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...

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