Friday, April 23, 2010


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

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

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

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

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

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

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

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

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

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

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

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

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

Wednesday, April 21, 2010

I hope you had the time of your life

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Good day and good night!

Tuesday, April 20, 2010

Don't wanna talk about it....

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

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

In over my head?

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

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

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

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

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

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

Wednesday, April 14, 2010


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

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

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

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

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

Tuesday, April 13, 2010

The again, maybe not

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

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

Wednesday, April 7, 2010

Gracias por mi elote primero!

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

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

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

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

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

Tuesday, April 6, 2010

You're just a kid!

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

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

Monday, April 5, 2010

Amazing rain and humming birds

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

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

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

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

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

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

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

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

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

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

Friday, April 2, 2010

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prescription as well as OTC drugs can make dementia worse

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

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

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

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

Happy Easter!

Thursday, April 1, 2010

Hey, I'm not your wife...

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

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

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

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

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