What a Day

Every Tuesday is a challenge at the hospital. After a four day break I often find myself struggling to remember everything that seemed like second nature when I left the week before. Each week it takes less and less time to get back up to speed. But today I was thrown into the deep end from the word Go.

 

First surprise of the day, I was going to be seeing my own patients. Usually I arrive at the hospital, the patients we need to see that day are divided up between the four dietitians and I end up shadowing one dietitian, helping her with her patient load. This morning when I arrived I found out that the patients were going to be divided between the five of us. Not only would I have my own patients to see today, but I would go and see them all by myself. My charts would be signed-off by the registered dietitian in the afternoon, after I had completed my assessments. I knew this day was going to be coming, as I am scheduled to do staff relief the week of and the week after Thanksgiving. But it was quite a shock to find out that this would be happening today. I was responsible and apparently ready to be completely independent and of all the floors they could have given me, I was faced with the Coronary Care Unit (CCU)

 

The coronary care unit and the intensive care unit are referred to as "The Unit" by hospital staff. The Unit is located behind automatic doors that you must know the code to in order to enter. There's a security guard inside to escort all other guests in and out. It is also where you tend to see the sickest patients. Little did I know that today The Unit would be the location where I would experience my first Code Blue- Medical Emergency Adult. Luckily for me, we had discussed patients coding in debriefing yesterday. A few of my classmates had shared their first experiences, and how much it had impacted them. It got me to thinking that I had never seen a code and I think, in a way, it prepared me for what I saw today.

 

I saw the code being called, I saw the doctors run in, I saw a previously empty room become packed with medical staff doing everything possible to try to save the patient. I saw CPR, not the fake stuff you see on TV, but actual chest compressions. I saw them shock the patient and sadly, I saw them call the time of death. What felt like hours, actually occurred in only minutes, and I was completely motionless, just watching what was going on. It wasn't until the patient's family came in that the reality of the situation hit and I had to leave the area. Moments like these bring up so many emotions, so many thoughts.

Chocolate Spiderweb Cookies

Happy Halloween! Thanks to an old issue of Cooking Light I had a festive treat to share with my coworkers today. Easy to make, not to sweet, and completely fun to frost, these cookies are sure to be a halloween favorite.

For the Cookie Dough

• 1 cup all purpose flour


• 1/3 cup unsweetened cocoa


• 1/2 teaspoon baking soda


• 1/8 teaspoon salt


• 1/3 cup butter or margarine


• 2/3 cup granulated sugar


• 1 teaspoon vanilla extract


• 1 large egg white

For the Frosting

• 1 cup powdered sugar


• 1 tablespoon milk

In a small bowl combine flour, cocoa, baking soda, and salt. Set aside.

Place butter/margarine into a large bowl. Beat with a mixer until soft and fluffy. Gradually add the granulated sugar until well blended. Add vanilla and egg white. Add flour mixture until well blended. The dough will be very dry. Turn dough out and form into a six inch log. Wrap in wax paper and freeze until solid.

Preheat oven to 350 degrees. Cut log into 24 slices, place slices on a baking sheet and bake for 10 minutes or until set. While cookies are baking, combine powdered sugar and milk. Spoon into a ziploc bag and set aside. When cookies are cool, snip the corner off of the ziploc bag, pipe frosting onto cookies in the shape of a spider web. Alternately you could also make ghosts.

My London Vacation

Wow! What a week! My trip to London was an absolute blast. Lots of friends, lots of family, lots of food and, in true Johnston fashion, a lot of alcohol. I spent the majority of the trip helping my mom unpack and settle into the new flat in London. Located in Pimlico it's a gorgeous two bedroom flat with views of big ben, the houses of parliament, westminster abbey, canary wharf, the BT phone tower, and the London Eye. Here's the video I took from the balcony of the panorama view:



Here are some shots taken around London during my tour guide day with my brother and his girlfriend.


Create Your Own!

In all honesty this week in London and especially the party was the best break from Los Angeles a girl could ask for. And the rarity of it all was having all my immediate family members in the same town for more than a day.

If you are interested in shots from the party, check out my flickr page by clicking the picture below (when you are taken to the photo at flickr.com click on "Dad's Set" on the right hand side, to see all the photos). I warn you there are a lot of people shots, but there are also some nice shots of the appetizers and the location. If you have photos to add to the collection don't feel shy about sending them my way or posting them on flickr. Enjoy!

www.flickr.com

Curried Couscous with Broccoli

This is one of my favorite uses of couscous, and the flavors only get better after a night in the fridge. If you buy prepackaged broccoli florets and shredded carrots it's simple a combine and mix salad. You can easily elimante the feta and onions or alternately throw in more ingredients. But however you make it, it's great to serve as a side salad on a warm day or to pack for a brown bag lunch. Enjoy!



1 ¾ CUPS WATER
1 CUP UNCOOKED COUSCOUS
1 ½ CUPS SMALL BROCCOLI FLORETS
½ CUP FINELY CHOPPED RED ONION
1/3 CUP SHREDDED CARROT
¼ CUP RAISINS
¼ CUP DRY ROASTED CASHEWS, CHOPPED
2 TABLESPOONS WHITE WINE VINEGAR
1 ½ TABLESPOONS OLIVE OIL
1 TABLESPOON SUGAR
1 ½ TEASPOONS CURRY POWDER
1 TEASPOON BOTTLED MINCED FRESH GINGER
¾ TEASPOON SALT
1 (15 OUNCE) CAN OF CHICKPEAS, DRAINED AND RINSED

Bring 1 ¾ cups water to a boil in a medium saucepan; gradually stir in couscous. Remove from heat; cover and let stand 5 minutes. Fluff with a fork.

While couscous stands, steam broccoli florets, covered, for 3 minutes or until tender. In a large bowl combine white wine vinegar, olive oil, sugar, curry powder, minced ginger, and salt. Add couscous and mix thoroughly. Add onions, carrot, chickpeas, cashews, raisins and mix thoroughly. Add broccoli and toss. Sprinkle cheese over top and serve.

It's Time to Celebrate!

Once again I am taking off to travel the world. If you know me, you know this is what I live for. This time it's for a week and the destination is London. The last time I was there, Christmas 2004, it was a trip to say goodbye to my grandmother. This time it's a time for celebration, and boy do we have a lot to celebrate! 

• My dad turning 60. 
• 20 years of living in the United States.
• My brother joining my mother, father and I as a dual citizen.
• My sister completing ten years as an accountant.
• 15 years of my dad working as an independent consultant.
• 15 years as an American Pharmacist for my mother.
• 25 years of living outside of the United Kingdom.
• My 25th birthday.

The big party will be next Saturday on the bank of the Thames. I'm excited to spend time with my family, meet new significant others and catch up with both extended family and friends. I know a week isn't long enough for everything I want to do, but for now it will have to suffice. I just hope that I can sleep some on my flight tomorrow.

Portrait Plum Tart

As pretty as a portrait, this plum tart is easy to make and is perfect for the fall. From start to finish in under an hour this recipe from a friend is a winner for when you need to whip up a delicious dessert that will always impress.

• 1/2 cup butter or margarine
• 1/2 cup granulated sugar
• 1 teaspoon grated orange peel
• 1/2 teaspoon almond extract
• 1/4 teaspoon salt
• 3 large eggs
• 1 cup all purpose flour
• 1 pound firm ripe red or purple skinned plums
• 1 to 2 tablespoons powdered sugar

Cut butter into small pieces and put in a bowl. Add granulated sugar and stir to combine, then beat with a mixer on high speed until well blended, about 2 minutes. Add orange peel, almond extract, salt and eggs. Stir to mix, then beat on high speed until well blended and smooth, 3 to 4 minutes. Add 1 cup flour and stir to mix, then beat on high speed to blend.

Butter and flour an 11 to 11 ½ inch tart pan with removable bottom. Scrape batter into pan and spread level.

Rinse plums, cut in half, and pit; cut fruit into ¼ inch thick slices. Overlap all the slices on the batter; sprinkle with remaining 2 tablespoons granulated sugar.

Bake on the middle rack of a 375˚ regular or convection oven until the batter that pops up around fruit is lightly browned and tart begins to pull away from pan sides, 35 to 45 minutes. Let cool about 10 minutes. Dust with powdered sugar (on the cut fruit, the sugar melts quickly). Serve hot, warm or cool.

Patient Interviews

Part of being a dietitian is doing patient interviews. During the initial assessment the interview allows us to find out about eating habits, appetite and special diets of the patient before they were admitted to the hospital. We also find out about food allergies, weight changes, and problems with chewing or swallowing. In the follow-up assessments we focus on the patients tolerance of their diet in the hospital, i.e. whether they are experiencing nausea, vomiting, diarrhea or abdominal pain. We also are responsible for nutrition education, whether it is explaining what they are getting in the hospital or preparing them for when they leave. Interviews are my favorite part of the job because each patient is a different story. Some interviews are frustrating, some are very rewarding. Below are some examples of the characters that I meet during my interviews:

1. After a patient education session on a low sodium diet, I asked the patient whether she had any questions. To which she responded, "When they lower me into the ground, I am going to lift the lid and ask, 'Can I have some salt now?'"
2. Often times when entering a patient room, you find that that patient is sleeping. Sometimes we let them rest, sometimes we wake them up. Last week I interviewed a patient who was determined to sleep through the interview. After "waking him up" by calling his name, he answered my question and then would return to his snoring/sleeping state. After calling his name again, he would answer the next question and then return to sleep. It made me wonder whether he was just talking in his sleep or actually answering my questions.
3. When you do get patients awake and alert and ready to talk, it is important to not take their answers for truth. For example, today I asked a patient whether they followed any special type of diet at home to which they responded, "Yes a low sodium diet." I then asked, "What types of foods do you eat at home?" To which I was informed the patients low sodium diet consisted of cup of noodle for lunch and TV dinners.
4. Today I also learned that heavy exercise isn't necessarily defined the same for every person. The cardiac patient I was educating about a low sodium diet informed me that he didn't watch his sodium as he exercised and therefore lost a lot of sweat. For clarification I asked him how often he exercised to which he responded, "Right now, about once a week." I then asked, "What does your normal exercise routine consist of?" To which he responded, "I play golf." Hmmm.

The rewarding part of interviewing is when you get a patient who is really interested in what you have to tell them. They ask loads of questions, give examples of what they eat and suggestions for making their diet healthier. They want the handouts you provide, they read them with you and they ask questions to increase their understanding. It's when you get these patients that you feel like your education interventions might actually make a difference. As long as I keep getting one of these patients a week, I will be happy.

Roommates

Wikipedia says, "A roommate is a person with whom one shares a room or rooms. Affectionately known as a roomie."

 

My roommate and I share rooms . . . the kitchen, the living room, and the bathroom. However, we don't share bedrooms. In England you would call this person a housemate or flatmate. Why don't we, as Americans, differentiate between a roommate and a housemate. Wouldn't it eliminate confusion? And what exactly are the right words for this relationship in other languages? Consider this example:

 

While I was in Mexico I had the good fortune of having my roommate/housemate come visit me. I was very excited that she was coming to visit and therefore told everyone as many times as I could. When talking with my host family I wasn't exactly sure what term to use to describe our relationship. The dictionary told me companera de cuarto, but companera means companion, mate or partner. So, in order to avoid confusion, I decided to take it back to the basics and referred to my roommate as the girl I live with. I only realized that this was a mistake when my host mother asked me whether my roommate was my pair. Unsure of whether I understood her completely, I asked her to repeat herself. To which she responded, "Your pair, are you a lesbian?" Taken aback I realized I did understand her and had to figure out how to explain that no, in fact my roommate was not my partner, but rather a friend that I shared an apartment with to make rent cheaper. In the end we got it all sorted out, nothing like a little embarrassment to cement the bond between host mother and student.

 

So why am I writing about roommates? Because I have been living with mine for two years and 10 months and she's amazing.