A Day in the Life of a Registered Dietitian

Melanie Savoca, MS, RD, CNSC, LDN, has been a registered dietitian in the Department of Clinical Nutrition for 11 years. She works as the dietitian for the Evelyn and Daniel M. Tabas Cardiac Intensive Care Unit (CICU) and the Jill and Mark Fishman Center for Lymphatic Disorders. This is a day in her life.

5 a.m. Alarm sounds. Everyone needs to be fed: golden retriever Gus, betta fish Blaze, and her two kids, Madelyn, 8, and Vinny, 5.

5:54 a.m. Catches a train at the Jenkintown station.

7 a.m. Attends the weekly lymphatics team meeting. One role of the lymphatic system is to absorb and transport fats in our diet, a process that is altered when the system is injured. Savoca creates specialized low-fat regimens for these patients and consults on complex patients within CHOP and for outside hospitals who seek out her expertise.

7:10 a.m. As the lymphatics patients are reviewed, eats a Clif bar and drinks coffee. When people find out what she does, they often ask questions about their diet. “People often think my job is being the food police, but it’s so much more than that.” She determines amounts of breast milk and formula required for adequate growth in infants, provides recommendations for starting and adjusting intravenous nutrition, and monitors weight gain.

8:25 a.m. Reviews records of patients in the CICU. Notes a puzzling case: “Usually, babies need about 115 calories per kilo of body weight, but we’re giving this one 140, and he’s still not growing.”

9:44 a.m. Attends bedside rounds. The front-line clinicians turn to her to direct the nutrition plan for each patient.

9:56 a.m. Shows parents in one room how to administer a vitamin D supplement to their baby, who’s being discharged today: “One drop on the tongue, not mixed with breast milk.”

10:20 a.m. Checks with a father of a tiny patient about how much his daughter typically takes from a bottle versus through her feeding tube. “Because the CICU kids can be so complicated, often, their nutritional status is poor.” For babies with congenital heart disease, eating by mouth is like a workout, and they may tire quickly. Feeding tubes help them get the calories they need.

11:05 a.m. Heads to an exam room in the outpatient clinic where a family from New Jersey is waiting — mom, dad and round-faced 15-month-old with a scar on her chest. Yoav Dori, MD, PhD, Director of the lymphatics program, is explaining the surgical procedure the child will need in a few years. Then Savoca discusses adjusting the formula they’re using, which needs to be carefully weighed and mixed. “That’s my job every morning,” says the dad.

12:10 p.m. In a department meeting, reviews literature on protein intake in infants. The Clinical Nutrition department — which is part of the Department of Nursing & Clinical Care Services — includes more than 80 registered dietitians who provide individual nutrition assessments and counseling.

1:35 p.m. Emails the New Jersey family with new mixing instructions and amounts for the baby’s feedings. She’s been on her phone’s calculator throughout the day, figuring calories and weight gain trends, creating formula recipes, and making adjustments to nutrition care plans.

3:10 p.m. On the train home, reviews a draft of a chapter on growth and nutrition she co-wrote for a pediatric cardiology textbook.

3:50 p.m. Pulls up just as Madelyn gets off the school bus, then picks up Vinny from preschool.

7:15 p.m. Dinner: sausage, pesto pasta, broccoli and fruit salad.

8:10 p.m. With Madelyn, helps Vinny read Ten Apples Up on Top.

9:00 p.m. Practices her guitar, which she recently picked up for a hobby, then reads until lights out!