Sick Baby!

Day four of the Fever Than Never Ends . . . Malcolm's been sporting a high fever since Friday morning.  Started at 101, and soon found cruising altitude at 104.  It even hit 105 at one point (which was a little scary.)  An advil/tylenol regime has helped us keep it from getting too high, mostly leaving him at the 102 range for all of friday, and saturday, and sunday, and monday. .  .  .  .  .  UGH!  Poor baby!  He's pretty miserable.  Too tired to play, too sick to sleep.

We spent this morning with our pediatrician.  I have to take a moment here, to share how incredibly stickin' proud I am of Malcolm, who conquered his fears with great courage.  We pulled into the peds office parking lot; I'm pretty sure he remembered the place (he got a booster shot at his last visit) and started whimpering.  "No bear," he begged, seeing the panda bear logo on the side of the building.  When I parked the car, he shook his head, and told me "Mommy, drive car!"  Clearly he didn't want to stay.  When I got him out of his carseat, he looked at me with tears sliding down his cheeks.  "Momma, please all done?"

And yet, when it came time to see the doctor, he held still, opened up and said "Ahhhh," sat quietly while she listened to his heart, took deep breaths while she listened to his lungs, and even held still for the dreaded ear check.  He did try to convince her to skip that step, saying "No ears.  No, thank you, Doctor."

Malcolm bravely survived his sick visit to the doctor, and we were declared fit to return home.  Random viral nasty (NOT swine flu!), and we can expect a few more days of it.  We should have one fun day together at home, however, once the crudlies are over, as his school has a "24 hour fever free before returning" policy.  So, likely sick tomorrow, but better wednesday, and hopefully back to school on Thursday.  I guess I won't be getting much packing done this week.  I do seem to be getting lots of snuggles, though, and those are always sweet.  I just wish he were well enough to enjoy them, too.

Child Life Specialist -- A Job of My Very Own

So, today is an exciting day!  I just accepted a job with Rochester General Hospital!  We're going home!

So, here's the whole story . . . .

About 3 weeks before the end of my internship, I dropped an email to the Child Life Specialist I used to volunteer under back in 2001, to let her know my internship was wrapping up, and do you happen to have any openings in your department.  She didn't.  But she sent my info to someone else in her department, who was helping another hospital in town recruit a full-time CLS.  This recruiter liked my resume, and sent it on the Associate Chief of Pediatrics at Rochester General (RGH), who was spearheading the CL project there.

RGH is a moderately sized hospital on the edge of downtown Rochester, serving families from all over the area, but primarily under-served (aka:  poor urban) families.  It's an adult hospital with pediatric services:  inpatient unit with 25 beds (half adult, half peds), a pediatric ER that serves about 24K kids a year, and a primary care clinic that serves about 20K kids a year.  The peds team also has specialists in Adolescent Medicine, and Behavioral Pediatrics.  Additionally, there's a small Day Surgery Unit (tonsils, ear tubes, etc.)

The hospital does not currently have Child Life services, so they are looking for someone to come and start their program.  The first few years, it will be a "one man band" kind of deal.  Just me, for the whole hospital.  This is very do-able, but will require some careful balancing and extraordinary prioritizing skills.  Fortunately, these were emphasized in my internship.  Long term goals for my department include adding more CL staff as the peds dept in the hospital grows.  But that is years away.  Right now, it's all me.

This is an incredibly exciting opportunity, with tremendous growth potential. I think this will be one of the most challenging, and most rewarding experiences of my professional life.  While some of the MDs know about CL services (RGH shares docs and residents with the nearby children's hospital), none of the nurses have worked with CLS before.  So I think I'll end up spending my first 6 months running around the hospital (inpatient, ER and Clinic mostly) saying over and over again "please call me."  There will be a lot of staff education to help nurses learn what services i can offer, and why paging me to come work with their patient will be of such tremendous benefit.  i think once CL catches on, i'll spend the next 6 months say "you can't all be calling me at the same time!"  As I said, it's all about balance.

So, back to the story -- we left off with the Associate Chief of Peds, who's been the one working to get a CLS for her hospital.  She phone interviewed me during the last week of my internship, and invited me to fly up to Rochester to interview in person.  Excellent!

So, my internship ended Friday the 17th, and they fly me up the following Tuesday.  Since there was no CLS to interview me, they decided to have someone from each discipline interview me!  So, for two days, I met with one person after another (including Chief of Peds, Chief of Nursing, nurse manager, ER doc, Clinic doc, special projects, social worker, doc from behavior peds, etc.)  it was a whirlwind.  9 parts exciting, 1 part overwhelming.  At the end of the second day of interviews, met back with the Chief of Peds again, who has the final say.  We talked a bit more, and then he offered me the job on the spot!

WOOT!

The catch -- since the hospital doesn't currently have CL, the HR dept didn't know what to offer for compensation.  so they had to do market research before they could make me a compensation offer.  So, I flew back to Atlanta Saturday, knowing the job was mine, but not how much they could pay me to take on this opportunity/challenge.

I've spent the intervening time wondering if the offer would be enough to make moving my family worth it.  Matthew, sweet man, was more than willing to support my new career, and agreed to move the family if the offer was at all reasonable.  So, I sat, staring at my phone, willing it to ring.  Which it finally did this morning.

The offer was great, and I called Matthew.  Within 5 minutes I called RGH back to accept.  It's official!  SQUEEEE!  So, Rochester, here we come!

Meanwhile, Matthew is looking into his job opportunities in Rochester, and I'm working with a realtor to see if we can afford to buy a home right away.

And that's the news!

Monday Magic

Nice shoes, Little Man!

A Day at the Park

Hello Blog Fans!  (all four of you!)

I know it's been a month, at least, since I posted Malcolm pictures.  I'm a bad, bad person, what can I say?  I have very valid excuses, though -- none of which I'm going to bother blogging about.  I'll just jump right to the Malcolm pictures.  These are from a glorious, if cold, day at the Botanical Gardens, with my Mom who was visiting for the weekend.  Enjoy!

Internship: The Grand Finale (Week 15)

Friday afternoon marked the end of an amazing, intense and extremely educational internship.  In my final week, I ran the floor all by myself, feeling competent and confident the whole way through.

I had one last shadowing experience this week -- just a few hours, not a whole day -- in the Child Advocacy Center.  This center is housed adjacent to the hospital, and is affiliated with it, but provides services to the specific population of children who have been abused (physical and/or sexual).  There I witnessed two forensic interviews, and the accompanying physical exams.  I can't write about any of what I saw or heard, for obvious reasons.  I found the experience intense, heartbreaking, and eye-opening.  Some of these cases go directly to Advocacy, and some go through the Emergency Department first.  I think that in the course of working in an ED I could handle these cases as they came.  But to see nothing but abuse cases all day, every day, week after week, would soon see me suffering severe compassion fatigue.  This is the one venue I've seen child life in that I can clearly say:  This is not for me.

My last day sailed along smoothly until about an hour before finish, when suddenly I got called for three procedures back to back.  Looking back, it kind of seemed like an impromptu final exam.  My teacher said I handled the intense pace with aplomb -- organized, calm, efficient, and effective.  My final review came back with flying colors, and offered praise so generous and sincere it brought tears to my eyes.

 The coming weeks will see me handing out a lot of resumes and hopefully doing some interviewing.  I won't be posting updates about the job hunt process, but rest assured that once I land a job, you'll be hearing all about it.  Matthew has reaffirmed the generous offer he made when my internship started -- to move if I get a job out of town.  So, please keep our family in your thoughts/prayers as we travel through this next transition period in our lives.  All in all, I feel ready for this transition.  The internship provided me with a strong foundation that will serve me well in whatever child life job I find myself.

Meanwhile, you can expect to see lots of updates to the website with all the pictures I've taken of Malcolm in the last 15 weeks, yet failed to get around to posting.  The coming weeks will also see lots of other "catch up" -- like house projects, mountains of laundry, penpals to write to, etc.  Somewhere in all the work, there will be some lazing about, watching of movies, and maybe a yoga class.  And some Starbucks treats.  

Internship: Reflections Week 14

It's all come together this week, and I feel completely ready.  I ran our floor myself this week, which felt amazing!  What a confidence rush!  I can't really offer a "high and low" for this week -- because I have whole fistfuls of "highs" and not a "low" in sight . . . .  which is a pretty good week, I guess.  Let me share a couple highs . . . .

Therapeutic Activity:

Our floor serves all the kids with cystic fibrosis -- a genetic disease that effects the lungs and pancreas.  CF patients are particularly vulnerable to lung infections, and there are even a whole variety of germs that find CF lungs an especially fun place to settle in.  The net result being that we have extra infection control rules to protect our CF patients.  The two big ones are that all CF patients must wear masks when they leave their rooms, and all CF patients must remain at least 6 feet away from any other CF patients.

Right now, we have several teenagers with CF on our floor.  And, as you know, the most important thing (developmentally speaking) for a teenager is hanging out with other teenagers.  Having CF sucks, drastically reducing your life span (average is now 37 years), and really impairing your quality of life with a regime of daily treatments.  So, teens facing all this have a lot in common, and can really relate . . . from 6 feet away.  At least they can text each other, right?

So, this week, I went "way outside the box" and planned a fairly elaborate therapeutic activity for my teens with CF.  We used a large area in the hospital to stage a human board game.  The large room was the board, and the patients the pieces on  the board.  On their turn, patients would roll the dice to see how many steps they could take.  If they came within 6 feet of another patient, that person had to move backwards, in order to maintain the 6 foot infection control rule.  I gave the patients 6 foot poles to measure distance with.  Patients could earn "bonus cards" on their turn by drawing a card and answering the therapeutic question on it.  Questions addressed lots of issues specific to CF and teens.  If they answered, they got to keep the card, and use it to get extra movement on their turn.  The goal is to move in such a way as to "push" the other players out-of-bounds.

All in all, it was a big hit, and the patients seemed to really enjoy it.  It gave them a chance to talk with other teens about their disease, and things they had in common.  Two kids in particular really hit it off, and ended up spending the rest of the week becoming best buds.  There was some tug-of-war with the infection control rules, but eventually they settled into being "texting buds." At least when the grown-ups were around . . . 

Diagnosis Teaching:

I haven't had a lot of opportunities to practice my skills in diagnosis teaching in the last few weeks, let alone demonstrate them for my teacher.  So, I was quite delighted when the perfect situation fell right into my lap.  I was sitting in the playroom (which adjoins our office) playing with a school-age patient, helping distract her while she waited for her upcoming procedure.  The office door was open, where my teacher was sitting doing paperwork, a lucky hearing-distance from the patient and myself.  While we played, I asked her if she had any questions about her upcoming test.  Turns out that she had quite a few, and soon I had out my teaching doll, and was explaining the purpose of different organs, and showing her how the test worked.  She kept asking questions, so we kept talking, until we worked our way around to her core concern, about a possible surgery she might need, based on the results of her test.  Fortunately, I already knew all the info she was after, so the teaching went pretty smoothly.  And my teacher got to listen to all of it, unobtrusively from her desk, and give me feedback after to help me improve my skills.

Procedure Preparation and Support:

Another big "high" this week, was working with a sweet pre-schooler.  My first interactions with the family were providing play opportunities for him while he was in the hospital for testing.  Mom came to me to ask for help with an upcoming procedure, and I was happy to help.  The procedure involved placing a long tube down the patient's nose, which then had to stay there for 24 hours.  Needless to say, this is an incredibly invasive and uncomfortable procedure under any circumstance.  Now imagine it on a pre-schooler.  He was understandably upset with the insertion, and stayed mad for most of the 24 hours following.  The moment it came out, he snapped right back to his charming, playful self.  Mom was crushed to learn that the doctors wanted a follow up test only a few hours later, that involved more things going into her son's nose.  I was called in again.

"Ciliary brushing," involves putting a very small brush up the nose to take samples from the sinuses.  It's very uncomfortable, but luckily pretty quick.  Neither my teacher, nor I, had ever heard of this procedure before, let alone seen it.  Here comes the "high" for me -- my teacher left it all in my hands, and I handled it on my own.  First I tried the internet medical sites, finding little-to-nothing.  Next, I asked the nurse about it -- she'd never seen it before, but was able to show me the tool that would be used.  It looked like a barbie-sized mascara brush, but on the end of a two foot wire.  To a pre-schooler's eyes, it would look very much like the hated tube that had just come out only a few hours before.  My next stop was chatting with the resident who would do to procedure, who explained how far in it would go, and that it would be quick but painful.

Given the age and developmental stage of the patient, I advocated with the medical team for the procedure to take place in the treatment room.  Keeping the patient's bed and hospital room as a "safe place" empowers coping skills at this age.  If nothing "bad" happens in bed, then it's a safe place to rest, play and sleep.  The team agreed to my request, and set up in the treatment room, as I set off to prepare the patient.

He was happy to play with my distraction-toys, but not much interested in hearing about what was about to happen.  In the end, I chose to keep things very simple, especially considering his age.  I asked him "do you ever brush your teeth?"  Turns out he loved to brush his teeth, and told me all about his toothbrush when I asked.  He was able to tell me that the toothbrush's job was to clean away the food on his teeth.  I told him that the doctor had a special brush, much smaller than a toothbrush, that she would use to brush his nose.  "To clean away the boogers?" he asked.  For a pre-schooler, that was certainly close enough.  He was actually quite charmed with the idea of having his nose brushed.  So charmed, in fact, that I took the time to explain that this was a special way to clean out boogers that only the doctor in the hospital does.  At home, we just use a tissue.

Tune in next week for the exciting conclusion of my 15 week Internship Series!

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."