I'm in Love and I Don't Care Who Knows It!

What an amazing photo shoot we had with Hannah White (<--- click this link to see her pictures...amazing!!!) We got to frolic through fields, pose with huge rocks, hike through trails...everything I ever hoped for in an engagement picture session.

But first, can we talk about this sunset?! Couldn't have asked for a more beautiful evening to take pictures :)

How lucky am I to spend the rest of my life with this guy!?

Outpatient Nutrition Clinic

My rotation in the burn unit is complete, and I'm moving on to the outpatient world. Specifically, my rotation is through the Nutrition Clinic. I am working with a super friendly and fun dietitian named Natalia. Yesterday was only day one for me, so I don't have a ton of updates. So far I like outpatient WAY more than inpatient, though! It seems much more laid back and there are many more opportunities to use my motivational interviewing skills.

For those of you who are unfamiliar with motivational interviewing, it's a way to counsel people in a way that is conducive to behavior change. It helps people come up with their own solutions to problems they may be facing by setting their own goals which they believe they can accomplish. The counselor must ask questions that will enable the client to see that they need to change and, in addition, use reflective statements to confirm what the client has already stated. For example, I might ask something like, "What have you heard about diabetes?" This would show me what the client may already know, but at the same time may reveal some misconceptions they may have about the topic. If the client were to say, "Well, I know that when you have diabetes, you can't eat carbs, because they turn right into sugar and that's bad," I might respond with something like, "You're afraid that if you eat carbs, it might have some sort of negative effect on the treatment of your condition." The client might go on, or I could say, "This might sound different than what you have heard, but carbohydrates are an essential part of the diet, even for people with diabetes..." and so on. The whole process may take longer than me simply saying to the client "You need to balance your carbs into your diet by doing this, this, and this," but would that make the client feel good? Probably not.

If I've learned anything in my internship so far, it's that people just want to be heard and treated like...well...people. No matter how sick they are, they deserve to be treated the same as anyone else. That's why motivational interviewing is held in such high regard. It allows the client/patient to feel confident in what they already know, feel like they are being heard or understood, and also to motivate them to change without  overwhelming them with research, facts, figures, etc.

From the sounds of it, this week I will just be observing while Natalia does the counseling. She said we would also do some role playing so I could practice my counseling skills before I have to actually counsel her patients. Then the last two weeks, I get to be the main counselor, while she helps me out if I miss things. I'm pretty excited because nutrition counseling has always been an interest of mine. She said most of our patients have diabetes (type 1, type 2, or gestational), IBS, or Celiac disease. I have been doing a lot of reading on these topics, especially regarding the nutritional impact, and I have to say, I have learned a lot! I know I learn best by doing things, so I have confidence that I will continue to grow in this rotation.

Burn/Trauma Unit

While I'm making the transition into the clinical world of dietetics, I am learning so much about so many things. Wow. Vague. Let me explain.

I've officially completed two full days in the Burn/Trauma unit. This unit has been particularly difficult for me, emotionally, to rotate through. I know, it's only been two days, but it's been tough! First of all, the patients at UIHC, in general, are the sickest of the sick. Going into this rotation, I thought I might see somebody who burned their hand really badly on the stove. In my head, this person might be a busy mom, who forgot what she was doing and ouch! Better go get it looked at in the hospital. But I was very wrong. Right now there are patients there as young as 3 months old and as old as their upper 70s, with wounds caused by grease fires, scalding water, meth explosions, and bed sores. Their wounds are as small as 5.5% of their bodies all the way to 55%. I cannot imagine the amount of pain these people are in, and I always catch myself thinking that this could happen to anyone. 

But then I see this light among the darkness. The dietitian I am working with is the nicest, light-hearted person you'll meet. She is educated and has years of experience in the field. I feel lucky to study under her, especially because she actually knows the answers to all my million questions. When she talks to her patients, she is non-judgmental and caring, and speaks with words they can understand. I hope to gain traits like these when I am a dietitian as well. 

Like I mentioned, as an intern, I have a million questions. I also have this...fault...you might say, in that I expect to understand everything and retain it the first time I hear it. We were talking about a patient's protein needs at one point, and she mentioned that this person needed 1.2-2 g protein/kg. You see, in classes, they say things like, "You give them 1.2-2 g/kg and adjust when you need to." Which leads me to think, "What happens if you give them too much? What happens if you give them too little? Can they die if they get too much or too little? What classifies moderate stress vs. mild stress? How do you know how much to adjust it by? How can you tell if you're giving them too much?"...etc. So anyway, 1.2-2 g/kg is a HUGE range if you calculate that, so she ultimately decided to give this particular patient 1.5-1.7 g/kg. I asked her why she chose that, and she kind of laughed and said, "Because when you do this for as long as I have, you just sort of..know." 

So, rant for one second. I remember a specific time in college when I asked a similar question in class, and the professor responded, "Because I just know." And I wanted to ask, "Well how can I learn that?!" I was so mad, because how rude! I was doing my best to learn everything I could and she was so snobby about it! Like when you're a kid and you ask your mom if you can do something and she says "no". When you ask why, she says, "Because I said so." Hello! No lesson learned whatsoever. 

Ok, back to the story. Because of my previous experiences, my initial reaction was to blow her off. "Here we go again. I'll never learn this." But then, it hit me! By practicing more and more, I will eventually understand it. She "just knows it" because she has done the same thing every day for the past 10 years. I'm sure she's made mistakes and had to correct them so many times, so now, she knows what to do. 

I know, my epiphany is not one for books, but I feel some sense of security in the fact that I don't have to know everything yet. That's why I'm in an internship. If I knew everything, I would be makin' the big bucks, and be a world-renowned dietitian. But I don't yet. And that's ok. Especially since I have an awesome preceptor who will teach me :)

I promise I will try to keep y'all updated more often. (When I sat down to write this, I didn't think I would have anything to say. Ha!) Stay tuned for more about this unit! I'll be there for 5 more days!