It's What You Learn After You Know It All That Counts

I thought I would devote my final blog post to processing how much I've grown throughout the past six months.

When I began my internship, I was proficient in guitar, meaning I could play simple chords and barre chords (although with some buzzing and sore fingers). I knew a few strumming patterns and a couple of picking patterns that I used over and over again. I could not read tab to save my life and playing licks was completely out of the question for me. My tone quaility wasn't great, as I strummed with the nails of my right hand. I can now say I have fully formed calluses not only on the tips of my fingers, but also on my left index finger from using barre chords and on the thumb of my right hand from changing the way I strum. My tone quality has improved immensely, I can play clear and clean sounding barre chords, and I have learned how to play diminished chords, which has helped expand my repertoire! I can read tablature (although it still takes me a while to figure out) and I have learned a lot of licks to familiar songs. I have seen such a great change in my guitar skills, which was something I came into this internship needing and wanting to improve.

I can remember back when I took the Arts in Medicine class at FSU, which was meant to give music therapy students a feel for interacting with patients in the hospital setting. I was TERRIFIED to even knock on a patient's door and ask if they wanted company. A classmate and I went together and saw patients because I was so uncomfortable going alone. I got nervous every time I had to interact with a new patient and took it personally when they turned me down. When I began my internship at Hospice of Palm Beach County, I was so nervous the first time I had to make a phone call to a patient's house to arrange an assessment visit. Now, I do it all the time, without fear! I have become so comfortable initiating relationships with patients, knocking on their doors, introducing myself to their families, etc. It's like I'm a completely different person.

When I got to HPBC, I was well prepared for their style of documentation. My music therapy lab class at FSU had us practice writing SOAP, DAR, and free-text style notes. My documentation was proficient, but I was so lucky to have supervisors that gave me a crash course in making my documentation more clinical
 and have seen such a huge improvement in my note writing abilities. They use SOAP here at HPBC and I have become really good at listening for a good "S" during my sessions, making sure I am observant and remember important details about the patient such as whether or not they were using oxygen at the time of my visit. I also had the opportunity to attend Russell Hilliard's session on documentation in end of life care, which really helped me think more about painting the picture of a declining patient. Since then, I've made it a personal goal to really capture the patient's hospice diagnosis within my notes.

When I started my internship at HPBC, I was bashful when interacting with other HPBC staff. I was hesitant to contact them if I needed to and was really shy about introducing myself when meeting them. Now, I can say that I have established great rapport with nurses, social workers, chaplains, CNAs, doctors, integrative therapists, bereavement counselors, and team supervisors alike. I've also met many employees who work in accounting, education, and human resources.

Something I was really uncomfortable with at the beginning of my internship was explaining music therapy to others. One of my competencies the first month of my internship was to write out seperate explanations for a doctor, a patient, and a patient's family. I got used to explaining music therapy to patients and families throughout my internship and even had a new HR employee observe a session that I led. I was able to explain the education and training needed to be an MT, the goals and care-plans that we are able to work on, the referral and assessment process, the outcomes, etc. I just forgot to mention the MAJORLY important fact that it is evidence-based!! At AMTA '11, I attended a session on how to explain music therapy to people and it really helped me pinpoint the important things to mention.

Throughout my practicum at Big Bend Hospice in Tallahassee, I worked a lot with imminently dying patients, but never really became comfortable doing so. I didn't know what to say when patients were unresponsive, or if I was supposed to say anything at all. I was afraid to see a dying person, scared that one would die while I was in the room. I have become so comfortable with death, it's kind of frightening. I know the signs to look for when death is imminent, I know the smells associated with it, I've even watched someone die before my eyes, which was difficult, but I did it! That's not to say that death has lost its sting. When a patient of mine dies, I do feel really sad and have to go through my own little grieving process and I never want that part of it to go away. To feel grief when a patient dies is human and I don't ever want to become numb to it.

At the beginning of my internship, I was completely uncomfortable using music to increase spiritual comfort and freaked out when I had to discuss spirituality and religion with patients. I've been so immersed in it now that I almost feel MORE comfortable playing and singing hymns and working on spiritual needs with patients than I do playing secular music. I had to overcome the nervousness I felt when patients asked me personal questions about my religious beliefs and had to think of things to say and ways to address those situations, which I have become really good at! I even led a session yesterday where the patient expressed to me her fear of God judging her and sending her to Hell when she dies. I was able to choose a song in which the lyrics discuss that fear, we discussed it and the song was able to bring her a lot of comfort. It makes me so happy to know that I can have an effect on a patient's spirituality even if their beliefs differ from my own.

I honestly cannot believe how much I've grown as a music therapist and as a person throughout the past six months of my life and I can't believe how quickly the time has gone!! I feel like I just started and now it's time to close this chapter in my life and begin a new one. Soon, I will be heading back to Tallahassee to complete my master's degree in music therapy. I will be continuing this blog throughout my journey, it will just have to take on a different title because one week from Friday, I will no longer be a music therapy intern.