklist.

In other good news, I finished one of my projects today. Quite an easy project, actually. Each of us are to be assigned to a camera for 2 days during our rotation. Our task is to take 2 pictures for each of the following categories: Teamwork, Automation, Service, Quality, Communication, and Empowerment. Definitely harder than it sounds, but an easy project nonetheless and fun to do. We then turn the cameras in and they will have a contest during our wrap up session and people will be awarded prizes. I volunteered to be one of the first people with the camera so I could get this project out of the way and have one less thing to worry about. I'm really excited to see what people come up with! 


And, last but not least, of course, I'm started to get a head cold. There has been weird shifts in weather lately in Michigan, which always seems to mess with my health. A few days ago it was sunny and 80 and then today it shifts to 55, windy and rainy. It just seems to give me super bad headaches and make me feel like crud. But, luckily we got out early today and I was able to take a nap.

Short day, but felt very long. Basically we had an orientation that reviewed the 7 projects we're going to have due in three weeks! Which include....

1. Customer Satisfaction Survey and Statistics
2. Tray Delivery and Pick Up Time Statistics
3. Cleaning/Sanitation In-Service Program
4. Knife Handling In-Service Program
5. Personal Journal Reflection Paper
6. Camera Project
7. Recipe Development and Taste Test
8. Healthy Eating Tip of the Month (just for me!)

So, lots to do! Not a lot of time to get them done. But, that's why we're a team and we're going to tackle them head on. Then, on CMU's Homecoming on October 16th, the day after everything is due...I might be able to relax. We'll see...

277 days...