Friday, July 22, 2011

Keeping It Simple

On the first day of my rotation this week, I introduced myself to the dietitians I would be working with. One was significantly older and the other had recently had her second child. They were talking about the challenges of being working parents and when I said I was the new intern, a recent graduate, they recommended I "keep it simple a little while longer." The question of living simply and what that means has stayed with me throughout the week.

This first rotation, which continues for another week, is very hands-on and I am exposed to patients at all stages of the process of bariatric surgery. I observe the consult group where the surgeon explains the different types of procedures, the nutrition classes for patients about the undergo surgery, post-op visits to hospital rooms 24 hours after surgery, phone calls one week later, and follow up appointments with patients six months, one year and two years out. Eligibility criteria for bariatric surgery includes a BMI of >40 or BMI >35 with co-morbidities, such as diabetes, and nearly all the patients I observe have multiple complications and medications. And many of them are young. Younger than me. Their lives are far from simple.

Simple living has become a new aspiration in the green era. I recently watched No Impact Man, the documentary that follows one NYC dwelling man and his family as they try to live "simply," ie. in a manner that generates as little waste and environmental impact as possible. In our modern world, one could argue that living "simply" is a fallacy - in fact, living without many of the conveniences that carbon-emitting technology affords makes life much more complicated. The film reinforces this and after watching No Impact Man, I have a newfound appreciation for my refrigerator. At the same time, the family spends more time together, watches less television, and is far more conscious of the food they eat, traits we associate with simplicity.  

Somehow I felt a strong connection between this film and my work this week. I had mixed feelings about doing a rotation in a bariatric center. Like many people I wonder whether surgery is really the only option for people struggling with their weight. In the consult group I was happy to hear the doctor state that surgery is the last option when all others have been exhausted. When he insisted that the long-term success of the procedure would depend on how well patients had addressed the underlying emotional issues that had led them to this place, I was further encouraged that it was not being marketed as a quick fix surgery. And after watching a laparoscopic gastric bypass, the cynical voice in me that suggested that patients might simply opt for surgery because it was covered by their insurance, that it was easier than actually losing weight, was quieted. The surgery is invasive and the recovery takes time. Even post-op, losing all the excess weight is not guaranteed, as I witnessed in patients who had the surgery years ago and displayed varied levels of success. Whether or not I would recommend it, bariatric surgery provides a second chance for patients to simplify, to start over, create a new relationship with food and new behaviors. I found this reinforced in speaking with patients after their surgery and wished them to best of luck in cultivating new healthy habits.  Today my supervisor told me that last week a patient cried tears of joy when she learned that she could finally transition from the all liquid diet to eating pureed foods. Learning to eat all over again brings such bliss - a good reminder to enjoy life's simple pleasures.

Sunday, July 17, 2011


A lot has happened in the past month since school ended. I left Seattle, got engaged, drove to Ann Arbor and started a dietetic internship program at the University of Michigan's School of Public Health.  Back in April when I "matched" at UM, I rationalized all of the reasons it would be the best program for me. I remember thinking how being far away from my friends and community would allow me to focus my energy on the internship, and perhaps work on some side projects that never receive any time or attention.  Now I wonder how I will have time to focus on my internship at all, when my thoughts are occupied with Skype dates, travel arrangements and potential wedding plans. So in attempt to devote some reflection time to my various rotations, I hope to use my blog to capture my experience as both an intern and a Michigander over the next six months.

My personalized lab coat.

My internship started last week with orientation. I am one of 13 dietetic interns, but one of only two who did not attend UM for my master's degree. And I am also the only one who has never lived in Ann Arbor (AA) before. I guess that makes me the outsider, though by the end of the first week I certainly didn't feel that way. We spent the first week at school filling out paperwork, touring some of the rotation sites, and attending lectures and presentations on a variety of topics that are either important enough to warrant review (eg. a full-day crash course in food service management!) or were likely not covered in our degree programs (eg. palliative care, hospice). My house turns out to be only a 20 minute walk from school, so I enjoyed a week without use of my car and I'm sure the Echo appreciated a break after the 2,500 mile drive out here. And it only took me about a week to re-adjust to the constant state of sweat that comes with summer's 90 degree temps.

On Friday we went on a field trip to the Henry Ford Hospital in West Bloomfield, MI. I was surprised at how much it reminded me of a mainstream hospital equivalent of the Bastyr Center for Natural Health in its integrative approach to patient health and wellness. Unlike other hospitals, the entrance seems more like a shopping mall or resort, complete with concierge and valet services, a spa and shop selling local products. Just past the shop is the Demonstration Kitchen where classes are taught for the general public by a chef and a registered dietitian.  We peeked in on summer camp program for kids, and noted the space, which could easily serve as the set of a cooking show on the Food Network. 

We toured of the facilities, led by the Culinary Wellness Director (!), a trained chef who explains to us that food used to be used as medicine and it's important that we remind people of that. He showed us the cafeteria, Henry's, where instead of hiring food service workers, the hospital employs cooks who prepare the food on the spot using fresh ingredients. Other interesting tidbits about the place: they host a weekly farmer's market, there are in-house pet "therapists" or trained dogs who visit patient rooms, the salon stylists are trained to recognize melanomas, and every single room has a view of nature.  The attention to detail is so completely impressive - from the room service menu model to the private rooms to the massage therapists that make room calls - I really walked away with the impression that patient satisfaction is paramount.  We were told that the hospital was designed to reduce stress and alleviate fears  and it certainly achieves that effect. In fact, we noticed several groups of women from the community utilizing space in the atrium to play bridge and mah jong. 

Henry, one of the hospital's pet "therapists" takes a rest.

I couldn't help but wonder, who pays for these services and who does this hospital serve? (The question was later answered by my roommates who explained that West Bloomfield is the wealthiest township in the state.) Part of me wondered about the increasing income gap, and as I continue to hear how economically devastated Michigan is as a whole and Detroit in particular, I hope to gain a better understanding of the socio-economic landscape around me. Still, I walked away from the Henry Ford feeling like maybe in this Midwestern pocket I'm not as far away from Seattle as I feel, maybe the Bastyr bubble is larger than I imagined and maybe there are some ways in which our country is moving in the right direction.