The Many Hats of Dietitians

On Friday of this particularly hard week (that is over now, thank goodness), I was driving home from my North Little Rock clinic visit, with 30 #10 cans in the trunk of the company car, and I had a realization.

Who knew?

Who knew when I signed up to become a dietitian that I would wear all these hats. Who knew I would track 400 children's nutrition and growth? Who knew that I would meet with parents one day, compare food costs and consult with our company's CFO on how to lower food costs, meet with clinic directors, and do feeding therapy...and the next day I would spend in the kitchen because my cook didn't show up, cooking for 80 children and washing dishes for 2 hours? Who knew I would create menus and then have to cook the food that I ordered weekly if a staff member calls in? Who knew I would have days when I was not just mentally and emotionally exhausted from figuring out how to get tube fed children to want to eat but also physically exhausted from moving 30 #10 cans of fruit from one clinic to the next?

When I was in college, my internship director would often tell us stories of when she worked in a hospital setting. I remember one day she was giving the class an expose on her work as a Foodservice Director at Doctor's Hospital. She said that she kept an extra pair of scrubs in her office in case her line cook called in and she had no one to dish out mashed potatoes. This, she said, was the nature of the beast. Good money, but making sacrifices to keep it running smoothly, because ultimately, you are in charge of getting patients fed.

I snickered at this at the time and said "I will NOT do that!"

I officially am eating my words. They don't go down very easily.

Now I find that I have an extra scrub top in my office just in case, and when the cook calls in I suck it up and put on a white bonnet hairnet and get to work. Andy gets frustrated with me about this and says that if I don't do it or say I won't do it, then they'll find someone else. But, just as my teacher said, ultimately, the job is mine to get the kids fed efficiently, safely, and in a timely manner. So much hinges on them getting a good meal at the right time.

As a dietitian, I am flexible. When you are in school to be a dietitian you aren't particularly trained in one area. You are taught a variety of things and are expected to find your niche when you get your first job and are also expected to basically...figure it out. You have 2 weeks of a pediatric rotation but are expected to hop into a job full swing. You learn about geriatrics, pediatrics, heart disease, autoimmune diseases, sports nutrition, weight loss, diabetes, general health, maternity. You learn about how a bill becomes a law, writing nutrition grants, and legislation. You learn about how to calculate how many FTE's your staff equals, how to calculate your food cost and percentage of plate waste. You learn about how to replace an egg in a recipe and the aspartame controversy.

But you don't learn what to do when you can't feed a child because their tube feed button is messed up, or why the child with autism won't eat anything but Cheetos, or how to get a child to swallow correctly when they have an unrepaired submucous cleft, or what to say when a parent tells you they feed their child dog food.

And so, these are the many hats that I wear. Not to mention wife, daughter, sister, friend, aunt, and follower of Christ. There were times when I thought my decision to become a dietitian wasn't a good one, but as I learn and grow I realize how important we are to so many people and so many patients...and I can't help but smile at all of my different hats.

Matthew 19:26
"With God all things are possible."


Unanswered Prayers

This week has been a particularly hard week.

If you work with special needs children, you understand. There are wonderful, rewarding times. There are times when you wonder if a child recognizes you because they can't see but respond to your voice and touch by offering a sweet smile. There are times when you see them overcome an obstacle that you have never had to face, all the while wanting to give up and call it quits but they just keep going.

And then there are the hard times. These are the times when you can't figure out what is wrong, or how to fix it. These are the times when you call their doctor, brainstorm with their other therapists, research on the internet, post messages on listservs, and still you just can't figure it out. Sometimes we are lucky and the problem fixes itself; the body's way of correcting itself can be amazing at times. Sometimes we are lucky in that the child ends up in the hospital or at the doctor's office but the doctor discovers the answer.

And sometimes, they don't.

It is particularly hard when you work with a patient, day in and day out, and you wonder if they will make it. There are just some children that you just wonder...even though you try not to think that way, you still wonder if - and how - they will overcome what has happened to them. You wonder what God's purpose is for keeping them here to begin with, but trust that they are here to show you strength and courage and give you the push to go to work again the next day. And then, the patient gets sick, and you wonder again if they will make it. Sometimes they do, and sometimes God decides, for whatever reason, that the struggle has been long and hard but that it is the end.

We wonder how these are fair. How crack addicts can have healthy babies who wind up in foster care, but a loving mother who faithfully takes her prenatal vitamins and cuts out all caffeine ends up having a stillborn.

A few months ago, I was diagnosed with adenocarcinoma. This sounds incredibly scary, as it did when I first heard it and was assured that it is "not as scary as it sounds." Basically, I have precancer cells on my cervix that did not resolve with my first surgery. I remember sitting in the doctor's office after my first surgery, and seeing my doctor frown and shake his head, and say "we just didn't get it all like we wanted to. You're just so young." I remember the distraught look on his face and then him saying that he would refer me to an oncology specialist. I remember the words "It is NOT cancer, but precancer." And then, I remember him saying that the oncology specialist would most likely talk to me about my plans for having children and possibly, a hysterectomy.

Andy held me as I cried uncontrollably in the parking lot. I thought on the way home that day about plans. The doctor would want to know our plans for having children. Of course we had a plan, as most newly married couples do. We wanted Andy to finish school and us to buy a bigger house, we wanted him to get a good job and then I could get pregnant next summer and maybe, just maybe, not have to work when the baby was born. But as I drove home that day, I realized that there was a chance that this was something bigger than our plans. You make plans, you think about them, you pick out names, you prepare, you dream...just as you work with a patient day in and day out and you see them pass a goal and you see them regress a little but you have hope for the future and so you make a new treatment plan...but in the end, they are just plans. And our plans are not always God's plans.

To some, this sounds cruel of God. I've heard comments before, questions concerning why an innocent little baby would die, or why God would let a child live until four years of age and overcome so much just to take them away, or why a 24 year old develops cancer. But to me, this thought is comforting; we may not know why, but God does, and He did it all for a reason that we can only trust in.

Isaiah 55:8
"For my thoughts are not your thoughts, neither are your ways my ways, saith the LORD."


Life As I Know It

So, we had a fantastic time in Cabo San Lucas, Mexico, save for the unfortunate catastrophe that took place when my mother broke her ankle. Actually, she broke her fibula, which is around her ankle, but I do believe it is actually her leg. We went ATV riding through the desert, went deep sea fishing and hauled in a 280 lb 128 inch blue marlin (took 1 hour and 20 minutes to reel it thanks to me, just the men on the boat), walked around the town of Cabo, got deep tissue massages, and ate as much food as possible.

And now, back to the grind of things. Upon returning I found a letter from Harding, an acceptance letter into their MBA program that I applied for recently. I have to admit, I was a little worried I wouldn't get in for whatever reason. I registered for my first semester of classes today, 12 hours along with an MBA tutorial program I have to complete prior to my first class. So, tonight while Andy finished his last final, I started the MBA tutorial.

I was a little overwhelmed. When did everything get so complicated? I guess I don't remember my last graduate degree being very complicated, but then again, that was 3 years ago. I am hoping that all of the technicalities will register as I start working through my courses and won't be so confusing. I guess all new things are a little overwhelming at first.

What hasn't hit me yet, but will soon, is that the life as I know it will be over soon. No more being bored while Andy works on his schoolwork. Not only am I going to be continuing my wonderful job as an RD full time, I will also be a full time MBA student as well as working a second contract job on the side. I am hoping I will take the transition from having nothing to do to having no time at all smoothly.

Then again, it is only for one year. The program is quite concise and I'm hoping this year will fly by. Not only will that mean the end of my second graduate degree and hopefully an added credential and new opportunities, but it means the end of Andy's BA, which he has worked his cakes off to finish while working 3 jobs. He will then jump headfirst into his own MBA program, but at least by then he will be done with the biggest part.

Of course I am trying to heed the advice in that Trace Adkins song "You're Gonna Miss This." If you haven't heard it, listen to it sometime. I am trying to savor our time together just being a newly married couple, but it does seem hard sometimes when he is wrapped up in finishing school and we are caught up in thinking of the future all the time and what we need to do to get where we want to be.

Aside from all of that, I have been off of work for one week now and it feels s.t.r.a.n.g.e. I checked my work e-mail yesterday, nothing alarming. I am hoping I won't have a lot of catching up to do, but will have to jump right back into my clinic visits next week. Enough of that. Andy is snoring on the couch next to Hershey, our chocolate Cocker Spaniel, who is also snoring. I believe it is past all of our bedtimes.

Matthew 6:34

"Take therefore no thought for the morrow: for the morrow shall take thought for the things of itself. Sufficient to the day is the evil thereof."