Saturday, February 5, 2011

One week down= thirteen to go

Things I've learned during my first week of Internship

1) It's always good to make sure you have quarters in your car BEFORE getting on a toll road access- you never know when you'll find a booth with no cashier.

2) Admitting you love college football is the fastest way to bond with male patients of any age. However, admitting you're a Florida Gator fan doesn't always work as effectively.

3) Always double check (and triple check) your alarm clock to make sure it will actually go off

3b) It's amazing how quickly you can get ready in the morning when under a time crunch

4) Packing lunch the night before is a great way to save money AND time in the morning

5) Granny Smith Woodchuck is NOT as satisfying as Amber Woodchuck

6) Being surrounded by Disney figures all the time is super great for my mood, so is walking under a two story castle to get to the elevators

6b) Its very easy to forget in the midst of all the exciting activities and environments that tragic events do occur in the hospital. Children get sick, painful and uncomfortable procedures still occur, some patients will die. Tragedy is all around, our job is not to erase or eliminate that fact, but to make it more bearable.

7) Cute kids tug at the emotional heartstrings- its important to take care of yourself to keep from burning out

7b) Drinking wine with the roommate over home-cooked dinner is a GREAT way to do this.

8) No matter how early you go to bed, 6:15 will ALWAYS feel early.

9) Good friends send you 'good luck' wishes and tell you they will pray for you. GREAT friends call and text you constantly on your first week to make sure you know they are thinking about you, and tell you they can't wait til you come home.

10) There is nothing more exhilarating than feeling overwhelmed and underqualified- but also knowing that you are living out God's will for your life.


So I'm through with the first week, and Friday I spent a few hours shadowing the inpatient acute pediatrics floor that I will be working on for the next four weeks. Acute peds means that the patients typically have less severe diagnoses and do not need the same types of constant monitoring that those in Pediatric Special Care or the Pediatric ICU require. Examples of things we might see on these floors include asthma, short gut (part of the bowel removed), Appendix removals, new diabetes diagnoses, etc. Length of stays are typically 2-4 days on these floors (although they can certainly be MUCH longer). I would wager a guess that the majority of child life internships start their students off in an acute setting (or something similar) because it is less emotionally and physically strenuous than some of the more critical care units, and it is a great place to start to develop a craft. Our acute pediatric floors (AP has 2) have very large playrooms, and a lot of our children can come down when we are open.

However child life's mission is to provide services to children regardless of their limitations. For example, even if we had a patient who had a ventilator (meaning they can't talk very well) and was in complete traction, we are still responsible for helping them cope. In these cases we might use vicarious play where we work on art projects and have the patient decide what colors and materials are used, even though the specialist is the one actually making the project. Or perhaps we might build with blocks, but the patient chooses what shapes to make, and where to place particular blocks.

Child life is more than simply 'playing', we work with the purpose of helping children deal with the traumatic stress of hospitalization and try to facilitate normal coping and development. Its easy to get caught up in the 'fun' aspects of what we do (like Friday when I got to work with a pet therapy dog and a character (Clifford the big red dog) visit) and forget that more importantly we are there as advocates and support for children during their stay.

Because of confidentiality, privacy and HIPAA laws, the amount of information I share about my experiences will be very very limited. So instead of describing particular situations I find myself in, I figured it might be more appropriate to describe the general medical problem or procedure that I observed and talk about what role child life plays in those circumstances.

For example, on Friday I was given the opportunity to observe an NG tube placement. NG stands for nasogastric- and it involves running a tube up an individual's nose, through their esophagus, into the stomach. The NG tube is used for feeding purposes but also for the administration of chemicals and medications that can not be taken orally. For instance, a patient I observed on Friday had to ingest a chemical for contrast purposes during an X-ray that was so disgusting it would be impossible to take by mouth. NG tubes are also used for suction in the case of bowel obstructions.
borrowed from

Placement is difficult for children because it is not a procedure that we can sedate for, or even use distraction,, because the patient must be sitting up right and is asked to swallow constantly to assess the placement of the tube. When all goes well the tube can be placed in as little as 10 seconds, however when a patient is uncooperative it can take a lot longer.

As I mentioned before, Child Life Specialists can not always use distraction in these cases because the procedure is done in the line of vision of the patient. For procedures like IV starts, we can help the patient direct his or her gaze away from the doctors and instead focus on video games, picture books, i spy games, etc. For NG placement our interventions usually deal with preparation. My preceptor talked to the child and explained what the doctors would be doing. She described the procedure in terms that he could understand and then answered any questions he had. She was honest when he asked if it would hurt  and told him that some children say it hurts a little bit, but that once it was placed, he would forget it was there, and then it wouldn't hurt coming out.

During placement we serve as emotional and procedural support. Child Life Specialists NEVER serve as restrainers (in fact we try to discourage restraint all together and typically work with children to try and increase cooperation). Instead we sit by the child and help talk them through things, enact any coping strategies that were put into place, and support the parents during the experience. Afterwards we talk with the child, provide rewards and prizes for dealing with such an invasive procedure, talk with them to get their take on what happened, clarify any misconceptions, and then design activities to try and help them regain mastery over the environment.

Watching the NG procedure was a good reminder for me. I've been getting so caught up in all the fun exciting elements of my placement that I think I was forgetting a bit that the hospital is NOT a fun place. Even though we try to decrease the negative experience, we can never make it GOOD we can only  make it a little bit easier.

It's going to be an interesting three months, that's for sure. I'm continually praying and asking for support, and I know that will just increase as I get farther into this experience. I'm so thankful for all the support I've received from family and friends; that support is the only thing getting me through.

Now if I can just figure out how to guarantee my alarm goes off in the morning, life would be good!

1 comment:

  1. I think it's amazing what you're doing. I'm also glad you're blogging about this because as many times as you've explained your chosen field to me, I've never totally grasped it. As a former sick child, I know how valuable your work is. I didn't have a child life specialist working with me, but I had a nurse who held my hand during everything, from when I was eight until I was seventeen. And now I'm tearing up, thinking about how much that meant to me. So please just remember when you're discouraged that you really are making a difference, even if the kids don't think to tell you. I love you.


Thanks for taking this journey with me! I always love to hear your thoughts and promise to respond whenever possible.