Sunday, June 25, 2017

The Next Chapter

The Next Chapter

It’s not my birthday.  However, it is a new chapter.  A new chapter in my career.  I am leaving my current position and moving on to something new.  I’ve shared recently in various blog posts about creating a balance between my work and life, so it should come as no surprise.  My previous job prior to this one required a 150-mile daily commute - amazing views of the Everglades, but it was a long commute. 
Snake Road - Big Cypress
And while my job was 8-5 the day ended up being 6:30-6:30 (or later, depending if there was an accident).  I went against traffic, so my 75-miles in an hour and a half was sometimes quicker than people’s 10-mile commute in traffic.  Regardless of the distance, it was the time that was taken away from me.  Moving forward I vowed I would stay with the job (as I loved teaching the kids) until I found something I truly, truly loved.  After three long years of searching I found my current position, a dietitian at a diabetes education center, 5 miles from home.  I thought what could be better?  Teaching about diabetes?  Close to home?  I’m in!  In my first year at my job I learned more than I could have ever imagined – insulin to carb ratios, insulin sensitivity factors, and that old notion of three meals/day, three snacks/day was based on an older insulin not often used anymore!  It truly was and has been an amazing opportunity and experience.  But with the good comes the bad.  And shortly after starting, that short commute didn’t really matter.  I was leaving so late there was no traffic to speak of.  My normal 8-hour workday was back to 10 and 12 hour days.  I love teaching about diabetes and how to manage it through diet and exercise.  I had a patient the other day who attended our diabetes class ~2 months ago.  His A1c at the time was 8.8% (well above goal) and upon his return to see me one on one, his A1c was down to 7.0%.  I asked him what he did to help improve (as medications had been removed and not added per his chart).  He said, “I followed what you and Lory (the nurse educator) told me to do!”  That my friends, that is what is rewarding.  He literally made my day!
Year 1
Teaching about diabetes is what I know I love.  There’s nothing better than helping a person count their carbs and match their insulin to what it is they’re eating to adjust a dose.  Maybe I’m a numbers geek?  Science nerd?  Not sure.  But what I do know is that I do not love teaching a person with a sole diagnosis of “obesity”.  Sure I understand that within diabetes the weight loss talk comes up.  How can it not?  If a person does lose weight it only helps their insulin work that much better.  But I know what my strengths are and teaching/coaching/being a cheerleader to help people lose weight is not my forte.  I had a patient come in the other day and stated that she gained 80 pounds in one year and there was nothing medically wrong with her (as she had everything checked out, thyroid, etc.) and she was asking me why she gained weight.  Um, I don’t know?  I feel helpless at times in talking to the patients and ultimately feel that I’m not helping them.  Food is so much more than just the science behind it.  I should’ve been taught more psychology in my college years in order to be able to better assist patients.  Sure I’ve gained knowledge over the years and sure my yoga background helps me to teach them to be mindful.   But at the end of the day, I haven’t been coming to work happy anymore.  And that my friends, is critical (in anyone’s job), to find what you love and love what you do!
Year 2
And so I move to the next chapter in my career.  I will be doing group nutrition education at various events all around South Florida.  I will be teaching about prevention mainly and there will be some pilot type programs that are geared towards some of the most common disease states within nutrition – diabetes, heart disease, and yes, weight management.  I think the thing that excites me the most is actually being able to reach a LOT of people all at once.  Teaching one on one can be rewarding (do not get me wrong…I will miss that to a certain extent). but it can also be taxing when you repeat the same thing over and over.  Group education with the premise of prevention…yes, I get excited just thinking about it.  Nutrition dork?  Maybe just a little too extreme when it comes to nutrition?  I prefer to think of it as being passionate – passionate about helping people to be healthy.  Isn’t that what you’d want from a dietitian??

So as my time winds down,  I started to reflect on my patients and what they’ve taught me  over these past three years.  A few stood out and here’s a few ditties that I pass on to you:

Working where I work, we get many international patients.  Patients from all over, i.e. Venezuela, Trinidad, Colombia, Brazil, etc., come to the United States for their care.  Pause just a moment and think about that for a minute – how lucky are we to live where we do have access to progressive thinking, state of the art healthcare?  (I will not get political in this post as to the state of insurance with healthcare…just keep thinking that we have access where many others do not).  There really were too many to recount.  The international patients were something special.  Appreciative of everything we could teach them in order to improve their health upon returning back to their country. 

The marathon runner/yogi. I’ll never forget the first day we were doing a program that she was attending.  Her continuous glucose monitor (CGM) was buzzing that she was “low”.  I nudged my nurse educator and we looked at each other communicating without speaking, “should we do something?”  It was in that moment I was taught a valuable lesson - patients know their bodies better than anybody else.  She immediately took out a cracker and kept watching her CGM – it was her way to nudge the blood sugar in the right direction, not to over treat, but simply to steer it in the right direction.  Sugar surfing at its finest.  She’s one of those patients that already knows so much, I often wondered if I was ever teaching her something or was she the one really teaching me?  Learn from others and look around, there’s always something new to learn. 

I used these measuring cups for every session I taught patients.  They were my special gift.  I received them from a kid with Type 1 diabetes that used these cups on repeat.  He wanted other kids to not have to go through what he went through and help transitioning to “counting carbs” to be as easy as possible.  He donated a whole box of these measuring cups for us (the nurse educator and myself) to pass out to newly diagnosed kids with Type 1.  Read the note.  You’ll see how special a kid he was.

This particular patient was sugar surfing before she knew she was sugar surfing.  We do a 4-day intensive program with patients in teaching them how to manage their diabetes.  Teaching them all the key concepts about real life situations and how to manage their diabetes, i.e. insulin adjustment guidelines, how to check their basal, etc.  This patient came in pretty much on the brink of giving up (as she described) because all of her doctors had told her that what she was doing wasn’t “right”.  The truth?  She was doing exactly what we were going to teach her to do – manage her diabetes, sugar surf, and make in-the-moment decisions about how to better control her diabetes.  She gained the confidence to know that she was in fact managing her diabetes and doing it to the best of her ability.  She has since communicated to us that through the use of the CGM and using multiple daily injections (versus a pump) her last A1c was as low as it’s ever been (without having hypoglycemic episodes).  She was writing to thank us.  Giving patients the tools to better manage their diabetes, yeah, that’s the rewarding part.

The local grocery store here in Miami has a program to give some medications free of charge and with others at a minimal cost.  Think that’s not a big deal?  For many of my patients it’s a REALLY big deal.  I had this one particular patient that kept continuously calling me in regards to her low blood sugar levels.  After various probes, I finally realized what was going on.  Her medication (for her DM) could induce lows as it was working for 24-hours.  This patient only ate once/day as she didn’t have enough food to have more meals than just one.  BINGO.  Her lows were due to lack of food access.  I found a food program here locally that the patient was able to get one free hot meal/day due to her age.   I taught her how to use the “Buy One Get One Free” at the local supermarket in order to get more food for the money that she did have (so she could have food for the month).  I was teaching her smart shopping and showing her ways to extend the money that she did have.  And at the end of the day, I taught her not to take her medicine if she wasn’t going to eat.  This patient taught me that it’s really easy to tell someone what to eat, but at the end of the day what do they really have access to in order to make that happen?  Compassion and empathy are key.
I wish I could give ALL the needy patients free food!
To all the kids with Type 1 DM – you are amazing, resilient, and capable beyond your means – you CAN do anything you want.  For whatever reason your own body decided to attack it’s beta cells so your pancreas doesn’t work anymore, but that should NOT stop you from doing anything your little hearts desire.  In one of those 4-day programs this one particular kid was thanking his parents for buying him his supplies.  What 12-year old has to think about where he is going to get his supplies from?  And yet he was here thanking his parents for being selfless and giving him what he needed before buying things for themselves.  These kids, surprise me every time.  Sometimes the kids would call us super heroes, when in reality they are the real heroes.  In case you're wondering, I was Super Girl.

In addition to the international patients, I receive what are termed VIP patients.  While I should preface and say that to me ALL patients are VIP, these particular patients are deemed to be a little more important (whether it’s their financial contribution to the university or whether they truly are famous).  There are some that come in and demand to be seen yesterday, when my schedule is booked for the next three months.  And then there are some that don’t want a big fuss at all made about their VIP status.  I think what the VIP patients have taught me is that no matter what your background might be or where you might progress to be, always remain humble.  Fame and fortune shouldn’t make you think you’re any more important than someone else.  We all need to be educated and helped at some point.

Last but certainly not least, my co-worker.  We started within in a few months of each other.  Who would’ve known that we would get along as well as we did?  Luck of the draw?  Not sure, but what I do know is that I’m beyond grateful for having met Lory.  I describe her as THE best nurse educator around.  She’s been given the nickname, “Flo” and “Wonder Woman” because she is just that, always going above and beyond in helping patients in their care.  It’s hard to put into words just what Lory means to me, but I know that I am forever changed having met Lory.  I have had other great co-workers (don’t go getting jealous out there Jill or Lance!) but when you have just each other to rely on, we were truly lucky to have had each other.  So glad you were my co-worker, but beyond that, I'm truly blessed to call you my friend.
I am truly grateful for these past three years and all that I’ve learned.  As I said, I’ve felt in these last few months that it’s time for me to move on.  Sometimes people look at change and are fearful.  For me, I’m hopeful of what’s to come and look forward to all the opportunities that lie ahead!

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