Thursday, May 6, 2010


If there is one thing I have learned from working in the hospital, it's that 90% of all conversations are either directly related to, or somehow manage to incorporate poop. If not poop, then bowel movements which in my mind is the same thing. Even if no mention of poop or bowel movements was made, people tend to say do do a lot. Not on purpose, but in a normal everyday sentence without even knowing it. The trick is not letting them see how hard you are trying not to laugh. Apparently not everyone thinks it's as funny as I do. For those of you who are unsure as to how someone could say do do with out realizing it, here is an example: "It doesn't matter what you do do, as long as you don't do that." I'll admit it, I just snickered while reading that sentence in my head.

As a dietitian, poop seems to cause a lot of people's issues, and is often the reason for a referral. Too much poop, not enough poop, runny poop, hard poop...we hear all about all of it. I learned this week that often patients, specifically elderly patients and those in palliative care, will become really irritable and grouchy and difficult for the nurses to handle. This is understandable, I would also be grumpy if I was stuck in a hospital for a prolonged period of time while sick. The one thing that makes these people less grumpy, and in fact quite pleasant, is nice satisfying bowel movement. So basically our patients are of two types; those who's bowel movements are causing the problems, and those who just want more of them. After seeing so many people with bowel movement issues, you definitely learn to appreciate the small things in life...such as regular bowel movements.

Since I am working in a hospital, obviously there are a lot of wheel chair accessible bathrooms. Normally in large public washrooms, depending on where you are, you can be fairly certain that if you decide to use the extra large wheel chair accessible stall, there will not be someone angrily waiting in their wheel chair when you come out, trying to kill you with their eyes for taking advantage of their misfortune. But in a hospital you can't be so sure. The hospital where I am placed is really small, so each washroom is just a single person room. There are two washrooms right beside each other in the cafeteria, one is wheelchair accessible, and the other is not. Well after lunch the other day, the none wheel chair washroom was occupied but the wheelchair one wasn't. I stood there for a couple minutes trying to figure out what to do. On one hand I had to pee, and probably wouldn't have thought twice about using the wheelchair washroom except for there was a nurse using the ATM right beside me. This made me wonder: what is proper wheel chair bathroom etiquette? I looked down the hall, both ways, didn't see anyone in a wheelchair coming in my direction and I just went for it, hoping that the nurse was too busy getting cash for lunch to notice me, or at least too busy to notice me enough to recognize me at a later date as I walked past the nursing station. I still have no idea what proper etiquette in that situation is. Obviously had there been someone in a wheel chair either waiting or approaching, I would have waited and given then the washroom, but there wasn't. I'm hoping this doesn't make me a terrible person.

I wasn't actually in the hospital today, we had a Clinical Dietitian's meeting with about 12 clinical RDs from across the province. We discussed interesting case studies people had encountered, new and innovative resources that were being used to educate clients and patients, and had a rep from Abbott Laboratories come in to do a presentation on elderly patients. The presentation was all about the syndromes that are associated with the severe weight loss and anorexia that often develops in older individuals and how to improve the care we provide in hospital to these clients. She also brought a new product called Promod (or something like that?) for us to taste. One of my performance objectives that I must accomplish to "pass" this internship placement is an evaluation of the commercial nutritional products that we prescribe and recommend to patients. Examples are Boost shakes, Ensure, Glucerna etc. Last night I brought about 5 different products home to taste test and since I didn't want to do it alone, and wanted more opinions for my report, I invited my roommates to join in on the fun. The first product was Boost Vanilla Pudding. I had high hopes for this one...I like pudding, it can't be THAT bad right? WRONG! I almost threw up my intestines after tasting it. It was horrible! Only 2 of the five products, in my opinion were edible. Chocolate Boost and Chocolate Graham Glucerna Bars. I could never ever make a patient consume these products knowing how horrible they are. The only time I think I could prescribe them is for an enteral feeding (tube feeding) because that way the patient doesn't even have to taste it. I for one, do not want to spend the last few days of my life being force fed gross chalky nutritional supplement drinks. When I get to that point, I want nothing but ice cream, milkshakes, real pudding or rice pudding, whip cream and yummy delicious things. I am assuming that by this point I'll be on a mechanical soft diet due to lack of teeth, saliva and ability to chew anything or really swallow much, hence the exclusive inclusion of all soft foods.

Tomorrow I am doing an assessment and counseling session for a self referred client in out patients all by myself! My preceptor will be there, but sitting quietly in the corner unless I screw up. The client is coming in for a weight loss consult, so I'm reading up and gathering resources for the client.

Wish Me Luck!

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