Wordless Wednesday: Goodmorning Boston

Boston's Back Bay.  Taken from the South End.

Giveaway Winner

Thanks to everyone who entered the giveaway.  I picked a winner through random.org, and am pleased to announce Emily from The Health Nut as the winner!  Congrats Emily.  Please email me for the gift card promo.

Other news.  Vintage fun from Sowa Open Market.  Went with a friend last Sunday.

If you're in Boston's South End, make sure to stroll by!

Remember that insatiable pizza craving I mentioned on Monday?  Yup, it's still here.  My family is visiting Boston, and we went to a new restaurant near Tufts Medical.  Why hello again pizza!

Thank goodness it's Friday!  Today is my last day on the ICU units.  

These past three weeks my motto has been "One breath at a time."  Even still, I'm sad to leave.

Your plans for the weekend?
Goodbye,
Rachel

Weekend Pizza Crumbs. And Giveaway!

Goodmorning!  Let's start this week with a $40 gift certificate giveaway.  Thank you CSN Cookware!  CSN is currently featuring a variety of dinnerware sets, however their website offers a plethora of culinary treats for whatever strikes your fancy.  (My wish lish includes a measuring scale, popsicle molds, and a yogurt maker!)  Keep reading for giveaway details.

Last week I ceded my oven strike to a delicious Sausage Squash Pizza.  Slap down that easy Trader Joe's whole wheat pizza dough, and top with tomato paste, onion, chicken apple sausage, sliced tomato, and fresh CSA summer squash.  Garnish with grated mozarella.

That homemade pizza aroused a craving.  So this weekend I ventured arm in arm with fellow dietetic intern and friend Renee into Boston's South End. We set out for a charming placed called PICCO, Pizza and Ice Cream Company.  Oh yum.  Renee and I were easily romanced by the corn soup and herb ravioli starters, leaving us completely vulnerable for the undeniably delicious carmelized onion and eggplant pizza.

By the time we tasted the Coconut Chip Ice Cream, our defenseless hearts were taken.  

Here's the sad news: this weekend my roommate left for India for a three week visit with family.  I miss her already.  But there's nothing like frozen yogurt for a proper goodbye sendoff.  

Berryline.  Harvard Square, Cambridge 

Kitchen Splurge Giveaway!  

With all the heat and mess they put up with, I think it's time to pamper your kitchen.  How about a $40 gift certificate to CSN Cookware for starters?
To enter, leave a comment on this post.   Please tell me about your weekend crumbs, or share your kitchen's wishlist.
Of course, second entries for tweeting.
Deadline: Thursday August 19th, 12noon EST.  

This giveaway is now closed.

Happy Monday!

Rach

Lesson 7: Bumping the Walls. Questions from the ICU.

Charles River, Boston Massachusetts

Yesterday, in an attempt to escape the world of scrubs and sanitizer, I laced up my running shoes and walked home from the hospital.  90 minutes later I arrived at my doorstep with sagging shoulders (I think my bag gained 10 pounds along the journey), and brimming over with fresh musings about the dietetic internship.  I'm currently working with the dietitian on the Surgical Intenstive Care Unit (SICU) and Medical Intensive Care Unit (MICU).  Here's some thoughts.

Longfellow Bridge, looking into downtown Boston

What's to like about the Intensive Care Units (my opinion!):

• Morning rounds.  I enjoy listening to the MDs and residents talk their stuff, and it's much easier to stay updated on my patients.  I like to measure my learning progress by counting the number of terms and abbreviations I don't understand.  Each day the long list is shrinking!
• Complex medical conditions.  Our body is smart, but so much can go wrong.  Amazing pathophysiology.  I want to know more.
• Calculating tube feeds and IV nutrition (TPN).  This is why the doctor needs a dietitian!

Intensive Care Units, Dislikes (my opinion!):

• Minimal patient interaction.  Once a patient is sedated and on a breathing machine, be prepared for  a one-way conversation.  *wink*  But honestly, I do not like spending the entire day talking only with the medical team and family.  Talking with a patient makes me feel like I am helping them.
• The limited scope of nutrition in critically ill patients.  I feel silly worrying about a patient's eating when the rest of the team is working hard to keep their heart pumping, their lungs breathing, and their blood vessels open.  It's frustrating, but I understand.

Here's where nutrition leaves me hungry.  In these critically ill patients, I want to dig deeper into the medical state, I want to understand the disease process, I want to directly affect the medical plan.  As a dietitian-in-training, I wish that the field of nutrition could be more involved, more helpful.  Is Dietetics in a glass house, and do I keep bumping the walls?

Questions that I'm trying to figure out:
How does a dietitian justify his/her usefulness in the ICU, without overstepping his/her scope of practice?  Do you know what I mean?
How does a dietitian assimilate to the medical plan, while also gracefully asserting his/her nutrition recommendations?  Hopefully this comes with experience.

Welcome to new readers!  I'm very pleased to make your acquaintance.
Cheers for Thursday,
Rachel

A Rooftop Dinner

A recent trip to New York City left me many fond memories, including fantasies of a fabulous rooftop dinner hosted by my friend Kristina who is attending Columbia University School of Nursing.
We all know that a rooftop dinner means three things: delicious food, a great view, and delightful company.  This post is a tribute to delightful company, a shout-out to all my friends new and old.

Thanks ladies for a wonderful weekend.

A specific thanks to the friends who speak encouragement into my life. 

(For more fun, check out Jenna's blog! She's the cutie in the dress.)

On our way to Ellis Island.

He was so amazing!  ; )

George Washington Bridge, NYC

 

Check out Cindy's blog, (on the left).  Her video-blogging about life in NYC cracks me up.

Thoughts on rooftop dinners?
Thoughts on friends?  
Don't you love these corny posts?  *wink*

Friday is such a promising day; let's see what the weekend brings!

Cheers,

Rachel

Lesson 6: Changing Hats

flickr photo from splinkyhoo

The dietetic internship goes on: first week on the Intensive Care Units (ICU) is over!  Learning-induced headache?  Yes.  Excited to work this weekend?  No.  Thankful for the amazing ICU staff?  Yes.  These nurses and docs are the best!

The ICU houses the very sickest patients in the hospital-those most likely to need breathing support, fluid stability, and pain control.  From a nutrition standpoint, many of these patients need feedings through tubes and IV catheters.  Calculating IV nutrition is a new role, and a new hat that I'm adding to my closet.

(Photos from a NYC trip last month.  Pardon my randomness.)

People often ask me, "What is a dietitian?  What are you learning in the hospital?"  Earlier I wrote about a dietitian's contribution within the larger medical team.  As a member of this team, a dietitian must don different hats depending on the situation.
Examples From the Hat Rack:

• Educator:  (A unique role that doctors do not have time to do!)  In a few brief minutes, dietitians provide knowledge and application on a variety of topics spanning carbohydrate foods for a newly diagnosed diabetic, to food safety instructions post kidney transplantation.  No poking, no prodding, just talking.  And I love the talking!
• Cheerleader: After 10 days of nausea and vomiting, a patient wakes up with an appetite.  What to do?  A dietitian pulls out her pom poms to cheer her on, shouting out tips and encouragement to optimize eating and nutrition.    
• Nutrition Support: Sometimes a patient needs IV nutrition or tube feeding because they cannot eat.  That's when a dietitian whips out their calculator to calculate and concoct a feeding formula to meet a patient's individual protein, calorie, and fat needs.  I like doing this work.
• Consultant: A man with cerebral palsy is admitted with breathing problems and a mysterious 40 pound weight gain in recent months.  While the doctors tend to his respiratory needs, a dietitian is consulted to assess the weight situation.  What are the specific energy and protein needs for a man with cerebral palsy (they are actually decreased due to less muscle mass and activity)?  How much weight, if any, should this patient lose?  Dietitians use their expertise to investigate and provide recommendations for the medical team.

Note: This is based on my opinions and experiences thus far at Tufts Medical Center.  Outside of the hospital, dietitians enjoy a variety of roles in diverse settings which may include outpatient clinics, private practice consulting, sports nutrition, research, public health, culinary arts, corporate wellness, and food industry.

Have a fabulous Friday.

Rach
ps- Thanks for bearing with my journal entries and absurd titles.  I love sharing my thoughts, and I also want to promote the field of clinical dietetics!

Lesson 5: Teaching Hospitals-Team Kaleidoscope

flickr photo from dalefarwalker

In the hospital, I'm learning that nutrition is merely one contributing color in a constantly rotating kaleidoscope of patient care.  A dietitian's unique expertise is but one viewpoint tossed amongst the various shapes and perspectives of the other doctors, medical students, nurses, technicians, physicians assistants, social workers, case managers, unit coordinators, physical therapists (who did I miss?).  This multidisciplinary team is really quite beautiful, yet it demands quick flexibility and clear communication.  A single event-one abnormal X-ray finding, a new IV infection, a hold-up in insurance approval-is enough to rotate the scope and send us all topsy-turvy as we shuffle into new positions. 

Despite the inefficiencies, I love the teaching hospital setting.  Although I still struggle to confidently communicate my nutrition recommendations to the residents.  I think the trick is learning how to frame my recommendations within the context of the larger medical plan.  I see myself as one bead (preferably canary yellow!) in this pattern of color, and it is my job to quickly fall into place with each changing scape.
What are your thoughts about teaching hospitals?  Do you mind the inefficiency?

Boston Harbor.  It's been a beautiful summer.

What did you do this weekend?

I went to Ikea for the first time in over a year!  Way too much stimulation for this little heart of mine...afterwards I felt short of breath and pleasantly giddy.

Cheers for Monday!
Rachel