By Moira Cain
If I told you that I once almost passed out watching a video of a woman changing her ostomy bag, would you be worried about me during my clinical rotation? Well, that actually happened, and I was very worried. I started my 10 week primary clinical rotation at CalvertHealth Medical Center back in November, and I was terrified. I’m not a huge fan of hospitals, but mostly because I hate bodily fluids. I was convinced that I was going to pass out at some point.
On the first day, I saw a patient with a nasogastric (NG) tube with intermittent suction, and was not prepared for the color of the bile, or the fact that intermittent suction meant that the bile went back down the tube. That was not the last time I was going to see bodily fluid unexpectedly.
Given my apprehension, I was not expecting to like clinical at all, however, I ended up absolutely falling in love with it. The registered dietitians (RDs) at Calvert are so incredible, and really care about their patients. The RDs are treated as an integral part of the interdisciplinary team of providers at the hospital. Everyday, we would get together and “round” on each patient on the floors. The nurses would explain to the hospitalist, case managers, pharmacists and RDs what was going on with the patient, and then the hospitalist would explain the plan for the day. It was great to be part of the team where you could ask questions and have your voice heard. It was common for the RD to notice a low lab value and request repletion of the nutrient or to notice that a patient hasn’t had a bowel movement for a couple days and request a bowel regimen.
There are four RDs that work on Calvert’s two floors, the Intensive Care Unit and the behavioral health unit. Instead of working with a dietitian in a particular unit each week, I saw whoever came onto whichever floor I was working on. During my staff relief weeks, I performed many congestive heart failure (CHF) and diabetes educations. This included speaking to a patient about the different foods she should be eating, and things she could substitute to improve what she was eating. This taught me that even in an inpatient setting, as a healthcare provider I need to meet patients where they are. This patient had many questions about her diet and was confused about the different diet recommendations given to her by a variety of providers. It is important to remember that every patient has a different back story; if they are chronically ill, they may have had many different providers manage their diseases. Each provider may differ on how to best treat that patient.The RD must teach the patient how to make nutritionally sound food choices to speed the recovery process, help manage existing diseases, and maintain a healthy lifestyle. The RDs at Calvert were so willing to help me learn. They looked up articles for me in their spare time, including articles about refeeding. They emailed me articles about the effect of hyponatremia and the brain. In my last week of my rotation before staff relief, the dietitian I was working with told me that I was doing great, and the team knew I was ready for staff relief. It gave me a big boost to know that they had confidence in me. I felt so much more sure of myself during my staff relief. I really knew what I was doing as I gave my diet educations and wrote my assessments.
I am happy to report that I never passed out during the whole ten weeks. I entered this internship without much experience in a hospital and a fear that I wouldn’t be able to handle the exposure to the messy aspects of working in a hospital. I was able to overcome those fears and am now confident that I will continue to be able to handle hospital work as a dietitian. I was told going into the internship that I might change my mind about a practice area during a rotation; they were right. I did not think that clinical would be the rotation that stuck with me the most, but I was wrong. It taught me so much and I am very happy that I had this opportunity to change my mind.