Monday, November 5, 2012


[Note:  this post, to preserve patient privacy, was saved in my "drafts" folder for an entire year. I sat on publishing it, but I am going to, because I think it is worth commenting on.  No names have been given, and hospital location will remain anonymous.]

Today has got me thinking.

I love my job. I love people...talking to them, helping them, figuring out what we can do to make them just be able to go poop. (It took me about 2 days in clinical dietetics to realize that poop is first and foremost on everybody's minds, and understandably so)

I've also come to realize that nutrition is about more than calories, protein, fat, carbs...those are just the "semantics." The real push behind the shove, when it comes down to it, is motivation.

Very little of nutrition consulting is providing information. Yes, tube feedings and parental nutrition require knowledge. Yes, calculations for patient charts require some judgment calls. Yes, lab values are reflective of medical phenomena that need detecting.

But more than all those fancy calculations and lab detections...people need motivation.

What gives motivation?

For most of us, nutrition doesn't get high on the priority list until our bodies give us a wakeup call...maybe Type II Diabetes, heart disease, swelling...the signals are not in short supply

Sometimes, these symptoms are awesome motivators. I'm so thankful for that "I'm gonna go get 'em" response that seems to make patients almost rebound off their hospital beds in a newfound pledge to "steer free of sodium," "lower the fat," "limit the carbs," "stock up on produce!"

But sometimes...sometimes that motivational "tick" is more elusive.

A young patient admitted with uncontrolled Type I Diabetes. He is in acute renal failure, dehydrated, blood glucose through the roof, beginning signs of peripheral neuropathy. In ten years he may be an amputee, may be blind, most certainly will be on dialysis. Heart problems set in, as his weight has dropped to that of the average ten year old.

All of these symptoms are a result of uncontrolled diabetes.

Cherry on the top: same age as me. Down to the exact ol' month.

I figure this will be good...from one youngin' to another, we can talk blood glucose monitoring, we can put together a meal plan...we can do this. None of those awful things are going to happen, because today we're going to talk about preventing them, and that will be that

Wakeup call...

..He does not care. Every day I get elderly people that are so excited and ready to make changes to add a few more years to their lives, but this young, beautiful person, full of life, does not care. I don't know if he doesn't get it...if he just doesn't like me...

I offer to recommend another dietitian. I try the scare tactic with pictures of scary AV fistulas (internal hookups for dialysis machines) and gangly amputations related to uncontrolled diabetes. If I'd thought singing and dancing would do the trick, I'd have karaoked on the spot.

Nothing. I am politely thanked, and the handouts are left on the table, where they will absolutely be politely discarded.

Days like this I don't feel so big in my lab coat. I know all the facts, but I still have so much more to learn about motivation.

What motivates you to make healthy decisions?
Working in a hospital motivates me. I love the people I encounter throughout the day, and I love leaving my job every day with a renewed gratitude that my health, for now, is intact.

Peace, Love, and Veggies,