Are you a "4th Mealer" and completely unaware of it?!!?

Time is flying and I can't believe that at the end of this week, I will be halfway done with my Medicine/Surgery rotation.  So what has happened recently?  Well, I started talking to patients on my floor without my preceptor standing over me.  The first did not go so well, but amazingly I am building up my confidence and starting to talk to patients better and better!  This is so exciting!

Also, I had a really great moment on Friday that I absolutely must share!  A patient of ours was barely eating, probably eating <50% of her breakfast, lunch, and dinner.  But somehow, this went unnoticed by the nurses (scary, I know!)  But at the last minute, before the patient was discharged, a doctor came up to me (yes, yours truly!) to tell me that he wasn't going to discharge the patient until I assessed the patient.  Of course I started panicking.  I immediately dropped what I was doing and started flipping through the chart of this patient.  To our surprise, she was hardly eating anything. I went and talked to her (on my own!) and asked her what was going on with her eating. To make a long story short, she is depressed and has no appetite.  She has tried supplements, such as Ensure, but she just can't stomach them any longer.  When I left the room, I immediately told the doctor that we can't discharge her yet.  She was going to be released to an assisted living home where there isn't really a lot of supervision with meals.  We set it up so we could record everything that she was eating (calorie counts) and I put in my own tube feed recommendation, if she continues to not eat.  Tube feeds are one of the things that interns fear most, but they really aren't that scary!  The doctor agreed with my recommendations and she was still at the hospital today! I felt amazing.  You have to realize how great MGH is for students.  In some hospitals, Dr's don't even consider what the RD says.

So, that was my amazing moment last Friday.  I have a huge presentation next week that I am trying to find time to prepare for.  We have 4 presentations during the entire course of this 1-year long internship.  And I'm about to do 2 of them this month.  Kind of freaked out, but at least, by some miracle, we get Columbus Day off, so I can have extra time to work on it (and sleep in!)

Also, I thought it would be nice to add some pictures on here.  This is a picture of the subway station where I get off to go the the hospital.   MGH is on the "Red Line." My commute takes about 45 minutes and involves 1 transfer (each way!):

Also, here is a picture of MGH...did I mention that MGH is not 1 building, rather a small city?  All of these buildings are part of the campus.  Crazy, I know.

Other more exciting things, we had a party for one of the interns birthday this weekend.  It was so great to see everyone out of the hospital.  Also, Justin, me, and my roommate went apple picking this weekend. Can I just say that the only way that I'm staying sane during this internship is by maintaining a normal life on the weekends?! It's so good to get out of Boston every now and again!

One more thing, I recently read a study that came out of NC Chapel Hill about snacking.  In the past 30 years, the average calories from snacks have increased from 345 cal/d to 547 cal/d.  Can you say 4th meal?? Do you know how much you are snacking!!?!