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.