Internship: Reflections Week Five

So, here it is Sunday evening, and I'm finally getting a chance to sit down at my computer.  This past week was a gold-star-week for me at work!

Monday, my mentor sent me out on the floor alone for the first time.  Just to see a few kids for small things, nothing major, but it felt pretty good to walk down that hall alone, and know that I was ready to go into patients' rooms without supervision.  

This week, I also witnessed a Bone Marrow Harvest!  That was an amazing experience!  I had to wear the special sterile blue scrubs, and had as close a view as anyone could want.  Reading up on it ahead of time, I thought that if anything I saw this rotation would make me squeamish, that this would be it.  For the harvest, they use a giant needle in the hipbone, push thru the bone with brute strength, and suction marrow out.  Repeat again and again and again.  They had two harvesters working at the same time.  It was first thing in the morning, so I skipped breakfast, and watched from the farthest corner . . . . But it didn't phase me in the slightest!  Once I watched the first syringe worth come out, I started inching in a bit.  One of the ladies gave us a running lecture the whole time, explaining everything, and she kept encouraging me to move up as close as I wanted.  I ended up about 3 feet from the patient, as close as I could get without being in the way.  It was amazing!  A couple hours later, I watched the very same bone marrow be given to the recipient (donor's brother).  Amazing!

This week, I did two "preps" all on my own.  The first was an OR prep -- we had a patient heading to surgery for a procedure there, so I had the job of preparing her for the experience.  I had a book full of pictures of things she would see (holding room, doctors in blue scrubs with masks/hats/etc., the mask that she'd get her "sleepy medicine" thru, the recovery room where she'd wake up, etc.  Describing the process to her, I focused on sensory experiences -- what she'd see, hear, smell, and feel.  Beforehand she told me she was really scared to go to surgery.  After my "prep" she appeared calmer, though admitted to still being a little scared.  Which is so very normal . . . I and told her that, too!

My second "prep" was for an NG tube.  Nearly all our kids end up with one at some point -- the chemo just ruins their appetite.  And most of them get mouth/throat sores from the chemo, too.  Prepping a school-aged kiddo for an NG tube is never fun.  The decision was made quick, so he didn't even have much time to get used to the idea before we were in there explaining the process to him.  Getting an NG tube is a pretty crummy procedure -- it's wildly invasive, horribly uncomfortable, and there's no really good way to distract a kiddo while it's happening.  But, at least I could prepare him, so he would understand what was happening.  I started by showing him a picture of the GI track, and reviewing with him why nutrition is important.  I asked if he knew what an NG tube was, and he did not.  So I showed him one, letting him touch and manipulate the tube, talking about how it was very thin, soft and flexible.  I also showed him the actual tube (still in its sterile packaging) that the nurse would use for his procedure.  I explained that the tube would go from his nose to his tummy, and that the nurses could put special nutritious "milk" in the tube, so that he could get his food without having to eat.

We talked about that for a bit, then I showed him the procedure on a doll, gently threading the tube thru the doll's nose.  Seeing it on the doll, I think, is what really helped him to understand.  We talked a lot about what his "jobs" were.  This is one of the best coping techniques for kids -- give them a job to do, and help them do it!  His jobs were to "hold still" and "swallow."  We talked about what would help him to do that, ie: holding Mommy's hand, drinking soda to help swallow, etc.  He wasn't happy to be getting an NG tube, but at least he wasn't going into it frightened and confused.

Let's see, what else . . . I attended a conference on Bereavement, and what Child Life Specialists can do to help patients and siblings facing a loss.  We talked a lot about "legacy building" and the grief process, different therapeutic things we can do with patients and/or siblings to help them grieve.  One of the frequent services child life offers is making molds of a child's hands or feet.  (And yes, we do this with a patient who is dying, and for patients who have all ready passed on.)  Much to my delight the workshop included hands-on practice and mold-making.  (I sooooo don't want to be doing this for the first time when it really matters!  My first attempt at mold making, and I snapped the thumb off getting it out of the mold!)

I spent one whole day shadowing another Child Life Specialist on a different floor.  This was an amazingly fantastic experience.  Her style is very different than my mentor's, as different as Yo-Yo Ma compared to Bruce Springsteen.  Both fantastic and what they do, though they do it in very different ways.  Seeing the same things (procedural prep and support, therapeutic play, etc.) done in very different ways really helped to deepen my understanding of Child Life and the skill set I'm trying to build.

My "high" this week:  On friday morning, I arrived at work early.  Walking past the nurses' station to put my lunch in the fridge, one of the nurses flagged me down, saying "Oh good!  Child Life!  I have a new patient is room such-and-such, and he's getting a port today.  I explained it a bit, but he seemed pretty scared.  Can you go talk to him?"  That felt amazing!!  To be tapped by a nurse, treated as part of the team, valued for the service we offer, and knowing just what to do to help the patient . . . . well, that felt really good.

My "low":  (and I can't believe I'm putting this on the blog . . . .) So, it's said that every intern does something stupid at some point.  This week was my turn.  Remember that NG tube prep I told you about a couple paragraphs back?  Remember how I did an extra good job and even showed him the actual tube his nurse would use?  Yeah, well . . . when I finished my teaching, I scooped up all the supplies, dropped them in my prep kit and put it back in the office.  Next morning at flash rounds, his nurse jokingly asked me how much the kid had paid me to sneak the tube out of the room.  Fortunately, she had a whole store room full of spares, but I was still pretty embarrassed!

That's it for now.  See you next week, for more stories from the life of an Intern.