Monday, February 8, 2010

Orientating the Oriental: My 1st day as a MTI

Today was the first day as a Music Therapy Intern! My new non-favorite thing to do: waking up at 6:00am. But hey, that'd be 9:00am EST, which isn't as bad. Maybe I'll just set all my clocks to EST so I don't hate mornings as much :)

I got to the office about 25 minutes early like a good little intern, and then sat in my car for 20 of those minutes because I was too nervous to walk in the front door by myself. But, I finally mustered up enough courage to go in, and thankfully was greeted by one of the employees I had already met (phew!)

At 8:45am, we gathered in the conference room for "stand-up," or morning rounds, which is basically a little meeting they have every morning to start the day. Between the employees present, and the ones on checking in on speaker phone (I don't know where there are that they have to be on speaker phone... so far it's a mystery...) everyone discusses any updates on pt. statuses they might have, such as recent learning of certain preferences a pt. might have, any pts. who passed away overnight/over the weekend, complaints or issues from a family member or SNF (Skilled Nursing Facility), any updates in general, etc. etc.

After morning rounds, I joined the MT at her LTC (Long Term Care)/SNF Task Force meeting on "PIP" or Performance Improvement Projects. There they discussed ways to insure that all the charts for their hospice company are appropriately kept up-to-date, and that there are no errors or necessary pages. The pt. charts should be kept as detailed but as concisely organized as possible. This way, when someone comes to review a facility, they will be able to see that their company's charts are well managed. Also, they discussed ways to educate SNFs on what their hospice company does that makes them different than other companies. After only my first few hours, I could tell that their hospice company truly was different. They pride themselves in always putting the needs of the pt. FIRST, and making sure the pt.'s QOL (quality of life) is at its highest. For instance, a pt. is not immediately taken off meds or life support just because he/she is put in hospice care. Instead, the pt. is supplied with all their medical needs (funded for by medicare) until the pt. and family has come to terms with the current situation, and is properly prepared to begin the dying process. For many, hospice implies immediately "pulling the plug," scaring away many potential pts. who could highly benefit from end of life palliative care, especially from this specific company.

After the task force meeting, I spent the next couple of hours with the volunteers coordinator. She was very nice, even though her job seems overwhelming daunting. There was trees and trees of papers to sign, forms to fill out, manuals to read... not a good day for my "Convergence Insufficiency" to say the least (I couldn't focus my eyes properly at all!) I received my first of three binders for the volunteer training process. This binder alone contains 19 sections of information and quizzes to complete. Perhaps if I hadn't just gone through this with WPIC and Children's I wouldn't be so reluctant to read the 20lb manual...

So after meeting with the volunteer coordinator, we ate lunch. The MT received a call from a pt.'s son. He gave the MT an extensive list of music his father enjoyed, but also informed her that he might not be having the appropriate emotional response to knowing his father is about to die. I guess in his eyes, his father wasn't doing much with his life anyway, so it was okay for him to die, which made him feel guilty that he even felt that way in the first place! I completely understood why he might "feel guilty for not feeling guilty" as the MT put it... it made sense to me... I don't think I would feel the same if my dad was dying, but I understand. I also think that as long as he continues to support his dad and continues to help him, it's okay that he feels that way. Maybe it's appropriate, or maybe it's something that a therapist would try to work on... I'm too new to the game to really know what is right and wrong or appropriate in the world of death and dying... but I'm sure I'll learn.

In the afternoon, the MT took me to see a pt. (who sadly was a relative of one of the employees...) We were greeted at the door by who I'm assuming was her son. He welcomed us in with a big smile as he led us to the kitchen. There sat the cutest old lady in her matching pink sweats, eating a bowl of soup with her two little dogs wagging their tails nearby. The son helped the woman over to the couch as the MT took out her guitar. The MT had visited the pt. many times before and seemed to know her well. Wouldn't you know she put me on the spot and asked me to sing a song from memory! I was dumbstruck. All of sudden, any recollection of a written song in the history of music had left my mind. Finally, I resorted to "Amazing Grace," which I hoped that I remembered the chords, not to mention the lyrics. The first verse wasn't awful, (despite the dogs crawling all over my lap and licking my hand,) but I had to seek a little help from the MT for the lyrics of the second verse. By that time, I was feeling pretty comfortable and was even debating an encore of the first verse to finish it off, but I decided 2 verses was enough, and strummed a final I chord with the cutest smile I could make, hoping that way the pt. would be more forgiving of my poor musical skills. Thankfully, she was pleased as punch with my little "Amazing Grace" rendition. However, I was still quick to hand the guitar over to the MT as I admitted to her that I didn't know any other songs (which of course is not true, but at the time, that really was the only song I could think of...) The MT took over and we flipped through her big black binder of bangin' boogies (how's that for an alliteration?!) We sang a lot of patriotic songs and folk tunes. It was nice to see the pt. singing along, although she only did minimally. She said she liked to hear the MT sing. As we were about to leave, the son came back in the room and requested "Red River Valley." As we all tried to remember how it went, we eventually burst into a spontaneous rendition of the song with missing words here and inserted la da da's there. Everyone in the room had a smile on their face, and for those 40min or so, I think everyone forgot that the nice old woman was about to die, which I think means the music therapy was effective. :)

The son walked us out and showed his utmost appreciation for coming today. He told the MT how wonderful music therapy is and how happy they are she keeps coming. It's always nice to hear that people appreciate music therapy and see first hand the benefits it has... (and hopefully they tell their friends! woo!)

And...... that was it! End of day 1, and so far, so good :)

Read below if you too want to know the difference between Palliative and Hospice care:

Since I wasn't even sure myself, I googled the difference between Hospice and Palliative Care. From what I gather, palliative care is basically "comfort care," which differs from medical care in that it may not physically improve the pt.'s health, but it can make them more comfortable. Hospice is specifically for end of life care, and provides a pt. with palliative care, allowing the pt. to die as comfortably and peacefully as possible. So, if a pt. is dying, he/she can receive hospice and palliative care, but if a pt. has a chronic condition and is not dying, palliative care is appropriate. There are other differences as well, such as how they are funded, etc., but for the sake of sticking to the main points, Palliative Care is general comfort care provided at any stage of a condition/disease while Hospice is palliative care provided to a dying pt.

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