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!

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