Photo Phlashback

Hello to all our fans out in blogland!  Did you think I'd given up on the Malcolm pictures?  No way!  Here's some photo flashback, courtesy of Cousin Liz.  There are pictures from Halloween and Malcolm's 2nd birthday, two wonderful events shared with our cousin when she came to visit.  These pics are from her camera.  Hope you enjoy!

Above:  Playing in the back yard after school.

Below: blowing bubbles with Cousin Liz!

Above:  Malcolm helping himself to a birthday cupcake.  

Below:  Halloween party at school.

Internship: Reflections Week Four

Week Four was a whirlwind.  I feel like it ended before it even began.  I had my first shadowing day this week, that might be why.  I chose to shadow in Radiology.  This floor is known for it's very high-paced, procedural focused child life services.  It's mostly out-patient as well, so a very different experience from what I've had so far.  Instead of focusing on rapport building, therapeutic play, etc, in Radiology you have about 5 minutes to prepare a kid you just met for a procedure they've never heard of.  Basic X-rays aren't too bad, but some of the other procedures are pretty invasive:  like a VCUG (child gets a catheter, then we fill the bladder with contrast and take lots of pictures to see if it creeps up out of the bladder towards the kidneys.  Then the kids have to pee, while still lying on the table, and we take more pictures.  So, on top of the painful and invasive catheter in their privates, then they have to pee on command for an audience!  Needless to say, this is tough!)  We also prepped kids for ultrasounds ("jelly on your belly!")  Those were pretty easy. 

Sadly, the day I went to shadow was the slowest day in the history of radiology!  Instead of the usual 30 or so patients the Child Life Specialist would work with, we saw a grand total of 4 kids.  Bummer.  But what can you do, right?

I did a lot of therapeutic play this week.  We made playdough and then filled medical gloves with it to make stress-balls for squeezing.  Making the playdough himself helped boost the patient's self-esteem:  "I made this!" and pounding/squeezing it provided a safe and appropriate outlet for expressing anger and frustration.  The playdough-filled glove was designed for squeezing, but the patient decided to instead use it to trick the doctor into shaking hands with the glove.  Good thing it's a children's hospital.  Hee Hee!

With another patient, we made collage posters for his door: one of things he likes (he cut out a lot of food pictures!) and one of things he didn't like (like getting pokes, aka: needle-sticks).  It was a great way to get to know him, and the posters provide a nice way for other staff to know his likes and dislikes.  It also helped the patient to understand that it is okay to express himself, and say when he doesn't like something -- this was something he'd been very hesitant to do.

I'm starting to feel pretty confident on the floor.  In the morning, the charge nurse gives us "flash rounds" -- just a quick report on each kiddo for Child Life and the school teachers, so we know what's changed over night, new admits, etc.  I can follow just about everything at flash rounds now, and have a good grasp of what questions to ask.  Then I can look at my list of patients, and figure out where the highest needs are, who I should see it what order, and what sort of activities I want to do with each patient.  I still need a lot more practice in the different interventions (like medical play, diagnosis teaching, and procedural prep and support), but I'll get that in the next few weeks.  Hopefully in a few more weeks I'll be running mostly on my own.

I got my first try at charting this week.  For those not in the medical world, this is when I write in a patients file about what I did with them.  The hard part is that the correct method for doing it is so exact and complicated, that it is much like learning a new language.  I handed in my first charting assignment yesterday afternoon -- and it promptly came back to me with more red ink than Iceland's national budget.  I get to re-write them and hand them in next week, in addition to next week's charting assignment.  *sigh*  But, she then said to me: for a first effort, my chart notes were really quite good.  So . . . yay!

My low this week:  I thought watching kids get sick with cancer, sicker with chemo, and then maybe die anyway was going to be the hard part of being in hematology/oncology.  I was so very, very wrong.  That part I was ready for.  Turns out, for me at least, the really hard part is the crappy family situations -- the ones that leave the kids crying not because the chemo makes them sick, not because their pain is out of control . . .  but because the parents haven't come to see them in a week.  Or a thousand other sad, horrible, hurtful things.  I wear my oversized heart on my sleeve, and I want to make it all better for these sad, suffering kids.  I want them to have perfect family situations, where they always feel loved and wanted, always nurtured, always provided for, cared for . . . But you know what?  That's probably what their parents want for them, too.

My high this week:  an "ah ha!" moment during a therapeutic play session, that gave me insight into the patient's mind, and his reluctance to express himself.  It was one of those moments when the pieces just click into place, and you see the hidden picture, and you know what to do about it.  That felt really good.

Internship: Reflections Week Three

This week has been all about deepening the skills that I began learning last week.  My first time taking lead was a simple "introduction of services."  This is when we go into a new patient's room, introduce ourselves, and explain what Child Life is, and what services we offer.  I had the chance to observe that last week on two occasions, so when a new patient arrived this week, my mentor asked me if I'd like to take point.  I felt pretty confident, so I gave it a try.  As I knocked on the door, all the pieces of the puzzle bounced around my head -- the 20 things I needed to remember about what to say, and how to say it.  My little heart raced!  Then I opened the door, made eye contact with the patient . . . .  and "click!"  Suddenly, instead of having 20 frantic pieces scrambling about, all I saw was the picture they made.  I smiled, and said "Hi.  I'm Teresa.  I'm with Child Life.  We're here to help with the fun stuff, and the not so fun stuff."  I chatted with the patient and his parents for a bit, then brought him some toys to play with, as well as setting up a chance to teach him about his hospital procedure.  My mentor gave me the thumbs up afterward, telling me I did really well, and helping me fine tune a few points for next time.

Phew!  Later, I learned that most interns report that the first "intro of services" is often the hardest part of the whole internship.  While I was nervous ahead of time, I felt like it was completely natural the moment I opened that door.  I guess my "biggest challenge" will be elsewhere . . . 

Some big highlights of the week:

I had the opportunity to observe a 4 year old get a lumbar puncture (aka "spinal tap")  Our hospital does these under "conscious sedation," so she mostly slept through it.  It was textbook perfect, both medically, and from a patient coping stand point.  My mentor told me afterward "don't ever expect to see an LP go that easily again."  I told her, "Now I have a benchmark to aim for!"

I also witness two Bone Marrow Transplants (BMT)!  WOW!  Sounds exciting, huh? . . . . .  Turns out, it's a bit anti-climactic.  (Though I was still thrilled to pieces to be there.)  For those not too familiar with it, let me give you the quick run down.  For BMT, you start with a series of rough chemo/radiation to wipe out your own bone marrow.  This leaves you seriously immuno-compromised, because you have no white blood cells to fight off infection anymore.  We have a special BMT unit to help protect the kids.  Each room is "positive pressure" which means that air flows out of the room, but never in, to keep all the germs out of it.  Everything is super super clean, and it's isolated from the rest of the hospital.  So, once your bone marrow is all gone, you get your transplant of new cells.  The new cells are stem cells (undifferentiated blood cells.)  These can come from one of three places:  a donor (usually a sibling, taken from the hip bone), cord blood (from an umbilical cord), or from the patient themselves (removed from the blood through aphoresis ahead of time, then frozen until transplant day.  After the transplant, you hang out for a couple weeks and wait to see if the transplant was successful (that is, the cells graft, and start producing new blood cells.)

Here's the anti-climactic part -- the chemo before hand is really rough.  The weeks following the transplant are brutal -- you're the sickest you'll ever be in the whole process.  But the actual transplant . . . . is barely a blip on the radar.  No surgery, no fuss.  The new cells go into the blood stream (via a central line) either by  syringe, or a hanging bag.  Just like a blood transfusion.  The cells then find their own way to the bone marrow.  Like magic.  I was really surprised.  The whole thing takes about 5 minutes, and it's done in the patient's room.  It takes more time to verify identity (match patient ID band with label on the syringe) that the actual transplant does!  Even so, I was very excited to see it.

Let's see, what other neat things did I get to be a part of?  Oh!  Needle play.  We had a kiddo terrified of needles, and he'll be getting several blood draws in our out-patient clinic in the coming weeks.  So we brought a stuffed doll for him to "play doctor" with.  He played doctor and drew "blood"!  With a real tourniquet, alcohol swap, a real needle, real vials that he filled with pretend blood, and a band aid to finish.  We asked him "what should the doll do when you put the needle in?"  He told the doll "close your eyes, and say your prayers!"  That cracked me up!  After some practice, play, and talking, he decided that the doll wanted to lay down when he got his "poke" and that the doll should close his eyes and count to three.  So we practiced those skills, and talked about how he could do the same thing as the doll when he's at clinic, and it's his turn to get a "poke."  By practicing, and playing it out, especially from the doctor's role, he gained some mastery over the situation; relieved his fears, & practiced his coping skills.

One of the tougher things this week . . . . I've been learning a lot more about the diseases on my floor . . .  many types of cancer and other things that lead to BMT.  The presenting symptoms, the different treatments, chemo drugs, their side effects, and when hospice care is called for (we sent a kiddo home on hospice care today.)  So, my brain is filled will all the stuff I'm learning about cancer, then I go to sleep at night, and my brain reviews the info, playing it over, rehearsing it, and replaying all the cases I'm working with. . . .  With Malcolm in the starring role.

The first night I woke up sobbing, in a cold sweat.  The second night I watched Malcolm get diagnosed, treated, suffer through chemo, and die about 6 times.  The third night I watched him get a BMT, have it fail, then suffer infection after infection till he died miserable, blind and in pain.  That morning I decided to never sleep again.  Ever.

I talked to my mentor about it that day.  That night, before I went to sleep, I reviewed frequency rates of childhood cancer, reminding my brain how very very rare these diseases are.  Just 'cuz we have 30 kids with leukemia on our floor does NOT mean it's common.  It's really really far from it.  Then I review the fantastic survivor and cure rates.  Then I look at pictures of Malcolm happy and playing, and picture him healthy and growing as I fall asleep.  I've now been nightmare-free for three nights running.  My brain is still reviewing all the things I'm learning, in my dreams, helping me to process and learn all the new info.  But Malcolm is, happily, no longer in my dreams!  Soon, I will have mastered most of the relevant medical info for my internship rotation in hematology/oncology, and my brain can move on to review other things in my sleep.  Like the sweet sound of Malcolm's giggle.  (Which, if you haven't heard, you can still enjoy by calling our home when we're not around, and listening to our answering machine.)

That's all for now.  See you next week for more updates!

Christmas with Malcolm's Birth-Family

This is my first post about some very, very special people in our lives.  I would like to introduce you to an amazing young woman, named Michelle. 

 We first met her the day after Malcolm was born.  She is Malcolm's first mother, his birth mother, whom he calls "B-Ma" (which is short for "birth mother.")  We first met through the adoption agency, though I am very grateful to say that in the two years since we have developed a true friendship.  I could write a thousand pages about our love for Michelle.  Let it suffice to say that she is smart, funny, beautiful, artistic and selfless.  And we love her very dearly!

She's also an accomplished poet!  Maybe I can talk her into letting me post some of her poems here.  What do you think?

When Malcolm was born, Michelle had a one year old son.  This is Malcolm's big-brother, Nahlo.  He lives with Michelle, so we get to see him whenever we visit!  These pictures were taken at Christmas, last month.  (Nahlo on the left, Malcolm on the right.)

A year after Malcolm was born, Michelle's third son arrived.  This is Noah, Malcolm's little brother.  He lives with Michelle and Nahlo.  This picture was also taken at Christmas this year.  That's Michelle holding Noah.  You can also see Nahlo peeking out from the backseat.

Here are the three brothers together.  When we're not home visiting with them, they keep in touch by looking at pictures of each other, talking on the phone, and sending mail.  Hopefully when we finish up here in Atlanta, we can move a little bit closer to home, so that it will be easier to visit more often!  We love having such an open adoption, and knowing the Malcolm and his brothers will grow up knowing each other!

Sweetest Sound in the World

Today is Saturday, and it was my turn to sleep in.  Matthew took Malcolm out to breakfast while I lazed about in bed.  I heard them come home a bit later, and the dogs barking to greet them, but I must have dozed off again.  I woke a while later to the sweetest sound in the world.

Drifting through the house were the voices of my husband & son, singing together . . . 

I see trees of green,

Red roses, too.

I see them bloom,

For me and you.

And I think to myself,

What a wonderful world.

Internship: Week Two Reflections

Week two was an amazing whirlwind!  It was my first week on the floor.  For those of you following along at home, I'm on the hem/onc floor which means I'm  working with kids with cancer, blood disorders, and bone marrow transplant.  Our floor is sponsored by Aflac, which means we have a ton of resources, including a HUGE Child Life staff.  We have 2 Child Life Specialists (CCLS), and a Child Life Activities Coordinator.  The Activities position does group activities, and can do play at the bedside for kids on isolation, and check in with some of our kids who have less urgent needs.  That leaves the Specialists to focus on the more urgent needs, and high priority stuff.  To put this is perspective, most CCLS serve about 30 kids at a time.  We have about 12-17 kids per Specialist, plus the help of the Activities person.  It's really nice.

On our floor, the kids are split by diagnosis.  So one CCLS gets the kids with blood disorders (like Sickle Cell) and ALL (the kinder, gentler leukemia).  The other (my mentor) gets solid tumor (like brain and bone tumors), AML (the rougher, tougher leukemia), and all the kids getting bone marrow transplants.  

Day one on the floor was an eye opener.  We started with morning report at 8:30 am, in which we met with the charge nurse to get a quick run down on each child.  This was my opportunity to learn how very much I need to learn about the medical side of treating cancer, blood and bone marrow disorders.  I think I understood about 10% of what the nurse said!

At 10:30 am we had a Code Blue.  My mentor later told me this was the second one she'd ever seen in all her years in hem/onc!  For those who don't know, a Code Blue is true medical emergency.  I means that someone is not breathing/heart not beating.  The situation ended happily, the child was fine.  But for about 5 minutes it was pretty scary.  About 6,742 people came running as the alarm went off.  Doctors, nurses, NP, respiration therapist, social work, chaplaincy, child life, security, etc.  It was reassuring to see so many people responding so quickly, calmly, and competently!  I performed my role perfectly, and with out prompting -- I stuck my back up against a wall, and stayed the heck out of the way!  Once the first wave of responders went running by, my mentor and I checked the hallways and surrounding area for any kids/families that might be witnessing the Code and feeling confused or scared.  We didn't find any, but if we did, it would have been our job to help them understand what was happening, and soothing their fears, and helping them to cope and process this frightening event.  The child that coded was assigned to the other CCLS on the team, so she went to the child's room to provide support for siblings and family present in the room.  A few minutes later it was all over, child safe . . . happy ending.

The rest of the week was much quieter by comparison.  My mentor walked me thru the basics of the medical stuff, so by Tuesday morning's report, I was able to understand about 90% of what the nurse said!  Yay!  (Learning that fast was a huge boost to my confidence!)

I had to opportunity to observe two different Diagnosis Teachings.  One of the jobs of the CCLS is to educate patients, in an age appropriate manner, about their diagnosis.  As you can imagine, explaining leukemia to a 4 year old is very different then explaining it to a 16 year old!  The first teaching I observed was for the siblings of a newly diagnosed leukemia patient, helping them to understand their sister's disease, as well as helping them to understand why she's in the hospital, and Mommy is away from home so much to help her.  The second teaching was for also for a sibling, who would be a bone marrow donor for his brother.  My mentor used a giant toy bone, which unzipped, and pulled out felt pieces representing each type of blood cells.  "The red blood cells' job is to bring energy to all the parts of your body.  The white cells are your solider cells, they fight off infections!  These are called platelets, and they are like band-aids.  And these cells are cancer cells.  They don't have a job.  They make your blood sick."

This week, I also learned a lot about working on a healthcare team, and about the roles of the different people on the team.  I especially enjoyed a talk from one of the Chaplains about the spiritual teachings on death and dying offered by many of the different religions from around the world.  From intake meetings, to care conferences, I got to see it all!  And everyone was so welcoming and made me feel right at home.

One of my most rewarding moments this week was with a sweet little boy who came in to the hospital on a return visit.  (Our kids in hem/onc are in and out several times for multiple courses of chemo.)  When he came in he was in a great deal of pain.  That combined with his anxiety and shyness made it very hard to connect with him.  We kept checking back with him throughout the week.  Yesterday when we brought bubbles, he actually smiled and made eye contact.  It was pretty exciting to see that rapport beginning to build.

Check back next week to hear more.  I'll try and post reflections each Friday.  Meanwhile, I hope to get some Malcolm pictures up later this weekend.

Internship, Week One Reflections

Hello Family & Friends,

Many of you  have kindly ask how the internship in Child Life is going, so I thought I'd share a few thoughts here.  It's Friday evening, as I write, and I have just finished Week One.  This week was all orientation -- two days of official hospital stuff (policies, infection control, HIPPA training, etc.) and three days of orientation to the Child Life Department, and the internship.  The Child Life days were my favorite, as they including presentations from each department, such as:  Radiology, ICU, Child Advocacy Center, Emergency Dept, etc.  This gave me a look into what Child Life Specialist do in each of these departments.  Throughout the next 14 weeks, I'll have the opportunity to spend a day shadowing a CLS in a different department.  I get 5 or 6 shadowing days, so I'll have a chance to try out several of the ones that intrigued me this week!  Monday will see me start my first 7-week rotation, which will be on the Hematology/Oncology/Bone Marrow Transplant floor.  I am very excited about this placement!

So, beyond the factual report, here are my reflections . . . . Orientation was, undoubtedly, the "info overload" week.  I have so many handouts, articles, and booklets, I think the pile outweighs Malcolm!  It will take me far longer than this weekend to digest it all.  But that is to be expected.  The other intern (there are two of us) came straight to the internship from a college program in Child Life, so this gives her a broad base of reference and experience that I seem to be missing.  Mostly, I've been playing catch-up learning all the terminology and field-specific vocabulary. (And my knowledge of specific child development theories is a little dusty!)  The contrast of seeing the other intern pick right up on the terminology and such, while I'm thinking "Wait, what does that mean?" has left me feeling slightly . . .  I'm not sure.  Not "less confident" . . . maybe a  little "unprepared."  Not really sure.  I think after I've had a week on the floor, I will be completely caught up with this part, so a week from now it probably won't even be an issue.

Overall, I'm wildly excited to be here.  This will be an amazing opportunity, and I'm looking forward to getting everything out of it that I can!