Back to work

This past week was the first of my internship and I have to say, going to work 5 days a week really interferes with my play time. I guess having 104 days (yes, I counted) without a schedule wasn't quite enough for me :) Okay, so maybe you can't feel sorry for me, but it was a shock to my system to be back in the real world. It's been a LONG time since I've had to hold any kind of normal hours. At least I get Monday off (who in this world gets Columbus day off? I guess they do in Massachusetts).



So then, before I tell you about the internship, I guess I have a couple of other things to bring you up on... two weeks ago, I finally got to the JFK museum/library.

It was a good museum and I learned a lot, but I think I was spoiled by the Lincoln museum. I've been telling people that the feeling I got coming out of JFK's, the thought was "what a great man. How could any one be as good as him?"; but coming out of Lincoln's it was "what a great man. I could be that good, too." Basically, JFK was portrayed as having an unattainable moral standing, while Lincoln was portrayed as a regular man of good morals. I guess the point is that the Lincoln museum made me feel more empowered. The other difference is that Lincoln's went into great detail about the assassination; JFK's only mentioned the date and had a clip of the news reel. It didn't even mention any details.

My other fun trip was to do Boston's community solar system. If you remember, I did the larger one in Peoria. So I just had to do this one. But I was bummed out that Saturn and Neptune are not reachable (I guess they've been put away while their locations are being remodeled.) So I'm two planets short of a solar system (actually of the "old" solar system since this one includes Pluto).

Oh, and by the way, I'm going through sticker shock on energy prices. I was surprised at the size of my electricity bill; at first I thought this old house must be leaking energy somewhere (actually, it probably is) but it turns out I'm using the same amount as in Seattle. But that it costs twice as much here (by my math, somthing like 9-cents per kWh in Seattle and 19-cents here). Crazy. I miss the cheap hydroelectric power :(

Anyway, did I mention this was my first week at the hospital? Oh, I guess I should tell you about it... So far, it's just orientation. On Monday, I had the normal hospital orientation. The only funny part there was that I couldn't find my social security card in time. I remember putting it somewhere "safe" when I moved, but even after playing "find the social security card" for a couple of days, I'm still at a loss for where it went (I think I shredded it). No big deal in the end; I just ordered a new one. On the second day, I finally got to meet my internship director and learn about everything I'll be doing. And then the rest of the week has just been learning more details.

And there's two exciting things that have come out of the week - one is further proof that Bastyr's nutrition program is awesome: just from the fact that many of the things the other interns are worried about, I feel Bastyr gave me a good background on. And secondly it turns out, I have the most hospital experience of the group, which surprised me because so many other of my Bastyr classmates had way more than I did. But more importantly is that the RD I volunteered for in Seattle was super awesome because I'm tying all the stuff they introduce me to here back to what I saw in Seattle and it's making things seem really easy. So I'm actually not nervous about any of the projects or rotations at all. It's a good feeling.

Anyway, enough of the love fest for my school... How about one of the lessons I learned this week:

What are the main indications of fulminant hepatic failure (acute liver failure)? Certainly you'll see ALT/AST labs through the roof and hypoglycemia due to the livers inability to do gluconeogenesis. But the real key is the presence of coaguopathy (since the liver can't produce clotting proteins). So then, the next question is, assuming you can't feed the patient enterally, should you use TPN? The concern is that TPN would likely cause amino acid toxicity (because the protein cannot be handled by the liver). So, if say, you were waiting a few days for a transplant, you'd probably avoid feeding because of the risk. If they weren't a transplant patient, well then you've got more to think about...