Tuesday, May 11, 2010

Back to business

I shall now attempt to re-invite blogging into my daily routine once again. My week home threw me for a bit of a loop... I got off schedule and never quite got back on fully.

Here is an update on the past week and a 1/2 since I've been back...

May 10 was an interesting day, so I'll write a bit about that I guess...
From my last day at work till the day I started up again, I had watched the new HBO movie "You Don't Know Jack" not once, but twice. The movie is based on the work of Dr. Jack Kevorkian and his place in the euthanasia movement. Many of Dr. Kevorkian's patients suffered from the heart-breaking terminal disease Amyotrophic lateral sclerosis, otherwise known as ALS or Lou Gherig's Disease. The disease is progressive, neurodegenerative, and fatal. As the disease progresses, the patient loses motor abilities from the bottom up, while cognitively remaining in tact. Every movement is extremely painful, and muscles easily cramp up.

My first day back on the job, I went to see our new admit, a 63 year old Thai woman with end stage ALS. She could at best make grunting noises, but even that caused her to grimace in pain. I got her to laugh, but she quickly regretted that laughter as the pain shot through her body because of it. I sang some songs from the 60s by her side as she and her caregiver listened and smiled. The patient's husband, an adorable little Asian man, came in and out of the room throughout my short visit. He bowed to me and thanked me for the music. I couldn't even begin to imagine what he's going through. Just watching the movie made the realities of ALS hard to digest, so seeing it in person was almost too much. For a person to have to gradually and painfully lose motor function bit by bit as their mind stays completely intact is beyond what anyone on the outside could even imagine. To have to watch your family member gradually decline and suffer with every slight movement while knowing that this disease is ultimately incurable... there's just something about Lou Gherig's that breaks my heart more than any disease I've encountered thus far...

Anyway, I saw the Korean doc this day as well. He is doing very well to say the least. Not only did he actively participate with his shaker egg during my visit (and he can now shake on the beat!) but he now took the initiative to move his feet and dance in his wheelchair. He was absolutely thrilled! We even did an impromptu Hokey Pokey which he just loved! Not sure hospice patients should be hokey pokey-ing.... but what do I know :)

I stopped to see a patient that the MT usually sees. She had been on our services for awhile now, but this was the first time I personally had met her. Wouldn't you know she died that night. My grim reaper status is still in tact even after being gone for a week. Oh joy.

Since the day I flew home to today, we lost 6 patients who I used to see on a regular basis, including Kiss from God, two of our little Asian ladies, the Scottish hallucinator, our friendly little man at the board and care, and the little lady who told me my singing sounded 'just terrible!'. Everyone is dying!! :( This line of work is getting more and more difficult now that I really know the patients who are dying...

My current struggles: what is the appropriate response to a hospice patient who says "I just want to die." 1. The patient is dying. 2. Isn't it good that the patient is accepting of their imminent death? 3. Do they wish for death for the right reasons? (Are they emotionally ready or just giving up?)

There's so much more to tell... But that's all I can rant about for now...

Sorry to my Grandma, mom, and dad for not blogging for so long! Love you all dearly!

Friday, April 23, 2010


So yes, I am getting lazy with keeping up with my blogging. Lo siento! Forgive me. Here is my combined blog for Thursday and Friday of this week.

Patient #1: We re-admitted a patient who we discharged right after the start of my internship. I didn't recognize the name or facility, but when I saw the patient, I immediately remember visiting her with the MT back in February. I remembered her to be sweet and kind. Well. Pft. She literally yelled at me because she is hard of hearing and I wasn't singing loud enough. Seriously though, I can only sing so loud. And my voice is just naturally on the soft side. "You really must sing louder. It is entirely too frustrating to struggle to listen to you sing. Now either you sing louder or you might as well stop all together." Frustrated and a bit ticked, I chose a song lower in my range so I could attempt to belt it out a bit louder. "That's hardly better I suppose," she said. That's when her daughter and son-in-law arrived. I thought they were on vacation... but I was wrong. I offered the daughter the packet of songs I was playing out of, and from then on, she dictated which songs I sing. I mean, yes, that was my intentions when I gave her the packet in the first place -- I wanted her to pick the songs her and her mother wanted to hear. It was just how she did it... maybe I'm too sensitive. Nevertheless, we sang some traditional campfire songs, and the patient and her daughter were able to reminisce about their Girl Scout adventures back in the day.

Patient #2:
I visited one of our newer patients. I didn't know much about her, other than she was Jewish. Since I don't know any Jewish songs, I just sang some songs from the 20s and 30s. She smiled at me so sweetly, but never spoke a word. Her tube feed machine started beeping mid-song, so I stopped and went to find a nurse. I was informed that I was not permitted to touch any buttons, which is frustrating to me since I used to be a nursing assistant and know how to turn the machines on silent or at least on standby. I sat with the patient for a good 10 or 15 minutes before a nurse finally came in a turned it off. The beeping was SO loud! I thought it was a fire alarm at first. I felt so bad, but the patient didn't seem to mind at all. Half the time I wondered if she even noticed.

I called the patient's daughter to follow up with her on our visit. When I had called and left her a message this morning that I was planning on visiting, I didn't realize that she would have tried to join. When I spoke with her, she expressed that she would've liked for me to be more specific on the time that I was visiting her mother. Apparently she was fully planning on attending as well. I had no idea. I apologized and ensured her we would better coordinate our schedules for the next visit. I believe we are doing a small birthday celebration for her next week. The daughter also informed me that the patient is verbalizing more, and would like us to try and stimulate her speech as much as possible. Another thing I did not know. I would've just assumed the patient was aphasic. Learning process, right? Right.

Patient #3:
Good 'ol Walter. Think of the puppet Walter from Jeff Dunham. That is our patient. I played piano music for him and the other residents. He actually vocalized some sounds while I was playing, and watched me. I was beyond thrilled that he was attentive to the music!

Patient #4:
Usually when the MT and I go to this facility together, I go and see Walter while she goes and sees the lady. The only time before that I had seen the patient, she was curled up in bed and fast asleep. Since I arrived at the same time as one of our HHAs, we traded off patients. She brought the lady patient back to the group, and I gave her Walter. We discussed in team this week how she has been trying to stand up a lot lately (she is a fall risk.) She again was trying to stand up yesterday, so I grabbed the guitar and went over next to her. I knelt down by her side and sang her a song, occassionally putting my hand on her shoulder to keep her from standing. Then, out of nowhere, the patient made a disgusted face and said, "That's just terrible!" I stopped singing immediately. "Do you really think the music is terrible?" "Why yes! How can you listen to yourself?!" Hmpf. Well then. That was that. No more music for you! That's not really how I felt. I just acknowledged that I was doing more harm than good, so I stopped. I joked with her though and told her that I'll stop singing as long as she stays sitting, but if she tries to stand up again, then I'm going to sing! She didn't find it funny. I talked to one of the facility staff members about the incident, and she informed me that the patient has had an extreme change in personality as of two days prior, and that her visit with her daughter the night before was overly unpleasant, as she presented the same rude and rash behavior.

"Patient" #4:
I went back to visit the 12 year old boy. His father had passed at 5am, so the MT and I both went to visit him. I was preparing myself to have to have a deep discussion with him about grieving and accepting his father's death. Rather, it was more of a play date. The boy's friend from school was over, and I tagged along. He kept referring to me as his "guitar best friend" and said things like "I'm bored. What are we doing now? Can we play this song? What's this do? Ever hear this song? Do you have a youtube account? Lets go on youtube. You have to watch this video." He wasn't grieving one bit. I just wanted to be like, "HELLO!! YOU'RE FATHER JUST DIED LIKE 10 HOURS AGO! AREN'T YOU THE LEAST BIT SAD??"

I worry that he'll feel a rush of grief in a month or two when the MT and I aren't around... since the family is friends with one of our nurses, I'm sure we'll all stay in touch. Poor kid :( COTI!

Drove to see the patient at the nunery (the other nunery). When I got there, I was told she was taking a shower, and then going to eat breakfast. Since the nun house is only 3 miles from our office, I decided to just go to the office, pick up my keyboard, the come back and see the patient afer she is clean and fed. So, I drove to the office, and returned about 45 min later. The patient was sitting in a chair in her room, door closed, lights off. She has the coolest Bostonian accent by the way. At any rate, she told me politely that she didn't want muic because it was too early, and to come back in the afternoon. I wasn't about to come back to the nunery for a third time today, so I just told her I'd come back to see her sometime next week. She smile and said she looked forward to seeing me then, which out of her mouth is golden, because she is known to be quite sassy (and all the nuns caring for her just aren't having it!)

Next stop: yes, that place that I think I gave a fake name to in an earlier blog because I go there so often, but now I forget the name... I decided to visit the older patient first. She wasn't sitting in front of the TV in the lobby like she has been the last few times I've been there to visit. Instead, I found her in the activities room fast asleep in her geri chair, in a long line of her fellow residents, also fast asleep in their chairs. It seemed odd to me. It looked like they were on display. Like I could've walked up and down the aisle and picked out my favorite one. But anyway, they were about to have a prayer service, so I went to see Miss Chicago instead. I had found the Elvis song she was talking about during a previous visit, and attempted to sing it for her. Attempted being the key word. Yes, it was an awful rendition, and Elvis was probably frantically searching for some earplugs up in Heaven, but it didn't seem to matter. The patient was so excited to hear the song, that she made me sing it not once but twice. I had a really good visit today with Miss Chicago. We made a list of all her favorite songs that we sing together, and also some of her other favorite songs that I don't know. I'm going to burn her a CD since she asked for a copy of the Elvis song. If you want a copy of one song, might as well make a mix!

When I returned to see our other little gal in the activities room, she was still fast asleep in the long line of sleepers. The whole situation seemed staged... like everything was secretly being filmed. Right as I knelt down next to her to say hello, a big wad of drool dripped from her lips right onto her shirt. Plop. It was lovely. I softly said hello, and sang an acoustic "You Are My Sunshine". She picked her head up, but never opened her eyes. I sang all the verses, and she never awoke. I felt bad waking her, so I just let her be. I'm getting quite attached to her though I've noticed... she's just the cutest little lady you'll ever see... I don't know what I'm going to do when she passes... Ugh I don't wanna think about it....

Fourth patient of the day was our Russian lady. Between deciphering her Russian accent and her caregiver's Mexican accent, it's a miracle the three of us ladies can muster up any conversation whatsoever. We make quite a trio though :) Since the patient was completely uninterested in the music during my last visit, I decided to tote along the piano this time and play some classical music for her (since every single visit with her, she tells me how her father played the violin, and then taught her brother to play as well.) I played some Beethoven, some Chopin, and some Mozart. She closed her eyes and looked very at peace. After each piece, she smiled at me, applauded, and said, "Bravo, bravo." She was so happy with the music. She even gave me a kiss on the cheek before I left, and repeatedly thanked me for the music. Thank god. Finally she actually cared about the music and not just my company! Not that we ever had bad visits... she just was always preoccupied with asking me questions instead of listening to the music.

My last patient today was the angry French woman. When I finally found her in her wheelchair in the hallway, she perked right up and flashed me a big smile. She was happy to see me! What a change from the first time I met her! (She asked me what I wanted with her, then immediately told me to go away.) Today, the patient kept asking when the plane was leaving, and where it was. She said there was 16 people on the plane, all from her hometown in Belgium, and that it left without her. She continued to ask about the plane, so I decided to sing with her "Leaving on a Jet Plane." I was shocked that she actually knew the song, and that she sang along! That girl belted the notes out, and even added octave jumps at the ends of phrases as she closed her eyes and sang her heart out. I felt awful though... she kept talking about how she just wanted to go home, but she was stuck here in this country all alone while everyone else got to leave on the plane and go back to Belgium.

Wednesday, April 21, 2010

I hope you had the time of your life

As I sit here and stare at a blank computer screen, I realized that the song I chose for today's morning visit was Green Day's "Good Riddance". The song's title is anything but ideal for a hospice setting! However, the words "good riddance" are never used in the actual lyrics, and the song doesn't elude a direct tone of "good riddance!" But anyway...

One of RNs told the MT this morning that the 56yo patient is actively dying. I asked the MT if I could go see the family as well. Even though I do learn a lot from all our routine visits, my experiences with the actively dying patients is where I really gain some experiences I'm sure to never forget.

Our first visit consisted of playing guitar with the 12yr old son "David", and jamming with the patient as he played harmonica (and extremely well I might add!) After stopping at the office for some supplies for the patient, I drove to the patient's home. David answered the door and let me in. By instinct, I just asked "How are you?" to which he replied, "I'm alright." He just stared at the ground and spoke in a low tone. Duh, Gina. What a stupid question. The kid is 12 years old and his dad is dying. How do you think he is?? Already I made the wrong move.

The MT had already been there for almost an hour. She was sitting on the bed (the patient was now in a hospital bed) playing guitar as the wife sat next to her husband/the patient, stroking his face and lightly crying. David was in his room playing video games and avoiding being in the room with his father. I knocked on his door and asked him if he wanted to go for a walk or to just talk. He replied simply, "No," without even turning around to face me. I conceded and went back to the patient's room to sit with the MT. She sang a beautiful rendition of "In My Life" by the Beatles. I was going to jump in with some harmonies, but honestly, I just enjoyed listening to her sing!

I waited a bit longer, and then asked the MT if I could try and teach David a new song. Once I got the 'okay', I went back for my second attempt in engaging him in music (or in anything productive...) I wondered into the hallway and talked to the patient's sister-in-law. David came out of his room and asked her if he could walk to the corner store to rent a movie. I jumped at the opportunity and offered to walk with him. At first, we were both pretty silent. I tried getting him to talk about what was going on and how he felt. He said he didn't like to be in the room with his father because of a recent experience. His great-grandmother had passed away earlier this year, and he would spend a lot of time with her at her bedside, up until the moment she died. He explained how now when he thinks of her, he doesn't recall fond memories of times they spent together, but rather, of just how she looked laying in bed before she died. I interpreted him to mean that he didn't want his most prominent memory of his father to be of him laying comatose in bed, which is understandable. But, I also think if you are blessed with being able to know that someone is about to go before it actually happens, then you should take full advantage and make that time as meaningful as possible. I worried that David would regret spending his last few hours/days with his father alive locked up in his room playing video games...

When we arrived at the corner store, David browsed through the movie titles in the Red Box. I made some typical dumbfounded "Gina"-comments about what a neat contraption a Red Box is. (I'm still amazed every time when the red space machine magically produces the DVD you selected out of nowhere...) I got a few chuckles out of him, which I charted as tremendous project! Best way to break the Awkward Wall --> humor. He picked the movie Men Who Stare at Goats because he and his father were supposed to go see it together. COTI!!! (my new acronym for "crying on the inside"! Watch out world, it'll catch on and be the new "lol".) The things he said today just ripped me apart. No kid should ever have to go through this! It's not fair! Forgot to mention. On the way over, he told me how he and his dad were supposed to go to the boy scout Jamboree this summer over on the East coast (who knew kids all the way from Cali went to Jamboree!) It was the first year he was going to get go, and now, his dad can't take him (COTI again!!). I told him that just means he's going to have to have twice as much fun -- fun enough for him and his dad. Voila! He cracked a smile :)

On our way back to the house, I offered him some insight that I pulled from my "I might have made this up, but it sounds good" archives. I'm not implying that the advice I give people is a bunch of B.S., but just that I'm never 100% certain that it's the best advice to be giving... I know... I'm always questioning myself, the things I do, and the words I say... but hey, how are you supposed to improve upon yourself if you never question things? Anyway, I told him that there is a difference between distracting yourself, and keeping your mind busy. Playing video games is a way to distract yourself, but there are other ways to make this difficult but very important time easier to deal with. I suggested he do something that will not only keep his mind busy, but will be focused on his dad. I asked if he'd let me teach him Green Day's "Good Riddance" on guitar. I told him we could perform it for him... One last big performance for his dad where Dad gets to be the VIP guest... a special concert just for him... I also told him that even though his dad's eyes may be closed, he can still hear us, and that's why the MT and I play music -- but also that hearing his son play music will be far more meaningful than music from the MT or I. Well, he agreed! Hooray!

By the time we reached the house, David and I were laughing and engaging in normal conversation. Awkward Wall defeated! David's mood changed from closed off and disengaged, to laughing, having fun, and being a total kid. He was joking around, talking to all the family and friends coming to see his dad, singing, helping us write his own lyrics to the song... it got to the point where he was border-line having too much fun! if that's even possible... I hope you get what I mean. [Side note: you should have seen the picture on his wall by his bed. It was a huge blown up picture of him and his father getting baptized. They were emerging from this giant pool soaking wet with big smiles on their faces -- most epic baptism picture I've ever seen.]

Performance time had come. We went into the patient's room, guitars in hand. David kicked everyone out except for his aunt, mom, and grandmother. I guess he was getting shy again. His grandmother asked if she could film the song, but he refused. We performed the song, with David singing right along with us. His mother cried and was really touched by it. It was the exact moment and reaction I was going for -- I can't believe it all actually worked out! But boy am I glad it did :)

When I first began rehearsing the song with David, I gave him the option of re-writing the lyrics to Green Day, or writing lyrics to the chord progression he had made up himself and played for us during our last visit. He picked just doing the Green Day song hands down. When the MT and I were leaving, he told me that next time I come over, we can write words to his song -- YAY!! I made him promise we'd actually do it -- we even shook hands on it. I was so happy to hear him say that. It was like his way of showing me trust and respect. Musicians don't share their own personal music with just anyone!

It's 8:45pm now and I haven't heard anything about the patient... so far he is still hanging on, which means another visit might be an option for tomorrow... we'll have to wait and see...

When the MT and I stopped for lunch, one of our nurses sent out an email stating that our Scottish patient is depressed and requested a visit from the psych/soc team. So yes, I went to visit her for the fourth time in 10 days. I don't mind visiting her. It can be frustrating, but I definitely am far from minding. She was highly disoriented today. She kept asking for clear water... then asked for clean water... "They gave me clear water, but I need clean water." "Yes, clean water. But I need clear water." "Yes I need clean water." I was getting so confused. Clean-clear-clear-clean-- what are you talking about, lady??? The most disturbing part of my visit was our next conversation: (I tried to remember how it went best I could...)
Pt: "My mother died this morning. About six hours ago."
G: "Oh I'm so sorry to hear that!"
Pt: "I died too. They sent my body to Scotland. My husband died too.
I love him so much. Married 44 years. He died 6 years ago."
G: "I see."
Pt: "They sent my body to Scotland. They sent the wrong body. They knew because
of the ring. This gold ring. It's my wedding ring. I love my husband."
G: "It's a beautiful ring. Must be pretty special.
Pt: "They sent the body to Scotland. I died. It was the wrong body. They saw the ring
so they sent the body back to America. I really love Scotland. It was my home."
G: "What a shame! They sent you all the way to Scotland! It's pretty far away!"
Pt: "Oh yes, about 600 miles or so. (I'm seeing a theme of 6's...)
There was a body underneath the body. They were just confused. I want them
to send my body to Scotland. With the flag. I received my husband's
flag when he died. I love that flag. It's very dear to me."
G: "Oh, how nice they gave you his flag."
Pt: "My mother just died. I'm so fearful. This room... can I stay with
you tonight?"
G: "Don't be scared. You'll be safe here."
Pt: "No, I can't stay here. I'm too frightened. Can I please stay with
you? Please?"
G: "I can't sweetie. I rent a room and I'm not aloud guests."
Pt: "Oh, please? I don't need a bed. I'll just sleep on the couch."
G: smiling "I don't even have a couch!"
Pt: "That's alright. I'll sleep in a chair. I just can't stay here. I'm scared."
G: "There's lots of people here to protect you. You'll be just fine, don't worry."

Oh gosh, I felt just awful! Her eyes were shifting around all crazy paranoid like. She wasn't kidding--she really was scared! I tried to shift the focus back to the music. We sang "My Bonnie Lies Over the Ocean". She likes that song. I always change the words though. "Last night as I lay on my pillow, last night as I lay on my bed, last night as I lay on my pillow, I dreamt that my Bonnie had said... Bring back, bring back etc. etc." (The song really goes: "I dreamt that my Bonnie was dead"... yeah, not the best lyrics to sing to people on hospice...)

After our team meeting, the MT and I went to visit our little boy up north. It's been difficult getting him to focus during our visits. He's constantly wanting to show us a new toy or eat snacks. BUT, he's super adorable and hard not to love. The MT tried to talk to him today about his dad/our patient. She asked, "So what's been going on with your dad lately?" All he replied was, "He's a little sick." It's terrible. The poor kid has no clue what's going on with his dad or the seriousness of the situation. The patient had about a dozen seizures this past weekend, and his son thinks he's "a little sick". Ugh, COTI yet again!

So yeah... that was my day... It's 9:00pm and I'm just finishing this blog... I was supposed to work hard core on my research paper tonight! Looks like that's not really going to happen... Well, procrastination is my style after all so intense paper-writing session this weekend it is!

Good day and good night!

Tuesday, April 20, 2010

Don't wanna talk about it....

Not even going to write about today... not very productive or fun by any means. Twas a day full of parking issues, sleeping patients, unanswered phone calls, unanswered doors, driving around aimlessly, a meeting bust... everything and anything....

Let's just hope tomorrow is going to be amazing enough to make up for the ickiness of today :)

In over my head?

Almost half-way through my internship, and I'm still having plenty of moments during which I feel way in over my head. I'm learning so much every day, but when it comes to put that knowledge into action, I freeze up and freak out (internally... gotta play it cool on the outside 8-) )

But anywho.... yesterday, yesterday, yesterday...

Ok. Started my day with the cutest little old man. I played music with him and a fellow resident at his board care. We sat in the living room and just had a nice bonding visit. The other resident worked in the movie business and is from Philadelphia! They were just the sweetest old men. They were very agreeable and just very pleasant... a simple kind of a pleasant... a refreshing kind of simplicity and pleasantness...

Well anyway, my next visit was Kiss from God. She hasn't been doing well lately... she was sleeping in her geri chair when I arrived... she looked pale and weak... I played some soft piano music for her. When she awoke, she turned her head towards me and smiled slowly. She was too weak to even lift her head up. I brought her the song lyrics that she wrote... I had typed them up for her and even put a picture of an angel at the bottom... she said she didn't even remember writing the lyrics... I think she does remember though, and that she was just tired and distracted and wasn't really thinking about what I said. I thought it would be best to just play more calming music for her and help her rest, but the physical/rec therapist lady from our initial visit way back when arrived and started kicking the balloon around in the living room with the other residents... I accepted that a calming atmosphere was not going to be realistic, so I told her to rest and I'd be back to see her soon.

After some office-time goodness, the MT and I were just ready to make our way up to LA county to see our little kiddos, like we do every Monday, when the mother emailed the MT saying that today was not a good day. Poor family... the pt had over 10 seizures this weekend and they were all exhausted... all I can think of is whether the kids had to see their dad have a seizure... what a traumatizing experience! And at the ages of 6 & 9, they are still very young and impressionable, but old enough to realize that seizures are serious and real.

So instead, I went to see our Scottish lady since the team has been emailing a lot back and forth about her cries for help. She's been telling people "I'm dying" and begging to see her daughters, while her daughters are hearing this and freaking out. This is the point in my day during which I freaked and felt overwhelmed. I spoke with the daughter on the phone and tried my best to comfort her... but the lady was sobbing and saying things like how hard it is to see her mother like this etc etc... I wasn't really sure what to say or what the right thing to say was or how to help... the patient was sad too and she's not dumb -- she knows she is on hospice and she knows she is dying... I know this is what hospice work is all about, but honestly, situations this blatantly hospice-related haven't really come up much... the patient apologized for her behavior since she's been calling out for her daughters to visit (apparently... does not do this during my visits with her...) I told the patient it was okay, she didn't have to apologize, and that we're just here to support her... I didn't think there was anything wrong with her wanting to see her daughter, but I just read an email from our social worker about the case, and apparently it is a personality 'quirk' of the patient's to try and manipulate/guilt her family members into getting what she wants, and that is why her daughter is stressed, emotional, upset, etc. Maybe I was wrong for telling the patient she wasn't in err for her behavior... I don't know!! Therapeutic conversations is something you can read about and hear lectures on for years, but you don't really learn how to do it until you actually do it for real...

Wednesday, April 14, 2010


Okay, sorry I've totally been slacking on my blog lately... but here is the happenings of the great wonderful today for you :)

I went to see our little Japanese patient this morning. I took my keyboard and played some piano music for the patient and her daughter, sister, and family friend. Visiting the ladies is always simply lovely. Sadly, today the patient was even less responsive than normal. I can usually get her to smile at me at least 10-15 times during a visit, but today, it was more like 4 or 5. She seemed tired and distracted. Our HHA was just finishing bathing her when I arrived, so maybe she was just tired from that... I told the daughter that maybe we'll try to start visiting in the afternoons instead, since the patient is so tired in the morning. Next time I visit, I will keep trying to work on her making more eye contact and focusing on the session.

Second patient of the day was my Pennsylvanian. He was resting in bed when I arrived. I greeted him, to which he responded, "Oh yeah sure sure..." And that was it. Two minutes later, he was out like a light bulb, fast asleep.

Third patient was a new admit. I did her assessment yesterday, and came back to see her again today like I promised. She used to sing in her church choir, so she really responds to MT and I think it's good for her. Her terminal diagnosis is COPD, but she has bouts where she is disoriented. Yesterday, she beckoned to my reflection in a mirror across the room, telling (me) to come and listen to the music. She then called her daughter over to join as well, even though her daughter wasn't present. She enjoys spiritual music and anything Scottish since she grew up in Scotland.

I guess it's been too long since I've blogged, because they're usually much longer than this... but.. that's all that happened today. Our team meetings got changed to Wednesdays so that's where I am now.

Tuesday, April 13, 2010

The again, maybe not

Went to see a new admit yesterday while the MT attended to another actively dying patient (the one who's husband was the drummer for Johnny Cash!) When I arrived, the new patient's daughter and son-in-law were there, as well as her caregiver. The three of them were just the nicest people. The daughter laid in bed next to her mother, who was now comatose and unresponsive. They seemed to really love the music. The daughter kept telling stories about her mother and all the absolutely crazy things she used to do, like strap her feet to airplane wings and do stunts while the plane was moving! It was so nice being with the family, listening to the stories, and just being able to be there for them. One of our nurses came in to see the patient right as I finished, and as soon as I left, I got an email from her asking if I could come back tomorrow to the see patient.

I found out this morning the patient had passed, so I guess I won't be going back to see her this morning.....

Wednesday, April 7, 2010

Gracias por mi elote primero!

Okay, so my day began at 8:15am as I spent 2 hours searching for Country songs for later today. It's now 6:30pm, and I still have a lot of documenting to do. I'm a bit sleepy, but not tired... does that make sense? Anyway, I saw a still fairly new patient this morning around 10am. The MT had visited with her a few times before, but today was the first we met. Freshly bathed, the patient was sitting in her wheelchair at the foot of her bed, slouched over in a sort of granny pose, one that suggested mid-scold. Already nervous to approach the patient and upset her even further, I slowly crept into the room, avoiding any sudden movements. I greeted the patient with a warm smile. "What do you want?" she asked in an irritated tone. I asked if she wanted music, to which she replied, "I don't care" as she threw a disregarding hand my way. I sat down in front of her, guitar in hand, and began to play. I tried Let Me Call You Sweetheart and Home on the Range, but she was not at all interested nor engaged. She persistently spoke over the music, grumbling about her hair still being wet. Well, she's obviously upset about her hair being wet, so maybe if I sing about it, she'll pay more attention to the music. Her wet hair was my bright idea to lure her in. I made up whatever C major melody came to mind as I sang "****'s hair is wet... if only it would dry..." etc. etc. you get the picture... She looked at me like, "You gotta be kidding me, who sent this whack job in here with a guitar?" I found a cheap plastic comb in her drawer and combed her hair for her. "It'll dry soon," I said. "WHEN??" she asked. "NEXT YEAR???" Yeah, she was mad, but hey, it made me laugh! I asked if she knew who George Gershwin was. "WHO???" "George Gershwin," I repeated. "Yes, I know him," she replied, still disgruntled. I sang and played a popular Gershwin tune, and would you believe it, she sang along! Yes, she mumbled all the words, but heck, I would've been happy with some eye contact at this point, let alone her singing along! I was so excited! Every song thereafter, she either hummed or jargoned along with me. It was going so well when she interrupted me to say she had to use the restroom. I tried to find a nurse to help her, but I was repeatedly being ignored and overlooked. One of our RNs came soon after, and eventually, she was forced to take it upon herself to help the patient to the restroom. Well, the music portion of the visit was over, but I was more than satisfied with what we had accomplished already. I stayed until the patient was safely back in bed. I said my good-bye to the patient and asked if she'd like for me to come back and play music for her. She, very politely, said 'yes'. :)

After some more intense chord searching, I traveled to the city of softball field after softball field to see our little Russian. It wasn't long before I discovered that she doesn't give a hoot about the music, and she really just wants to talk. "Beautiful dreamer, wake unt-- 'Do you have any brothers or sisters?'...." "Starlight and dewdrops are wai--'My brother lives in the Ukraine'..." She kept interrupting me! It's one thing to talk in the middle of a song, but she was asking me direct questions, so what was I to do? I eventually accepted the fact that it's okay that she isn't getting anything from the songs I was singing. The caregiver, patient, and I sat and talked outside on the patio for the remainder of my visit, which wasn't exactly music-related, but still, it was nice. She loves to talk about how her father and brother used to play violin, so I think for our next visit, I'm going to bring my keyboard and play some violin concertos and famous orchestral pieces for her. That woman loves to gab! Which is great, because I love to listen to her accent!

The last patient of my day was our other young Mexican patient. He and his wife (she may not be his wife... she barely speaks English so I'm not sure what their relationship is...) are just the nicest people. I sang for him the country songs I found earlier today, and not only did he sing along and play egg shaker, he even made up counter-melodies to accompany me. Both the patient and wife also dared to stray away from the typical steady 8th note egg shaking vamp that I myself tend to over kill. They were getting quite fancy with their musical participation. In the middle of one of the songs, I heard a bell outside. "Ring, ring, ring!" I said, just as a sort of acknowledgment that I heard the sound. The next thing you know, the wife jumps up, runs out the door, and returns with a giant ear of corn smothered in melted butter and cheese. "Elote!" she said. "Grandchildren love elote! You break now! Eat elote! Si?" I politely told her no thank you, but she was very insistent. "No guitara! You eat! Take break!" I conceded, put my guitar down, and ate some elote. What I learned today: elote es muy delicioso!

In the middle of the next song, two of the grandchildren burst through the door (one of whom I met during our previous visit.) The wife said the little girl knew how to play guitar, so I offered it to her and asked her to play. She began strumming the chords for a Taylor Swift song, and soon gave the guitar back to me. I wasn't sure what song she was playing at first, so the grandson told me it was Taylor Swift. I began singing and playing Taylor Swift's "Love Story", and the grandchildren sang along as they gathered their things from the house. By the time the song was over, they were already back at the door and ready to leave again. The grandson was so polite, and apologized for having to leave. I told him, "Next time!" and he smiled and said, "Yes! Yes, next time!" How flippin' cute were those kids?!! Gosh darn it. I hate meeting cute adorable kids who want to play music or nice wives who feed you elote when the only reason you're at their house is because their family member is dying. Life really stinks sometimes....

We ended with some Spanish songs, to which the wife sang along loudly, proudly, and off-beat. It was fabulous. Such nice, nice, nice people. She even let me borrow a cassette for learning Spanish. I told her that "Tu dueles your ears from mi ingles?" That's spanglish for 'your ears hurt from my English?' My Spanish is despicable. But her English isn't that hot either, so I guess we're even :)

Tuesday, April 6, 2010

You're just a kid!

Yes, I went back to a nun house this morning. I feel like God is trying to tell me to get me to take a vow of nunhood. Every week it seems I'm back at the nunery. At least today it was a different nun house. They are all so nice though, so don't think that I don't like going to the nun-topias. The case is probably just the opposite. I joke because I care. At any rate, I met our new patient who is not a nun herself (just lives in the nun assisted living home). She's a super sweet 88 year old Bostonian Irishwoman. She said the nicest things to me during our visit, like "Just because my eyes are closed doesn't mean I'm not listening! Cause I am!" and "You're a looker, ya know that!" and "Do you have recordings? Cause you should!" I like this patient. :) Even if she didn't say all that, I still enjoyed seeing her, and was glad to be able to play music for her. She's terribly bored and isolated in her room, and she's too weak to run about the nunery and explore. Of course they had street sweeping on Tuesdays from 8-12 and were trimming trees on that block, so I had to park 20 miles away and dodge tree branches on my walk there. But, meeting the little Bostonian with the 'scawws' on her tummy made it all worth it.

My second stop of the day was to a facility with MTs on their full-time staff. I got there, had the valet park my car, talked to one of the facility's MTs, found the patient's room, was told she was sleeping by the patient herself (honey, if you can verbally tell me that you're sleeping, then you're not sleeping... sorry.) got back in my car, and now, at the office for a afternoon of meetings!

Monday, April 5, 2010

Amazing rain and humming birds

Our first patient today was a nice, sweet old man who the MT had seen before, but I just met today. He sang along to the songs and loved loved loved to talk! Our new LVN was shadowing that morning, and sang right along with us as well. It was a lovely chorus of voices on this first Monday morning of April. (would've made for a better alliteration had it been May...)

Around 11:00, I went to go see Kiss from God with our company volunteer. There was lots of visitors and hub bub bustling around. Between all the talking, the caregivers making lunch, and news about the hurricane on the TV, the patient was horribly distracted. I wanted to relocate, but to where?

The patient's boyfriend was in attendance once again. He enjoys participating and is very friendly. The patient didn't seem quite like her usual self today. She seemed like she had been depressed, although she was able to speak or visit all four of her children for Easter.

We tried a song writing intervention, despite the crowds of people and the patient's lack of sincere focus. Since she sings Amazing Grace every night before she goes to bed, I thought it would be good for her to write her own verses for Amazing Grace (since there's already 25, might as well add a few more...) Well, the volunteer helped jot down some of her ideas, and I assembled them into lyrics as quick as I could.

Amazing rain and humming birds
outside my window be!
I thank thee for my nursing skills
that you have given me.

I love my children, 4 in all
2 boys and 2 girls
There's T** and J** and N** and K**
and thank you for my friend M**

Well, after we sang together the lyrics I had assembled for her, she began reciting more lyrics. It was all stream of conscious, right off the top of head. Allow me to share with you what she came up with right on the spot:

Amazing grace and numerous friends
are always at my side
Ev'ry time I turn around I find one coming near
to ask me for a guide.

Holy moly!! I couldn't believe it! The lyrics were not only incredible, but they even fit the music and rhymed!! Kiss from God, I am quite impressed :)

The afternoon consisted of another quite extraordinary experience. The MT and I went to see a new admit. She's only 71 years old. Her caretaker, the patient's cousin, was very warm and welcoming of us (as soon as we convinced her we weren't selling her magazines!) She told us the patient used to play 17 instruments! But, she's been sleeping the past two days. The patient was asleep when we arrived, her mouth gaped open, eyes shut, body limp. As the visit progressed and the patient heard more and more music, she went from dead sleep, to a twitch here and there, to slight movements, to fuller movements, to almost constant moving, to her eyes open, to direct eye contact! The response of the patient was absolutely phenomenal!

Friday, April 2, 2010

No, I can't sing and kiss at the same time. Sorry!

I visited with my favorite Asian doctor/professional egg shaker this morning. He had with him an old prescription he had written from back in the day when he was a MD. Other than "Vitamin B", the rest of the prescription was written in Korean. Although I cannot speak the language, I can tell whether something is written in Korean vs. other Asian languages. "Dr. Lee," I said, "are you Korean??" His eyes lit up and a big smile appeared. "Oh, I am Korean!" "Me too!" I told him. His eyes lit up even bigger, and that's when the word garble came out. "Sheem shu guk ahm-ni-dah blah blah..." "I don't speak Korean, Dr. Lee!" I told him. Just as he began to look slightly disappointed, I quickly told him, "Ahn-yong ha sae yo!" and he quickly bounced back and said, "Oh! Ahn-yong!" I knew learning how to say 'hello' in Korean would come in handy eventually :) All I had to do was move to what I like to call The United State of Asia aka California. So. Many. Asians.

But anyway, I just love that 의사 (doctor). He loves it when I shake his hand and tell him what a good egg shaker he is. I gave him two egg shakers today: one for himself, and one for another resident. I told him to pick someone else to play the egg shaker today. Wouldn't you know he'd pick the only other Asian resident in the room (hehe). It was too cute. Her eyes brightened as she pointed to herself, as if saying "Who, me?" I placed the egg shaker in front of her and told her that the doctor has specially chosen her today. She picked up the shaker and gave it a couple good warm-up shakes.

Alright, the band is equipped, warmed-up, and ready to go. The guitar is (somewhat) in tune. Let's get this party started! Between the doc playin' the ba-jeebers out of the egg shaker and these two residents applauding me as if we were at Carnegie Hall, it was just a grand old time! That is, until we sang "Five Foot Two"... you never know what can of worms you'll open with some of these songs. They seem harmless, but then they trigger something or someone. One of my biggest fans raised his hand like a little school boy and said, "I'm 5'2"! I'm 5'2"! No, wait... 5'3"! I'm 5'3"! How tall are you???" "I'm 5'4"," I told him. "Oh, well I'm 5'3"!" he added again. So I said, "Well then, a 5'2" eyes of blue girl would be perfect for you!"

After I finished the next song, the old man school boy interrupted me mid-sentence to ask me if I saw him blowing kisses to me.

"No, I must've missed it," I said.
"Hey... hey!... can you kiss and play guitar and sing all at the same time???"

Ok. This has gone too far. I politely told him that it would be impossible to sing and kiss at the same time. Yeah, he looked disappointed, but serves him right for asking me questions like that! Sadly, he wasn't discouraged. He continued to blow me kisses in bunches of 50 or so. Just incessant air kisses. One after the other after the other. After the end of the next song, he said,

"You're 5'4" and I'm 5'3"... that's perfect!"
"I think I'm too tall for you."
"It's okay! I'll just stand on my tippy-toes!!"

Thankfully, just then, the aide told me to wrap it up so they could get ready for lunch. I had about enough of this man for one day. We sang a quick good-bye song, I collected the egg shakers, shook the doc's hand one more time, and gathered my things as efficiently as I could. As I left the room, I could hear the man behind me yelling, "You should stay all day! At least for a few hours! It'd be perfect!"

How persistent these old men can be!! No means no!

The middle of my day was spent at a very lovely open house, hosted by a new assisted living facility. They had a guest speaker give a presentation on Alzheimer's and Dementia. She is a geriatrician. (Think 'pediatrician' but for old people.) She was really funny and gave a wonderful presentation! The coolest thing about her was her wholistic approach to her practice. She sounded like she was advocating for the same things Music Therapy and Hospice advocate! (Natural, non-medicinal remedies [like MT] vs. strictly pharmacological treatments, and ensuring quality of life over a cure [hospice!!].)
Here's some notes I took:

MCI - Mild Cognitive Impairment
•Loss of memory
•Loss in language, spatial relations, or judgment
•Still able to function

Distinguishing types of Dementia
•storage vs. retrieval
•retrieval of some things more than others (personality, language, spatial skills, concentration)
•motor symptoms

Cognitive symptoms:
•personality change
•delusions - fixed, false belief (someone's stealing from me!)

Lewy Body Dementia
Frontal-Temporal Dementia
Vascular Dementia
Alzheimer's Disease

People w/ dementia in the US
10% of 65+
50% of 85+

Prescription as well as OTC drugs can make dementia worse

Goal: to enhance QOL and maximize function by improving cognition, mood, and behavior

Tips for CGs:
•DON'T argue, correct, confront
•DO distract and pay attention to emotional context rather than verbal context

My afternoon was spent at yes, that place I always go to. I saw our cute little looker once again. She was sitting right in the lobby entrance when I arrived. Her daughter decided to grab some lunch while I visited with her mother. She took the patient's purse off her lap and went off to lunch. Okay, just to remind you, this patient usually either is A.) sleeping or B.) looks at you sweetly and says "oh that's just lovely!" Today, I saw a whole new side of her. "BRING BACK MY POCKETBOOK!!" She was sooo mad!! For the next 10 minutes, all she could talk about was how badly she needed her pocketbook and how her daughter took it from her. Every time I said 'your daughter', she got mad all over again and screamed for her pocketbook. Even when I said a word that rhymed with her daughter's name, the same reaction was given. Finally she calmed down, and we sat and watched CNN together. The TV was blasting and the radio on the PA system was blaring, so I figured, heck with the music -- we'll just hang out today. And that's just what we did. We had a very lovely conversation. She understood what I was saying, and I understood (most) of what she said. She was extremely in-tune with everything today. What a change! The only inaccurate thing she told me was that she was over 100 years old. I said, "Oh wow! You must take really good care of yourself!" Really though, the gal's only 97. :) You don't want to start a confrontation or conflict. As the geriatrician said, find the emotion behind the words, then focus on that and try to make it better.

My last patient of the week was Miss Chicago. She loves to analyze the lyrics to songs, so we sang some of her favorite songs (Leavin on a Jet Plane, Can't Help Falling in Love) and talked about the words. We also sang some Catholic hymns in honor of the Easter season. She always thanks us for coming and says "I love you!" It may not seem like that big of a deal, but this lady is notorious in her facility for being a huge B*word -- with us though, she shows a much softer side. She introduces me to her teddy bears as if they're real people, and says things like, "I love you!" When considering the rougher side of her personality, I take to heart her 'I love you's' that much more. :)

Happy Easter!

Thursday, April 1, 2010

Hey, I'm not your wife...

Went to see my long last Asian family today. The patient's daughter is so nice, and the patient's sister always says "What a treat!" when we come to visit :) The patient was sleepy today, and had trouble keeping her eyes open. She seemed a bit more ornery than usual, but did occassionally let out some of her signature giggles. We picked up-beat songs for her, and even tried some wooden flute music. The patient says "ow" a lot when someone touches her -- it might not indicate pain, but rather, is an easy and familiar word for her to verbalize.

Our afternoon patient was our kisser-eater. His wife wasn't able to come today, so as the MT led the group, I was able to sit beside him and give him some 1:1 attention. Prior to our visit, the MT and I discussed how the patient's wife seems to be benefitting from our visits, sometimes seemingly more than the patient. We discovered today that the patient simply tends to devote his focus to whomever is seated next to him. Since today that person was me, we were able to engage him more in the session. We gave him a maraca to play, which he shook lively with a big grin on his face -- and then he stuck it in his mouth and tried to bite it. He put that darn maraca in his mouth every time I turned my head. Last time, it was his wife's hand he was trying to bite, so even though maracas weren't made to be eaten, at least it isn't another human being.

The patient is usually very affectionate towards his wife. He holds her hand, lays his head on her shoulder, gives her kisses, etc. Today, that lucky receiver of loving affection was me. The patient stared at me constantly, with a longing look. He held my hand, gave it kisses, and even tried to pull me closer to him (I'm assuming to kiss me.) Despite his transference of spousal love onto me, the MT and I also discovered that our patient is very intuned to our music! He was singing along to the older songs and folk songs, as well as tapping the beat with his fingers while we held hands, and swinging arms with me to the beat. His wife told the MT months ago that he doesn't like those old songs, but it looks like he very much does! He even answered all the questions I asked him. Let's see... I asked:

"Do you want to sing music with us?" "No."
"Is it okay if *MT* sings the music and we just listen?" "That's okay."
"Do you know Frank Sinatra?" "Yes."
"What are some of your favorite things?" "I like everything."

I was very impressed with his interaction with us today. Could have done without the kisses and the date-like scenario, but, still... he did well :)

Tuesday, March 30, 2010

"As a well spent day brings happy sleep, so life well used brings happy death."

Hearing the MT yesterday sing all these wonderful old folk tunes inspired me to get my act together and start organizing some music and really working on expanding my repertoire. I arrived at the office around 8:30am to print out chord sheets for traditional, folk, and older songs I found the night before. I thought I'd have enough time to put together a good solid packet of music to take with me to see our two patients this morning, but I barely got 4 songs printed out before I had to leave to go meet the MT. If you're the type of person who begins a project and doesn't like to quit until it's completely done, than you probably understand what I felt like today having to stop and start my repertoire boom.

But anyway, our Miss Chicago was sleeping, so the MT and I went to see our cute little looker (the patient whose smile lights up a room.) She too was sleeping, but we stayed and sang some music to her acapella. When the MT gently touched her hand, the patient awoke. As soon as she mentally processed that there was music in the room, she smiled. I just love seeing her smile. It makes my day every time. We stayed and sang with her for a bit. I touched her hand, trying to offer some comfort and to let her know that we were there for her. She doesn't speak much. Sometimes she'll smile and say, "That was very good!" in the most stereotypical yet adorable old lady voice you've ever heard. Today, she said something different. "You're hands are cold!" As much as I felt bad that my touch wasn't offering the level of comfort I had hoped, it was nice to hear her say something that was completely sensible and appropriate! It was an entirely normal and acceptable thing to say, so kudos, Smiley! :)

The middle portion of the day consisted of paper work (more chord searching), an office luncheon to celebrate the awesomeness of our social workers, and our weekly team meeting. Mid-meeting, our social worker answered a call about my favorite nun. She had revoked our services the day the MT came to visit her with me. I think I was still bitter at her for letting us have a whole session with her and through its entirety, failed to mention she was revoking us. Who knows, maybe it was out of her hands and she didn't even know about it till it happened. Either way, I was not very saddened knowing it was our last visit together.

So anyway, the call. The nun was in the process of being re-admitted to our services. (Oh joy!...) I was anything but excited. They told the social worker that her identical twin sister came since the nun was now actively dying, and that a psych/social team member would greatly be appreciated to support them. Yes, I got voted to attend to the patient. I had seen her two or three times before, and knew her the best out of the psych/social team. And so, I left team and journeyed back to the nunery. I didn't even need my GPS! (big day for me haha)

I ended up staying with the patient for over an hour and a half. In the beginning, I played music as our HCC helped the patient sign the necessary paperwork. I sang the standard Catholic hymns I had in my book, and some praise and worship songs I learned from Cryptora back in the day. Eventually, more and more sisters shuffled into the room, and the mood began to change. It was quite a powerful experience to say the least. To be there and witness a person's last hours of life... I really think it's a "you had to be there" kind of thing. I can explain here what it was like to sing and play guitar as the other nuns gathered around her... I think when I found myself providing background music for the priest as he gave Sister her last rites... that's when it really hit me... the whole experience was just... it was surprisingly a lot more intense than I thought it would be. As I sang songs like, "Open the Eyes of My Heart" and "Refiner's Fire", I kept thinking "Who would've thought that when I was playing these songs back at the FOPs in high school, that I'd be playing them again 6 and 7 years later for someone receiving her last rites...." I honestly didn't think I'd ever have a need to sing those songs again. Turns out, the words are perfect for end of life reflection.

When everyone was gathered, I re-played all the traditional hymns again. (Morning Has Broken, How Great Thou Art, Amazing Grace, Hail Mary Gentle Woman) The nuns, priests, and family members all sang right along with me. There must've been over 20 people gathered, and they were all singing, supporting Sister, and letting her know that they're there for her.

Despite her state of weakness, Sister's twin called their family members so they could say their last good-bye (SO SAD!) I heard Sister say, "How am I? Oh, I've been better." Everyone in the room let out a little chuckle. When asked 'how are you' by the second caller, Sister replied, "I'm okay. The lady is here playing music." I felt so touched that she mentioned the presence of the music! Up until that phone call, I was standing there, playing and singing, wondering if it was having a positive affect on her. It was so nice to have a verbalized confirmation that yes, she hears the music, and yes, she valued it enough to tell her loved one that there was music for her.

I don't know... I thought the whole experience was just so much nicer with the music in the background and everyone singing together... sometimes silence can be awkward, especially in situations like this... it's not every day you see a loved one gradually pass away right before your eyes... the music created this calming, reflective quality...

I felt bad leaving, but after an hour and a half straight of playing guitar, my finger tips were about ready to fall off, or slice open and bleed (too graphic?) Well, I guess it's my own fault for not practicing enough... or maybe that's just how life goes for guitarists... anywho... I'm beyond grateful for my experience today with Sister... I've had a complete change of heart... I feel incredible guilt for ever disliking her, and now, I'm actually quite quite sad that she is leaving... poor thing... I remember her asking her twin in her Croatian accent, "When am I going to die already?" Her twin didn't understand what Sister said and couldn't get her to repeat it, but I heard it. I know what she said. Poor thing was ready to go. Imagine being in her position... everyone's crowded into your room... the priest is anointing your forehead and giving you last rites... your sister hands you the phone to say bye to Mom... to have to know that you are about to die, and to just anticipate it for hours like that... I can only imagine, what it would be like...

Monday, March 29, 2010

Una semana nueva, una dia nueva, el tiempo nuevo! (91 degrees today!)

Went to our other office today to observe their MT. She did two assessments, which both ended up being wonderful experiences! Both patients were elderly women, but had very different personalities and responses to the music. The first patient was initially very unreceptive to the MT and I. She lived at home with a 24hr caretaker (who was a middle aged Chinese-Filipino man, hard rocker, smoker, cut off jeans... the two made quite a pair!) She was sitting in her easy chair watching Deal or No Deal. The patient took one look at us and said in a harsh tone, "What do you want?!" as if we had dared to interrupt her mid-show. The MT politely introduced us and asked if the patient would like to listen to some music. "No!" the patient responded immediately. Thankfully, the MT was able to tell that quickly to not give up so easily and to keep trying. We definitely don't want to force music therapy upon our patients, but sometimes patients turn down anyone and everyone until they experience first-hand our purpose and that we're there only to help and be supportive. If I was ill and had person after person come into my home, asking me questions and prodding me with needles, I'd probably be the same! But anyway, the caregiver was very helpful and kept saying things like, "C'mon 'Sue', just let her sing a song. She plays the guitar and sings. You'll like it!" The MT added, "I think he (the caretaker) wants to hear a song... can I play one for him?" Finally, the patient huffed in frustration and nodded her head, agreeing to one song. The MT got out her guitar and began singing. Immediately you could see a reaction in the patient's affect. Her features softened and her eyes slightly glowed. It was obvious she knew the song. From there, the session progressed further as further through the continuum of acceptance, as the patient gradually opened up to the MT more and more. The MT made sure to continuously ask if the patient wanted to hear more. It's always important to ask the patient what their wishes are. Often times in the medical system, the wishes of a patient are often ignored, even though the patient is truly (unless consciously incapable) an expert in their own care. The patient went from refusing music all together, to saying, "Well alright" to the suggestion of another song, to "Yes!" It was so wonderful to see her open up and smile. She became a whole new person. The music transformed her from a cranky old lady to a sweet and loving woman. She smiled and watched intently as I sang "Blue Skies" for her, as if she was envisioning the blue skies in her head. At the end, the MT gave her the option of singing more songs, or singing a good-bye song. This is a good example of what I was saying earlier about asking the patient what they wished to do. Even though the patient was clearly enjoying our visit, she told the MT that she was tired and we should just say good-bye. She said it though in a very polite manner and kindly told us she was done for the day. We sang our good-bye song, and we all ended with smiles on our faces and joy in our hearts. :)

Too cheesy? Okay, maybe that was too cheesy... but it was all true!

The second patient was an adorable old lady with a big friendly smile glued to her face. When the MT saw the picture of the patient on the wall in a nurse's uniform, she asked the patient if she used to be a nurse. The patient's smile got even bigger! At least we know now that she understands what people are saying to her, even though she herself is nonverbal. The RN and HHA were just leaving as we arrived. The RN said that she was in a bit of pain from changing her dressing and the meds haven't kicked in yet, so it was good timing for us to be there to distract her from her pain. We played a few songs for her, and she slowly drifted off into a peaceful sleep. She was so sweet and cute!

Both patients were excellent candidates for music therapy. Patient #1 was able to experience some positive social interaction, while patient #2 was relaxed after a painful dressing change. All in all, a very successful start to the day :)

The second half of my day consisted of documentation and seeing the little Mexican ninos. Well. Nino. El otro nino was at his piano lesson. The MT made a clozed writing activity for the kids, but since the one son wasn't there, decided to save it for next week. Instead, she asked the boy for some of his favorite things, and then put them to music. The patient (his father) came downstairs during this, and so the MT asked for some of his favorite things, as well as added the older son's and the mom's favorite things.

Saturday, March 27, 2010

The observer became the observee

Wow. Okay. I'm a little behind it seems. Time to finally blog about Friday...

In the morning, I went to see our Miss kisser from God. One of our volunteers is a psychology student who was interested in observing MTx first hand after my presentation at the volunteer training session last month. He came on Friday and joined me for our morning session. The pt had recently fallen while trying to use the bathroom on her own, and as the nurse put it, was embarrassed after failing at her attempt at a little independence. Since then, she's been contemplating her purpose in life here on Earth if she's unable to care for even herself and knows she is going to die. Tough stuff to deal with, I think. It seems perfectly rational that someone would feel this way. What is the point? I made sure to explain to her that there's a lot of people who care deeply for her, and that she's around to just be herself and to love and be loved. She told me she was "on the list (to die)". I told her we were all on that list. No one is going to live forever. We're all going to die eventually. I told her that she's just as much alive as we are, and that she should live that way. She's still alive now, and that's all that matters. That's something the MT taught me from the very start. Yes, hospice work is dealing with those who are dying, but our focus is on the fact that they are still very much alive right now, and to not cast aside those last days just because death is known to be imminent.

It was nice having the volunteer there to support me, sing along, clap to the rhythm, etc. I was a bit nervous to have him observe... I'd hate for his only vision of music therapy to be from a product of my own facilitation since I am so new to the field, but hopefully he gained a fair understanding of what it is we do.

Oh, and the patient's boyfriend was able to join us for the session today, which was adorable to have the two both there together. :)

After that, I saw a couple patients at a nursing facility, then saw a new patient who was comatose, and that was about it!

Sorry this blog is hardly apt. Mondays will be better, I promise!

Thursday, March 25, 2010

Para bailar LA BAMBA

Spent my morning researching dementia, MTx and dementia, how to talk to people who have dementia, how dementia affects these people...

I suppose it would be rather difficult to research a topic such as dementia... although it affects hundreds of thousands of people, it is so patient-specific, and even varies in severity and symptoms within a specific patient. Also, it is difficult for a mentally healthy person to fully understand dementia without experiencing it first-hand. There's been a fair share of conflicting advice when it comes to interacting with pts who have dementia. If there is apparent short-term memory loss, I am currently in support of the tactic to just go with whatever the pt says, rather than fight it. If a pt says their husband should be coming home soon from work, even though her husband has been dead for 10 years, I'd rather say something like, "Okay, hopefully he doesn't hit too much traffic" rather than get the pt all worked up and upset by trying to convince her that her husband is dead and not coming home soon. Either way, sooner or later the pt will most likely forget the conversation ever happened, so why bother upsetting the pt and arguing? By appeasing the pt and going along with the reality the pt creates, a more peaceful here and now can be instilled and maintained, which is of all-importance.

Should you do this with anybody who is disoriented or creating an alternate reality to live within? No. Take that episode of House for instance. He saw the medical director at the psych hospital try to tell one of the patients that he wasn't a really a superhero, nor had superhero powers. The patient became extremely depressed that no one believed in his powers. House thought it would be nice to help make the patient's alternate world a true reality. So, the next day, he took the patient to a county fair where they had a wind machine. They gave it a go, and the patient was a new man. He was experiencing first hand what it felt like to fly and be suspended in mid-air. Thanks to House, his superhero reality was given a rebirth. But, on their way back to the car, parked on an upper level of a parking garage, the patient scaled the wall, and, with a big smile on his face and one last thank you to House, he jumped, believing that he could actually fly.

One must always assess the situation as to whether someone's alternate reality holds any potential danger to the person or to society. An elderly woman living by herself who wants to set the dinner table for her family, even though nobody is coming over for dinner, is yearning for the time in her life when she felt purposeful and just wants to somehow contribute. This situation is very different than a 30yr old man with PTSD who covers up his past trauma with a superhero alternate reality, which can cause harm to him or others.

Despite how blatantly different these scenarios might seem, not every situation is this black and white. One of the facilities we have pts at has a pt with dementia who has physically harmed the other pts. If you recall me saying, she pulled out one of our pt's hair a while back, and was then allowed to return to the facility unrestricted. She roams around, asking where her son is, and mumbling sentences unrelated to anything going on. She has highly progressed dementia. This past visit, she tried stealing my bag of music. For pts like this, buying into their reality may not be the best way for someone to interact with them, or in the least, buying into their reality in order to lead them to a safer place.

But anyway, enough of that. I visited with our lovely Russian patient around noon. She had just woken up, and was sitting in her wheelchair in the living room, slowly eating her breakfast. I played songs from many different decades for her, since she did not grow up in America and therefore does not recognize the songs from the 20's and 30's like our other elderly pts do. As long as I played the songs slowly, she was happy. Every song, she closed her eyes and let her mind wander.

Her nurse had become concerned around the time of our last MT visit because the pt had become disoriented, becoming preoccupied by thoughts of visitors coming over for dinner, such as her brother and sister, who are deceased. I was able to note today that the pt was able to tell me with no hesitation that her sister has passed away many years ago. Like I said, dementia can come and go, and differs from person to person, and within each person, from day to day, hour to hour, minute to minute...

The middle portion of my day was meetings, so I will not bore you those details :)

Our last pt of the day was a new admission. He is a very kind Mexican man, who speaks enough English for the MT and I to interact with him without needing someone to interpret. We played Spanish and country songs for him, like La Bamba and Shania Twain. He and his family played their little shakers happily with us. It was a lovely and fun visit. Again, so sad that the pt's grandson is so cute! The whole family was as wonderful as the pt, and it's so unfortunate that we always have to meet these wonderful people under such circumstances. If only I could meet all these people for a reason other than their loved one is dying...

It's a celebration!

Hello world!

Started my day by the beach today (although didn't get to actually see the beach *sad face*) The MT had me observe a friend/colleague of hers who's a music therapist turn music educator. After completing his internship and working a few years as a self-contracted therapist in southern CA, he took on the role of an elementary/middle school music teacher at an independent K-8 school. It was a lot of fun watching the kids play and hearing all the wonderful music they made. Such talent!! Today I got to observe the 7th, 3rd, and 1st grade classes. The 7th grade was working on their "band" for the spring recital. He had kids on drums, bass, acoustic guitar, electric guitar, keys, and vocals. They played "Revolution" by the Beatles, and it sounded absolutely amazing! I was blown away by them. I'm being completely honest when I say that some of these kids could surely outplay me easily, and they're only 12 yrs old. The talent level didn't diminish as the younger students strolled in. He sang popular pop/rock tunes with the kids, and they not only had the lyrics of the songs they practice regularly memorized, but they easily recalled songs from way back in the beginning of the school year. I had no idea that 6-yr-olds could memorize and sing accurately classic rock hits, Jack Johnson, and Bob Marley!

Overall it was a great experience to just sit and watch the kids have so much fun at school, but to also see how he incorporated therapy techniques into his classes, like the drumming workshop he did with the 1st graders. It made me wish I was a kid again!

After driving back to the inland part of the OC, I met up with the MT to see a pt. She was the first pt I saw as a MT intern, so it was special getting to go back and see her again. The pt went through quite a transformation from the beginning of the session to the end. When we first arrived, the pt was laying in bed, moaning of pain and wishing away her very existence. I took a passive role and let the MT facilitate to the needs of the pt. She practiced some deep breathing with the pt and allowed space for her to cry and display her emotions. By the end of the session, the pt was up in her wheelchair, sitting in the living room in the sun with her dog on her lap.

The last stop of the day was to a memorial service for our beloved pt who recently passed. I felt a bit undeserving to be there... I barely knew the pt, while everyone else there seemed very close to him (family, friends, our staff, their staff, fellow residents). It was an eye opening experiencing nonetheless. It served as a reminder to treat every pt as we would like our own family member or even ourselves to be treated and cared for. I saw his family. I saw them cry and heard their stories and words of remembrance. All our pts are leaving loved ones behind (physically), and there is bound to be pain and grief. Just because our staff has to work with the dying process 5 days a week makes it even more important that we never take the situation lightly, and always remember to be sensitive to the feelings and emotional process of the pt's family and friends. However, even though people pass, they leave behind many wonderful memories and legacies. As one of our nurses said to me, "It's [the memorial] not a sad thing... it's a celebration!"

Tuesday, March 23, 2010

That's nice, but when's lunch?

Saw the nun again this morning. She has labored breathing that highly resembles snoring. I thought she was snoring today, but realized today that since her eyes were open while she was making this sound, she was actually just breathing. The MT and I sang some more spiritual music for her, and ended with He's Got the Whole World In His Hands and Amazing Grace. We added everyone's names into He's Got the Whole World as a way of acknowledging those there to visit and facilitate a bonding experience for everyone. I learned today in our team meeting that the pt is only 66 years old... :(

I went to see a pt before our afternoon team meeting who has been sleeping the last couple times we went to see him. Since I arrived at noon, the pts were already gathered in the dining room for lunch. I went over the pts table, set my book down, and began to play. The other 2 men at his table were talking up a storm to me. The one kept objecting to my song choices, while the other continuously demanded his lunch! First, I sang Beautiful Dreamer. The one man objected and said, "No, no, no. Not that one!" I smiled at him, but kept playing. I'm sorry he didn't like the song, but I was there for our hospice pt, who was not objecting to the song. I did spice up the guitar accompaniment a bit for him so it didn't sound so slow and pretty. "No country western!" he demanded. "Keep it Eastern!" I kept thinking Eastern as in Asia, but then I realized he just met the East of the US. So, I asked him where he was from. He told me "the East! We're all from the East!" "All three of you are from the East coast?" I asked. "Yes, yes, yes, we're all from the East coast." I asked him what state he was from, and he told me New York. "New York? That's wonderful! I'm from Pennsylvania!" "Oh, he's from Pennsylvania too." He was referring to my pt. So I asked our pt, "Are you from Pennsylvania?" "Yes, yes," he said. It was the first time I heard him speak. I was so excited. "That's awesome! How come you never told me we're from the same place?! What city are you from?" ---- "Are you from the East or the West?" ----- "The East side of PA, or the West side?" ----- "Near Pittsburgh, or Philadelphia... or in the middle?" ---- I lost him. I was saying way too many words and asking way too many questions. From now on, simple questions, yes or no.

Aside from the talkers at the pt's table (although they were pretty funny!), some of the other pts in the room were singing with me and conversing with me. I wasn't even overtly trying to involve them, but they were drawn to the music on their own :) So thank you to all the other residents there today!

The rest of my day was documenting and meetings. Alright, time to get back to class. Later aldagators! (I miss Jon & Kate plus 8...!)

Monday, March 22, 2010

Life's not fair...

Long Monday...

This morning, I went to see a new admit. She was another nun from the same convent as the woman who just revoked our services. This pt was found unconscious due to seizures and rapidly declined thereafter. She went from alive and well to actively dying in only a matter of a few days... she also bit her tongue multiple times while seizing, which I can attest to after meeting her today (she didn't seize during our visit, but I saw the sores and scabs covering her tongue...)

The pt was unresponsive. There was a nun sitting at the foot of her bed, quietly watching as her fellow sister rested. I must admit, I would have much rather it been just the pt and I. It's not the pts that seem to make me nervous... it's the caregivers, family, and friends. But anyway, I introduced myself, and asked if it was alright if I played some music. She told me that the pt really enjoys music and that she's sure the pt would love it. I played, of course, Amazing Grace, and Peace Like A River. Yes, the songs are easy to sing and play on guitar, but, they're both really pretty songs that I find very relaxing, so even though I feel like a broken record when I type my blog every night, it never feels repetitive during my visits. In a way, it's always like the first time I sang the song... it somehow becomes renewed in the moment... but anyway, after I finished singing Peace Like A River, I knew that I didn't have any other simple spiritual songs in my memory bank. It was time to reveal all those Christian songs I copied from the MT's fake book the other week. One by one, I played through the songs, picking out the ones that sounded the most Catholic and the most Ordinary Time appropriate.

Once I reached the chorus of How Great Thou Art, I heard a small voice behind me join in. I turned around to find not one, but seven nuns behind me, some standing, some sitting, just listening to the music and being part of the moment. WHEN DID THEY GET HERE?? Thank goodness I didn't know they were there, or else I really would've been nervous! Hopefully I was able to confine my sense of shock to only my inner self, and not to my facial expression. I continued to sing as I smiled, acknowledging the presence of the flock of nuns behind me.

The more I sang, the more comfortable I felt. By the time our visit came to an end, I was even glad that the other sisters were there to hear the music. Not only was it good for them to benefit from the music and that special moment with the pt, but also, not a bad way to advocate for MTx and our company! ;-) Unfortunately, I just missed the pt's family. Just as I was walking out the door, about 8 family members came strolling through the door to see the pt. I can't believe I was actually disappointed that they missed the music! At that point, I was on this high from playing that I wanted everyone the pt knew to come and listen! Okay, maybe I got a bit too confident there...

My next stop was a SNF near the office. We have three pts there. All male, and all with some form of dementia. One of the workers was very kind, and helped me track down my three pts (I shamefully could not remember what they looked like, even though I've seen them 3 or 4 times by now...) One was in the side room, just sitting in his wheelchair, in a row of 5 other pts. They were all just sitting, staring, sleeping, rocking... the second pt was in the back dining room where the aide who gave me the boot off piano last time was doing her daily quiz of "What day of the week is it?" The third pt was asleep in his room.

I began with the pt chilling out with his fellow idlers. I knelt down in front of him and began singing some traditional songs. Initially, he stared at the floor and would not look at me. Eventually, he began to look around and change facial expressions. I finally was able to make eye contact with him, to the point where we locked stares and smiled at each other. Once the eye contact wore off, he began fiddling with his neighbor's pillow and shoes (there must be something about dementia pt's and their neighbor's shoes...) I offered my songbook to him to help distract him from bothering his neighbor (who was asleep and completely defenseless) and to keep the pt focused on the music and myself. He grabbed the songbook and held it firmly, upside down. I flipped it right side up for him, and asked him to choose a song. As I pointed to a song on one of the pages, I noticed his silver chained medical ID bracelet. It resembled my own bracelet, so I decided to point it out. "Look! Our bracelets match! How 'bout that?" The pt grabbed a hold of my wrist, and began to finger my bracelet. He then started turning my wrist, left, then right, left, then right. Yes. My wrist can turn. Wow. Now let go of me!!! I tried to stay calm and keep smiling, but really I was just afraid he wasn't going to let go, or he was going to turn my wrist too far. He had quite a firm grasp on me, and I couldn't quite pry myself free. Finally, he let go and went back to focusing on the songbook in his lap. Hooray!

The aide asked if it was alright if they moved him to the dining area and that we continue in there with the other pts. I agreed, and the two of us joined pt #2 in the dining room. I asked pt #1 to pick a song out of the songbook for the group to sing, and he flipped the page to a song I didn't know. Figures. I took my songbook back and graciously thanked him for choosing a song. (I know. Indian giver.) We sang (I sang) Blue Skies and Five Foot Two. Then I moved over to pt #2 and sang by his side for awhile. When I first saw him, I said hello, and he smiled and nodded his head to me, but when I went to sing next to him, he seemed a bit agitated and suspicious, like, "Why is this girl next to me... singing... with a guitar... what is she going to do to me?..." I hoped that he would would eventually be set at ease by my naturally sweet approachable personality (ha) but I don't think he ever did.

Just in time for the last few songs, the aide wheeled in our sleepy pt #3. And so, the gang's all here, at one table, ready to eat some lunch, and listening to music. I always think it's so cute when we have multiple pts at a facility and they hang out together. :)

My last visit of the day was one of the most difficult. Although the session went great and actually was a lot of fun, the reality of the situation is one that'll rip your heart out, throw it on the ground, then stomp it to pieces. The pt is a 40yr old cop, with a beautiful, kind wife, and two adorable little boys, ages 6 and 9. They are a lovely Mexican family, and all have Spanish accents - even the little kiddies, which I think is so cute! The MT scheduled the session for the kids, so we can help them through this time in their lives and to express the emotions they may be experiencing because of it. Today's session was more of a get-to-know-you kind of session, so we didn't delve into anything too deep. We merely introduced the kids to some instruments, the MT taught some simple African songs and led some drumming exercises, we played some piano, and really just talked to them and got to know them. Did I mention how cute they are? The older boy wasn't feeling well and took a sick-day from school, so he left in the middle of the session (poor kid!), but the younger boy was full of energy. When we first introduced ourselves, the MT asked, through a hello song, how the boy was doing today. He answered, "Good" with a big smile and a cute little giggle. That really got me. This little kid is so happy, while his dad is walking around the house in his PJs, weakened by his disease, with a catheter hanging on his hip. How am I supposed to help this kid accept his father's dying process if I don't even want him to know? He's so innocent and happy. Why does this innocent, happy little boy have to have his father die? He's only 6 years old! But hey, life's not fair, right?...

There has yet to be any moment during my internship where I couldn't control my emotions or was so affected by a situation that I wasn't able to remain professional, but today... this family... just thinking about it... everyone knows that there are kids who lose their parents at a young age... but now I have ingrained in my head two adorable little faces, and the face of a very saddened wife, to put to this reality...

Working in hospice can be wonderful, but the pain and difficulties are so subtle that sometimes they sneak up on you, or pile up undetected, until one day they just all spill over...

Friday, March 19, 2010

6 weeks down, 20 weeks to go

Day 2 of being on my own!

Since we've been so busy this week with meetings and in-services, I felt like we didn't get to see many pts! So today, I saw 6 patients. My first stop was to a board in care not too far from where I live. This blog writing thing is getting to be so frustrating with not being able to use names of people and places! "Oh, then we went to that place with that one guy with the beard and that lady who likes to laugh... then we went to that place with the piano and..." Ughhh!! Haha sorrry. Anyway, it's the board and care with the young aide who played guitar for us last time. The residents were gathered in the dining room for their morning snack. I stood in the back corner next to our pt so I could be near him, while still being visible to the other residents. The pt greeted me with a cute little smile. The mood seemed a bit dull, so I started with a few slower songs, then picked up the pace with some fast, upbeat songs. During the faster songs, our pt clapped along, and, once again, was horribly off-beat. I think I may even like it better if they can't keep a beat... it tells me that they're doing it because they want to and because it makes them happy, not because they know how or can. It puts a bit of a different motivational spin on it, I think. We sang songs from the 20's all the way up to the 70's. I gave our pt and one other pt an egg shaker. He shook that egg shaker every single song whether it was an egg-shaking kind of song or not! He was just so into it! He didn't even stop shaking to eat his snack (which he ended up pushing towards me while I was singing, offering his yogurt and bananas to me -- thank you!, how sweet!)

After we sang our last song, I told the pt that he did a marvelous job and that he should be a professional egg shaker. He blushed and graciously thanked me as if I just awarded him the Nobel Prize. He was just so darling. It's so nice to have pts who are so responsive and make it easy to tell whether the music helped them or not. I'm a little bummed that his wife wasn't there today. She was the adorable little Asian lady who almost followed us out the door last time like a lost little puppy. The two of them together is the most precious thing. It's so nice that they both can live in the same board and care together, and both have dementia. I feel so bad for the spouses who have to watch their husband or wife decline as they stay perfectly healthy...

Next stop: Back to that place I was at last night! Again! Yay!
I came here to see the memory care pts, since they were eating dinner when I was there last night. Our little "Minnie" was asleep in her room, the 2nd pt was out for a drive (don't worry, she wasn't the one driving), and the other 2 were conveniently sitting in the dining room together at a table off by themselves. Inconveniently, the crazy one-armed pt who pulled out Minnie's hair last month followed me over to the table and stayed by my side for the whole visit. That woman kept trying to speak over my singing and even tried to steal my bag! (which is really heavy, so I totally underestimated her strength and ability to pick things up!)

I stayed with the two ladies for about 45 minutes, but got pretty much no response from either of them. The one had her eyes closed for most of the time, and the other was busy looking around the room, and combing her hair with a spoon. I met the daughter of the spoon comber last night, and she said she hasn't verbalized a full sentence in years, so her lack of response was entirely disappointing or surprising to me. I realize that these pts don't respond much to anything, but I'm always so hopeful going into it, with full anticipation that music is going to make them snap out of their dementia. I know people don't snap out of dementia. But I also think the music can really help them! I just don't know how to let the music help them... not yet at least... but I'll find a way. I won't give up on them that easily.

When I went to the 2nd floor to chart on the pts, I stopped in to see our pt who is slowly leaving us. Before I went in, a nurse there sadly told me he wasn't having a good day. It seems he wasn't only a favorite pt of our company's, but also at this facility. The man loves Sinatra, but I don't know any Sinatra! (Sinful, I know.) The whole time I was playing, I kept thinking to myself, "This isn't what he wants! Play some "Fly Me to the Moon"!) I really wish I could have played him something he liked more. Maybe this experience will motivate me to learn some Frank Sinatra tunes, even though I'll never ever sound as good as he does. :( (I'd kill to be able to sing those smooth turns like Frank Sinatra and Bing Crosby!)

3rd thing on the agenda for today: National Music Therapy Conference Call. Won't go into detail about that :) Just an opportunity for the other therapists in the company to toss around ideas and discuss issues they may be having.

Stop #4 of the day was too see the pt whose family was saddened by the fact that she doesn't focus her eyes well anymore. When I finally found her room, her son was there, sitting in a chair at the foot of her bed, listening to his iPod. He politely greeted me and turned off his music to listen to mine. I played a few slow songs to help her rest. Then I asked her her favorite kind of music. I wasn't expecting a response, but wanted to ask her anyway. Her son chuckled and said, "She no understand English. She only speak Taiwanese." I jokingly said to the son, "Well she's probably wondering who this crazy person with the guitar is, singing songs in funny languages to her!" "Oh, no no," he said. "She like music. She hate music when I play mp3 for her in room. But don't worry, she like your music." He was really nice. I spoke to him a bit about his sisters being out of the country, and asked him how long he's been in America, etc. Asking an Asian person with a thick accent how long they have lived in America seems like an obvious question to ask, but when they ask the question to me in return, I'm always a bit surprised and confused, like "why are they asking me?? I'm American!" Then I have to remind myself that I'm Asian too... Asian people seem to take great comfort in seeing others of the same race (like the Korean couple who waved me down at Six Flags, asking if I was Korean too)... hopefully I can offer them some comfort just by being someone they can somewhat relate to or feel comfortable around.

My last patient of the day is one of my favorites -- our Miss Chicago. A lot of the stories she told me today were repeats from our last visit, but I just acted like it was the first time I heard it, unless she asks if she told me before, which of course then I'm honest and say yes. She told me about how in college, she accidentally signed up for an Entomology course instead of the Etymology course, and she ended up learning lots of interesting facts about bugs -- like when an ant gets stepped on, the other ants will wait for the area to be clear of people, and then will go and collect the smushed ant's body and bury it! I felt so guilty for ever squashing a bug! She said that ever since that class, she never hurts bugs, because they're all such fascinating creatures, and some, have more good in their hearts than people!

We also talked a lot about Schwarzenegger -- she hates Arnold Schwarzenegger! I told her we can write him an angry letter if she wants to, to which she responded, "I'm not sure how much good that'll do... the man probably can't even read... I'll have to recollect my 3rd grade writing skills just so he can understand it." That woman is full of sass, class, and sassafras. Love it. And she loves us too. She said it makes her day when we come to visit. They've been talking about discharging her from our services though... not sure if she's still hospice appropriate :(

And that was my day. Attempted to go to the beach to reward myself, but ended up driving there, not knowing what to do with myself, and driving home. Maybe I'll go to the beach tomorrow instead...

Happy weekend everybody! :)