Humans of the Healthcare industry Indy...

So I hope everyone is familiar with the Humans of NY accounts floating around facebook and instagram, and if you aren't.. seriously you should be.  This guy goes around new york city interviewing people on their fears, their greatest moments in life, their accomplishments yada yada yada... it's really cool and I recommend it to everyone.  Really good reading.

Anyway, I just finished this internship in Indianapolis and I met the best people! So, in an attempt to not break HIPAA violations (none of the people I am quoting will be patients, I just wanted to mention HIPAA since I had to sit through 2(!) presentations on it) I will be describing some of the people I got to interact with while working in the hospitals.  I've included life advice, work advice, and anything I found amusing. AGAIN none of them will be patients!

G- G recently switched jobs because of the pay raise.  And try as they might (raises, more responsibilities, managerial positions) the original job can't get him back.  G wants to go back to school because he 'doesn't want to be a chef his whole life' and his GI bill is still good for a few more years. He's also doing it to set a good example for his daughter, a senior in high school.

M- M is a foodservice worker whose job falls as the communicator between the doctors, nurses and the other food service guys.  She's been doing her job for almost 4 years now and knows all the tricks of the trade. Her jobs gets very stressful at times but she loves it because she gets to make sure no patients get any 'whack ass food'.

A- A was a medical assistant. "My mom was a stripper.  I made a lot of choices to avoid being like her.  Hopefully my daughter doesn't have to do that.  Who knows, maybe she'll make choices in an attempt to be like me.  Wouldn't that be nice?"

C- C is a nurse that I was talking to during a health fair. C- "I should've gotten married", Me- "you were never married?", C- "No, the woman I was going to marry, married my brother instead"

R- "I used to be a deadhead. Now I'm all cleaned up but I'm still a hippie in here" *points at heart* "Being a hippie is not about what you look like, it's about how you treat people"

A- "I just bought a new house with my boyfriend." Me- "oh so do I hear wedding bells anytime soon?" A- "yeah, maybe, but I figure it's harder to get out of a house than a marriage so I'm not that worried."

L- L was my first clinical role model.  We were sitting on the unit and I was getting nosy with the machine that tracks heart rate.  Me-"do you know what any of this means?" L-"all I know is- flat line, bad!"

D- D is young, single, dietitian.  "I already stopped telling people what I do for a living.  I just say I'm in 'health care' to avoid having to analyze someone's diet when I'm just trying to get into their pants."

A- A is a nurse that I met while on his floor.  He has no history of diabetes or seizures.  He was friendly and helped me unjam the printer paper tray.  The next day I was on his floor again when he went down in front of me.  I was rounding the corner to the nurses station he fell out of his chair and was seizing.  It was scary and the only help I provided was staying out of the way.  I don't know if he is ok.

M- M was the dietitian I got along with the least, she told me "you better get thicker skin, this is health care.. nobody is going to hold your hand through it."

J- J is a transplant doctor.  We were discussing patients on the transplant list at the weekly meeting.  Social worker at the meeting- "this patient is 50 years old, he's got blah blah blah condition, with blah blah blah symptoms for this amount of time.  He lives in Random City, IN, he enjoys photography, oh and he's a registered sex offender" J- "No way am I transplanting him." Social worker- "Well it's illegal to deny him because of that." J- "Fine, we'll accept him on the condition that he fund raises for surgery.  Maybe he can open a photography studio for little kids."

A- A is a pediatric dietitian.  "My whole job is making sure the babies are growing enough everyday.  When they are struggling then have a really good day I like to go and tell them." Me- "tell them that they are growing?" A- "yeah, it can be tough with all the other things going on.  They need to know they are doing a good job."

D- D is a restaurant health inspector.  While we're standing next to a very dirty dish washing machine he tells me "life goes by pretty fast. I'm telling you in 5 years you're going to wonder where the past 5 years went."

L- L is a 50 year old dietitian with sparkles on her fingernails.  When she asked where I was from she said "yeah, I've been to Vermont once, it was really scary... there were liberals there." She also told me "the country would be much better if both the coast just fell off into the oceans."

Same L- She takes pride in her work.  You can tell when you watch her interact with patients, but she told me "when I talk to doctors, I've found it's better to dumb yourself down.  They give me what I want more often if they continue to think they are smarter than I am."

B- B is a nurse practitioner.  I was talking to her about how nurses always get blamed for everything and just generally dumped on (figuratively and physically) when she tells me "I feel like I can be mean to nurses because I am one."

D- D has worked with low income families for 16 years.  Me-"what's the craziest thing you've seen here?" D-"Someone offered to sell me drugs... and to put a hit out on anyone that I wanted.  I actually considered it for a second... the protection, not the drugs! Well actually... no I couldn't do that."

B- B is a lactation consultant.  She works with breastfeeding mothers.  "People get way to comfortable with me.  I think it's because they have to, but I had someone ask me if having a lot of sex made you lose weight.  It's funny and I had a hard time keeping a straight face while her breast was out, but yeah, it burns calories so I guess it could help with weight loss."

H- H is one of my fellow interns. We were discussing how dietitians perceive their worth and how that effects their job performance- "No one will value you unless you are valuable."

B- B is a colorectal surgeon.  He sees patients for anything colon related, a lot of them could benefit from speaking with a dietitian.  Unfortunately he has a typical surgeon ego.  Me- "Hey, I got a nutrition screen on your patient in room 9" Him-"Yeah, I'm following him for a benign reason, you don't need to see him" Me chasing B down the hallway as he is walking away from me-"But, sir, he's experiencing a lot of weight loss do mind if I just peek in?" Him- "Uh clinic is backed up, you can see him next time he comes in."  I understand B is a busy man but I didn't hold my breath on that one.

A- A is also a colorectal surgeon.  She works in the same clinic as B and showed up in my doorway one day- "hey, I've got this lady in room 6, she's got blah blah blah condition and I really don't want to have to operate on her, I just don't know if it will go well. I think you could help her, she's experiencing these symptoms, and has this attitude about surgery... and medicine... and nutrition... and PLEASE fix her."

B- Different B.  "When everyone works with blinders on and forgets to communicate with each other... that's when the patient suffers.  And who wants to work in a hospital where all your patients do is suffer?"

S- "I used to eat like crap, then I started doing diet histories on people with chronic illnesses and was seeing similarities. Is their diet the reason they got the illness? Maybe not. Is it one of the reasons they have a lower quality of life than another patient? Maybe."

S- S is a medical assistant at the clinic.  She is the first face the patient sees when they get there and the final one before they leave.  "I like getting to know my patients. It helps for when they have questions about what the doctor has said to them.  I had to explain to someone about why you can't eat before surgery.  You think I'm trained and educated for that? Hell no! And I know the doctor talked to them about it.  Sometimes they're so freaked out while talking to the doctor they forget to comprehend what is being said to them.  Once they realize that they have no idea what was just said, someone has to answer their questions."

N- N worked with me for a long time to tear down a lot of my demons and insecurities in the field.  I was working on a difficult and complicated patient and was a nervous wreck about missing something important when she said "don't ever let what you don't know get in the way of what you do know."

This is going to be a special post...

This is going to be a special post about the greatest man in the universe... yes offense, to everyone.  I actually had to pull over off the side of the highway to write some of this down.  It was getting unsafe for me to drive so here I am in the middle of a very flat, very windy, midwestern highway in the middle of a field that has a whole bunch of windmills in it.  It's a really boring drive, but here I am.  Reminiscing about my grandpop.

I said good bye to someone very special to me today.  He goes by many names: William, Bill, Billy, Billy Boy, and my personal favorite Pop.  Or as his beautiful wife would say 'just don't call me late for dinner'.  Pop is my grandfather and my moral compass.  A lot of wonderful things can be said about what Pop has done his whole life, he was a doctor and he helped teach and train new doctors at the med school in Youngstown, Ohio.  Sure he did that for a living, there was that; or I could describe to you all the amazing things he did on the side to help people.  He was in charge of the entire branch of Habitat for Humanity in Youngstown as well where he did amazing things helping to build houses for those less fortunate.  But to me, and all of my cousins, Pop had one job: Grand Kid Entertainer Extraordinaire.  I may be biased but I think this was his true calling.  Some of my first memories of Pop are following him around the house in silly hats, to his Forth of July music, waving our little American flags.  And does anybody else remember the Abercrombie Fitch and Penelope Pinwheel stories?  The flying bed, and the time machine washer?  He told me he came up with those on the spot, but I have a feeling there were ideas for those stories always floating around that brilliant and busy mind.  He also convinced me that when he and Gam would fly home from visiting us, they would parachute out of the plane and land in the backyard.  He told me once that he calculated wrong and ended up in the woods belonging to the next door neighbors, but not to worry because Gam landed on the trampoline.  Yeah, I believed that until I was 12.  He would participate in our hide and seek games.  He would whoop our butts in ping pong and he even taught me how to play beer pong.  He let one of my cousin's drive a golf cart and she ended up destroying a garden.  He would let you wear his coke bottle glasses until you felt sick from the prescription.  That is exactly how I remember Pop... surrounded by 10 squealing grand kids.  Whether we were playing with his hair, or fluffing his eyebrows, or one time he tried to 'de-ticklise' my feet, I think it's safe to say that our parents always knew that if they could hear fun happening on Whippoorwill Way, Pop was close by.

Pop is the greatest.  He has a closet full of crazy sweaters, and multicolored pants.  He was wearing a floral shirt once and told me he had to water it daily to keep it looking good.  He got kicked off of a golf course once for having shorts that were to short.  He thinks very carefully and uses his language to his advantage.  Instead of saying 'yes, please', Pop says things like 'yes, I think a touch of pudding would be splendid'.  He told me stories about working on his fathers farm growing up and he and his sister taught me the secret language they used around their nannies.  He was a man of his stories.  I remember one time he was taking the grand kids to a driving range.  Somehow we missed the turn off and drove past it for about 30 minutes because he was navigating and got so wrapped up in the story he was telling that he forgot to tell the driver to stop.

Pop had the stretchiest face of anyone I've ever met.  I used to stretch it for him and place it into silly positions.  He used to try and make me break into laughter during the serious parts of dinner by hiding behind napkins and appearing with a different funny faces each time.  Even today he was winking those beautiful blue eyes at me and flashing that crooked smile, all for the purpose of making his youngest granddaughter smile. 

He loves his family more than anything.  He organized multiple family get-togethers for various reasons on the Jersey shore and in the Berkshires just because he wanted to be surrounded us.  He told me he feels bad when he talks to other people about his grand kids because he feels like he is bragging.  That never stopped him, though, from beaming with pride whenever he discussed his high quality family.  And the feeling couldn't be more mutual.

I recently realized why he is so good at his Entertainer Extraordinaire job; he is making other people happy, and that's what brings him joy.  His happiest moments are those when he can share joy with others.  I shared a lot of laughs with that guy and I couldn't be happier to call him my Pop.

You know those moments in life...

You know those moment in life that you were miserable at the time or you think you could never make it through, but then you look back on and you say 'gee, I'm really glad that happened and I learned so much from it,'?? You know what I'm talking about.. you put yourself out there for the first time, you get in way over your head, you get lost in the middle of a big city and need to find your way out?  Well suppose you realize you're in one of those instances while it's going on... is there anything you can do?  How can you make it better?

No, I'm asking for real.

This is a story about someone not liking me and what I've learned from it.  It's finally over and now, in an effort to put it behind me,  I'm going to try to tell the story from her point of view instead of mine.

Well first of all, to put it politically correctly, we had a miscommunication.  I actually don't know her true feelings toward me and frankly I don't really care.  Well, now I don't care.  I cared a lot at the time, since she was my preceptor and she got to evaluate my performance.  This is what I wrote about it in my weekly journal. We submit these for a grade.  I tried to be as humble as possible, but to give you a little background: she had called my internship director earlier this week after I cried because she threatened to fail me.  After a very long tearful meeting with my director we decided it was a personality mismatch and that I was to move on from it.  My director reminded me however, that I needed to address it in my journal and in doing so I was amending the evaluation Monica did of me.  Here's what I wrote:

With regards to what happened early in the week I think what I was up against, was a big miscommunication.  I think *Regina George* got the wrong impression of me early and it spiraled from there.  She assumed that I was not taking my own learning into my own hands by not asking questions when the reality was, that when questions arose she was simply absent.  When I would come across something that stumped me, for example estimating calorie needs in tricky patients or where to mention things in my charting, I would give it my best attempt then keep moving in the interest of time management, which I was told I needed to improve upon.  We would then review my charting and end up needing to discuss the issue that I came across, giving the impression that I was lacking clinical skills.  I am aware that bringing up an issue like this would have been beneficial and it is something I will work on.  I was, however told at the beginning of this week that I was expected to work more independently so I was trying not to stop her work flow for a simple question on where to put something in the chart.  I received my evaluation and it wasn’t as bad as I thought but there is room for improvement.  Through it all I learned a tremendous amount from Monica, but unfortunately I actually feel like she had more to teach me.

I know it doesn't sound like I'm taking any responsibility for what happened but if you had been a fly on the wall during our meeting you would hear me wonder if it was all my fault at that time.
Now here's how I see it from her point of view.  And just as a warning this is my blog so I can portray her however I want.  (name's have been removed)
Hi, my name is *Regina George*.  I just spent 2 weeks with an intern named Lisa.  I've had interns in the past, 5 or 6 of them to be exact and I thought they were the shit.  I rave about them so highly that it makes anyone that can't live up to the expectations they've put into place feel terrible.  When Lisa first started with me she was nervous.  I probably couldn't tell that she was terrified of her first day of her clinical II rotation, even though it's to be expected given how intimidating a hospital can be.  I started off sweet and nice but would switch and project a very strong, authoritative energy at the drop of a hat.  I informed Lisa that I was amazing and that during my internship I could do no wrong and was offered a job at the hospital... but I turned it down, because of how amazing I am.  I like talking about how hard my preceptors were on me to prove once again, how awesome I was.  Anyway, Lisa's first day I brought her up to speed on how she will be perceived by the other health care providers, how professional she is expected to look, and that cell phones will not be tolerated for personal use during the day.  By the way, that doesn't mean that I can't use my phone to text my husband and friends all day, because... well, authority.  So I dragged Lisa along to morning rounds but didn't expect her to pay attention or gather any information so when she did I was pleasantly surprised.  I showed Lisa around the floor I work on and we went to see a patient.  I charted on him in front of her and explained to her where everything goes.  I know everyone talks about how complicated our computer system is but she had training back in August so she should be fine.  Alright, one patient down, I think she's ready for her own.  She talked to the patient well, asked the right questions and was starting to draw the right conclusions.  Her charting was a mess though.  She couldn't get anything in the right place. Since she was to quiet to talk to me about it though, I'm just going to assume she isn't understanding the patient.  A shaky week goes by and everything seems to be progressing at a snail's pace.  She's not offering to take all my patients, even though interns in the past were able to handle all of that.  I guess she's doing some things right, but definitely not enough for me to be happy.  Tuesday rolls around and she remains quiet, maybe it's because she's just a private person and not because I intimidate her.  I'm going to tell her that she has to work independently this week because if she's going to be a dietitian one day she's going to have to work alone, and even though this is still her internship and she's still learning, she's going to have to figure it out sometime.  Jeeze, first day back from the weekend and she screwed up the calculations on one patient.  This definitely doesn't seem like it could be a learning opportunity, and she's definitely not going to kill them or anything, but I'm going to scare her a little and threaten to fail her on Friday.  I'm being so nice about it though by warning her now and buy her cake when she almost cries because, well, I don't want to be a terrible person.  Tuesday was rough, but it seems like today she is coming out of her shell a little more, she's asking me where things go in the chart and what I think about calculating certain needs.  When she asks me about calculating needs, something I've been trying to get her to speak up about since day 1... I'm going to tell her that I don't know enough about the patient since I haven't looked them up.  I not glad that she was able to swallow her own pride enough to ask me these questions and I definately don't see that as her taking learning into her own hands though, because I've already formed my opinion of her and that doesn't fit with my preconceived view.  She just told me that she's pretty hard on herself and puts a lot of pressure on doing well but she started crying again while she was saying it.  What is with this girl??  I'm just going to call her internship director...

Well her internship director seemed like she really likes Lisa.  She said it was impossible that we were talking about the same person.  She even read me some of Lisa's journal from last week and it seemed like she was learning?!  Well either way, I don't want to deal with her so I'm going to send her over for a meeting that lasts all morning.  Then I'm going to get on her case when her time management skills are off for the day.  Speaking of time management, I'm going to make myself unavailable to her most of the day so when she finishes on time it won't seem like it.  But every so often, I'm going to breeze by on my way to see a patient and ask if she has any questions, to make it seem like I care.  Then while we're going over her first note of the day I'm going to waste her time so it takes longer to move onto the next patient.  I'm going to stop and answer my phone, I'm going to talk to the PAs on the floor, and I'm going to chit chat with the other dietitian when she stops by.  I'm also going to keep reminding her that I need to leave the hospital early everyday for personal reasons.  Oh, and when I do her evaluation I'm going to give her bad marks on the section for professional behavior for crying, even though I was the reason.

Phew! I needed that. Now that portrayal may seem a little harsh, but like I said... my blog!  My opinion doesn't have to be your opinion. And while, maybe her train of thought was different, each of the specific examples in there actually happened.  So to go back to being politically correct, I do agree that some issues probably could have been handled better.  I could have stopped her and asked more about the questions I had.  I could have spoken up more earlier when I was unsure where everything in the chart went.  I could have had thicker skin when she was coming down on me. It was like a daily occurrence though.. I think she just liked bullying me.  And I felt like I need to sit there and take it since I was her intern and she does know more about the field than I do.  Don't get me wrong, I did learn a lot from her and from working with her patients.  And I'm sure she thought she was just making me a better dietitian. And I'm sure one day I will realize something extraordinary about her or myself or something, but right now all I can do is try to move on from it.  We need challenge in life to keep it from becoming to boring.  Everyone runs into obstacles on their way to their dreams.  People are always going to get in the way.  They are going to tell you that you aren't good enough, strong enough, bright enough, ____ enough to do, whatever it is that you want to do.  The only thing we can do is, learn from it, write bitchy blog posts about it, and move on.

So this might be my first...

So this might be my first nutrition related post.  Other than the occasional post on weird things that happen to me during my internship I haven't written to much on the topic that I am choosing to spend the rest of my life studying.  Right now is different though.  Enter nutrition related post:

So I was sitting around bored during my internship today (future employers- you didn't hear that).  The topic of the rotation I'm currently doing is diabetes or the 'beetus for you Wilford Brimley fans.

Quick refresher on diabetes; it's a chronic illness that presents in a few different ways.  It effects the way that your body absorbs and uses the energy you get from food.  All food gives you energy, but food specifically in the form of carbs (bread, rice, cereal, pasta, fruit, and sugar) turns to sugar in your blood. Type I diabetes is when something happens early in life to signal your body to attack the cells in your pancreas that produce insulin.  No insulin = food that you eat doesn't enter your cells. Now it can't be used as energy and stays in your blood which raise blood sugar.  With me?  Type II can be caused by a number of different risk factors; age, weight, race, family history, inactivity.. blah, blah, boring dietitian stuff.  Either way Type II is when these factors cause your cells to become resistant to insulin made by the pancreas.  This forces the pancreas it to create more and more to the point that it eventually gets pooped and stops making as much.  Diabetes can be discovered at any point along this physiology and is a dangerous and difficult disease.  People with diabetes go through a lot when they first realize they have it.  Classes on carb counting.  Classes on blood glucose readings.  Classes on insulin delivery methods.  Kids can even go to special diabetes camp to learn how to live with it.  I've seen patients that finally got the hang of it after 20 years of battling.  20 years.  Not only is it life changing but it can also be scary.  If your blood sugar is too high for to long you can destroy your eyes, feet, heart and kidneys.  If it's to low you can faint and even fall into a coma.  So basically if you are insulin resistant or have diabetes and have it under tight control give yourself a pat on the back.  If you don't I can refer you to some dietitians I know...

So I'm at my rotation today dreaming of the 'beetus and I had a realization.  Diabetes is the Earth's way of getting back at human for treating it so badly!  Human treat Earth like a giant BM, we all know that.  We ravage resources for our own consumption with little regard as to who or what it will affect years in the future.  Well I think that Saturn and Mercury, as concerned friends of Earth's probably staged an intervention. After all cave men are like the marijuana of evolution and modern humans are the heroine.

Voice over (probably Morgan Freman): Earth has been struggling with it's human addiction now for thousands and thousands of years.  If it doesn't get better, the humans will destroy him.  Earth's closest friends and family have gathered to stage an intervention.

*Curtain opens on Saturn and Mercury sitting in a living room.  The year is 12,000 BC, before modern agriculture was on the map. Venus, the Moon, Uranus and Pluto are also there.  There is an 'INTERVENTION' banner hanging up in the background.*

Saturn

'Earth, we're all here today because we love you and Sun couldn't make it back from vacation in time.'

Mercury

'Yeah man, we love you and we hate to see you destroying yourself like this.'

Earth

 *somewhat annoyed*

'Look guys, I've got control of this, I'm just going to let the humans be here a few thousand more years... they promised they wouldn't evolve any further than this and they don't even have domesticated crops yet!'

Saturn

'Dude, you're letting them start fires and take advantage of your floods... it's only a matter of time before they are flying around you and tearing down your trees'

Everyone

*in mumbled concern*

'yeah Earth, yeah, yeah, you have control over the humans, don't let them take advantage of you!'

Earth

'... I suppose you're right *deep breath* I don't have control over the humans. *starts to feel better* Wow! That feels great to say! I guess the first step is admitting it.  Ok! What do I have to do??'

Enter Wilford Brimley

Wilford

'Ok Earth, what we're going to ask you to do is not going to be simple.  It's not going to be easy. You are going to have to work very hard at it, for a long time...'

Earth

*with a shaky voice*
'I think I can do it... with all of your help of course...'

Wilford

'Alright, the first thing I want you do to is let them plant their crops during the flood season'

Everyone

*Gasp*

Pluto

'But that means, agriculture, domestication, technology! The mind boggles with what they could come up with!'

Wilford

'I know it's a risky move. But if we can get them to settle into one area and plant in the same spot year after year, we'll have a chance.  After we lure them into thinking this is a safer way to live... then, we introduce to them wheat!'

Earth

'Wheat? But how's that going to help my human addiction, isn't it just going to feed them?'

Wilford

'Well, I'll tell ya, humans love wheat, and it can be a great nutrient for them!  But human don't have the will power you planets do.  They won't be able to control their consumption and they will eat to the point of self extinction. '

Earth

'You mean to say, I provide them with the tools and they will cause their own extinction?'

Wilford

'Precisley!'

Earth

'But what will be call the disease that they get from the inability to store the wheat they are eating?'

Wilford

'Well we'll just have to call that the DIAAAABEETUS'

Earth
'There's got to be anther way!'

Wilford
 *Slams fist on table in frustration*
'THERE IS NO OTHER WAY!!'
*starts to calm down, takes a deeps breath*
'Look, Earth, you're a good planet, and I hate to see the humans ravage you like this, and just imagine your future... this is the only weapon we have against them, they are already to strong...'

Earth

'Well.. I don't know..'

Mercury

'Oh come on Earth! Don't be such an oxygen producer!'

Uranus

'Yeah, Earth, you have 2 choices, kills off the humans slowly over time with the only resource you have... or let them continue to evolve and destroy everything you have worked so long to create...'

Moon

'Yeah Earth, what's it going to be??'

...
you get the picture.  Mercury and Saturn are bullies and obviously this is a dramatization but if we don't do something the human race is doomed to a slow and painful sugar extinction.  Or as we, in 'the biz' like to call it the diabeetus.

So here's a little story about...

So here's a little story about those times in life that you just have to laugh at yourself.  It was one of those amazingly mundane yet profound moments that nobody really realizes has this intense effect on you because it's just a part of their regular day.  Like I happen to know, for a fact that this moment held no weight or impact on either of the two other people that it involved.  If asked about it in a month they probably won't even remember it happened.  But for me it was one of those 'what the fuck am I doing here?!' kind of moments.  One of those moments you just have to laugh at yourself and say 'chill there girlfriend, you were kinda just taking things way to seriously there for a second'  then buy yourself some ice cream and call it a day.

So I'm in this dietetic internship right now, right.  And right now the majority of my day is spent doing the work that real dietitians don't want to do.  So whenever an A1C screen come through- A1C being a test that can indicate pretty well what someone's blood glucose has been running over 3 months, which is especially important for diabetics since it tells me that while you claim your blood sugar runs 'somewhere between 90 and 120' that really it's more like 190 and you're a lying asshole.  Anyway.  The hospital I'm working at screens; meaning we look through the patient lists for our floors and just browse for specific criteria for why we might go see a patient- we screen, for an A1C level of over 8%.  This means their average blood glucose level is ~183 which is much higher than the norm ~90 and your diabetes is getting out of control, you're going to lose the feeling in your fingers and toes... blah blah blah *dietitian talk*.  So anyway, we screen for these A1C tests and we have to go discuss with the patient why their blood sugars are running high and like 99% of the time it is because the person genuinely doesn't give a fuck.  Not to generalize the diabetic population; how undietitianlly of me. But at the very least my small. tiny. insignificant experience tells me that IF your A1C levels are running high, and have been for a while, you don't want to hear about carb counting and we're both going to sit here with smiles on our faces talking about things neither one of us wants to talk about.

Those are the kind of people I get to go see during this internship.

So I've got this patient.  And in an attempt to not break HIPPA we'll call them Daffy Duck.  Now Daffy Duck's condition I can't really describe either so let's just say that Daffy's principal problem is that someone ate his peanut butter.  Now along with someone eating his peanut butter Daffy also has dementia.  The doctors describe him as 'pleasantly demented' but he has it never the less.  So I'm in Daffy's room and my plan is to go through my typical laundry list of things I talk to patients about, bowel movements, nausea/vomiting, how you eat a home...the good stuff.  So I'm talking to Daffy and first question in he starts going off.  He's going off about how scary someone stealing his peanut butter is and how he doesn't want to be in the hospital because it scares him and how they got his diagnosis wrong and really they just THINK someone stole his peanut butter but really it's just someone playing a prank on him and they just hid it under his bed.  And so on and so on in a sort of gibberish, demented, smile and nod along sort of way.  But still I'm starting to feel Daffy's emotions and starting to connect with him when I realize I haven't asked any of my questions!.... So I panic.  I decided I have to interrupt Daffy.  I really didn't want to do this but it was getting to be to long, out of my scope of practice and I did have other patient's lives to save.  So I do it. I interrupt Daffy right smack dab in the middle of this really heavy conversation.  And I ask. I ask, in my grown up *loud and slow* so the patient can understand properly voice,  I ask, "SO HAVE YOUR BOWELS BEEN MOVING ALRIGHT RECENTLY??"

So I made this huge mistake...

So I made this huge mistake last week.  This wasn't any old, left my hair straightener plugged in all night and now there is a char mark next to my sink kind of mistake.  This was a brain mistake, the kind where I screwed up my train of thought out of purely selfish actions.  And now I'm writing about it to help myself understand and get back on track.  This is for me, not you.

So I finished my food service rotation of this internship that consumes my time last week.  To remain politically correct about the experience, I learned a lot from it.  And that's all I'm saying, fill in the blanks on that one, mind reader.  To celebrate the fact that I was done I spent the weekend preparing for my next rotation... CLINICAL!  To answer your question, yes it is a scary as it sounds!  My name is out there in the medical field- after only 4 days there I am officially official.  If something gets fucked up with one of these patients my name is on their chart.  Legitimately Legit.  So, in order to prepare for this rotation I... studied from old textbooks, reread some old case studies from college, took a prequiz, tried to relax, and dusted off and watched some episodes from one of my old favorite shows, House. Ok, that last part wasn't exactly a way that I was preparing for my rotation but I was bored and House was on the 'flix.  This was the huge mistake I made.

I go into my first day of the rotation a nervous wreck just trying to make it through.  The first patient chart I look it was pretty standard.  Coronary artery disease, which like most other heart failure patients had run it's course in the rest of the patient's body.  This lead to some elevated laboratory findings, some renal issues and a nutrition consult.  So silly me, after watching like 13 hours of a television show about a doctor dedicated to only solving the cases that others can't, my mind starts freaking out! What does that lab mean? Is that the only thing going on with them? How do those medications react with those ones? What about all the crazy underlying issues that we haven't tested for yet? Are we going to test fro them? What kind of healthcare workers are we? How is this going to progress to a more complicated case? Don't they all do that??  I forgot to remember that like 99.9% of the people that end up in the hospital are standard patients whose problems run a standard course and there is a standard treatment that, if followed properly, will lead to a discharge.  So now I'm grounded from watching House and I'm not allowed to assume someone's prognosis is immediately going down hill.  SORRY for caring...

Once upon a time...

Once upon a time there was a pretty pretty princess.  The princess lived in a tiny, secluded, and protected part of the northeastern part of the country.  We'll call this place "Vermont".  I'm going to tell you a gripping story of how she dropped her glass slipper (who wears shoes made of glass), let down her beautiful hair, and moved half way across the country.

Growing up:
So... there was this princess.  Most of the life she could remember happened in tiny little 1 hour radius in the Adirondack region of New York, with 130 other people her age that knew every single thing the princess did from the moment she stepped into her first kindergarten classroom to when she tripped and fell across the stage at high school graduation.  I'm saying- EVERYONE knew EVERYTHING.  They knew when you picked your nose, they knew how you liked your milkshakes, they knew exactly why you weren't wearing your NHS sash during said graduation. Now, the princess didn't exactly love where she lived growing up- standard teenager complaints, nothing to do, nowhere to go, boring people yadda yadda yadda, but she didn't exactly hate it either.  There was enough room in her street that she could play roller hockey with the neighbors until the street lights came on, she had best friends that would do anything for her- like punching someone in the face after they tried to push your friend out of a moving vehicle- and there was always adventure to be had in the mountains on the weekends, well the weekends that she didn't have basketball or track practice.  The princess had experienced other parts of the country too, ski trips to Colorado, visiting family in Chicago, flying to Disney World to hobble around the whole week with a questionably sprain ankle... and recently a vacation to Barcelona, but that deserves a separate story.  The princess was by no means "sheltered" but she also was not exactly well traveled.

The college years:
The princess spent a lot her first year of college- we won't call it miserable- but... without a proper social outlet.  She was struggling to find her niche at such a wonderful place and could not grasp how people made new friends so easily.  Don't get me wrong she had friends that she went to go get pizza with at 2am, and would let her into their rooms while her roommate got busy with the guys down the hallway, and granted some of it had to do with the fact that she lived on a primarily sophomore status floor she couldn't help but to be jealous when she saw people getting to know each other around her instead of with her.  Now the princess got very lucky toward the end of the year freshman year and made some wonderful friends that she would eventually go on to live with and spend the next 3 years of college making amazing memories with, but like I said she got lucky and she did this with the help of one specific and very special friend.

Post coital I mean college:
All through college the princess' confidence was growing and by the end of college she had blossomed into quite the young lady.  While her group of friends had shifted somewhat she was a part of a group of people that had gone through a lot together already and had much more coming for them, and she was proud of that.  After college the princess was terrified to venture out into the world alone.  She claimed time and time again that she was only moving if she had someone to do it with, after all who just goes to another city without and friends or plan or anything to do??  The princess continued to live her new-experience'ly' challenged life (and I hesitate to call it that, I did have some major adventures, they all just happened in New England, but I couldn't figure out what else to call it) until one day she decided to move half way across the country...

Ok she didn't just decide, she was forced somewhat by the Academy of Nutrition and Dietetics, the IUPUI dietetic internship program, and the inability to attain those things we call "dreams" without fulfilling a certain amount of supervised practice hours which based upon selection criteria has landed the princess in the flattest part of the country.

Opening a new chapter:
So the princess moves to a city who's population is larger than the population of the entire state that she moved from, that she had never even been to, and into an apartment with 7 other princess' in the same situation.  And you know what she's learned so far.. she's learned that when you know where you're going and you avoid the hours between 7 and 9 in the morning and 4 and 6 in the evening, you barely even notice the size of the city.  She's learned that even though it's a bigger city, there still is very little to do, very little that costs very little at least.  She's learned that you can make your city seem smaller by going to even larger, dirtier, meaner cities (sorry Chicago).  And she's learned that making friends takes practice.  She learned that all those kids at the beginning of college, or those people that start a new job and are immediately part of the team, aren't necessarily better people or more charismatic, they just have more practice at meeting new people.  They've had the opportunity to make mistakes. And life is all about making mistakes; and learning from those mistakes.  That carries over to meeting people: you meet someone, you talk for a little while to see if you're on the same page and if your not you find out how to be.  When you've done this enough times it becomes second nature, but if you've never had the opportunity to meet people that are different from you (like never leaving New England for more than a week at a time), you don't get to have the opportunity to practice.

Now, I don't know if you could tell or not but, drum roll please... the princess is me!  Yes, moving to a new, big, scary city has been quite the learning opportunity... I'm getting lots of practice meeting new people and I flipping love it!  When I got visit home in December I'm going to be the friendliest mofo you've ever seen!  And to thank you for your time here is a little preview to the holiday card the IUPUI Internship Class of 2015 will be putting out this season.  Side note, we got yelled at by our teachers for laughing too much during this photo shoot. We hot cause we fly mother fruckers.