Meeting Them Where They Are by Kelly Six

(Hey, future interns! How are internship applications going? You OK? Remember to feed yourself! It will all be OK!)

Just a nice message at Marian Hospital

I am half way through the Cal Poly internship now. This literally feels like the Wednesday of the internship; lots behind me and a long way to go.

So, I’d like to share some of the reality of entering into the dietetics profession, from my perspective. Let me paint a picture for you; I’ll tell you a story. Close your eyes and listen (just kidding, I know you’re reading this, keep your eyes open!). Here we go:

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You’ve gone through a lot to get here. You’ve taken tests, had evaluations, studied your BUTT off. You’ve applied and gotten into an internship that you’ve dreamed about (congratulations!). You’ve graduated, maybe moved, and dove head first into life as an intern.

Now, you’re starting clinical. You’ve prepared for months (maybe years) for this. You have your reference manuals, your binder with all your formulas and cheat sheets, your notebook. You are ready to go. During one of your first weeks, your preceptor gives you a patient to work with. This patient came in with diabetic ketoacidosis (DKA). You assess as much as you can given the previous notes from the doctors in the chart and then you head off (with your mask and your goggles, of course) to interview the patient. It’s a pretty straightforward diabetes case and you feel prepared to conduct a quick assessment and education.

My "library" of reference manuals

You have your hand-outs ready to go, the referral phone number for the diabetes clinic practically memorized, and you rehearsed your carb education on the elevator up to the patient's room.

When you get there, the patient clearly does not want to talk to you. Fairly obvious, as they keep repeating, “I’m fine, I’m fine. I don’t want any help, I don’t need you.” You feel a little disappointed and a little shaken.

So, here’s where you make an important decision. All that you know, all the facts that you’ve memorized, all that work that you put in to prove yourself in years of school and applications, you drop it. Just like that- it does not matter right now.

It does not matter to this human in this moment that you can provide diabetes education. They are not a case study, they are not a patient in the hospital who needs education. They are a human going through a really tough time.

So, you pivot. You say, “Sounds like you might have a lot on your plate. I’m so sorry you are going through this. I really feel for you, and you are in good company. This is all really hard right now.”

(And this is hard for you, because you have 100 interventions, and tips, and interview questions bouncing around in your head that you are dying to try that you know might be helpful.)

Then they tell you that they are living with their aunt and uncle who are also sick, and their sister lives out back, but she had COVID so they had to take care of her from afar. They are stressed. They are really, really tired of this. And they do not want to talk to you about diabetes. They have a doctor already and they don’t need you. (details have been changed)

You talk for a bit longer, not about diabetes, but about home life (you throw in a few questions about access to food). Then the patient’s eyes well up and he says “Thanks, it was nice to talk to you.”

And you leave. And you write “education deferred” in your chart. And you save those handouts for another time.

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Taking much needed adventures with a friend

The most important thing I’ll take with me from being an intern into being a dietitian is that no matter how much we know, sometimes the facts are just not that important.

So, as you move through this incredibly stressful time of internship applications, or being a student, or being an intern, or living through a pandemic, I have one thing to share with you; I really feel for you, and you are in good company. This is all really hard right now.