Week One and Week Two

Sorry I haven't posted since I've begun the internship (a mere week ago today, eeekk!!). But honestly, you didn't really miss out, considering the first week was all about orientation.  Here is a brief synopsis of my first week: met all of the interns (everyone is awesome!), learned my rotation schedule, did a scavenger hunt in the hospital (awkward, but helpful), had talks from preceptors about what to expect in each rotation, went on a Boston Harbor Cruise with the interns from last year (got the dirt on everything), and finally, the week ended with everyone presenting a brief autobiography about themselves (nerve-wracking...who likes to talk about themselves in front of a huge group of people?)

My first rotation that I have been assigned to is Medicine and Surgery (AKA Med Surge).  This is often the most dreaded of all the rotations. It's during this rotation where I will be learning how to talk to assess patients -- looking at their charts, assessing their needs, talking with patients, making notes in charts, etc.  I will be at this rotation for the next 6 weeks. Today was my first day with my preceptor in Med Surge.  Her name is Ellen.  She is in her late 40s and just completed  her dietetic internship 2 years ago.  She is very motherly and very understanding that I don't know a lot. This is a very good thing!

I saw my first patient today and was overwhelmed with sadness.  She is 80 years old, and is the cutest, tiniest Asain woman I've ever seen. Unfortunately she has squamous cell carcinoma.  The cancer is malignant and for some reason, the woman is sure that her cancer has been cured. Her chart said that she is dealing with her cancer by being in a state of denial.  She has been living alone and hasn't been able to take care of herself for about 8 months, so you can only imagine how nutritionally deprived she is. We asked her if she drank her Ensure (a supplemental drink) this morning and she said she couldn't remember, even though the empty can sat right on her tray in front of her.  Also, when asking her about foods she tries to avoid, she said she avoids eggs because she wants to keep her cholesterol down.  Now please realize, a person who has lost a significant amount of weight due to muscle wasting and catabolic activity in the body shouldn't be too concerned about cholesterol intake, relatively speaking.  But she is so set in her ways and said that she didn't want to start developing high cholesterol now, so no eggs for her.

So what do we do for this type of patient?  We want to provide her with as much nourishment as possible. If she will drink supplements, we will give her those.  If she wants pickles (which she did, in fact, request) we will request that she gets some during her next meal.  It's all about providing her with nourishment to give her strength during the remainder of her life. 

I really don't want to leave this entry on such a somber note.  Everything else has been nothing but positive at MGH.  I really feel comfortable at the internship and I couldn't be happier that I am in Boston.  I have lots of projects and assignments that are waiting for me, so I better get back to it.  Thanks for reading!