UMHS Inpatient Rotation
It’s been quite an interesting month -- the UMHS inpatient rotation was certainly the one I was most anxious for, and it has proven quite a challenge. I was mostly worried that I was going to be asked a question and I would freeze up, or that I was going to pass out without warning. Fortunately, neither of these things happened! I even saw burns (on a screen) and one patient got a nosebleed while we were in the room on rounds and again--I prevailed!
Inpatient GI… it was so smelly. LOL. I know that’s probably not what my first thought should be but my sense of smell is out of control (probably to make up for my inability to hear my own name or anything else, really). Every day I dreaded going up to the floor because I just knew it would smell for awhile. One day was super bad because someone literally projectile pooped everywhere. I didn’t see it, BUT I KNEW and my nose knew and everyone within that block of the floor knew. People feel bad mentioning potty training or other GI issues around me and I’m just thinking, YOU DON’T EVEN KNOW. On the bright side, I was only there for two weeks, and I learned a ton!
I know more about Irritable Bowel Disease than I ever thought I could know, and I learned about reading lab results more in-depth, as well as what the workload looks like for an inpatient dietitian. Most cases of IBD are treated outpatient, so we were seeing people who were having the most intense flares/the most severe cases. We also had people with pancreatitis, and GI is actually paired with Liver, so there was a lot of hepatic encephalopathy. For example…
Doctor: Do you know where you are?
Patient: Dearborn heights!
Doctor: Do you know who we are? (referring to the 10 whitecoats in the room)
Patient: Um.. well you’re my priest!
Clearly this patient was not going to be able to tell me what he ate yesterday. Having said that, this patient went through quite a lot during their hospital stay, and I’m so happy that they figured out the problem and were able to address it (no it wasn’t lupus all you House fans, it was a GI bleed in the jejunum).
I think what I appreciated most was feeling respected on the GI unit. When nutrition came up, the attending physician and all the others looked to me and my two fellow interns. Between the three of us, we almost always came up with an intelligent, well-educated answer. That doesn’t mean we weren’t terrified though! You never want to lie or guess an answer, but having confidence in your training goes a long way (it probably doesn’t soothe any of your worries if you’re an intern, I know hearing it didn’t soothe mine, but I promise it’ll be okay!). I was able to ask the physicians for lab values I needed, and recommend nutritional supplements and diet orders. Also, I got a dumping syndrome question wrong in Medical Nutrition Therapy 1 (two phases? First phase eat, second phase dump??), but lo-and-behold, you learn more from your mistakes. When the physician turned to me and asked me about the two phases of dumping syndrome and an anti-dumping diet on rounds, I was ready to go! For the most part anyway. My preceptor was my MNT professor and the director of our program, so I also had to make sure my knowledge was up to snuff for her. She. Knows. Everything. It was awesome to see her in hospital environment though, her skillset really came through.
Then I spent two weeks in the TBICU, trauma burn intensive care unit. If I thought GI was demanding, this was definitely a bigger challenge. Well-nourished people in GI could go anywhere from 7-10 days usually NPO and maintain decent nutritional status. In the TBICU, people needed tubes dropped within 24 hours--people need nutrition to heal. It could be head fractures, brain injury, third degree-burns… they all need calories and protein in order to rebuild. I was reminded just how incredible the body really is, and what it can come back from (or in one case, what it can’t recover from :( ). I have definitely tried to decrease any distracted driving--half the cases in the TBICU are from motor vehicle accidents. Don’t pokemon go and drive people!! (Public transportation FTW).
I had another great preceptor here, who was vocal and always in the patient’s corner. She made sure they got the support they needed and monitored every bed every day. She had great insight to share with us about her experiences as a dietitian in the intensive care unit, and she had a great working relationship with the nurses and physicians and SLPs and other team members. I learned how to be more vocal--I am so tentative when it comes to speaking up. My preceptor really encouraged us to be more autonomous and to believe in our training. (so inspirational)
Calculations that I never got the hang of in MNT 2 became second nature. I learned about calculating PN formulas (your pharmacist will be your bestie in these cases), as well as calculating tube feedings and making recommendations for nutritional supplements in severe cases. I learned in real time, looking things up between projects, doing small (very simple) assignments at home to come back the next day and have answers.
Overall, I was 100% sure I did not want to be an inpatient dietitian, and now I am 300% sure. BUT I learned so much at this rotation and felt that my scientific background was put to work. Drug-nutrient interactions, derailed cellular processes, and GI anatomy malfunctions were always on my mind. Whenever people find out I’m in nutrition, they respond, “Oh, so you tell people to eat healthy?” Grrr. I’d like to see you help heal a third-degree burn.