Taking Care of Business

December 7, 2011

Ah…the holidays.

It seems like this time of year is here before we know it, and then it’s gone with a poof.  I have been running around like a chicken with its head cut off trying to get everything done.  Between all of my contracts, students, shopping, decorating, parties, walking the dog and the shorter days, not to mention a little seasonal depression thrown in, it’s a little overwhelming to try to get everything done.

Something I’ve been able to realize is this:  If I don’t do something right away, it gets put off, and then turns into a list of twenty things that need to get done later on.

Ways that I’ve been able to make it through the holiday season [in the past] without wanting to hide under the covers all day are these:

1. Online Shopping

2. Taking holidays off

3. Exercising (even if it’s just walking the dog)

4. Saying no to things I don’t have time for

5. Watching “Love Actually” at least twice

6. Learning new songs

Unfortunately, since there’s so much to do (including a growing list of Words With Friends games to catch up on daily) blogging has taken a back seat lately, but I’m intent upon not letting my blog wither and wane.  I could use a little encouragement, though, friendly readers…

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What do you do to stay sane during the holidays?

 

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Georgia on My Mind

November 30, 2011

Foreword: Before I go on to rant and rave, I must apologize to all my faithful readers (some of whom will appreciate this post more than others) for being MIA from blogland for the past two weeks.  There really isn’t an excuse other than, “getting back into the swing of things after being away was harder and more overwhelming than I thought it would be.”  So I’m sorry.  And I’m back.

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Welcome to Atlanta, where the playaz play.

For starters, I thought about using the song “Welcome to Atlanta” by Jermaine Dupris as my blog post title, but upon looking up the lyrics, decided against it.  Good call.

Last weekend I was in a place where no one asked me what music therapy means – where drums, maracas, guitars and everything in between seemed to be everywhere and not looked at by passers-by with questioning eyes – the AMTA annual conference.

Since I became board certified and joined AMTA (the American Music Therapy Association) five years ago, I have gone to four national and four regional conferences.  Conferences are energizing, motivating and often a good time to catch up with MT friends who live far away.  This year, the conference was held in Atlanta, and I must say, even though I wasn’t able to go to the Coca-Cola museum [insert animated sad-face emoticon here], it was a great time.

Here are some things I learned and re-learned:

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Reunions are important.

Not only are reunions enjoyable for many reasons, but they are also great networking opportunities.  My internship from years ago has a reunion every year at the conference, and I always get new ideas, meet new people and make new professional connections.  Regarding the fun of reunions – one particularly enjoyable part of reunions (for me) is seeing all of my past students who are all entering or leaving their internships (a little shout out, past students – great to see you in GA).

Sessions led by non-MTs are a toss-up.

In two presentations I attended, it was suggested that music has an effect on our brains.  (!!!!!insert sarcasm here!!!!!) This is true.  This is also the most obvious fact, ever, to music therapists, and really doesn’t need to be reiterated at a music therapy conference, to people who learned that in the first semester of college. I was also informed that the way to find work in mental health facilities is to volunteer at different places for a half-hour or an hour per week.  (!!!!!insert palpable silence and blank stares here!!!!!) We make music therapy our careers.  This is not only a thing we love to do and are passionate about, but it’s also our job.  We have to make money doing it, or we can’t pay our bills.  Not to say that there’s anything wrong with volunteering in the more general sense of the word, but since half of the country thinks music therapists are uneducated volunteers, it would probably be beneficial to our field if we got paid for what we did.  That all being said, doing a promotional session or in-service at a facility certainly doesn’t hurt, but that’s purely for marketing and not meant to be the final solution. There was also a session where I felt that I was being sold a product,  instead of being taught about real-life applications, and in the hour that I remained in the meeting room I not only didn’t hear or see the product used, but I felt like I was being preached at about music therapy and its significance in health care.   We are music therapists, and we were being told how important music therapy is.  Talk about preaching to the choir…

7:30 AM is too early [for me] to be learning.

If you have been to MT conferences, you know that getting sleep while still going to sessions and enjoying all of the later-night festivities is very difficult.  There is music happening literally until 2 AM some nights, and there are parties, reunions, concerts, performances and open-mic/cabaret events to invest energy in.  7:30 AM is too early, in that regard, but the issue with starting sessions later every morning (there aren’t 7:30 sessions every day), is that the conference is only a few days long, and because it’s expensive to attend, I want to squeeze as much learning in as possible.  Getting enough sleep never happened at conference this year, and I realize that it’s okay because… Note to self: conference isn’t a vacation or a time for rest.  It is fun, but it is not a relaxing or restful time.

Location, location, location (does matter).

In the past six years, four out of the six national conferences were held in the mid-west. They were all in great cities, don’t get me wrong, and I still learned a ton and managed to have a great time with my friends I never see in two of those mid-western hubs.  I know that the mid-west is in the middle of the country, and that conference location bids are a factor, but it just doesn’t seem right that the scale has been tipped in that region’s favor, even considering the prices of certain locations. And…next year, the conference is an hour west of Chicago.  Mmmkay.  On a happier note, last night I had the pleasure of experiencing Pittypat’s Porch (a great southern restaurant based on a character in Gone With the Wind) which was an appropriate way to end a nice weekend in a fun city.

Keynote speeches are usually worthwhile.

Kenneth Bruscia – a guiding presence in the field of music therapy and the author of books that we all read in college, was our keynote speaker this year (that introduction was just for you non-MTs).  Not only was he funny at all the right times, but the content of what he was saying was valuable and also easy to grasp.  What I learned from Kenneth Bruscia, is that thinking of music therapy sessions in only one way is dangerous and counter-productive.  We all have to be more flexible in our expectations of how sessions are supposed to go, or our clients won’t benefit.  There was more to his speech, but that’s a little teaser for ya.

Lifetime Achievement takes a while.

I am blessed and fortunate enough to have been mentored and taught by two amazing women who have also won lifetime achievement awards from AMTA (one of whom won the distinction at this conference!).  When I think of all both of them have accomplished, I am humbled, and I realize that that kind of recognition only happens after years of really hard work, motivation and passion.  Regardless of a Lifetime Achievement Award,  I hope that in 30 years, I am able to look back with no regrets and be proud of myself for all that I’ve accomplished.  Someday…

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This conference also taught me several different clinical methods and interventions regarding the populations I work with, and brought me some insight about the end of life and it’s profundity (as I realize some of my more recent posts have been somewhat dreary) as well as some new ideas and a much needed kick in the tuchas regarding my contracting business and a project I’m working on (If I told you, I’d have to kill you).  Even if I don’t go every year, conference is always exactly what I need when I do go, and it usually happens during a time that I need it the most.
Thanks, Hotlanta AMTA conference, for being exactly what I needed.  I learned a lot.
Oh, and P.S.  Ben Folds was at the conference.  Yup – we’re just that cool.

No matter how many times you experience it, and no matter how old you are, loss is still a giant bummer, and with loss, sometimes emotions get the better of your decision-making skills.  When one has a family member who is declining, there is usually a perpetual feeling of loss (usually accompanied by some kind of guilt) and sometimes that emotion becomes very counterproductive for everyone involved.

I’ll start with an anecdote:

Several months ago, a man stopped breathing immediately before my music therapy group.  I have told a short version in another post, but I actually found out today that there was more to the story than I was aware of.  The man was a “full code,” which means that whoever was around was required to do as much as humanly possible to keep him alive in the case of cardiac or respiratory arrest.  He was an older man, maybe 80 years old, who had moderate-severe dementia and was in poor physiological health, and his daughter (also his self-assigned Health Care Proxy) had decided, in the absence of a living will for him, that she wanted her dad to live as long as possible. When EMTs and nurses were unable to resuscitate this man after trying for 20 minutes, his daughter berated, blamed and yelled at the nurses and EMTs for not doing everything they could to keep him alive.

I don’t know this woman, so there could be other issues at play, but I do know that screaming at the people who tried to save your father seems like a grief response.  In talking with a colleague in SNF-land this afternoon, I gained some insight into the process.  She suggested that I mention the responsibility that people sometimes feel for their loved ones when they are declining.  It is my guess that the woman who yelled at the nurses and EMTs was actually not angry with them, but maybe was angry at herself for not being able to keep him well or alive.  Maybe she hadn’t had time to say goodbye and she felt guilty for not visiting enough.  Maybe she was terrified of the grief that would descend in the event of his death.  Whatever the reason, though, she made decisions for him that weren’t actually for his welfare.  Not only was he older and in poor health, but the very process of saving an elderly person’s life with CPR and defibrillators can actually do more harm than good – they can come away with further brain damage from a lack of oxygen or cracked or broken ribs, not to mention the emotional stress.  Here are a couple of facts for your information:

90% of elderly patients who have cardiac arrests die despite CPR.

3% of elderly patients with dementia who undergo CPR leave the hospital and some of those suffer anoxic brain damage. (http://www.uaelderlaw.org/advance/4.html)

Would you want to be saved?

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As individuals with our own opinions, ideals, morals and values, there is no right or wrong answer, there is only a right or wrong answer for each of us.  We have the right to make decisions for our futures, and we need to take advantage of that so that someone else isn’t making decisions that aren’t right for us.

In the previous post, I discussed Advance Medical Directives and how helpful they are in assuring us that our wishes will be carried out even if we aren’t conscious or oriented enough to make decisions for ourselves.  Sadly, even living wills aren’t a guarantee not only because of guilt and grief, but also because of oversights and medical intervention, which I won’t go into.

When we write and sign living wills, the people we give copies of them to are equally as important as the actual legal documents.  This is because people become emotional, irrational, guilty and resentful surrounding loss, and sometimes make decisions based on their own feelings instead of what’s best for their loved one, themselves, the rest of their families, and the country as a whole.  People sometimes can’t emotionally carry out the actions designated in a living will and and up going against the person’s wishes because of their own guilty feelings or hesitation to let go, so it’s important to have other people aware of your needs as well as your Health Care Proxy and Power of Attorney.  Not only this, but we can’t possibly think of all of the potential scenarios that could lead to someone needing to make a judgement call, so often, someone has to make a choice anyway, regardless of how careful we are in writing our living wills, but it’s worth it to try as hard as we can so the burden isn’t placed on someone else

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Last year, my grandfather died.  He was 93, had vascular dementia and was unable to walk toward the end.  When my mom and her sisters made the decision to follow his advance directive’s orders, it seemed very obvious to me that this was the right thing to do, but he wasn’t my dad.  I loved him, and he was a wonderful grandfather, but there’s something about a parent/child relationship that is different than anything else.

Despite my many attempts to ease her mind, my mom still feels guilt and regret sometimes for not being able to do more for him toward the end (she visited him almost every day, but always felt guilty when she wasn’t able to).  She knew in her mind that letting him go was what was best for him, first and foremost, but in her heart, she felt like she had killed him.  Since he passed, we have talked about her feelings a whole lot, and she has definitely been able to move forward, but it’s taken a while.

I think it always does.

Let’s forget for a minute that I used a Backstreet Boys song as the title for this/these post(s)…k?

When they began getting older, my grandparents (mom’s side) started thinking about their futures. Around 1993, they signed documents stating what they wanted in later years.  Still cognitively able and comfortably aware of what happens at the end, they wrote and signed advance medical directives, giving the health care system and their families permission to let them peacefully “go” if something unexpected and damaging were to happen.  In 1993, my grandfather was still working as a veterinarian at the age of 76, and had all of his faculties still intact.  What he decided he wanted was to not be treated for certain illnesses if he wasn’t going to be able to bounce back to his usual lifestyle.  This makes sense.  He and my grandmother, until around that time, were avid bikers, and would frequently bike from their house in Montpelier, VT to visit friends and family miles and miles away.  He was still working.  They were still traveling all over the country together and had just taken a trip to Greece.  My grandmother later died of cancer in 2004 after a ten year struggle with Alzheimer’s-type dementia, and my grandfather (Grampa) was left to deal with his aging body alone.

 

He was a very rational man, and he wanted a DNR.  He wanted a DNR and he didn’t want to be put on IV antibiotics in the case of pneumonia (he always referred to pneumonia as “the old man’s friend”).  He signed papers deciding who would be his Power of Attorney (the person who is designated as the financial and legal “decision maker”) and his Health Care Proxy (in charge of medical decisions) in the event that he could no longer make decisions for himself.  He knew the kind of life he would be happy with, and it didn’t involve lying in a nursing home bed being force-fed pureed foods.  It actually didn’t involve being in a nursing home, period, let alone one that would eventually put him on “thinned liquids” so he wasn’t even able to eat ice cream, one of his favorite foods.  But I’m moving too far ahead of myself…

How do YOU want to be treated medically?

When he began to really decline in the summer of 2009, and for the months until his death in October of 2010, he seemed to forget a bit of who he used to be, and the “new him” wanted to be treated for everything under the sun.  He got pneumonia at one point (before anyone thought to look at his living will) and it was decided that he would be treated for it with IV antibiotics.  He came out of the pneumonia, but his elderly body was thrown for a loop, and he never quite got back to his old self again.  He had numerous infections after that ranging from UTIs to surface wounds gone bad, and all of them were treated with antibiotics.  When he had enough syncope episodes (also called Vasovagal episodes) to sink a small ship, he moved from his dementia specific Assisted Living to a nursing home close to where my parents live.  Shortly thereafter, someone found his living will and advance directives, and found out what the lucid, reasonable, rational man from 17 years ago had wanted.  The shell of who he used to be who was now living a zombie-like existence for the 1993 version and making poorly-thought-out decisions for him.  This is where the advance health care directives came in handy, because the next time he got pneumonia, in early October of last year, my family decided to follow the younger model’s directions instead of making decisions based on their own emotions and guilt.  That’s what those advance directives are for.  He died three days later, and you know what?  He looked peaceful.

In my years working in health care, there are some disturbing, alarming and depressing truths that I have come to realize.

One of them is that we are medically treating very elderly people for symptoms and illnesses that sometimes just come with the end of life (read this post for further thoughts on the matter), and which are all part of “natural causes” (when someone actually dies of those).

Another, is that we (the health care systems, and patients’ families) are sometimes trying so hard to keep people alive for as long as possible, regardless of their prognoses or levels of consciousness, that we aren’t always thinking of what’s best for them.  A good example of this is the controversial Terri Schiavo case.  You are probably familiar, but basically, her legal guardian and decision maker (her husband) had made a decision to remove her feeding tube after she had been in a vegetative state for eight years, based on a reasoned fact that there was little to no hope for recovery.  Her parents, on the other hand, wanted her to be kept alive for as long as possible because they believed she was still conscious.  Everyone’s heart was in the right place in this situation.  No one was trying to do anything wrong, but the whole courtroom drama could have been avoided, had Terri had a living will stating how/if she wanted to be cared for in the case of a traumatic and life-altering event.  She was kept on a feeding tube as legal battles were carried out for six additional years.  Six years!!!

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These kinds of stories of which (unfortunately) Terri’s case is not the only one, drag on for years and years, simply because someone wasn’t prepared.

Really think.  REALLY think about how you want to be medically treated if something life shattering were to happen?  Would you want to be kept alive via intubation if there was no hope for recovery?  Would you want to be treated for Metastatic Lung Cancer if you were 83 years-old?  If you were declining in health with a diagnosis of Alzheimer’s Disease and you had stopped being able to feed yourself, would you want someone to feed you?  You may have thought “yes” to these, and that’s your choice, but when you don’t make a living will, which legally designates someone to make these decisions for you, you run the risk of having someone make a decision FOR YOU that you would definitely not want.  Imagine if you were Terri Schiavo, trapped inside her body and deteriorating mind and you wanted to pass away…And you couldn’t tell anyone to take away your feeding tube.  Imagine if you are 96 years old someday and when your heart stops beating, a nurse realizes that you are still a “full code” and EMTs spend 20 minutes resuscitating you.

When the time comes, don’t you want to decide?

Every Day I Write the Book

October 31, 2011

So, remember this post?  It was my very first one, and I have written 33 posts since then (including this one).  I tell my boyfriend every time I write a new post.  “Hey – I just published my 11th post!” “Hey, guess what?  I just wrote my 23rd blog post!”  “I just finished my 33rd post!”  He always has nice things to say, and seems proud (as he should, as the person who convinced me I had something to say, after all).  I get so excited about each post because not only do I not normally have great follow through in my journaling (the number of one page journals I have written in my life is astonishing) but a year ago, I didn’t think I even had anything to write about.

Anyway, about that first post…

I had been burnt out for quite some time, partially because there are aspects of my work that are frustrating and exhausting, but also because there are some changes, professionally, that needed/need to be made, and I was feeling a little lost and stuck in a rut.

The things that usually get me out of my rut are: supervising students (this only happens for six months out of the year), gardening (only possible from April to October), trying new interventions at work, going to conferences, changing my schedule around, exercising and eating healthier.  Well, in July, none of those were helping (and some weren’t even possible) and I was clutching at straws.  One day, however, I was driving down the highway and had a vision – the title “The Long and Winding Road” came to me, and I thought to myself, “Self – you should write a blog about all of the many aspects of your work as a music therapist, and you should have all the posts be titled after well known songs!”  The rest is history…

I am always more motivated to do something if it has to do with helping someone/something else.  My go-to every day rainy day activity pre-blog was “Yelping” every restaurant and bar I ever went to in my life in order to contribute my experiences to the interwebs for the greater good.  I should have known that the reason student supervision is so rewarding for me is because I can share my knowledge with people and help them learn and improve.  I should have also realized that blogging would have the same effect, but I was a little slow on the uptake.

Unfortunately, my Yelping has fallen by the wayside since I began my blog, but this may be a blessing in disguise.  I really can’t afford to keep up my Yelp! habit, and I would much rather share my knowledge of the work I do, than share with the entire world all of the things I’ve eaten at Anna’s Taqueria various restaurants over the last four years (burrito pollo con un poquito arroz, frijoles negro y roja, lechuga y guacamole, y a veces uno taco al pastor).  Basically,  I kind of broke up with my hospitality industry critic-self and decided to put my remaining language skills to good use – professional use, that might actually give someone ideas, inspiration, information and insight.  And I won’t lie, it has cured my burn out this time around.

Writing helps!  Who knew?  Maybe I’m able to move forward with the help of validation I give myself by talking about my work in this forum.  Maybe it just feels good to send thoughts out into the world and see that people are receiving them.  Maybe there’s just something to be said for expressing your thoughts on a page, editing them, re-reading them, and making sure they’re suitable for public consumption. Whatever it is, it’s working, and I’m a huge fan.

Keep reading, and comment every now and then so I know who you are!!  You mysterious people have saved me from myself, so thank you!!

Patience

October 29, 2011

The following post is a sequel to this post about perfection and improvement.

I began my musical education when I was just a bambino, with musicians for parents, and it continued (more officially) throughout grade school, my (6) years of college, my internship, and professionally, to this day.  I’m a singer by practice, but at this point, I’m more of a practical musician than anything else.  I’m a decent rhythm guitar player, a good pianist, I can play various hand drums and auxiliary percussion instruments (woohoo!), and I can play most songs by ear to some extent.  I have relative pitch, so I can stay on key easily, but I don’t have the nails-on-a-chalkboard aggravation when someone changes the key of a song, like people with perfect pitch sometimes have.  I’ve gotten pretty good at some things over the years, and am still improving every day.  I’m not a virtuoso, and that’s okay (hey – that rhymed!).

I’m not trying to impress anyone in this work, right?

Right.  Unless I’m trying to impress myself.  I hold my music-therapist-self to high standards usually, so I try to do my best.  My best, though, is NOT playing everything perfectly, and always making the right choices, clinically.  It IS challenging myself and taking risks as often as possible, which means that I also have to have a lot of patience with myself when it comes to making mistakes.  It’s important for people in any job to take risks and chances, and if we don’t, we’re really not learning.  Patience is a virtue that helps us improve, not one that wants us to be perfect.

I have forgotten the lyrics to a song, and had to instead lead an impromptu improvisation exercise.  I have said the wrong thing to clients, and I learned not to say those things again.  I have asked questions with confusing wording, and have had to change the question numerous times in order to find just the right one for certain clients.  I have started songs in difficult keys for my clients, and had to transpose into a different key for the next time.  Just two days ago, I gave someone an instrument that ended up being very distracting for him, and I had to do a switcheroo.  It happens all the time. Oh well!  No harm done, and I learned something new about that resident.  The list of things I have done that I would do differently the next time goes on and on and on.  And I’m glad.  If I expected everything to go perfectly the first time, I would end up being sorely disappointed.  If I’m not able to make mistakes and learn from them, I’m really not doing my job effectively.

Most importantly, it takes time to learn.  We dont pop out of the womb knowing everything.  We learn new things, little by little, step by step.  When we’re babies, we learn how to turn over, crawl, walk, talk, and socialize (among other things, of course) at different stages of our infancy, and some of those take longer than others for us to achieve.  Some of those things are a constant process, like language (which unfortunately some adults still don’t have a good grasp on :P) and socialization (with every new person we meet, we learn new rules of that game).

With each stage of our lives, we learn different things, and it’s important for us to really experience and marinate in each of those stages in order to be present and self-aware.  It seems counterproductive to place pressure on ourselves in learning situations, especially when there is sometimes a scheduled process that our progress is dictated by.

As is with any process, whether it be playing piano, practicing yoga, learning to cook, re-learning how to use computers with each update and technological advance, or becoming a therapist, there are stages and milestones, but we’re really always improving ourselves and learning new things.  Which takes patience.  What concert pianists do you know who have stopped challenging their dexterity and musical abilities, and have decided that the most difficult piece they can play is “Rhapsody in Blue?”  I could make more comparisons, but you get the point…

You (and I) are NEVER going to be perfect, and we need to have patience with ourselves wherever we’re at in order to progress.

 

Hello, Goodbye

October 27, 2011

“I don’t know why you say Goodbye, I say Hello.”  There is not a more perfect lyric to describe my Wednesday group in the SNF.

In music therapy, for those of you who are not in my field, one of the most basic interventions used is the “Hello Song.”  The use of the greeting song is to ease clients into a session, and to make everyone feel comfortable and welcomed.  Everyone.

The following video was made for the benefit of MTs, students, and people looking for a different hello song to use, so if you choose to watch it and you don’t fit into those categories, bear with me 🙂

My Wednesday group at the SNF is a very difficult one to manage.  There is a complex web of personality clashes, and some residents are set off by extremely inconsequential things.  When a resident is aggravated by another group member, it’s never just left alone.  People yell at each other, call each other names, talk about inappropriate topics at inappropriate times, and intentionally go against the grain in a very negative way.  And this is baseline.  I get very frustrated, because while I have no issues managing large groups and loads of dementia-related behaviors simultaneously, with this group, I am sometimes at a loss.

There haven’t been any significant issues since a name-calling episode a few months ago, but two residents (E., and C.) have continued, after months and months to say, “Good-bye,” instead of “Hello” during the hello song.  They’re not doing it because they are confused about which end of the session we are at, they’re doing it to be funny, or difficult, or fresh.  Whatever the reason, it’s not appropriate social behavior for our setting.  There are people in my session with advanced dementia, who could be extremely confused by the change in that one word during the hello song.  I leave room for each person to greet the group in their own way, so if they say, “bonjour,” I validate their response by repeating “bonjour” where I would normally repeat “hello,” as with any other greetings.  I DO NOT validate clients’ responses when they are doing something that is intentionally counterproductive.  It feeds into the behavior, and since these people are adults, I’m not interested in feeding into behavior that creates a negative energy in my session, and potentially disorients cognitively challenged individuals.  If there’s a space for residents to talk about how they’re feeling, I ABSOLUTELY validate ANY emotions that people are feeling, be them anger, happiness, sadness or irritation, but this nonsense is different. It was funny at first, but after months of trying to get them to work with me, as two of the more “able” participants, I’m no longer amused.

Yesterday, B., a very sweet but somewhat confused woman took E’s silverware at breakfast.  It was an accident (I’m sure most of us have taken someone’s silverware from time to time…) but E. was so angry about it, that she brought it up to my student prior to our group.  She couldn’t let it go, and didn’t seem to believe that B’s slight was unintentional.  During the greeting song, after she said “good-bye,” in place of Hello when she herself was addressed (said with flat affect, shaking her head, and lacking eye contact) during the greeting, she also said “GOOD-BYE,” very loudly, when B. was being welcomed by my student therapist. It seemed like she was trying to make a point by being particularly harsh when directing her “good-bye’ toward B (she was looking over at B while she said that) and then saying “Hello” very enthusiastically when a woman she is friends with was addressed.  Nonsense.  Are we in third grade?  Anyway, these are the sorts of complicated group dynamics that aren’t even appropriate to bring up during a session. Picture it…

“Now, ladies…let’s all cooperate and be nice to each other while we’re in music therapy.”  Yeah, right.

I have resolved to speak individually with E. next week (and the others who are participating in “opposite day”) prior to the group and ask them to please cooperate for the sake of the other residents.  I chose not to work with children for a reason, and that reason doesn’t have anything to do with age.

It’s maturity.  Or so I thought…

The Great Gig In the Sky

October 24, 2011

As someone who works with elderly clients, I experience a lot of loss on a pretty regular basis.  I go into each session hoping all of my clients will still be there, but knowing that may not always be the case.

I’ve made my peace with death.  I really have.

La Jolla - The best place in the world to work ridiculously hard.

When I was in my internship, I was working at Scripps Memorial Hospital in San Diego in the ICU as part of my job.  It was intense, but there were so many people I worked with who were so touched in so many ways by music therapy that it made it all worth it.  There was one experience in particular that sticks with me to this day…

What ended up happening, was this: A 20 year-old had an accident in the ocean on either a surfboard or a jetski (details are foggy) and was in a coma.  After his family conversed with his doctors, they found out that if he were to come out of the coma, he would not be able to live even a small fraction of the life he once experienced and loved.  His family decided that the best thing for him would be for them to take him off of life support and rush him to the Operating Room so his young, healthy organs could be given to someone in need.  I came into this picture five minutes before he was extubated.  I was working in the ICU that afternoon, and his mother approached me, and told me that her son loved the Beatles and asked if I’d play a couple of songs while his family and close friends said goodbye before he was taken to the OR.  I played a slow (Joe Cocker-esque) version of “With a Little Help From My Friends,” and the old MT standard, “Let it Be,” while this was all taking place, and I felt like I was looking at myself and the situation from somewhere outside of my body.  It was so unreal.  I don’t know if I was sad, but I do know that I needed to take the rest of the afternoon off.  And I did.  And then I was fine.

I reflected on what had happened, and decided that it was my job to provide a service for people in the ICU, and that the real loss wasn’t for me, it was for that kid’s family and friends.  I sucked it up, and went back to the ICU the next day.  I have lost many clients over the years since then and have been present during some clients’ passings, and I’m always fine and usually honored to be there at such a significant time in someone’s life.  Maybe it’s because I haven’t had any traumatic losses in my life, or maybe it’s because I compartmentalize well, or maybe I have a disorder where the only losses that affect me emotionally are romantic relationships and when animals die in movies.  I don’t know.  OR…maybe I can let go of my personal issues for the sake of my clients.  Yeah – I like that one the best :/

Loss is hard, and for a lot of people, but…it doesn’t seem like it’s very hard for me.  When a client passes away, I process quite a bit with the people that client was close with, and I process with my students if they knew the person, but I don’t really feel like I need to process with myself that much – until my blogging began that is.

In the spring, a man in one of my groups stopped breathing literally minutes before my music therapy group was supposed to begin.  I asked my student to remove the two residents already in the group room, and I notified the nurses that something was going on.  We waited down the hall for twenty minutes while EMTs tried to revive him, and finally, we learned that he had passed away.  My student needed to process quite a bit, and never quite got over the whole thing.  I can’t say I blame him, but I was fine. I feel that when people are elderly and in poor health, passing away is not only inevitable, but often a blessing, so when I learn of someone’s death, I’m more relieved than anything else.  I’m happy I was able to contribute something to the end of their life, and increase the quality of it to some extent.  Most of my clients are so unhappy in their old age (outside of music groups) that they talk about being “ready,” and who am I to deny them of those feelings?  Who am I to decide that it’s sad?

Jazz funeral in New Orleans

In recent years, I have subscribed to the New Orleans Jazz Funeral perspective on death.  This is “THE” number, as in – “Oh lord, I want to be in that number, when the saints go marching in.”  This is why people march in procession to jazz music instead of sitting sadly in a church basement eating cheese and crackers.  This is why they call it “The Great Beyond,” and why in “Swing Low, Sweet Chariot,” the narrator wants to be carried “home.”

In the spring, five of my clients – regular group members – passed away.  I learned recently that seven residents I used to work with at the dementia-specific AL passed away between April and July, and one last week (A. from Young At Heart) and in the past week, three clients at one of my SNFs died, one of whom I did individual sessions with, and two of whom were regular group attendees.  I also learned today that G., of the last statement in this post, is in the hospital.

I am sad that it may not be too long from now that G. won’t come back to my group, but I’m happy for her, if she’s finally able to be taken from her suffering.  In my work, I find it harder than anything else to watch as my clients become frustrated when their bodies aren’t responding to the end of life the same way their minds are, and are treated medically (!!!) for symptoms and conditions that are actually just a part of the body’s decline, and would allow them to be released with some semblance of dignity remaining.  This is where hospice comes in, which I believe is one of the most valuable systems our society has in caring for aging or terminally ill people.  It’s just not used enough.

This post was a forum for me to express my own thoughts on death and dying, as I learned of two deaths today, and I hope that even if you disagree with what I say, you can understand the place I’m coming from.

“And I am not frightened of dying, any time will do, I don’t mind.  Why should I be frightened of dying?  There’s no reason for it, you’ve gotta go sometime.” –Pink Floyd

Tradition!!

October 8, 2011

Twenty years ago, when I was 9, my family began a beautiful tradition.  Every Columbus Day weekend, we would go up to my aunt and uncles house in NH, hang out, hike, shop, eat, go on “mandatory fun” field trips, kayak, watch movies, have a huge bonfire and relax for three days.  We celebrated in this way almost every single year, and it expanded such that relatives from California, Florida, South Dakota, South Carolina, Michigan, Nebraska, Tenessee and Texas have joined in the festivities at one time or another.  We have a lot of fun.

Last year's theme: Pumpkin River.

Columbus Day is probably my favorite holiday.  This is not because I have any strong feelings about Chris Columbus – the guy made a wrong turn, so instead of living in the warm West Indies, I reside in New England – but it’s because of tradition.  I love tradition.  I love the structured and predictable events that tradition dictates.  I love the anticipation before a holiday, and I love knowing that I’m going to have just as good a time as I had last year and the years before.

Harpoonfest in Windsor, VT - Last year

Four and a half years ago I began dating my special someone.  That very year, a friend of his from home began a tradition on Columbus Day weekend as well, and everything changed.  This was very disturbing to me at first, because with the positive aspects of tradition, comes a sense of inflexibility and rigidity.  I couldn’t understand why we couldn’t just do my tradition.  Four years later, we have grown in such a way that we try to make everyone happy, and if that’s not possible, we discuss what traditions to have, and where, each year.

While usually, we do a “half and half” Columbus Day, and try to be in both places for a little while, last year my grandfather died a few days before Columbus Day, so we spent the whole weekend with my family, and my traditions.  This year, I decided that it was only fair to spend the whole weekend in Maine, especially considering Columbus Day weekend coincides with my bf’s birthday weekend this year as well.  What’s interesting about this, is that it actually feels BETTER to be flexible.  It feels good to work as a team to make sure we’re both happy an equal amount of the time, and I find that I like the Maine traditions – not as much as my NH traditions – but I always have a good time, and I realize that change is not only inevitable, but necessary.

Not a bad alternative...

When I’m at work, I talk with an awful lot of elders who have decided that people don’t have the same values anymore, have complained that the world has changed, and that traditions have fallen by the wayside.  Especially regarding religious and cultural traditions, my old folks are often very inflexible and intolerant to progress.  Something I’ve noticed is that when someone is adverse to progress or change, they also have a really hard time dealing with non-tradition-related changes in their schedules, daily rituals, and physical and cognitive abilities.  The more we allow ourselves to change and step outside of our own complicated boxes, the easier life becomes.  We never know what’s going to happen to us, so why are we so fixated on rules and traditions?

A wise man named Tevye once said, “On the other hand, our old ways were once new, weren’t they?”  Fiddler on the Roof is one of the best musicals of all time, in my opinion.  It shows how a culturally rigid community can realize and eventually embrace the importance of progress and the necessity of change, in the face of pressure, violence, discrimination and war.

We are all capable of change, and it’s not a bad thing.  In fact, those of us who embrace it now are probably more likely to have successful interpersonal relationships and will be less likely to become debilitatingly discouraged when unfortunate things happen later in life.

Today, I miss my traditions to some extent, but I’m more than happy to compromise some things, sometimes, for the progress of my relationship, and my own mental and emotional health.  There’s always next year.

Right now, I’m living in the moment – I’m in a beautiful place, the weather is perfect, the people I’m with are happy to be with me (I think), my dog is overjoyed to be playing with his [much larger] girlfriend, I’m relaxed (and still in my PJs!) and there’s good food and wine.  Who could ask for anything more?  L’Chaim!