Clinicals: Week 5

I’m posting this a little later than I normally would because girlfriend needed a break from thinking about the hospital for a sec. I cried this past week…twice. I’m not sharing this for sympathy, but more of a heads up…You see, I have heard that interns cry at any given point during their clinical rotation. Whether it’s harsh preceptors, the environment, the pressure, stress, or all of the above- it seems to get you at some point. I stayed strong until week 5. I think I held out this long because I love the hospital and dietitian team I work with. What got me to crack was the pressure of trying to execute charting when I’m still learning how to chart certain things. It’s frustrating being a type A, perfectionist who cannot write a note without a correction, but that’s the learning process!

I realize these moments of pressure, stress, and being uncomfortable/unsure are catalysts for growth, so I’m embracing them. I tried my best to suppress my tears, but my sweet preceptor noticed I was being quiet on Wednesday and asked if I was okay. We all know too well that when we’re asked that question when already on the verge of tears, the floodgates open (and that’s just what happened). Luckily and thankfully, she waited until we were alone in the office. She heard me out and listened to what was plaguing me, and I swallowed my pride and moved on with the day, which included presenting RIGHT AFTER balling my eyes out lol.

I presented on this article titled the Association of DHA Concentration in Human Breast Milk with Maternal Diet and Use of Supplements: A Cross-Sectional Analysis of Data from the Japanese Human Milk Study Cohort. Check it out if you’re interested. I plan on presenting my findings in an Instagram Live this upcoming Sunday at 3pm CST. This is the handout I created to showcase the content of breastmilk and how it varies based on time of feed (beginning vs end), etc.

So Wednesday’s cry happened, I presented, and I thought I’d move on with my head held high with 2 more days to go before Christmas break. Nope. Friday I teared up again after I had multiple corrections on my notes. PEERS, repeat after me. “IT IS OKAY IF I MAKE MISTAKES IN MY INTERNSHIP. THIS IS A LEARNING PROCESS AND THIS IS THE TIME TO MISTAKES AND LEARN FROM THEM”. Give yourself grace in knowing that mistakes are how we learn! I will also say that all dietitians have their own charting/note-taking styles, so be patient in knowing that you may have to adjust accordingly without the expectation of being able to mind read how to match your next dietitian’s notes. This can be very annoying, but stay patient with this.

Aside from me crying, things worth mentioning were my cases with hyperemesis gravidarum and my pt who had an ileostomy. My pt with hyperemesis was young female who was newly pregnant (1 month) and was experiencing hypemesis (severe and frequent vomiting). She was dehydrated, depleted in sodium, and could not keep any food or water down, so she was a candidate for TPN. This wasn’t the only interesting part. The addition of cannabis use and suspected cannabis hyperemesis syndrome was also at play and could have been a factor of her chronic emesis.

The ileostomy pt was very interesting. He was a senior with current rectal cancer. He had his colon removed and an ileostomy (stoma, or hole, made through his abdomen into the ileum portion of his small intestine). He showed me his ileostomy bag filled with his excrements, so that was interesting. Surprisingly enough, these things don’t make me squeamish. I educated him on how to proceed with his diet post-op, including avoiding carbonated beverages, focusing on extra water and electrolytes, and slowly increasing fiber starting at 5-10g. These simple guidelines will help reduce stress on his GI tract while adjusting to his new norm of digestion and excretion. His water and electrolyte needs increased because the colon was removed, where most water and electrolytes are normally reabsorbed.

A little less than half my patients were PUIs or COVID+, so that was nice to see less cases for now…Swedish also started vaccinating on Friday! Heres the room set-up for vaccine screenings.

To end the week, the director of our department came by like Santa with gifts for all of us. This was very sweet of her to think of everyone, especially being a single mom with 4 kids! Impressive in my book. The rest of my learnings was first-hand, in-person experience, which I’m sorry, but real life experience cannot be replaced in the clinical context. I highly recommend getting most of your clinical hours done in person if possible. You’ll get way more out of it, even if it is more stressful.

And here are the terms and abbreviations I learned this week.

Terms

  • Spondylosis: degenerative and age-related spine osteoporosis
  • Capsulotomy: eye surgery with incision made on capsule on lens
  • High output ileostomy: fecal matter and excrements exceed >1500ml post-op ileostomy. This makes pt at-risk for dehydration and electrolyte imbalance.
  • myeloma: cancerous plasma cells that accumulate in the bone marrow

Abbreviations

  • AAA: abdominal aortic aneurysm

*Notice the list getting shorter! 🙂

What questions or comments do you have? 5 weeks left of clinical until I complete my supervised practicum hours and head to Big Sky, MT to study in a winter wonderland!

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