Dietary.

I spent Wednesday morning with the dietitians and diet techs. It wasn't exactly a complete waste of the time, though the woman I was with for most of the morning was a chatterbox and my nerves were wearing a little thin by the time I took off for lunch.

My preceptor gave a short presentation to the kitchen staff about gluten-free diets. For people with Celiac disease, gluten induces an allergic reaction which causes inflammation of the GI tract and makes digestion painful. In the hospital, the food prep people have to be careful about cross-contamination and have special equipment set aside for preparing gluten-free foods.

After the presentation, we rounded through the oncology unit and checked on patients, asking if they had any dietary concerns or needed anything added/subtracted from their meal orders. It's not an easy task to get sick people to eat, and it's harder when the majority have dietary restrictions (mostly diabetic or renal patients) and don't have much choice in their selections anyway. Moreover, the docs are not ordering patient weights as often as in the past, so the dieticians sometimes struggle to know how a patient is faring food-wise.

After oncology I was passed off to another tech, this time to round on one of the med/surg units. While we were standing in the hallway at the nurses station, a pacemaker code was going on a few rooms down. Since I was supposed to be paying attention to the dietician, I wasn't able to really listen to what was going on in that room, but after a few minutes of chaos (docs and nurses running in and out of the room, grabbing supplies, and lots of yelling), the patient was abruptly wheeled out of the room. In the commotion I gathered that they were en route to the cath lab, which meant that the guy probably had a heart attack. The patient definitely looked a little blue as they barreled past us, and just before the team got into the elevator, one of the nurses yelled in a panic, "I can't feel a pulse!" This caused the resident who was running the code to shout a bit too loudly, "No pulse?!? Shit!" But that apparently resolved itself, because they got the patient into the elevator and took off.

A few minutes later, after things had settled down on the floor, the patient's little old wife was brought up in a wheelchair, sobbing and nearing the point of hyperventilation. It took several doctors and nurses to calm her down, though she was still quite (understandably) upset when we left. I sometimes find that watching family members cry is harder than actually watching a patient in distress. For example, while watching the code, all I was really thinking about was whether I wanted a tuna or turkey sandwich for lunch. As soon as the little old lady pulled up, however, I didn't feel quite so hungry anymore. Weird.