On Digestion

As expected, working in the GI unit of the hospital is very different than working on a farm. I was excited to finally see the ways medical nutrition therapy was implemented in clinical settings - the tube feedings, the TPN - all stuff I'd read about, studied and heard about in lecture but I'd never seen them, nor spoken to patients who were relying on tubes for sustenance and life. Different indeed.

Early in the week my fellow intern and I tailed the doctors on their morning rounds for a few days, listening to the medical students, interns, residents and attendings hash out their diagnoses, treatments and prescriptions, and tried our hardest to keep up with the jargon. We then chose patients to follow, ie. to conduct assessments and chart using nutrition practice guidelines. It was all very intellectual and I found myself philosophically drawn back to my time at Bastyr where much of the focus was placed on digestion as the foundation of health. The gastrointestinal tract is a path for foreign objects to move through our body. When we ingest foods they technically remain outside of our selves until we digest them, break them down, absorb them into our very being. Digestion allows us to process that which is outside of ourselves and internalize it in a healthy, discerning matter. Finally, it is transformed into matter that serves us, creating energy and enabling life affirming pathways. In theory, anyway.

A reminder of the major organs involved in digestion

I've been thinking about this process all week - digestion, absorption, transformation - as I hit the two month mark of my internship. Somehow it feels like a real change. Maybe it was beginning my fourth rotation, transitioning from cold to hot cereal for breakfast, switching from running shorts to pants or leaving my house early enough in the morning to catch the moon still shining that it feels like summer is really gone and fall is here to stay. And while I look forward to the spectacular Michigan foliage I've heard so much about, to the abundance of honey crisps, winter squash, root vegetables, to wearing jeans and sweaters, I still find myself struggling with the start of the fall season as I do each year. I dread the inevitable extra curves on my body and roundness in my face, the result of less activity with the shorter, colder days and an increased appetite for warming, grounding foods. If summer is about expansion and openness, then fall brings contraction and retreat, a turn inward in preparation for the winter months. I'm finding it all a bit hard to digest.

Catching sunrise on my walk to work

And yet. Eventually I will make my peace with this transition, as I always do, with this new energy and space, this opportunity to reflect and re-evaluate my life course, a process facilitated by the onset of the High Holidays, the Jewish New Year and Day of Atonement that demand introspection and contemplation. Some years the holidays, based on the lunar cycle, fall earlier in September when the weather has not yet turned and they seem to appear suddenly, catching me off guard, unprepared to admit to my weaknesses and areas in need of improvement, to examine my relationship with the divine and with my fellow man and set an intention for the year ahead. But with another week and a half until the holidays begin, I find the change in weather, the change in my diet, the change in my mood appropriate for the start of a new year.

So what am I thinking about for this coming year? Most immediately I have career concerns. Re-entering the workforce this winter during this uncertain economic state is daunting and more and more I think about the importance of non-traditional entrepreneurial ventures. I've read, heard and been involved with many formal and informal debates lately about the relationship between education and employment. While a college degree may still vital be to getting a job, having one no longer guarantees security. Nor does a graduate degree or even two. Furthermore, tonight I was listening to a report on bankruptcy and in the past five years there has been a 20% increase in college grads filing for chapter 11, which honestly, came as no surprise.  Still, it is also an opportunity for incredible creating ways to (professionally) enact your beliefs in the world suggested by Peter Sellars who taught at UC Berkeley's Edible Education course (streamed here on YouTube). He posed this question to the audience: "What does it mean to put your belief system into your body? And actually live based on what you believe most deeply? Not at some future time, but now."

So for now, I try to focus on the task at hand: helping those with compromised digestive health achieve optimal nutrition status. And in doing so there is a reminder for me to measure my own digestive health. How well am I processing the information that is all around me? Am I integrating it into my mind and my body in a constructive way, or am I getting bogged down by the all the change, frustrated by the challenges and the dread of winter and all it brings? How can I optimize my spiritual and emotional digestion so that I can have a strong foundation in the year ahead? These may not be competencies I need to complete for my internship, but they are worth devoting some time toward nonetheless.

A Farewell to the Farm

After four weeks, I have completed my time on The Farm @ St. Joe's, my third rotation to date. Last week I posted on the farm's blog about why I felt it was an important component of the dietetic internship experience. But beyond some of the basic lessons in agriculture policy and practice and food growing 101, there were many more subtle messages that I learned in the process.

1. Free food will attract people's attention...even if it's kale.

After getting into the rhythm the first two weeks at the farmer's market, we decided to provide free samples and recipes utilizing some of the produce. The third week we featured red peppers with three different ways to prepare them and the fourth week we featured kale. Many people stopped by the farm cart who had never tasted kale before. They were curious, reluctant, excited, skeptical. But nearly everyone tried it. I consider that a success.

2. Find an ally in a position of power who will champion your cause.


According to the sources I spoke with, the idea for launching a farm on hospital property could not have happened without the support of the hospital's CEO. While it was a clinical dietitian and physician team who came up with the proposal, the fact that it fell on the right ears was critical to its success. The CEO is not only a supporter of health and healthy food in name and in print but he actually showed up to both the farm and the farmer's market during my time there and was clearly very proud of the project. He was simultaneously working on the hospital's new cafe, which opened during my last week there - sans deep fryers and fatty cuts of meat. It even has an elaborate system at the very entrance to help guide customers (70% of whom are apparently hospital staff) toward healthier options.

3. Acting local can still draw national headlines.

Since I started at the farm there has been at least one article a week published about the farm and its relationship with the hospital - and not all on annarbor.com. From the LA Times to Today's Dietitian, the media is taking notice of the work being done in this relatively small town. Not insignificantly, it is is also mentioned in Oran Hesterman's book, Fair Food, which was published this year and is making waves beyond just the food, health and agriculture networks. The lesson here is that you don't necessarily need to be working in a major city, on a large scale project, program or policy to catch the attention of people who matter. Acting within your own community, where you have relationships and opportunities (and possibly less red tape) can enable amazing things to unfold that can have ripple effects thousands of miles away.

4. It's never too late to learn.

My impression of farmers is that they've always been that way. Maybe they were raised on a farm, or at least with a garden, growing things, playing in the dirt, knowing that's what they wanted to do with their lives. Not so. Farmer Dan who runs the farm knows a tremendous amount about it, about organic practices, soil and growing methods but is relatively new to farming. He openly admits to us interns when he is experimenting with something new - a new crop, a new way of growing. He is teaching us and also learning as he goes. His approach to small scale farming makes it a lot less scary and a lot more fun. Through Dan I also had the opportunity to meet and volunteer with Diana Dyer, a dietitian who now runs a garlic farm full-time (actually, more than full-time). She and her husband had impressive careers before deciding to grow 42 varieties of garlic, which they sell at farmer's markets. They teach people about the power of growing and loving the food they eat.

Diana Dyer showing us how to clean garlic.

5. Calories in are not always equal to calories out.

The amount of calories one expends on a small farm is not insignificant. The work is hard and tiring and physical. To grow these low calorie foods required a tremendous amount of work and I couldn't help but think that if we were all growing our own food, this whole obesity thing would be non-existent.

6. Once you grow your own food it's hard to go back.

It you know anyone who grows their own tomatoes, you've probably heard them utter something like, "I could never eat a supermarket tomato again." This might sound snobby, but in fact it's a perfectly legitimate statement. Because after eating your own vine ripened tomatoes, the ones in the store are simply not tomatoes. They look like tomatoes, are labeled and sold as tomatoes, but they are not the same. Leaving the farm I will certainly frequent the farmer's market more, but I truly feel a loss at not being able to go out into the fields to see where my food grows and enjoy eating it, knowing exactly where it comes from.

7. Farming is not a fair weather activity.

During my month on the farm I saw the weather change from hot and sunny to gray and rainy. And I learned that while I loved being on the farm in the summer, the wet season was a whole other beast. Thankfully there was lots of work to be done indoors in the hoophouses because I hate wet socks.

8. Dietitians are uniquely positioned to connect the healthcare system and the food system. 

The fact that the farm was spawned by a dietitian and linked with nutrition and healthcare is not to be overlooked. While I may not be a farmer in the future (or I may! who can tell these things?) I certainly know that anywhere I go I will have the opportunity to build relationships between institutions and farms, communities and farms, schools and farms, all under the rubric of nutrition and health, which helps the cause more than one might imagine. During this rotation I met two very impressive dietitians who are using farming for improving nutrition and health status and, more importantly, as the best form of prevention.

I'm sure there there are countless other lessons to extract from this past month, but these are the ones that stick out the most. As a dietetic intern floating from one site to the next it's important to contribute as well as take what you can from each setting and then shift gears and move on to the next. In that vein and in yet another test of flexibility I will begin rounds in the GI unit at the hospital starting on Monday. After spending a month working on a hospital farm, I'm looking forward to working on the inside, with my clipboard, a team of physicians and, most of all, my lab coat.