Internship Recap: Week 5-7

Already 3/4 through my foodservice rotation!!!!!

Week 5
This week I started the second half of my foodservice rotation, moving over to another hospital and a new preceptor.  This hospital's focus is on rehabilitation (from musculoskeletal injuries, cardiac rehab, stroke and brain injuries, and others), and their patients tend to stay in hospital for a lot longer than they would in an acute care facility (like where I was before).  In most hospitals, patients stay for an average of 4-7 days or so - here, patients may be there for 2-4 months, sometimes longer, sometimes for years.  As a result, the foodservice needs for this facility are very different than what I saw in my last rotation!
This time around, my projects don't involve any shadowing (yay!!!), but do involve a lot of work from a cubicle.  So, once again, if nothing else, I'm definitely learning that I made the right choice in escaping the business world because working in a cubicle is really, really, not for me!  My projects this time around include figuring out the costing of producing some of our salads in-house instead of outsourcing (the rest of the hospital network outsources and gets boxed pre-made salads, but since our patients are here for a very long time, we'd like to give more variety wherever possible), and running a tasting panel of some new puree entrees for our special neuro rehab patients (again, trying to give more variety).  I'm also working with another intern on updating the inventory system at the hospital.  This facility was recently taken over by the hospital network and, thus, will be taking on the same ordering and inventory systems.  Again because the foods served here are different than the other hospitals because its such a different population, the current inventory system just isn't making sense with the system they need to move to.  So, its up to us interns to make it work.  Somehow.  Basically we're trying to match up what is being pulled for the belt line with what is actually needed for the trays.  Somehow this wasn't done before, at least not very well.  Goodie.
Meanwhile, as I was getting these projects started, I was also finalizing the projects from my last rotation.  I had a meeting with the foodservice supervisors to review my recommendations for the dietary aide job descriptions and present my draft re-writes.  For the most part it went well, but the supervisors challenged me on a few things (sometimes with valid reasons, sometimes due to a fear of change, sometimes the fear of change was actually a valid reason...).  I was able to handle the conversation so that it didn't escalate too far out of control, and we had a productive session in the end :)  My preceptor told me later that I handled the challenging people/situations extremely well, and had done a great job overall.  So, yay!

Week 6
With a week under my belt, I was able to get pretty far with my projects and actually finish a few things already.  I held my tasting panel on Thursday with the puree items - which were surprisingly more tasty than you'd think (and definitely more tasty than they looked...), and am already done the data entry, analysis, and report.  I've also gotten the pricing of salads that we're currently buying, the pricing of raw materials, staff hours needed to make them, extra materials and equipment, etc etc etc...  -- just have to put the pieces together to figure out which is the better deal for us.  I also had a visit from one of the suppliers, who wanted to give me samples of diced cucumber.  Um, I know what a diced cucumber is, thank you - but I will take your free vegetables anyway :D   The inventory stuff remains a mystery, but I've done what I can for at least one week of our 3-week menu cycle...
Other neat things this week:  I attended an education session with a group of dietitians who had recently attended a conference.  Apparently when people go to conferences related to practice, they almost always present a conference debriefing to share what they learned with their colleagues.  Some of us interns went over (it was off-site) to hear about the diabetes and vascular disease conference, and I'm so glad we did.  It was awesome!  Maybe it was only super exciting for me because I haven't heard anything about clinical nutrition in months, but it was great :)  Some of the sessions focused on counselling skills and psychology, others dealt with new medications and therapies, and others reviewed population health studies and strategies from international presenters.  I took lots of notes and asked lots of questions, and I feel like I took a lot out of the session.  I'll definitely keep my eyes open for more of these conference debriefing sessions!

Week 7
This week was actually a research week instead of a work week!  We're starting to do our literature review and critical analysis for our major research project.  So, unless there were meetings to attend, I didn''t actually have to go to the hospital - in fact, I only had to go in once.  On research weeks, I can be in my pajamas with tea and still technically be at work :D  hooray!  But because I'm terribly easily distracted at home, I packed up my stuff and wandered around between the various coffee shops in my neighbourhood instead.  Somehow I'm more productive when outside of the house (and well-caffeinated :P).  Our research project is basically doing a gigantic literature review to see what the evidence is for dietary recommendations in certain populations/in prevention or treatment of certain conditions.  My topic is investigating the evidence for recommending a reduced saturated fat intake for stroke prevention.  From what I've found so far, there's lots of evidence surrounding reduced saturated fat intake/greater mono- and polyunsaturated fat intake for cardiovascular disease prevention in general, but not a lot that deals specifically with stroke prevention.  The research I have found so far has been pretty interesting so far.


For the next couple of weeks, I'm back to my foodservice rotation and FINISHING IT!!!!!!!!!!!  Then, one more research week, and VACAY :D!!!!!  Erhmahgerd!!! 

And then this happened....

So this isn't an internship update, but an important update to share nonetheless.


I've posted before about my family's journey with multiple myeloma, but for some background --  almost 6 years ago to the day, my dad received the diagnosis of MM, a cancer of the plasma cells.  The treatment regimen involves medication therapy, chemotherapy, and a stem cell transplant.  Most patients will experience a brief remission, and recurrance usually occurs within 2-3 years.

But my dad's kind of a special guy.  He went for just over 5 years.  His doctors have been surprised every time he goes for his routine bloodwork that he's still clean, and still staying active and spritely.  He is, after all, only 57 years old this year.

For the last couple of months, he's been battling a pretty nasty chest infection.  He has lung issues to begin with, but this infection has been giving him a lot of trouble.  Last week, he started experiencing chest pain.  Like most people, he took that chest pain straight to the hospital, where he had an ECG and found that he wasn't having a heart attack.  Great!  But the chest pain persisted, sometimes becoming unbearable stabbing pain.  He happened to be due for a routine bloodwork check in the next week or two anyway, so he went to his oncologist early to talk about the chest pain and do the bloodwork all in one shot.  He talked on the weekend about how it felt familiar - like the last time he experienced bone pain and was diagnosed with MM in the first place.  We told him he was exaggerating.  Even the doctor suspected that it was probably a cracked rib, but did the testing just to be sure.


I'll never doubt his instincts again...


His bloodwork confirmed that his MM has returned.  Some time between his last blood test and yesterday, the myeloma started growing, compromising his immune system and contributing to this long lasting chest infection, and is now causing the bone pain he's experiencing in his sternum (chest plate).


So.  Now what.


Obviously my family is devastated.  It's like taking a punch to the gut.  And then getting stomped in the face.  But, dad's a fighter - he came out the first time kicking, and we're confident he's going to kick the crap out of MM again this time.

For now he's taking some major IV antibiotics to get that chest infection under control - no point in going forward with cancer treatment if his immunity is already compromised, since cancer treatment will only make it substantially worse and make more complications.  After the antibiotics, he starts medication therapy for 4 weeks.  From there... well, we don't know.  The next phase of treatment depends on how well he and/or the MM respond to the medication.  Likely, the next phase will be more aggressive treatment - chemotherapy, and his second stem cell transplant.

For the time being, we're dealing and life stays as normal - no one needs to take time off or do much of anything, as it's just medication therapy for now.  But sooner or later things will change for better or worse.  For now, I'd like to ask that you keep my dad in your thoughts and your hearts, and pass along any warm distant hugs that you can to support him in this next stage of his journey.


Want to learn more about multiple myeloma?  This link from the Canadian Cancer Society sums it up nicely.  Also, consider checking out the work of the Multiple Myeloma Research Foundation. 

Internship recap: Week 3-4

Hey guess what??  My first foodservice rotation is officially DONE!

Week 3: This week I was, again, mostly shadowing the dietary aides.  I managed to get out of doing all 5 remaining shifts because I went into the hospital last weekend to do one, which turned out to be not that much different than what happens during the week.  Plus, my preceptor has been pretty adamant about making sure that I actually have a life outside of the hospital, and has been encouraging me strongly to take a day (or more) off since I've been working lots of overtime and that extra weekend day.  So - day off :D!  I spent the morning catching up on all the housework I've been neglecting over the last few weeks.  I also managed to get in a Friday afternoon off to make up for all that overtime.  Long weekend, yay!
Having some time off also gave me the opportunity to do some reflective writing, something that is highly encouraged for interns for a few reasons.  One - it helps you to remember things, and to look back later and remember what you learned.  This becomes useful when you have to do evaluations (which seems to be constant).  Two - it helps you to really understand what you experienced.  Though I'm currently in my foodservice rotation, I've learned lots about patient-centred care through my experience following the dietary aides around, and come to understand the importance of excellent communication and understanding between disciplines.  Three - it helps to encourage self-directed learning.  Similar to reason two, reflective writing is helpful to show what you've learned, but what you have left to learn or expand on as well.  I've learned about interprofessional communication from the dietary aide's perspective, but have yet to see the same issues from the other side of the desk and gain a better understanding of how communication lines can be opened, and hopefully impart some of my wisdom from the foodservice perspective on the clinical end :)

Week 4: LAST WEEK!!!!!!!!!  My preceptor was away on Thursday and Friday out of town, so I actually had to get almost everything pretty well DONE by Wednesday.  Ummmmm, impossible?  Yes. Sadly this meant that I couldn't get everything quite done on time for my last day in this rotation, since the last bits of my projects would need my preceptor's approval before they rolled out.  But, one of the neat things about having 8 weeks of internal foodservice management split between two preceptors is that there is flexibility.  For the next week, I'll be kind of split between my previous preceptor and new one, finishing off the last of my current projects and getting started with something new.  The only thing I really have left to do of my current projects is follow up with staff - I've done my job descriptions and changes, and finished my maintenance policy.  All I need to do now is present it to the supervisors and staff, get their feedback and make final changes.  Presto chango, projects complete!

So, final thoughts on the first internal foodservice management rotation:

• Though I wasn't entirely convinced that I would be learning things by shadowing the dietary aides for the majority of my rotation, I ended up learning tons.  I saw the care that aides put into their meal delivery and interaction with patients, and I saw the frustrations that prevent them from doing their job to their greatest potential.  I learned that even something as simple as delivering a meal tray can be an opportunity to deliver patient-centred care, and can make a huge difference in the patients' experience in hospital. And, something as seemingly simple as delivering a meal tray provides an opportunity for interdisciplinary communication and teamwork to give patients the best care possible.
• While learning from the aides and the delivery portion of foodservice, I also saw the managerial side.  I came to understand management's role in foodservice, from production all the way to dishwashing after service.  Similarly to learning from the aides, I learned from managers about the challenges that they face in making changes to improve patient foodservice - things that I never would have thought of as challenges before, but become a huge issue when you understand the impact that a small change would have on the employees, patients, and food itself throughout service.
• I used this understanding to create the new job descriptions for dietary aides and my maintenance policy.  Going into the project, I thought "Well duh, just write XYZ and you're done.  Problem solved.  Why didn't anyone do this before?".  But as I got into the project and started asking questions, I found out why it wasn't done before - things were a lot more complicated than I had expected!  In writing the job descriptions and maintenance policy, I had to use this new knowledge to create documents that would be fair to all of the nutrition employees - from the basement to the management - and ensure that patients receive the best possible foodservice delivery (i.e. food is delivered on time, a the right temperature, is acceptable for their dietary needs/preferences, and allows aides the time they need to deliver patient-centred care in every delivery they do).

I'm still not convinced that I want to become a foodservice dietitian; I have a business background and understand management pretty well, but I'm interested in being involved in patient care.  However, I did find that I could still find a way to be involved in patient care through these projects, despite being in a cubicle.  I was pretty surprised about that, and it made me more excited to complete these projects to the best of my ability.  I'm intrigued and excited about what will happen in my next management rotation, as I'm going to a hospital that is in a period of transition with their foodservice operations, and I'm sure that I will find lots of opportunities to be involved in improving patient care and satisfaction during the next 4 weeks.

Vegetable of the Month

It's here, it's here!


This month's veggie is........................

Parsnips!

I love eating root vegetables at this time of year.  They're hearty, comforting, and yummy in your tummy (yes, that's a scientific fact :)!).  Parsnips are a great addition to your root vegetable rotation, along with other veggies you've seen here before (like pumpkin, beets and butternut squash!).

These cream coloured veggies are related to carrots, but they have a sweeter flavour (especially when cooked).  They can be used in similar ways though - including eating parsnips steamed, boiled, baked, roasted, BBQ'ed, in stews and soups, pureed, or even raw.  It can even be used to make wine!  And really, who doesn't love a vegetable that can turn into wine???

 They look like albino carrots.  Why should I eat them?

Like all of the veggies that I've written about before, parsnips are chock full of goodness!  According to the Canadian Nutrient File, 1/2 cup of cooked parsnips will give you:

• about 59 calories
• almost 3g of fibre.  For HALF A CUP! Much of this fibre is soluble fibre, which is the kind that can help to reduce blood cholesterol and help with controlling blood glucose levels.
• 12% of your folate needs, important for heart health and reproductive health (particularly for you women of childbearing age)
• 57% of your niacin needs!
• A surprising 17% of your vitamin C needs (surprising because unlike most other vitamin C-rich foods, parsnips don't have a vibrant colour!).  Vitamin C is helpful in building the immune system's defenses and fighting off infections (no colds for you this winter!)

I'm still suspicious.  How do I cook them so they don't taste gross?

They might not look like the most exciting vegetable, but parsnips have a unique sweet flavour when cooked (because its starches break down into simple sugars, making a tasty treat).  As I mentioned, you can cook parsnips in many ways - pretty well anything you can do to a carrot, you can do to a parsnip.  Here are some of my go-to ways of using this veggie:

• Add a diced parsnip to your beef stew this winter 
• Chop the parsnip into big chunks, and roast with other root veggies (carrots, squash, sweet potato...) with a splash of canola oil and sprinkle of salt and pepper for a great side dish that goes with just about anything
• Puree roasted, boiled, or steamed parnips into soups (much like you would with squash or carrot soups).  Try out combinations of veggies, like cauliflower and parsnip, for a warm winter snuggle-by-the-fire hearty belly-filling soup!

Another great way to prepare your parsnips - CHIPS!!!!!!!!!!!! 

Easy Peasy Parsnip Chips

1. Slice parsnips into thin rounds (use a mandolin if you have one), or you can make stick-chips (like really skinny fries) till you have about 5 cups (5 or 6 parsnips, depending on size).
2. Toss with 2 Tbsp of olive or canola oil, and salt to taste till your chips are lightly coated.  Want to spice things up a bit?  Add some other flavours like cardamom, curry powder, cinnamon, or powdered ginger (about 1/4tsp of these).
3. Lay your chips on a baking sheet in a single layer.
4. Bake at 350 for 30-35 minutes, flipping them over halfway through.  Watch your chips closer to the end of cooking time - depending on how thick they are, they make not take the whole time to cook (or may need a few minutes more).  They are ready when the chips are crispy and lightly browned.
5. Om nom nom!!

Stay tuned for next month's veggie of the month!