Updated: Feb 14
I was a graduate student and dietetic intern at a nearly 600 bed hospital and who happened to have ADHD - inattentive type. Let me start from the beginning. I got myself diagnosed with ADHD at the age of 21. I had an inkling I may have had it, and at the time I was living by a big research university which provided psychological services at a discounted rate. So, instead of taking the 1 page ADHD-questionnaire, the standard diagnostic approach at many clinics, I took an entire IQ test that took place in shifts over the span of days to complete. This is considered the ideal way to diagnose ADHD - so they told me. They also explained that the IQ test didn't just test for intelligence, but it was able to test different aspects of brain functions. Combined with a family history of ADHD, symptoms, and the IQ test, I was diagnosed with ADHD.
For the 2017-2018 school year, I was a dietetic intern with a different rotation each week or so. My internship was most often housed out of the local hospital system, and clinical dietetics was the primary focus of my particular internship program. Additionally for 4 weeks over the summer, I did staff relief where I saw my own patients with the patient load of an actual dietitian and with a preceptor who signed my notes. So how did ADHD effect me in this setting?
Experienced ADHDer so I thought
I was 33 years old at the time of my internship. By now, I had been diagnosed and self-aware of my ADHD for a number of years. I had already completed a bachelors degree with ADHD. I thought I knew my strengths and limitations and was able to receive accommodations as necessary through the college. But the internship/staff relief was nothing like what I had expected.
In this particular hospital, interns weren't allowed to work in the dietitians' office. It was deemed too small, and the dietitians felt they could get their own full patient load taken care of if interns weren't there asking a bazillion innocent questions. All dietetic interns had to work at the common computers out in the nursing stations with everyone else - nurses, interdisciplinary team members, doctors passing through. And OH was it noisy!
Beeps, alarms, VERY LOUD intercom announcements of "RAPID RESPONSE TEAM STAT CODE BLUE ROOM 404 / RAPID RESPONSE TEAM STAT CODE BLUE ROOM 404 / RAPID RESPONSE TEAM STAT CODE BLUE ROOM 404" which time and time again were patient rooms in the vicinity of where I was sitting. So I also saw members of the response team show up, one by one, traveling to the particular patient room. People onlooking from the hallway wondering what was happening with the patient. Not only was there tremendous auditory distraction. It was emotionally distracting, as I saw the emergency team arrive and attempt to resuscitate the patient. I had to keep working through it, because my patient load remained unchanged. I wanted to stop working, be an onlooker, or find a way to help. But I couldn't. It's like being forced to work at your computer when you are in a movie theater watching an action film.
But for most days, I just heard everyone's conversations. Most often, nurses' clinical conversations about patients or casual conversations about the weekend, having to work through a lunch break, or the workload. I always wanted to listen to the clinical conversations about patients in case it was a patient I had planned on seeing that day. This is where very useful information often came from. And it was also where I made connections with the interdisciplinary team and worked with them for the benefit of the patient. This was the most valuable experience that came from not being welcomed in the dietitians' office. I knew my interdisciplinary team and collaborated often.
What I learned as a dietetic intern was that clinical dietetics in this hospital setting was very fast paced. This is very relevant to the ADHDer. In order to get a mass volume of work done, which is the rule and not the exception in the hospital business, the ADHDer has to tap into their superpower: hyperfocus mode. But with the constant distractions and people whizzing around bumping your chair as they pass, it was difficult. I pushed through. I had no other choice! I just redirected myself a 1000 times over.
Or sometimes, I searched for a computer in a quieter area. But, unfortunately, they were often reserved for only doctors. Even though I was paying 1000s of dollars for my tuition to be there, I was at the bottom of the totem pole. I hardly had time for a lunch break, let alone to search the hospital for a reasonable computer. It was incredibly difficult. I even lost weight over the stress of it all (and not getting a lunch break). Everyone had a high patient load. I saw staff eating lunch in front of their computers charting on patients; it was the norm. Except I wasn't allowed to eat in the open common area with the computers where I had worked, so I couldn't even have lunch while I worked. I loved clinical dietetics, but I wasn't confident this was an environment I could flourish in.
An Unusual Mix
As I worked away at a computer, getting into a groove charting on patients and tapping into hyperfocus mode as best I could, an Occupational Therapist sat at the computer next to me. She may have had Tourette's syndrome, but I can only diagnose nutrition problems. She had many verbal ticks which she masked with humming and phrases spoken to herself. She also could not sit still. She was a big bundle of energy which she brought with her everywhere she went. This is fine. I respect and accept ALL people and their differences, but with my distractability issue it was one of my biggest challenges to focus on charting while sitting directly next to her. That's okay; I pushed on and eventually she was done charting and off she went to see another patient. Tourette's and ADHD in the same work space is quite an unusual mix!
A Discovery That Works
During staff relief, I got assigned to my very own unit. And I also tried something new - noise canceling headphones. These headphones were a game changer! I put them on, turned on the noise canceling technology, and all the buzzing, beeps, and noises of the hospital were turned down in volume by 5 notches. Enough where I could concentrate SO much better. Ah, what a relief! It worked. I wore them diligently whenever I was at the computer. And when I visited patients, I took them off, folded them up, and placed them in my large lab coat pocket.
Click here for the exact headphones I ordered from amazon and the black case that fit them perfectly. For me, these headphones were a miracle. I originally wanted the fancy and very cool Boise ones (I have tried them on, and they are excellent!), but I could never afford them as a student working my own way through college.
All Was Well.. For Awhile
The only problem was, I couldn't hide these. I had to wear my adaptation affixed to my head in the middle of the nursing station! I showed my preceptor my headphones. I explained to her that I am not listening to music with these, and that I am simply using them for the noise canceling technology. And that I could still hear my surroundings as well. She accepted. If it helped me do my work, why not? All was well... for awhile.
I found a great little nook in my assigned hospital unit. It was a small open-entrance office space hidden within the nursing station that housed a social worker, clinical manager, and a pharmacist. There was a TINY space in the corner with an open computer. The desk was big enough for a phone and computer and that was it! Not even room for my clipboard. That's okay though, this became my favorite place to work in the entire hospital. I put on my headphones, tapped into hyperfocus mode, and worked my tail off. I could even sneak a snack or drink back there without anyone tattling, and I never felt judged for wearing my headphones as I charted at the computer. I could also collaborate with the social worker which became an asset to my job! An edge other dietitians did not share as they were on a different floor in their office.
All was well; I was plowing through staff relief for a registered dietitian and working hard in my new work space. But I did have to go back to the dietitians' office to check in and to have my notes signed. Out of convenience, I worked at the computers near their office sometimes. On this day, I had my headphones on and was charting with fervor. My preceptor, a pleasantly cheery dietitian, asked me into the office. But something was different this time. She said, "The nurse manager called me from the unit just outside the office where you were most recently charting. She said you aren't allowed to wear your headphones." ..Crushed.. I said, "What's her name? Maybe I could explain that I'm not listening to music. I can still hear my surroundings with them on. I use them because I need them. They are so helpful." I felt devastated. Embarrassed. My preceptor said she couldn't remember the name of the nurse manager who called. Yea, right.. My preceptor said she supported me wearing them, but that I need to where them in a different unit and not in that one. So I did.
I never had any trouble with my headphones in my assigned unit. One staff member inquired about it once but in an inquisitive, non-threatening way. She thought it was an innovative technique. My primary goal was to get my work done, and that is what the headphones were used for. That is all. But sometimes, I had patients in different units. And this time, I had to go back to the same floor I was when I got "tattled on" by someone I have never even met. Though this time I would be working down the hall in a different unit. As I was charting within the electronic medical record at the computer, headphones on, a nurse manager approached me. She had a frown on her face. ..Uh oh.. She stated flatly, pointing at my headphones, "What are those." I replied cheerfully, attempting to add some humor in the middle of this cold clinical setting, "Oh, they're noise canceling headphones. I'm not jamming to music." Trying to make light of the situation and possibly reverse the frown on her face, I continued to explain the noise canceling technology. She paused as if I had swiftly intervened before she disciplined me. "Ok", she stated. She walked away, very uninterested in my technology. The frown never left her.
Disempowered vs Empowered
This is what it was like to work at a busy hospital system with ADHD - a condition many don't understand. And if they think they do, their ideas are vulnerable to stereotypes. Internet search results for ADHD are sub par and difficult to find accurate information that embraces neurodiversity without shaming it and furthering stereotypes - even popular authority websites on the topic of ADHD sometimes miss the mark with true understanding of the condition. It is often framed in a negative light which I find highly inaccurate for me and others I know with ADHD. ADHD is not a bad thing - it's simply a difference, a variance of human nature. ADHD is known as a "learning disability", but we are just as intelligent as anybody else. We're creative problem solvers, outside-the-box thinkers, innovative, and often a lot of fun to be around.
Why Didn't I Tell Human Resources?
I never did tell anyone I had ADHD at the hospital. I had no mentor there or person I felt comfortable being vulnerable enough to tell. I did tell my preceptor about my ability to complete more work with my noise canceling technology, but she did not stand up for me when the nurse manager confronted her about it. Was I supposed to tell Human Resources (HR)? I'm a college student, not a hospital employee. I don't even know where the HR office is, so they certainly didn't even know of my existence. My college did know about my ADHD, and I am able to receive legally-protected accommodations there. However, when I reached out to them about a different accommodation (receiving extra time on tests), they sent out a blast email to all the professors (even professors that weren't my own) at the college about my accommodation. My privacy was disrespected, and trying to advocate for myself again was something I was not going to do. My college was also in a different location than the hospital. Honestly, I felt insignificant as a student. I had to pay to be there, and pass the classes. They did not ask for my feedback otherwise. There was no two way conversations happening. My assignment was just to do what I was told. I was also blazing a new trail trying out this noise canceling technology - a shot in the dark. I didn't know it was going to work; I was just desperate to try. And I am so glad it did.
We, as a society, need to be more accepting and even boldly embrace differences and neurodiversity in the workplace.
Improving the neurodiversity in a workplace is two fold. It takes the person affected to be their own advocate. Employers and managers aren't going to know what you need if you don't say so. And this gives the employer the opportunity to provide what you need. But it also takes a workplace of acceptance to be able to state what one needs without the fear of judgement or criticism. Workplaces would benefit if they saw past the bureaucracy and looked at employees more as human beings. Many managers prioritize rule and policy enforcement but should instead prioritize what the employee needs to do his job best. Managers and preceptors, at this particular hospital, weren't there to provide mentorship or to create a safe, open environment. Managers are often there to just do their job which is to make sure all the employees are there doing their own jobs; however, humans are more complex than that.
What Does a Human Employee Need?
We have basic human needs: social, emotional, and physical. Maslow's Heirarchy of Needs is a well-known psychological theory that illustrates the basic needs of every human being (see triangle below). If a person has yet to meet a basic need that is lower on the pyramid, they won't be able to go higher to meet another basic need. For example, if they don't have their need for well-being met or sense of belonging (i.e. being able to ask for accommodations in an emotionally safe environment), they won't be able to focus on their self-esteem (i.e. confidence of doing a great job). It only benefits the workplace as a whole to care about each other and offer acceptance by embracing neurodiversity.
"Sometimes the best accommodation is an ally."
- David Flink, author of Thinking Differently
Eventually I found what worked for me in the hospital. Sometimes the first step to trying something new and to advocate for an accommodation is the most difficult and requires incredible courage. We have to stand up to societal norms AND subsequent push back for being different among a crowd of uniformity. Socially, staying within the status quo is so much safer; however I am the savage nutritionist after all. And I will be the first to try new things and to advocate for accommodations... for me and for all the others that come after.