went with the flow...

Emotional side.

I went with the flow going into the field of dietetics. I knew I always wanted to go into health care. The most well-known of course would be doctors, pharmacists, nurses. That's why that was all I considered in high school and college. I never wanted to stay in the United States for good, so I wanted to find an alternative to 4-year college, 4-year med school, 3-4 year residency = too long = I can never go back to Hong Kong. Went into dietetics because that's science, about food and working with people. I didn't even know what it entails...and went with it. 

I was very hopeful and wanted to make a difference in college even though I was clueless most of the time. I didn't know what is nutrition support; I didn't know I needed to apply for dietetic internship; I didn't know licensure... I didn't know way too much stuff and way too unprepared for this field. I applied for internship, got into one and went with the flow.

When I started my internship, sometimes, I regretted my choice. Sometimes I thought I could do bigger and greater things with bigger impact to the patient and healthcare. People don't even care about nutrition in the hospital. What's the point of my role? A lot of times, I love learning that's why I enjoy each rotation and am curious for knowledge. I am always scared of talking to patient and educating them, thinking that they don't even care.... what's the point?

It wasn't until staff relief started that it finally hit me. I do play an important role and I can change people's lives. So many incidents during this time made me realize that I have a big impact on patient's lives: 

1) Stopping inappropriate TPN for a patient who is on ECMO - the medical team thought the patient wasn't tolerating tube feeds and wanted to start TPN through his femoral central line which is high risk for infection. And now, three weeks the patient is getting better on ECMO.

2) Transitioning from TF with pureed, nectar thick liquid diet to dysphagia, thin liquid diet for a patient. This patient was on pureed, nectar thick liquid diet and wasn't eating at all like less than 25% because of the nature of the food. I suggested let's get SLP to see pt and get a swallow evaluation to liberalize pt's diet. 

When I brought that up, the attending was like why? She's already on a diet. If I didn't suggest that, she might be on this restrictive diet for a while and eating poorly and get a peg tube in. We just changed her diet so we will see if she eats more and hopefully she doesn't need a peg tube in.

3) Adjusting tube feed formula with free water flushes and TPN to make sure their electrolytes are within normal limits. 

4) Liberalizing a patient's diet in order for her to eat more even though that didn't work. It took the team a week to liberalize it after paging them so many times. She's still not eating; it's been 25 days. Suggest DHT and now she's refusing. I'm not sure what else to do other than recommending appetite stimulant. In this case, I wish I was more proactive in my patient care and suggest DHT earlier. Maybe she would be in a better place nutritionally.

5) Giving nutrition education, just providing them with some information is better than nothing. I want to practice motivational interviewing, but in this case, teaching is important when they don't have any knowledge and rational behind their new diet restrictions.

... and so many more... 

And I know I really like it when I don't feel tired or annoyed when I need to wake up early and stay later to talk to them, care for them and make sure they are getting the things they need. I do enjoy what I am doing!

Just because no one cares, it doesn't mean it is not important. That's why we are here to advocate for our patients. If we don't do that, then who would? Nutrition may not be first concerns in the hospital. It might not be important acutely, but it does make a difference in the long run. The long-term outcome does make a difference with nutrition.