Spring Break. YES!

So incredibly needed. A break. 7 days to do absolutely nothing and enjoy every second of it. Unlike undergrad, where you'd have to return from spring break ready to turn in a bunch of projects, papers, or exams the returning week...not in this internship. Friday marked the last day of my clinical rotation so now I have a nice, relaxing week to prepare for my community rotation, which will last 6 weeks. I'll  be spending time with diabetes education, MHealthy health promotion, general health care centers, high-risk OB clinics, the comprehensive cancer center, outpatient nutrition care counseling at the hospital, HomeMed, and the pediatric cardiology clinic.

So I remember that I said I'd update everyone on my elective PICU rotation patients. The burn patient was definitely one of my best learning experiences patients during the week. Just the dynamics of nutrition approach to burn patients was incredible. The patient was put on ECMO and was still on it on Friday, but they were going to be trialling her off of it. I'm not sure how it went and I won't be able to find out until I return next week. On a better note, my preceptor was out of the office on Friday so I covered the position all by myself! It was crazy. I actually wrote the TPN's myself (and had a quick last check from another RD, of course), but had no changes to them, which made me feel very confident in what I've learned this year! It's crazy how clinicals came and went so quickly! And especially how comfortable I am becoming with everything (writing TPNs, NCP notes, working with physicians, residents, and other medical students), but still learning so much every day. I'm really getting the hang of it and I feel like I could take an entry-level position at this point. Now, if I could only find one...

But anywho, I feel like I've accomplished a lot so far in my spring break as well! So far on break I've spent lots of time with friends and family, gotten my yearly doctors checkup, went to the dentist, ran on the track at my old high school (that was a weird feeling), scrapbooked, made dinner, gave myself a mani and pedi, and started a new book! Hopefully the rest of the week is just as productive and relaxing. Perfect.


66 days...

Whew.

I'd love to write more about what's been going on this week in my elective PICU rotation, but I'm simply too exhausted.

But, since I have a week off...I'll definitely fill everyone in next week. 

Whew. I'm pooped.

Elective Week!

This week is the last week of my clinical rotationnnn!! 

How crazy/awesome/scary is that!?

So, for my last week in clinical, I saved the best for last - my elective in the PICU. Now that I have successfully completed all of my rotations, I can easily say that this was/is my FAVORITE rotation. The diverse patient population in both disease-state and age of patients. 

Monday started off with a bang with a burn patient, which I haven't had experience with. Burn patients are such an interesting population in that their energy and protein requirements are one-of-a-kind, in that their SO high! It doesn't help that the burn patient that was admitted to the PICU is now also on ECMO, which is playing more with her nutritional requirements. Tomorrow she'll have an indirect calorimetry reading which will give us an exact look at how much energy she is burning. It also doesn't help that she might be put on CRRT, which will double her already sky-high protein requirements. This is the first patient that I may see exceed 4-5 grams of protein per kilogram! An average adult needs 0.8-1.0 grams per kilogram. 

Another interesting patient that we have right now is a little girl who has a mystery metabolic/genetic disorder that's directly related to nutrition somehow. We aren't sure if it's a glycogen disease, fat metabolism disorder, or something else crazy. This makes it really interesting for providing nutrition care because we aren't sure what type, if any, of formula we should provide and if we provide her needs from TPN, if we should include fat! I'll definitely keep you updated on that.

But what's better than being in the PICU!? Not a lot comes close, but I must say that my spring break next week gives the PICU some good competition. Unfortunately I won't be going on a trip anymore for various reasons, but I have lots of fun stuff planned which includes mounds of relaxation.

How many days until spring break? 3 full days.
How many days until this internship is done? 73

Ehh not my favorite.

As it says, this week hasn't been my favorite. Don't get me wrong, I want to be a manager one day and make my way up the professional ladder, but that's not where I want to be this point in my life. I miss the patient interaction. I miss the challenge of writing TPNs. I miss the NCP notes. I miss the little tykes in general. 

But nonetheless, it's been a great experience and I've learned a lot about project creation, especially that of policies and procedures. It's been refreshing to be in a group with other interns again, too. We created five great policies and procedures for the new Milk Room in the new children's hospital. They range from consent forms, eligibility requirements, labeling, medication/supplement documentation, and discharge of unused breast milk. I don't think I've ever typed "breast milk" so much in my life.

Turns out this upcoming week is going to make me earn my spring break. It will be another round of the PICU (my elective!) and trying to finish up my written case study. I feel like an expert on necrotizing enterocolitis now. 

78 days left...

Clinical Nutrition Management

Otherwise known as CNM. In this rotation, I am acting as a "manager" and practicing the act of hiring, looking at resumes, and creating policies and procedures.

For this rotation, I'm working with two other interns, which is nice to finally be around other interns my age. Don't get me wrong, I like all the preceptors and everything, but it's nice to be around other people who can relate to what I'm going through. We're all getting worn down, restless, poor, and eager for what's going to happen to us after the internship. 

For our CNM project, we'll be creating five policies and procedures for the Milk Room that will be in the new C&W Mott Children's Hospital that's opening in November. A Milk Room is a room that is controlled by dietary staff, ensuring that a mother's expressed breastmilk is properly handled, stored, and fortified (if needed). So, as interns, our project is to create a handful of the policies and procedures related to drop-off, delivery, storage, handling, and discharging the breastmilk. 

This week we also have a handful of other small assignments including a resume review, NCP chart audits, among other things. I can't believe that next week is my last week in the entire clinical rotation. Then it's about a month of community work and then about a month of clinical professional staff experience. Then I'll be done, OMG!

What I'm most excited for at this point is that our spring break starts next Friday, FINALLY. Much needed. I'll be hanging out at home, sleeping in, and visiting friends, family, and my love ♥. 

81 days.

Losing ideas for blog titles.

So, after almost a year of writing in a blog (who knew?!), I'm running out of ideas. I usually try to make it something related to food, or my rotation, or the internship, or how tired I am, but alas, my mind is running dry.

Either that, or my brain is just in overdrive because of my written case study that I'm preparing on necrotizing enterocolitis. This paper is basically like the oral case study but on paper and much more in-depth. But I know I'll live. I'm actually learning boat-loads about the subject and happy to report that the actual patient the paper is based on is doing well and hopefully going home soon.

Like I mentioned before, I'm in my BMT rotation. I mentioned yesterday that I really like the interaction with patients, which is still very true today. I find that I really like this patient population but for some reason today I found myself becoming very emotional when I was rounding on one of our BMT patients. She's a high school-aged girl who has leukemia, which she's had a bone marrow transplant, chemotherapy, lost all her hair, feeling horrible, mouth sores, etc. I'm not sure why I became emotional...it's weird and has never happened to me before. I'm not sure if it's because she's (somewhat) closer to my age and we have a lot of similar interests. She has amazing support as well through family and her significant other, so I'm not sure if it's just the overwhelming sense of love and support in the room that gets me out of sorts. I mean, it's not like I start tearing up or anything, but it's nothing I've experienced. .Weird Maybe it's because I can somewhat relate because when I was in high school, an acquaintance of mine had cancer and I was never sure how to react. Then again at the time I wasn't sure what the cancer treatment was really like.

But all personal things aside, I'm learning a lot (as usual). I am getting more practice with TPN, as well as discharge information and ordering forms and HomeEd consultations. HomeEd is the company that comes in and helps a family learn how to administer home tube feedings. The new attending that is on rounds with the BMT team is very thorough so rounds take about 1.5 times as long as they did before. But he's brilliant and has tons more experience than I do, and he's very open to educating medical students, residents, and interns like myself so I'm not about to complain.

87 days left. Gettin' there...slowly but surely.   

Pediatric Bone Marrow Transplants!

So, my last "formal" clinical rotation (this week - yikes!), I'll be working with kids who've had bone marrow transplants. These kids have all sorts of cancer, and I'll even be seeing adults up to 35 years old. This is because there is an overflow from the main hospital.

Many of the patients I'll be seeing will be on TPN, so I'll get a lot of practice again this week. It will still be a challenge, especially since these kids weigh a lot more than the little preemie babies I was with for the past two weeks. So far I've worked with little preemie babies who are as small as 400g to elderly adults, and now it's going to be time to work with those inbetween. I feel like I'm really going to like it. 

One thing that I know I'm going to love about this patient population is the ability to interact with the kids. Now that I got some of that again today, I realize how much I've missed it over the past week. As "depressing" as it may seem to work with children who have cancer, it never seems that way. These kids have such high spirits and amazing attitudes! So I'll get patient interaction, more practice with TPN, formula feedings, diet education, and also, this rotation is only a week long...

But, I'm still restless. While I do love being in an internship and doing what I love, it's somewhat draining to be doing everything for free and having the stress of working 60+ hours a week at the hospital and endless homework, with no pay - and no ability to hold a side job. BUT like I've said many times, I'm forever grateful for the opportunity to even be in an internship...and even better...only have 3 more months to go!!

Which reminds me - congratulations to everyone who got placed yesterday! 

88 days!!

Almost there?

I hope so. Yesterday marked the three-months-left-to-go mark. The second half of my NICU rotation went well, as I was able to continue to follow my patients and watch them grow. I find that I really like that area, and it's a toss-up between the NICU and the PICU that are my favorite. All I know is that I love the intensive care units. The patient care, nutrition support, watching them grow, the math and science aspect, it's perfect! Definitely my niche. 

For the NICU rotation, there weren't as many various medical diagnoses. I'd say about 50% of the patients in the NICU are just patients who were born prematurely, and they need to stay there to mimic intrauterine growth with heat and enteral/parenteral feeding. There were a few genetic disorders, such as cerebral palsy and congenital heart defects. There was also good exposure to necrotizing enterocolitis, otherwise known as NEC. It's commonly seen in neonates and results from decreased blood flow to the intestines, basically causing death of intestinal tissue. These patients are on total parenteral nutrition. I actually followed two patients of these all by myself, so I had amazing practice with writing TPN. 

Next week will consist of a bone marrow transplant (BMT) rotation. I will be working with pediatric patients who have/had cancer and therefore bone marrow transplants. A lot of these patients are also on TPN, mainly because they are unable to consume the amount of calories they need. Their needs, both caloric and protein, are so high and a lot of times their gut is so worn and injured from radiation that they are unable to tolerate eating food or consuming formulas. I'm sure it'll be an interesting week!

After this upcoming week, I will only have my clinical nutrition management (CNM) week and my elective week. The CNM week will be working with the administrative part of the clinical nutrition aspect. I'll get practice with formula purchases, scheduling, and other administrative issues. I'm not really sure what to expect?

Anywho, I'm not sure how to respond to comments left on my blog, but just a couple notes about the U of M internship as far as schematics:

• I haven't had to work any weekends for the internship, but I might have to work 1 or 2 during my community rotation. But, if I work weekends, I'll get time off on a few weekdays.
• It's extremely tough (or so I've heard) to hold a side job during the internship. One of my fellow interns had a night job as a hostess and it became too much and she ended up leaving to dedicate full attention to the internship.
• Commuting is much more expensive than anticipated. But, still much cheaper than monthly rent payments.
• I've made about $100 from donating a small amount of time (and blood) as a "healthy participant" for U of M clinical studies.

But, that's it for now! If you have any questions about the internship, feel free to post a comment and I'll answer them in my next post :)