Internship: Reflections Week 13

Pardon me, while I get a big existential here . . . 

You've spent months waiting for Christmas to arrive, counting down the weeks, then days, always knowing that Christmas was coming.  You know it will be December 25th, you have no doubt.  You go to bed on Christmas Eve, knowing with absolute certainty that when you wake the next day, that it will be Christmas.  So, why is it then, that when morning dawns, there's this profound, deep, abiding wonder . . . .  It's Christmas!

It's not like you didn't know when it was coming.  It's not like you doubted it would get here.  And still, you wake up that morning, and the realization pours over you in warm, tingly waves; your eyes widen, and excitement fills up your smile.  You know.  It's Christmas.  And in that moment, it is more real to you that you would have ever thought possible.  The epiphany of infinite reality for one moment fills your entire being, and all of creation becomes that moment, the moment of knowing.

Wednesday night driving home from work, I had one of those moments.  My existence just suddenly filled up with the infinite certainty of knowing.  Knowing that I would be ready.  When my internship ends in just two more short weeks, I will go out into the world, to find a job, and become a Child Life Specialist.  And I will be ready.  

I never really doubted it.  I have every confidence in myself as a student, and the quality of my internship program.  Even in the shaky, scary moments of the journey, I still believed I would learn what I needed to, and that when I got my first job in the field, I'd be prepared to do it.  But suddenly, Wednesday evening, I felt that glorious, all-encompassing moment, of knowing.  Like the arrival of Christmas morning.  Only, it was the arrival of me.

This week, my teacher handed me the reins, and sat back to watch as I confidently took the lead.  I start each day by checking in with each of the nurses, getting reports on all our patients, finding out which patients will need child life services that day.  Of course, lots of kids on the floor need normalization  --  that is, fun things to do, to keep there hospital experience as normal to their everyday experience as possible.  Popular choices this week included playdoh, crafts, coloring, movies, books, toys, and bubbles.  Especially for the kids on isolation (can't leave their room cuz they have a contagious bug), they need lots to do to keep busy and happy.  Remember that play is a child's work.  Playing is a child's first and primary tool for learning, and coping.  This also why we plan so many activities in the children's hospital, like the jugglers, clowns, bingo, visit from the pet therapy group, musicians, puppet shows, etc.  Also toddler play group, music groups, etc.  We usually have at least 2-3 activities going on each day somewhere in the hospital.  (Volunteer Services plans a lot of these.)

In addition to normalization, I have lots of other things to do each day.  Some kids cope better in the hospital than others.  For those kids that are having a harder time of it, I plan some therapeutic play, to address whatever their issues are.  This week, I focused a lot on helping a teenager find non-verbal ways to express her thoughts.  Developmentally, kids don't have the abstract thought skills to be able to "talk thru" their problems, as an adult might in therapy.  That is why we do it through play.  One patient ended up making a collage of her dream home out of words we cut out from magazines.  Thru this activity, she shared with me a lot of her hopes and dreams, her plans for life, and a lot of insight into the less-pleasant aspects of her here-and-now.

This week, I also had a lot of chances to practice my skills in supporting kids through medical procedures.  It was the week of Picc lines (kinda like the big-brother to an IV) and it seemed like everyone was getting them on our floor!  Wee little babies, who I swaddled and sang to while they got their "poke."  For the little ones (under 12 months) we also you a fabulous product, called "Sweatease" which is sugar-water.  We dip the pacifier in it, and give it to them right before the needlestick, and the the combo of sucrose and sucking minimizes an infant's experience of pain.  Of course, as with every single one of our patients, from infant to 21 year olds, we use the Emla cream on the arm ahead of time, which numbs the skin.  This week was the first time I got to help a teenager thru a Picc line -- and I got to do it twice, once for a boy, and second for a girl.  (With teens, those are very different experiences.)  In most ways, teens are easier to get through a procedure, as they can understand why it needs to happen, and generally seem less anxious about the needlestick.  On the other hand, finding things to distract them can be a lot more challenging.  Playing 20 questions, and talking about cheerleading and Hannah Montana seemed to do the trick, though.

My toughest Picc support this week, though, was a very anxious three year old.  Her parents were very nervous, and she picked right up on it.  Fortunately, Versed takes the edge off for our patients.  (For those unfamiliar, Versed is a medication which helps patients to relax, kinda like a "mellow buzz," occasionally causing patients to see double.   A small percentage of kids react poorly to it, and I've heard staff lovingly refer to these kids as the "angry drunks."  My three year old patient was a delightful drunk.  She decided that my Viewfinder was an excellent distraction, and happily looked at several discs of disney princesses to tune out the medical procedure.  Though she still cried a bit here and there, at one point she broke out into delighted giggles.  "There are two Princess Ariels!  And two dogs!"

For the most part, I was doing everything alone this week, with my teacher occasionally tagging along to watch.  Next week, we hope to focus on my skills in diagnosis teaching, procedural preparation.  On the whole, it was a fabulous week.  I know I've lately forgotten to do "highs and lows" at the end of my weekly reflections.  This is because I don't really have any lows to report!  I had so much fun at work this week.  I'm really coming into my own as a child life specialist, and loving each and every minute of it.  I wake up every morning, smiling, thinking "Today, I'm going to make a difference in the life of a child."