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! :)

Therapizing the Therapist

Sorry, didn't get a chance to blog about yesterday because, yet again, I fell asleep without actually going to bed. So anyway, here is what all went down yesterday...

Thursday, March 18, 2010
8:45am stand-up/morning rounds
9:00-11:15am Mock IDG meeting - the medical director from our national office came in and taught us how to properly hold our weekly team meetings.
11:30-12:18 Drove to south county for a marketing in-service
12:20-12:35 Introduced myself to the staff at the assisted living home. They had no idea who I was or the company I represent.
12:35-12:40 Drove to nearby SNF to see two patients
12:40 stop for lunch! hehe
12:52 Took first bite of sandwich
12:53 received e-mail to come play for dying patient 25 miles away
12:56-1:40pm Drove to SNF
1:45-2:45pm played guitar and sang for pt, sister, and nurses :(
3:00-3:30pm drove to SNF at a beach further north to see new admit
3:30 - 3:45pm sang Amazing Grace for new pt as she snored (but her roommate loves music, so at least she appreciated the song)
3:45-4:10pm drove to town near ALF.
4:10-4:30pm stopped at Wal-mart, bought some dinner (mmm Triscuits!)
4:45-5:10pm played music for actively dying pt at ALF
5:10-6:00pm sat in car and documented on day so far
6:00pm met with HCC back inside the ALF for a support group presentation
6:00-7:00pm Presentation about UTIs, mini-strokes, and MT!
7:10-7:45pm DROVE HOME!
8:00-9:00pm finished documenting on pts
9:00-? I don't know, it was all a blur...

The morning began as usual with our morning meeting, catching everyone up to speed on who passed, who needs supplies, etc etc. At 9am, the medical director from our national office, the team director from the new California office, and our to-be team physician, attended our "Mock IDG" meeting. For the next 2 hours, the medical director explained how our weekly team meetings should be run according to national protocol, using examples from our actual cases. I was a bit lost... but I'm sure it was helpful for the rest of our staff.

After the meeting, I got in my car and drove back down south (yuck) to an assisted living home where an in-service was scheduled. My GPS had the address set as a few 100 feet past the actual entrance, so I pulled into a church parking lot to turn around. Bad move. There was a huge line backed up to get back out of the parking lot, so "turning around" took about 10 minutes.

When I finally got out of the parking lot and into the correct parking lot, I parked the car and went inside. The secretary sitting at the desk welcomed me. I introduced myself and explained why I was there. She looked very confused, kept looking at my badge, and then repeatedly asked, "but why are you here?" She then sent me upstairs to see the director of nursing. When I got to the second floor, a staff member suspiciously asked, "Can I help you?" I told her who I was looking for, and she told me to look downstairs in the medical file room. I sighed, and just as I was about to head back towards the elevator, I heard a voice behind me say "I'm here, I'm here." I turned around and it was thankfully the director of nursing. I then proceeded to introduce myself to her, and she provided the same response as the secretary downstairs. No one knew why I was there, who our company was, why would we be doing an in-service...

I didn't know what to do. How could there not be an in-service and nobody tell me? Why would it be on my calendar if the appointment was never even set?

After some calls and emails to the MT and some other staff, I finally learned that the in-service was canceled and rescheduled for next week. Thanks guys.

Well, I thought to myself, at least I can go see our two pts at a SNF all the way down here. The SNF was conveniently located 2 mi from the ALF. I stopped at a bagel shop right down the street from the SNF for a quick bite to eat. As soon as I took a bite out of the sandwich, my phone vibrated. It was an e-mail from a nurse asking for music for an actively dying patient. She is just a year older than my mom, and has breast cancer. I never met the pt, and was nervous to meet someone so young who was actively dying.

I sat in my car and debated what to do. I asked the nurse if I had time to see my pts down here in south county, and she said yes, but do it quickly. When I asked the MT the same question, she said no and to go see the dying pt ASAP. I was torn. Do I stay here and at least see some pts since I drove all the way down here? Or do I leave to go see the other pt and make this whole trip a total waste? Then it hit me. You know how people ask you to help them, and jokingly, sometimes people say things like, "Right now? Is it an emergency?" or "Not unless you're dying!" The patient was dying! I can't believe I even thought about it for more than two seconds. Obviously the right thing to do was to go see the patient and to be there for her and her family.

I reached the SNF just as she was being transferred into bed. (I think she was receiving in-home care, and finally decided to move to a SNF...) Her sister was by her side, holding her hand. She was a bit younger than the pt, and had bright blonde hair. She was a nurse by profession, and was able to help our nurses get her in bed and change her into a hospital gown. She seemed so strong, sitting next to her sister, holding her hand. The pt was pale, weak, and bald. The sister kept saying, "I'm right here, I'm right here." By some miracle, their brother had already booked his flight to California for yesterday. Hopefully he made it there safely.

I played for about 45 minutes for the pt. I took a lot of songs from the 60's and made them into a slow acoustic version... the sister asked if I was coming back tomorrow, and I told her I would.

After driving all around creation to south county and back for what ended up to be no reason at all, I was so completely flustered by the time I had arrived at the SNF to sing for the dying pt. I was actually tearing up in the car from so much stress and frustration. For some reason, driving around aimlessly or lost is just one of those things that pushes all my wrong buttons. When I got back in my car after playing for the pt, I felt SO much better. I think I gave myself music therapy :-)

I left to go see our new pt, an elderly woman at an ALF near the beach. When I arrived in her room, she was fast asleep, snoring even. I played Amazing Grace for her, but she still did not awake. Her roommate enjoyed the music at least, having been raised in a very musical family as she was telling me.

My last stop for the night was to a ALF/SNF where we have 5 pts. The HCC asked for an MT presentation for a support group that night, so I figured I'd go early and see some of our pts there. One of the pts is a staff favorite. Everyone at our company just loves him to pieces. I met him for the first time just last week when we enjoyed a nice little visit with him and his son outside on the patio. The nurse told us this morning that he is active, which really really bummed everyone out. I asked the nurse if I should go play music for him, and she said that she thinks he'd like that, but that he is also pretty unresponsive. Well, he totally was. When I started playing, his eyes opened a bit and he shifted them towards me while raising his eyebrows, but it wasn't long before his eyelids began to close again, and he was back in his own reality.

When the HCC came for the in-service, we set our things down in the room upstairs. She wanted to stop in to say hi to the pt since his room was right down the hall. She went right over to his bedside, leaned over to speak into his ear, and said with a firm, audible tone, "Hi James." The pt perked right up, looked up at her, and grumbled a greeting, as pleasant as ever. I guess the pt wasn't completely unresponsive! He's hard of hearing, so I bet he didn't hear one note I just played for him! Man, I should have talked and played louder for him!

We went back to the room as guests began to arrive. They were all husbands/wives and children of the residents, mostly on the memory care side. They seemed to know each other well, probably from visiting so often and seeing the other visiting family members too. The facility had asked us to come and talk to the families about UTI's and Transient Ischemic Attacks (TIA's or 'mini-stroke') since they are common conditions in the elderly population. Since our head nurse couldn't come and give the lecture, one of our HCCs who is also a nurse came and talked to the families about the two conditions. For some reason, they seemed to be on the attack. As she provided the families with helpful tips, warning signs, symptoms, etc, the family members asked things like, "Well isn't the facility supposed to know if our family member has a UTI/mini-stroke?" "How are we supposed to notice a change in behavior?? Their behavior changes all the time!" Everything they said to our poor HCC had a "well why are you telling us about this?" kind of tone to it. I think the facility just wanted to educate the families on some conditions their family members might experience in the future so they understand more about it if/when the time comes, and can also function as an extra set of eyes and ears to notice the warning signs so that their family member can get help. Unfortunately, I don't think they saw it this way. They were so tough on our poor HCC. I don't understand why they were trying to throw all the information she was giving them back in her face. She wasn't selling a product or trying to persuade them to do something. We weren't even advocating up front for our company or marketing, trying to convince them to choose us over other companies. She was just offering some free education, and they completely attacked her.

Well of course I'm sitting there scared out of my mind for when it would be my turn to talk to them about MT. I thought to myself, "If they're being like this with 'Jessica', what kinds of things are they going to say to me??" The time had come for me to speak, and there wasn't much I could do to get out of it. I grabbed my guitar and walked to the front of the group.

They loved it! They were all about MTx and thought it was a great thing for the pts! They smiled and laughed at my jokes. Thank goodness!! I was so nervous! If I learned one thing from this experience, it's that I LOVE to talk about music therapy! I could blab on forever about all the different things we can do, all the benefits, how you become a music therapist, what is it about music that makes it so effective, blah blah blah. I talked for awhile, and could tell when I said enough. But I could've kept talking for another hour about all the things I've learned and how much I love it. What a change from a few years ago when I couldn't even give a basic definition of music therapy, even after taking multiple music therapy courses. I think now that I have experience in the field actually doing music therapy day to day, I have a more complete understanding and a fuller appreciation of music therapy and all it has to offer :)

Wednesday, March 17, 2010

Sunny day ~ sweepin' the clouds away ~ on my way to where the air is sweet!

Scorcher! It broke 90 degrees today!

So today... went to see the nun in the morning. She was super nice to us. We sang Peace Like A River and I tried to sing a praise and worship song I know from back in the day that has the same title as a song she requested, but I couldn't quite remember it all or figure out the chords (total bust) and then I tried to sing another song from that same era in my life (I Surrender) and made up all the chords and just tried to fudge through it. But hey, I don't think she minded much that it wasn't perfect. She asked if we were Catholic, (said it was okay if we weren't! which shocked me...) and gave us some rosary beads. And we were on our way to another marketing in-service.

Wouldn't you know we get an e-mail 3 hours later saying she signed the papers to revoke hospice and seek aggressive treatment for her illness? Thanks for telling us when we were there, discussing our next visit, that you were revoking our services, and there wasn't going to be a next visit! :-P well, so much for that....

But anywho, went to the in-service, got there early, picked up some sandwiches to take with us, met the HCC at the hospital, went in, they gave their spiel on our company and its unique programs, we schmoozed, chatted, they ate, we left, ate our sandwiches in a waiting room, met a nice pt who was just discharged and translated Erin go Braugh for me (Ireland until forever/eternity!) and, on the road yet again...

We went to see a pt this afternnon at a local board and care where there are the husband and wife caretakers. The pt is a little snuggly puppy who just latches on to his wife, lays his head on her shoulder, and usually, smothers her with kisses and affection. But today, he was totally into the whole biting thing, which I didn't want to encourage, but wasn't real sure how to discourage it either. He wasn't hurting her, but he kept trying to bite her arm and put her fist in his mouth. He can answer yes and no questions, but I'm not sure how much he truly understands, and sadly, if the music affects him at all. For some pts, it's obvious to us that the music is beneficial, but for others, we'll probably never know for sure. We sang a lot of songs and talked to his wife, but as for interaction with the pt himself, I don't think we really did all that much unfortunately... but we are there for the pt and family, so at least we could offer some enjoyment, company, and support for his wife (it breaks my heart thinking of a husband or wife having to see their spouse go through hospice...)

And that was our day. Tomorrow and Friday should be interesting... they will be a test to see if I can handle being out on my own! Am I scared? You bet I am! Am I ready? I guess we'll find out :)

Tuesday, March 16, 2010

To the south and back

Another day of a lot business, not a lot of MT or seeing pts. The one pt we did try to see was sleeping :( Other than that, we drove to do a marketing gig down in south county, came back to the office, had a short meeting about how we should document my hours as an intern, and now, we're having our team meeting.

I wish I had more interesting information to share for today...

Monday, March 15, 2010

An office kind of day...

Stayed at the office for most of the day trying to get ourselves organized and plan out the week, especially Thurs and Fri since my MT supervisor is leaving me!! (It's all good, she'll be back Monday:) )

The one pt she did take me to see is one we have had on our services for over a month now I believe, but I personally was yet to meet her. She was sleeping and did not awake to the music. I recently received an email saying that the RN visited her just a bit ago, and the pt is unresponsive and declining :(

I left to go run over to another town where our admissions nurse was admitting a new pt. My GPS told me to enter their neighborhood through the side that was gated and locked, so I called the nurse to ask for help. I could hear the daughters in the background trying to give the nurse directions to give to me. Their last direction was to look for a lady in a black shirt with red hair. It seemed like a strange thing to look for, but as soon as I turned the bend, I saw a woman standing on the side of the road waving her arms at me. One of the daughters ran outside and down the street to lead me to their home! What service! hehe :)

The RN was sitting in the kitchen talking to the pt's three daughters, educating them on what our company has to offer and how we can help. It's important to make the distinction between her selling our services and educating the family on how we can help them through this hard time. At no point did the nurse pressure the family into choosing us over another hospice company (which they had already called first) nor provided any false hope or promises in hopes of getting the consent forms signed. She was upfront and honest, yet sensitive to the situation and supportive. I admired the nurse for her ability to calmly talk the family through their decision. I tried to offer the family reassurance or insight when I could, but I felt almost unfit to even open my mouth. Who am I to tell this family about hospice? This nurse right next to me has been a hospice nurse for years, and I've only been working in hospice for a month!

The daughters were a most fascinating trio. All sisters with the slightest similarities, but all so completely different. One had red hair, the other blonde, and the third brunette. They had a great relationship though, and were able to laugh and warn of us of their mother's bluntness. Although a bit concerned for their children (pt's grandchildren), the daughters themselves seemed to not be experiencing any anticipatory grief, are accepting of their mother's condition, and just want her to be comfortable and not in pain anymore.

With the previous pt, the MT tried showing me how to follow a pt's breathing to match the tempo of the music with the pt's respiration rate. I tried to do the same with the new admit's heart rate (the two are different - how often a person takes a breath vs. how often their heart pumps blood), since I could see her heart was racing from the pulse in her neck, pounding away like an angry woodpecker. It took me awhile to get the music to line up with her pulse, but finally, and almost surprisingly to me, the two tempi became one. The speed of my guitar playing and the pulse in her neck lined up for a good 30 seconds. Once the music and a pt's heartbeat are in sync, theoretically, according to the iso principle, you should be able to lead the heartbeat to a slower pace, once meeting the heartbeat at its current fast tempo. I however was unable to find any success with this. I felt like I was gradually slowing the tempo of my playing, but the pt's pulse did not follow. Looking back, I'm sure I was not changing the tempo gradually enough and was expecting too much of a result too quickly. I think it's because I got so excited that the heartbeat and music became in-tuned to each other that I thought everything else would just fall into place. I'm excited to try it again with her, hopefully next time with a more controlled and patient approach.

And that was my day. Full of office-ing, driving, traffic-sitting, and observing admitting! As much as I was frustrated by sitting in traffic on my way to the admit, I'm really glad I was given the chance to go. I really learned a lot about the pt and was given a more complete understanding of the entire picture. The pts whose admits I have witnessed obviously seem different in my mind than the ones I just met through MT sessions. I feel like I know the new admits much better. It helps me gain a more complete perspective on the situation which can prove to be ver beneficial when offering a therapeutic service.

Until tomorrow...

Friday, March 12, 2010

I always love to see you smile!

And so, another week has come and gone. Today I was fortunate enough to see three pts, all of which are a few of my favorites to visit :) But, before we could go see any pts, we had an educational meeting on signing consent forms. Although as an intern I probably won't ever be asked to go facilitate a patient sign-on, it was still helpful to sit in on the meeting, as I learned a lot about not only the rules to hospice, but also some common dificulties we can help the pts and families through. The whole process can really throw the harsh reality into people's faces, (Do you not want CPR if you stop breathing? Where would you like to be burried? If you become mentally incapacitated, who would you like to make important medical decisions for you? etc.) so it's best to be as sensitive, patient, and understanding as possible.

So our first pt of the day was our sweet little giggler. She is the pt who has been with our company since our very beginning (a year ago!) Since the MT has been seeing the pt since she started working, she suggested I bring the keyboard just for something different. After our visit with the little Russian lady and the mini keyboard, I decided that we'd go all out and take my full-size keyboard.

As I was setting the keyboard up on the floor in their living room, the pt's sister (or sister-in-law...) kept saying, "Well this is just a treat!" She was so cute! She kept saying that throughout our visit anytime there was too much talking and not enough music :) The pt was sitting quietly in her wheelchair holding a baby doll. I have never seen an elderly woman be so attached to a baby doll until I met our one pt (who recently passed) who always had her baby doll with her. The MT told me that it is pretty common for female pts with dementia to become attached to baby dolls. It makes sense really, since us girls have that motherly instinct about us throughout our whole lives. It's just that when we get older, we can replace the baby dolls with nieces, nephews, and children of our own. Then, when the children grow up and the pt gets older, the motherly instinct remains, but at a capacity more similar to that of childhood and caring for a doll. When the pt's daughter tried to keep the doll from falling off her mother's lap, the pt thought she was taking the doll and immediately became defensive and agitated, just like a child whose toy is being taken from them...

I think the instrumental piano was beneficial to the daughter and pt's sister, as it seemed to help them relax. However, I think that the pt responds better to guitar and singing, because there's that eye contact and constant attempt to engage the pt 1:1.

The pt doesn't speak much, and when she does, it's one or two word answers or a mimic of what someone else just said. However, she does giggle a lot, which is just about the most adorable thing I've ever seen. When the MT and daughter were discussing what has been going on lately concerning our HHAs being out on medical leave and having aides from another company come in to work, the pt was just casually looking around the room, but every time she looked at me, she let out one of her little laughs! So either I make the pt happy, or she must think I'm pretty funny lookin'! Either are fine with me :) seeing her laugh is worth being funny lookin'.

Before we left, the MT mentioned to the daughter how the pt has such a pleasant disposition. Some pts are mean or grumpy or high anxiety, but her mother always seems to be pretty content if not happy, which is nice. The daughter added that sometimes dementia can change your personality, and that they are fortunate that her mother has acquired such a pleasant demeanor.

Our second pt of the day was supposed to be our Miss Chicago/NYC, but a little side stop to the nursing station to chart on another pt turned into a 1/2hr visit with another pt there. Our social worker had e-mailed the team with the mortuary info for one of our pts at this facility and that if anyone was going there, if they could add it to the pt's chart. This literally would've taken me two seconds, but when I found the pt's chart at the nurse's station, I thought that she had TWO volumes to her chart, since many of our pts at this facility did. So, I went on a wild goose chase looking for this non-existent volume 2 of the pt's chart, and eventually was instructed to check the pt's room to see if the RN was in their charting on the pt. When I reached the pt's room, the pt's daughter was sitting there quietly as her mother slept. The daughter said in a somewhat sharp tone, "Can I help you with something?" I told her I was just looking for the pt's chart so I could add some information to it. "Well, if you need to know anything about this pt, I'm her daughter, and I've been taking care of her for 10 years so I'd know." It was obvious the chart wasn't in the room, but I thought I should introduce myself since the daughter seemed to already hate me. "Hi, I'm Gina. I'm the intern from *hospice co name*. The music therapist and I come and have group MTx sessions with your mom. The MT usually leads the group, and I'll go over and sit with your mom and sing with her. She really responds to the music. She always wakes up and looks at me and tells me how nice it is." The daughter's presence changed immediately. She became warm and friendly, and proceeded to talk to me about anything and everything for the next 1/2 hr (probably even longer...) She told me how she's been in and out of the hospital with heart problems, and that her mother came and cared for her when she was in the hospital, and now she has to come and care for her mother. The past 10 years have been the two going back and forth, changing roles from patient to caregiver for each other. That's what happens though when your mom or dad lives to be 90 or 100... your children are in their 70's and experiencing health problems of their own. She told me about how they put a defibrillator in and the doctors said the battery is running low. When I told her that my dad has a defibrillator as well, I think she took comfort in having someone with a bit of a deeper understanding about it to talk to. We talked about how even though it's a life-saving device, it can still create fear, and that she's scared that it'll go off someday.

The pt seemed to be in a deep sleep as her daughter and I talked. Her eyes were closed and her mouth gaped open. The daughter saw that I had a guitar with me, and she insisted I do music for her mother. I thought getting the guitar out and doing a full session would be a bit much, so I just went over to the pt's side and began singing "Let Me Call You Sweetheart" (and totally botched the lyrics...) The pt opened her eyes and turned to look at me as I sang. This is the pt that I mentioned before how one look from her could melt your heart. She stayed awake for the whole song and smiled at me as I sang. She is one pt that I know for a fact truly responds to music, even more-so than speech. As soon as the song was over, she closed her eyes and went back to sleep. The daughter told me that she used to play piano by ear, and also played the violin. If she was gifted enough to play piano by ear, then it makes perfect sense why she is so engaged in the music!

The MT eventually found me, and the both of us were able to finally leave and go see the pt we were there to see. Miss Chicago is a real firecracker! One of the nurses came in to give her her medication, and she chewed her head off for only having water there for her to drink. I felt bad for the staff. She hates them, and she hates the whole facility. Luckily though, she loves her hospice care team, so thankfully we're on her good side :)

She's very smart, and very much with it, which is a nice change. She knows all sorts of music, not just music from the 40's or before. I asked her what she wanted to sing today, and she told me to play anything I like to play. I took that as an open invitation to play something written after the year 2000, and chose Love Story by Taylor Swift since were talking about how her and husband met and fell in love. I said, "Here's a cute little song by Taylor Swift. Have you heard of her?" "Yeah, sure, I've heard of her" the pt said. She actually knew who Taylor Swift was! So we sang some Taylor Swift and some I'm Yours by Jason Mraz. Even though it's music that I like, sometimes it's nice for pts to hear some new music, especially if they're mentally all there like Miss Chicago.

Since the MT had to give an in-service at 2:45, we had to cut our session short. We see this pt once a week though, so we can make up some time next time we see her. Every time we visit her, I always feel bad leaving. I feel like we're abandoning her and making her stay with all the crazies while we go out and run around in the real world. I know that's not how it really is, but she's miserable living there, and I don't blame her... I would be too...

Our last stop of the day was down in south county for a marketing in-service. But you don't need details on that :)

I got to see 3 of my favorite pts today tho! So that was nice :)

Until Monday...

Thursday, March 11, 2010

way too tired...

Okay, I am WAY too exhausted today for any extensive narrating, so here is just the basic concept of what happened today. I apologize in advance for the sparse detail.

I met the MT and our new HHA at 10:00am to see a pt at a board and care. This was my second time seeing this particular pt. She is very frail and mostly rests. We sang spiritual songs for her, and she continued to lay there with her eyes closed. However, whenever we would ask her if she would like another song, she opened her eyes, looked at us, and said with a smile, "Oh that's very nice... yes, very nice... thank you!" The MT, HHA, and I stayed for about 20 minutes with pt, singing traditional spirituals to her. Hopefully we were able to improve her quality of life and brighten her day, just as she brightened ours with her cute little smile :)

Our next stop was to see an elderly woman at a nursing facility a couple miles down the road. She was sleeping when we arrived, so we started playing some soft music to comfort her as she rested. She opened her eyes to the music and looked at us, but that was pretty much the extent of her response. The patient was nonverbal lacked any significant emotional response to the music. The MT noticed she was on TPN. Since she is being administered IV nutrients, she is considered to be receiving life-sustaining medical care, which is not part of hospice. Our company is unique in that it accepts a certain percentage of pts with such needs (but are limited to only a % due to funding since we have to pay the expense for that treatment). It's not that our company would stop services just because she's on TPN, but rather, the MT wasn't sure if they company knew, because it is an important factor in the pt's careplan, plus it affects billing.

The third pt was at a nursing facility that staffed THREE MUSIC THERAPISTS! I was introduced to two of the ladies, and hopefully I'll be able to go shadow them someday and observe what they do (it's always nice to meet other MTs!) Our pt there was sleeping, and since she experiences a lot of high anxiety due to her dementia, it is best to let her sleep and not disturb her.

Our fourth pt was also sleeping when we arrived. The MT said she usually opens her eyes when she hears the music, but today she continued to sleep. Even as the MT rubbed the pt's arm and spoke directly to her, the pt still did not awake. She noticed the pt had a small furrow in her brow, possibly indicating that the pt was experiencing some pain... either the pt was just having a bad day, or the pt is declining, as hospice pts do...

Our last visit of the day was to the pt I've visited most frequently. We are d/c-ing or "graduating" her from our services on the 16th, and came to drop off the lyrics I printed our for her, and to just say our good-byes. However, she wasn't in her room, and did not answer her cell phone when the MT tried calling her. We left her notes and I might try and see her tomorrow.

And that's that. Lots of traveling today, and now I'm pooped.

La de da!

Wednesday, March 10, 2010

Tu necesitas cantar conmigo!

This morning I arrived at the office around 9:15am to meet our social worker, a nurse, and HHA. The four of us left to go see a new pt who lives in a rather dangerous neighborhood (conveniently located about 4 miles from our office...) There is on-street parking there due to the high vandelism and theft rates. We all piled into the CHHA's minivan and off we went!

When we arrived, the RN pointed to an obese man riding on a mobility scooter down the street. "That's him!" she said. We met the pt on the sidewalk and walked with him to his home. He is renting a room in a rather filthy apartment. Since he only has that one room to call his own, he has a stove, microwave, full sized bed, table, chairs, dresser, and piles of medical equipment all shoved into this hardly grandeur bedroom. The pt plopped down on his bed, and the four of us gathered around him, trying to create as little of an overwhelming environment as possible. The RN and social worker took turns asking him questions as the HHA occassionally translated into Spanish for him some of what they were saying. Spanish is his native language, but he was able to converse pretty comfortably in English. The RN asked the pt that if his heart were to stop, would he want them to do CPR to try and revive him? The pt agreed to the CPR, fearful of the alternate... he was a very pleasant and kind man in a real tough situation, which breaks your heart. As someone who helps and cares for people day to day, it breaks your heart when someone is in so much pain or in a situation that just plain sucks, and you can't make it all better for them. I mean, we do what we can, but we're human, and there's limits...

The RN decided to change the pt's dressing on his left leg, which was covered in ulcers (his toes looked like lumps of dead tissue about to fall off...) I watched the HHA as he gently washed the wounds on the pt's leg... even though the HHA took care to be as gentle as humanly possible, it still must've hurt like hell. Still, it had to be done, and already it had made a difference according to the RN! Music was requested, so I got out the guitar and asked the pt what kind of music he liked. He said country -- Where is Katelyn King when you need her! I flipped through my songbook and found a song by Willie Nelson that I remember the MT at my last practicum singing. "Hey good lookin', whatcha been cookin? How bout cookin somethin up with me!" Unfortuantley that was the only part I knew, so the Willie Nelson part of the visit was severely short-lived. I continued to search through my songbooks, but, to no avail -- I didn't have any other country songs I knew. I came across "Hotel California" and hoped that he would like it. I asked if he liked The Eagles, and he said yes. I was a bit nervous singing the song since it's not every day I rock out to The Eagles, but I think it went well enough that he was at least able to recognize the song :) It ended up being good timing, since I was able to sing for him while the nurse was putting the new dressings on his leg. Hopefully it distracted him a bit from any pain he felt...
This pt had been receiving in-home care from another company (not hospice) and they refused to stop treating him. On top of that, the pt was told that he was put on hospice to die. All in all, the pt came onto our services with his previous caretakers refusing to leave, and in a mindset that our company and staff are out to kill him. The poor pt needs a lot of comfort, care, support, and constant enforcement that we are there to make him comfortable and pain free and NOT to kill him or speed up the dying process! Also, if his health improves, then that's wonderful! and we will gladly graduate him from our services and hope that he finds a cure. (The pt is young, but is severely obese and has highly progressed heart disease. A truly sad case...)

I met the MT, our ED, and a HCC at a new facility around 12:30 to observe a marketing in-service and try to take notes so I can give the music therapy spiel by myself next week at another in-service!

Afterward, the MT and I went to see a pt in the town where I play softball. She was an elderly Russian lady the MT knew well. However, it was my first time seeing this particular pt. She had a caregiver there who stayed and listened to the music with all of us. The MT had me bring in her little keyboard to play for the pt, just to add some variety. I have a lot of trouble making the keyboard sound good and am very easily frustrated when playing on it. I think I'm turning into a piano diva! When I play, I want nothing short of a nice Yamaha baby grand! :-P Diva, diva, diva... but anyway, after about a half hour of music, the pt said she was tired. The MT asked if she wanted one more song and then some time to rest, but the pt said we could stay all day. The MT had just received a call from one of our nurses saying that a pt was actively dying, so the MT left to be with that pt while I stayed and played some more piano for the pt. The pt kept insisting that her caregiver learn piano so she can play for her when the MT and I weren't there. I tried to teach the caregiver a simple song, just so the pt knew that she was being heard and understood, and that we were trying to follow up with her request.

After I played my last song, I said to the pt, "Well are you gonna help me carry this stuff out to the car or what?" I was just kidding of course, but she actually did it! (so cute!) I handed her a book that she could carry on her lap, and her caregiver wheeled her outside to my car. (Hopefully this made up for us refusing her coffee earlier -- people like to feel like they're being good hosts, no matter what physical condition they're in -- pretty understandable, right?) I thanked her for helping me and letting me visit her at her home. We said our good-byes, and the caregiver wheeled the pt away for a short stroll up and down the street for some fresh air.
Sorry if my blogs seem to be suffering this week... I'm starting to have to do more documenting, and I'm still learning the system, so it takes me quite a bit of time to do it, giving me less time to blog! But enough excuses... I guess I'll just have to kick it up a notch :)

And sadly, the MT got their just after the pt had passed... BUT, she was there to support the family, which I'm sure was wonderful!

Tuesday, March 9, 2010


Step 1: See 5 patients at one nursing facility
Step 2: Observe a new pt sign-on
Step 3: Ask God for a new set of eyes
Step 4: Sing and play guitar under pressure
Step 5: Beg God for a new set of eyes
Step 6: Rinse and repeat...

The more posts I write, the more I realize that referring to all these specific people and places in general terms is repetitive, confusing, and a pain in the butt. Maybe giving out fake names shouldn't just be a one-time thing... okay, you convinced me. I'm going to make up secret code names for everyone and everything, so -- try and keep up! (Okay well maybe just the nursing facilities for now...)

This morning, I met the MT at Magnolia Manor, where we care for five patients (four of which are pts w/ dementia) When we went to the reminiscence unit, all but one of our pts were gathered in the lounge, "watching" television. The aide from the facility kindly turned off the TV so I could play some music for the group. Despite the fact that I condensed our company's songbook into my own little binder of songs I've heard of, I still didn't feel quite ready to lead a group, especially for an older crowd. Still almost completely dependent on reading the chords and lyrics, I laid my binder on the ottoman, and knelt on the floor before those gathered. I began singing some traditional songs from the book, and was relieved to hear the singing voice of the aide join in with me. Thanks for the back up vocals! Some pts listened off and on while others continued sleeping. One patient even tried to secretly untie her sleeping neighbor's shoe. I made sure to divide my attention between our hospice pts, but they unfortunately joined the ranks of the group's snoozers. One of our pts (the little Japanese lady who the first time I met her, was all adorable-like and applauded after every song, but the next time was resistant and agitated) was noticeably different than the last time I saw her. She was extremely pale and looked as if she had lost weight (even though she's only about 65lbs to begin with...) The MT always tells me that we need to "document the decline" in our patients, but until now, I was too new to everything to actually notice our pts gradually worsening each visit. Seeing her frail tiny body while envisioning in my head her glowing happy self I met originally really struck me as something terribly, terribly sad...

Our fifth pt of the facility is a favorite amongst our company's staff due to his friendly nature and sense of humor. I was told he had a rough weak physically, as he had trouble breathing and the staff really noticed a significant decline. However, when I saw him today, he was outside in his wheelchair on the patio, sitting in the sun, and talking with his son. The pt and his son were already reminiscing about past times on their own, so the MTx really just helped facilitate and fuel the moment. The pt's voice was very weak and raspy, but he did his best to sing along with us. When we sang a song, it would remind the son or pt of an event, and from there, they were able to remember past experiences, like vacations, the war, his life back in Europe and how he had to live in poverty (he is Scottish I believe), etc. We stayed for about an hour with them, talking, singing, laughing, soaking up the sun... a nice little visit, and a huge boost to the pt's quality of life, especially after these last few days.

Right before we left, the pt looked over to my guitar sitting next to me, then looked to me. He nodded, so I smiled and said, "You see my guitar?" He replied, "You... play?..." I told him I did, so of course, I had to play a song for them. I couldn't think of a song off the top of my head, so I opened the songbook to the 1960's. On the first page was "Bad Moon Rising." I knew the song well, since we sang this song so many times in guitar class. Before I mentioned the title of the song, I said to the pt and his son, "Here's a song from the 60's, but I don't know who wrote it." Right as I said that, the son requested a song by CCR. Well wouldn't you know... CCR wrote "Bad Moon Rising." Que perfecto!

In the afternoon, I met our admissions nurse and one of the HCCs at a home for retired nuns where we had a new admit. The MT wanted me to shadow the nurse to see all that was involved with admitting a pt and signing them on to our services (what the LA music therapist had to do when I shadowed her). Before we could go in and meet the pt, we had a meeting with one of the sisters who worked there and helped care for her. She explained to us the background of the pt and why she is a bit of a difficult hospice candidate. Basically she told us this:
The pt is an identical twin. Her twin sister lives in Washington state if I remember correctly.
The two look, think, talk, and act alike. Even though they are separated, she believes the two
continue to share a special bond and have a sort of twin "sixth sense" (my words, not hers.) When the pt and her twin were about 10 yrs old, the twin became seriously ill. By the grace of God, she made a full recovery, giving hope to the pt that she too will receive the same grace. The pt has a sharp tongue, says exactly what she is thinking, and does not sugar coat anything. Some of the staff at the village are a bit frustrated with her, so the sister was glad to have some fresh help come in to care for her. The pt means well, but that is just how her personality is. Her twin is in denial about the severity of the pt's illness. The pt is in denial as well, believing that prayer and faith will eventually result in a cure. Sister asked us to refrain from using morbid terminology, as she is still sensitive to the reality of her condition.
In addition to being pressured by her twin, the pt is experiencing anger and resentment towards the Blessed Mother, Mary. She is a very devout follower of Mary and cannot understand why she is so sick. She is angry this is happening to her and is having trouble coping with integrating her strong faith with the realities of a medical diagnosis.
(Which is completely understandable... suggesting that anything is impossible in the
presence of God is blasphemous to a devout Christian!)
When we finally were introduced to the pt, I noticed that she has moments of denial and acceptance of her diagnosis. The HCC patiently and sensitively took her through the sign-on booklet, having her sign all the appropriate forms, including the form agreeing to no CPR if her heart were to stop. Then, after the pt signed the form stating she does not want rescusitated, she showed signs of denial. The HCC checked the pts tongue and skin for dehydration. Since she was dehydrated, the HCC suggested she drink at least two glasses of water a day. After explaining how it was difficult to drink so much, the pt sat up in her bed, grabbed her glass of water, and said that she needed to get better... if she doesn't, and she dies, who will help the poor?....
Sister was very eager to hear some music, and was just about to have me play the piano in the foyer for her when she remembered it was a retreat week, so the hallways had to remain quiet. The pt then asked if I had my guitar. I told her it was in the car, and so she then demanded I go and get it! I was really planning on just observing the admission and coming back to play music for her another time, but there was no saying 'no' to this woman!
I came back with my guitar and got it out to play for her. I told her I knew a lot of Catholic hymns about Mary, but they weren't memorized! I resorted to "Amazing Grace". The two sisters joined in, even though the versions of our lyrics slightly differed. After I finished playing, she smiled and said that was nice, but that was enough. The HCC told her that MT visits are usually 45 minutes, which shocked the pt that we would play music for such a long period of time! I have a feeling that 10-15 min sessions are going to be all this pt will want.
Before the HCC and I left, the pt asked the HCC if she prayed the rosary. The pt offered her some plastic rosary beads that were donated. She then asked the HCC if she prayed the rosary everyday. Before the HCC could finish saying, "No, not everyda--" "Well you do now!" the pt said sternly. What a little firecracker!
Afterwards, the MT sent me a message asking if I would sing and pray the rosary with the pt. I jokingly agreed, but I guess she was serious -- I think I'm going to have to brush up on my rosary prayers!

Monday, March 8, 2010

One more thing...

I was going through our company's songbook today, trying to pick out the songs I knew or had at least heard before. I searched through a lot of songs from the 50's and 60's, and I just have to take a moment to thank my dad --

Dad, if it wasn't for you having us listen to 94.5 on the radio when we were growing up, I wouldn't know any half as many songs as I do today... so thank you thank you thank you :)

And...... it's my dad's birthday today! so, HAPPY BIRTHDAY, DAD!

Sorry I was a grump when I called you... it's been a very "clerical" day, so my brain is pretty much fried!

Not in a blogging mood right now...

Sorry, just spent the past 45 minutes typing something of a narrative, stream-of-conscious form, so blogging right now is going to put me overboard I think :-P

Not much happened today to blog about though... I spent hours and hours this morning trying to get my laptop to connect to the office printer, organizing my songbooks, printing, fixing, adjusting, deleting, pulling my hair out...

I met the MT at a facility at 1pm... I sat down to play the piano in the large entrance room since all three of our pts were gathered there. I got through about half of Chopin's Prelude in E minor when all I heard over and over again was one of their worker's saying, "Now you'll probably have a hard time hearing me since someone is playing the piano..."

Okay, okay I can take a hint. So that's all. I played one song. Not much I can do if they don't want or appreciate the music...

The MT went over a lot of little things in our documentation server, which was helpful since a lot of it was either new information, or things I had already forgotten how to do. We also tried to find some popular Irish tunes we could sing and play since St. Patrick's Day is coming up!

So that's about it... that was my day... played guitar for almost 3 hours this evening... my fingers are burning in pain and my callouses are beat. I'm spent. Maybe I'll write extra tomorrow to make up for today's blog...

Until next time!

Saturday, March 6, 2010

Was Chopin Polish?

I arrived at the board and care (or maybe it was an ALF...) over a half and hour early, but sadly, the beach was no close enough this time for me to take a quick stroll around. Instead, I sat in my car, snacking on some trail mix, and scratching off a lottery ticket. Well, I lost. First time since I've been in California. I'm now 2 for 3. Not bad I guess... not that winning scratch-off tickets is anything to brag about. But anyhow, the MT arrived, and we went inside to see the pt. He was a doctor himself, but suffers from dementia. The MT informed me that she usually does a group when she visits him, and that sometimes, the aide there even joins in on guitar.

The outside of the house was tightly guarded by thick metal gates and security cameras, but inside had a warm, cozy feeling, complete with a roaring fireplace projected on the TV. The residents were all gathered in the living room, perhaps awaiting our arrival. The Doctor and his wife were sitting side by side, he in his wheelchair, and she on the piano bench next to him. They seemed excited to see the MT, and smiled simply, as a small child would do.

Since they had a piano, I played a few classical tunes to start off the session. It was certainly the most unique sounding piano I've ever played -- the notes above the third space C clanked like china, and the notes below bellowed in their out-of-tune glory. As I sustained the last chord and released the pedal, I prepared myself to turn around and see patients with their hands covering their ears. It was not exactly the performance I aspire to give. I surrendered and turned to face the room full of patients, only to see more of those simple smiles of childhood. "That was wonderful, thank you so much!" the man in the far corner of the room said. Well, maybe it wasn't really that bad then... or maybe their hearing impairments masked the four different sound timbres the old clunker produced (not to mention my missed notes here and there.)

The session rolled on as the MT and I played songs from ago. The pts smiled and nodded as we sang. The doctor and his wife, although terribly off-beat, clapped along to the music. How funny to think that this man went to years and years of medical school, had a successful career as this prestigious MD, yet he can't even clap to the beat of a simple 4/4 song. Just makes you realize how different people are -- what is difficult or easy for one person may be just the opposite for someone else. Maybe for him, memorizing medical terms comes as naturally as me clapping on beat!

As we continued to sing, I noticed the home's aide was highly involved with his patients each and every moment, encouraging them to sing and participate themselves. He looked only a few years older than me, and had long black hair that could compete with the length of my own! After a few songs, the MT offered the guitar to the aide, asking if he would like to play some songs. He happily accepted, and harnessed the guitar around him. He played some tunes by The Cranberries and a song by John Lennon. We tried to sing along since he was too shy to sing by himself. Although he didn't choose songs the patients really knew, I think they appreciated it just as much since it was someone they see every day and who they are close to. The music plus that intimate day-to-day relationship and familiarity is something we can't really offer our patients, so it's always good when a loved one or caretaker steps up to the plate and offers music of their own -- it adds a level of significance that the MT and I can't fake or recreate.

We wrapped up the session and said our good-byes. It was a fun little group of all very nice people. As the aide led us to the door, I turned around to see who else but the doctor's wife, a 4-foot little Asian woman with the most innocent childlike grin of them all. The MT stopped at the door to write a quick note in the pt's chart, the doctor's wife still standing there. We talked to the aide before we left, thanking him for playing and such, laughing a bit during the conversation. As we laughed, the little Asian woman laughed too. She had no clue what she was laughing at, I'm sure, but if one of us laughed and then looked at her, she gave out a little laugh too. She continued to follow us every inch of the way, her hands behind her back, like a little girl following her big sister, hoping to be accepted and be more like her. As we walked down the sidewalk back to our cars, the MT and I turned to look at the house -- the little woman was still there, standing at the door, watching as we walked away. I felt like I was abandoning a small child -- I think she wanted to come home with us! She was too cute! But I know she'll be just fine where she lived. It seemed like a very nice place to live.

Our next stop was back to that place I've been going to again and again. I feel like I need to give it an alias name since I refer to it so often. Hmm... how about, the Back Again Subacute, since it seems no matter what I do that day, I always end up back again at that subacute facility. Well anyway, the MT was there to assess a new admit. As we walked up to the nurse's station, a man was laying in a stretcher, his eyes wide open and focused on seemingly nothing, yet most likely something to him. The MT asked one of the nurse's the room for our new pt was, and sure enough, the poor man in the stretcher was ours. The MT went over to the patient and introduced herself. She sang softly to him and caressed his head. It took about five minutes for him to actually look at the MT, but when he did, I think it meant she finally got his attention. Soon after we arrived, our chaplain followed in suit. He performed his assessment after us, and I stood and watched. The pt and I had what seemed like a stare-down contest for a good couple of minutes. I didn't want to look away since I felt like it was an accomplishment on his part to be looking someone in the eye. I smiled at him as the chaplain spoke comforting words to him. The poor man had a tremor in his hand and mumbled to the Chaplain about random things like a girlfriend, etc. Poor guy... I don't think he had a clue as to where he was or what was going on around him...

Our third patient was our little giver of kisses from God. I knew her board and care had a nice piano, so I was eager to play her some tunes. I remember she really liked listening to the piano during our last visit. I played for her Chopin's Eb and B minor nocturnes. She shared how it reminded her of the music she used to dance ballet to. The MT led her in some slow, graceful arm movements, mimicking that of a ballerina. I asked her her ethnicity, crossing my fingers for her to say Polish -- sure enough, the patient is Polish. "I think Chopin was Polish," I told the patient. "Oh, was he really?" she replied. I don't think she believed me, which made me doubt my own historical knowledge. I debated it in my head for a minute, then explained how his piano music was big during WWII (I think I only assumed this since all the music from The Pianist is Chopin...) She still didn't really seem to believe me, but finally agreed that maybe that's why the music sounded so familiar to her. Well, I at least tried to relate the music back to her personal life.

We spent the rest of the visit with guitar and voice. I asked if there was any songs she'd like to sing, and YES! she's 2 for 2! -- she asked for "Amazing Grace." I finger-picked the chords on guitar as the three of us girls sang. The MT had me slow the tempo down since the pt had trouble keeping up. She closed her eyes, as if she was in deep spiritual reflection.

The rest of the session continued in that way. She told us how she wants to be a nun and teach nursing. She said that even from a chair, she can still inspire young girls to become nurses. Everything she said related to God. Again, she mentioned her 'boyfriend' being Jewish, and said that he agreed to convert. The MT and I didn't really know what to say... but anyway, I asked the MT to sing "How Great Thou Art," since I thought it was a good song for the moment and I didn't know the chords. I held the patient's hand as we sang the spiritual hymn. It's great how much the pt gets into the session and finds a deep spiritual and emotional connection to the music.

So anyway... we stayed for almost an hour, singing spiritual tunes and offering her emotional support. Her son and daughter-in-law came right as we were leaving (perfect timing!) so it was nice to get to meet some of her family. The son told us how he used to play saxophone, french horn, and guitar. It only took two minutes of talking to this guy to realize how much of a band geek he was. They're so easy to spot, and whether they still play music or not, the band geek within never dies. There's some sort of familiar feeling I get with band nerds... it made me miss all my friends at home...

And now for our last visit of the day -- our pt who's mother just passed away under our services, and who uses us as her musical guinea pigs. Our social worker was there meeting with her, so the three of us sat on her bed and listened to her tell stories from her mother's funeral service. Then, as if three workers in her room wasn't enough, her doctor comes in, plopping down on the bed right on next to us (almost squishing me...)

We weren't alone with the pt till probably almost a 1/2 hr after we got there. She handed us sheet music to a hymn her and her sister are going to sing at her mother's memorial service next weekend. She doesn't read music, so she sees us as these musical translators who can interpret whatever she sings into written notes. She kept trying to change keys at the end of each verse since she felt the song would be too boring otherwise. The MT nor I had no clue what keys she kept modulating to, so finally I tried to structure her singing by giving her a key to modulate to. She mentioned how it's hard for her to read the words off the page, so I suggested she have someone type up the words for her and print them out in a bigger font. Well, that "someone" is actually me -- so now it's my job. Not sure why I didn't just offer to do it myself in the first place...

And.... that's all for now, folks!

Happy weekend everybody! Sorry I didn't post this last night...

Congrats to Pittsburgh for their little heat wave! (I hear it's supposed to hit 40 degrees! yay!)

Peace and love.