August 7, 2000

Linda Cashman is asking an elderly woman with colon cancer what she ate on a typical day before entering the hospital. She is trying to get an idea of the woman's usual diet.

Cashman needs to understand her patient's diet because this woman has just been through colon surgery at the MGH, and her eating patterns should now change. For several days, she will be restricted to clear liquids, followed by foods that differ from her typical fare. Then gradually, Cashman tells her, she will need to eat four or five small meals a day, drink plenty of liquids and then add fiber back into her diet.

"It was very rewarding to work with this patient because she was so happy that I took so much care and interest in her," Cashman explains. "She felt the information I was providing would be in her best interest. When I'm counseling anyone, deep down I'm concerned for the patient, and I like to see the patient get better."

Cashman is learning these skills under the guidance of registered dietitians and Food Service managers, as part of the MGH's 12-month dietetic internship. The internship, which started in 1909, is one of the oldest in the United States and has become one of the most competitive in the field of dietetics. Interns must have a bachelor's degree from an accredited dietetics program and a strong science base. Out of 80 to 100 applicants each year, only a dozen are selected.

Much has changed since the hospital's early days when patients were offered tea, coffee or chocolate along with a slice of bread for breakfast, and beef, broth and beer for dinner. So has the dietetic internship changed to reflect the modern science of nutrition. These days, the internship's emphasis is on medical nutrition therapy, managerial skills, community nutrition and entrepreneurship. Last year, writing a business plan was added to the curriculum.

"The standard of food and dietetic practice here is outstanding, far superior to many places," says Kathleen Creedon, MHPE, RD, the dietetic internship director. "I take great pride in this program and in our graduates' accomplishments, knowing that some of what they accomplish during their careers is a result of their training here."

With direction from registered dietitians, interns teach patients how to manage their weight, watch their cholesterol or adapt their diets to illnesses such as diabetes and heart disease. They research the literature on topics such as dialysis and bone marrow transplantation. They develop new menu items for patients and for the Eat Street Cafe, the hospital's main cafeteria.

Many of the interns go on to careers in health care, but some choose other paths. Alice Kellogg, a 1945 intern, went to work for Northwest Airlines and introduced the concept of providing "fine dining" experiences for airplane passengers.

Jill Johnson, a current intern from Nebraska, hopes to work in nutritional sales in the Boston area after she completes the program this month. "I have learned how to communicate with a wide variety of people with different needs and personalities – whether they are patients, customers or employees," she says. "I have seen the sickest of the sick. I know that if I can assess and care for the patients here; I can care for anybody."