Clinical Rotation: Spinal Cord Injury/Dysfunction
My second clinical rotation was in the Spinal Cord Injury/Dysfunction unit. Again, like the Psychiatry rotation, having an SCI rotation in a dietetic internship is somewhat unusual. Even with the VA dietetic internships, not all of them may have an SCI rotation. Only nine of the 12 specifically mention having an SCI rotation on their website.
The VA has it set up so that there are main SCI facilities that are called “hubs” and other smaller facilities that are called “spokes.” If it helps, you can think of the set up kind of like Tinker Toys – one of the round pieces with a bunch of the sticks jutting out from it. The St. Louis VA is one of the hubs, so the SCI unit is kind big in comparison to other hospitals. Because it is a hub, SCI patients have to come to the St. Louis VA once a year for a full work-up where they get their labs done and they meet with all of the providers in the unit. When an SCI patient comes for their annual exam, they wait in a room while the providers cycle through the room. This was a cool experience for me because I got a bit of outpatient experience and it was good practice for me to use those motivational interviewing skills I so desperately need to refine.
SCI wasn’t just outpatient counseling, though- the majority of the rotation is inpatient. Some patients were newly diagnosed and needed help adjusting to their new circumstances. There were some patients who had been in wheelchairs for a long time, but had recent medical complications. I saw modifications for different pieces of equipment – for example, scales designed to weigh patients and the wheelchair or puff-tubes for quadriplegics.
Working in the SCI unit was another great experience in working in an interdisciplinary environment. I got to work with a psychologist, a social worker, PT, RNs, MDs, OT, volunteers… Like Psychiatry, I sat in on rounds and discharge meetings. One thing I did in SCI that I didn’t in Psychiatry was sit in on a planning meeting. That was cool because it wasn’t just the healthcare workers, but the patient, too. That meeting was a wonderful opportunity where the patient was able to voice concerns with the patient’s outcome and the healthcare team was able to help the patient understand why we were doing things in certain ways.
SCI also gave me my first experience with wound rounds. Wound rounds have grossed some of the other interns out, but I thought it was interesting. My preceptor and I, along with two nurses, an MD, and a nursing student, visited each patient and measured and cleaned pressure wounds. Well, the nurses and the MD did the measuring and cleaning – I tagged along and asked questions. It was awesome to see improvement in something nutrition has a direct impact on. With dietetics, you don’t always see improvement or changes, but healing pressure ulcers made me kind of cheer inside because I could actually see improvement. I know it sounds weird, but it was a “Yes! Something I’m doing is making someone else’s life better!” moment and those are the moments that you have to remember.
One challenge experienced during this rotation was the holidays. That may sound weird, but during the holiday season, many organizations like to provide special lunches for the patients and staff. There was one week where there were three days in a row of special luncheons. Plus, visiting family members like to bring holiday treats. It is very all very nice and it was the holidays, but I would just have to give a little sigh when I saw a patient eating fried chicken a day after we discussed elevated triglycerides. Or feel a little twinge of guilt after working with a bunch of diabetics and then going to the staff party and getting an entire plate of sugar-laden treats.
SCI was a lot of fun. The entire SCI team is amazing and they all very clearly love what they do. This was also the first rotation where I interacted with an intern/student from another discipline. It was nice to see that the VA really does encourage the next generation of healthcare providers.