Friday, August 27, 2010

Top 50 Blogs for Social Work Professionals

I found out today that Confessions of a Young (Looking) Social Worker was listed in MSWPrograms.com's Top 50 Blogs for Social Work Professionals. MSWPrograms.com developed the list to provide resources to current MSW students, as well as first-hand accounts of those of us in the trenches. I'm #31! Which I just realized is ironically close to my age. In any case, I am so honored to be featured amongst my peers. There are a number of notable blogs on the list that I already follow and a few more that I'm eager to start reading. Please do yourself a favor by taking time to read the descriptions and learning about these wonderful social work bloggers.

If this is your first time browsing here, allow me to give you a brief background. I was a hospice social worker and child/teen bereavement specialist for 5 years. I loved it! I started this blog about 4 years ago, originally so friends and family could learn about my work and play. Then, a couple of years ago, Christian Sinclair at Pallimed.org discovered I was going to take my patient skydiving and this blog hasn't been the same since. I realized that more people within the health care and social work communities were starting to take notice and began the process of making this blog purely professional.

This brings us back to present day. A few months ago I moved to Nashville on a leap of faith and landed my dream job. I'm a pediatric social worker working with children who have brain tumors, Sickle Cell disease, and other hematological disorders. To say that I'm in the right place is an understatement. I still have close ties to the hospice world though. You can expect to read a mishmash of pediatric and hospice-related posts.

So please, take a moment to peruse and familiarize yourself with this young (looking) social worker. Become a follower so you can stay tuned with my latest post. And please offer feedback because the beauty of any blog is the opportunity to learn from one another.

Thanks for stopping by!

Thursday, August 26, 2010

Flashback

Typically fieldwork placements are designed to help a future social worker experience an aspect of the field outside of their specialization. Since I applied to grad school knowing I wanted to focus on health care, I assumed I'd be placed in a school. However, since I'd worked in residential care during my senior year of college, they must have thought I'd had enough. (This is also, incidentally, the only reason I believe I got into my long-shot school.)

I was placed at the local county health department in their pre-natal and family planning clinics. Before I could start, my supervisor hauled me in to make sure I would be OK with doing options counseling. Some people feel so strongly about the issue that they would try to sway the client in one direction or another, which is the opposite of options counseling. I'm a fairly non-judgmental person and I have fully grasped that what's right for me might be wrong for you. I knew that I could be non-biased when it came to options counseling. My supervisor was appeased and I was allowed to start my placement. I learned a lot that year. I can hold my own in any conversation about pregnancy and birth control- a plus when it comes to my pregnant and married friends. At the top of list: what bad supervision looks like. While I met some great people and feel like I did make a difference with some of my clients, especially the girls I followed in the Teen Parent program, I walked away knowing that it wasn't for me. I was resolute in my desire to be a medical social worker and pressed on toward my goal to work with children with cancer. Seven years later, that dream came true.

What is interesting in all of this is that your fieldwork experience can show up in your present workplace.

A 15 yo girl with Sickle Cell came to clinic. I met with her, did a basic assessment, and began establishing rapport. She's a delightful girl and hopes to be a Sickle Cell doctor someday. I moved on to see some other kids at clinic when I received a page. The 15 yo girl had a positive pregnancy test. And so I went back to the exam room and sat with her.

Tears silently sliding down her face, nose running, vacant expression. Dazed. Shocked.

Slowly I was able to learn the details. Slowly I was able to help her decide who she would tell and when. Slowly I presented the options to her. Then I let her know she didn't need to make a decision today. Yet, some changes would be made. In case she decided to continue with the pregnancy, she needed to stop taking her hydroxyurea. If she decided to continue with the pregnancy, she would be considered high-risk and would need to see an ob/gyn as soon as possible.

I wondered what she would decide. She would need to think about how a baby would impact her life. Who would watch him or her while she was at school? Would the father contribute financially? What about her career goals? Maybe adoption would be a better option. There are so many more options with adoption now- open, closed. She could still be a part of the child's life if she wanted to be. How would it feel to watch someone else raise your child? Grateful, perhaps, but maybe sometimes jealous or regretful? Or perhaps she would decide to terminate the pregnancy. It was early enough that no one at school would ever know. She could graduate, go to college, medical school, whatever she wanted. Only, she would still know. Would she feel guilty? Would she wonder about this little one and who he or she would have grown up to be?

It turns out I was the perfect social worker for this girl. My options counseling training came right back to me, as if I'd been in the health department the day before. I can't say what she decided to do because that's not really the point. I only know that we can't escape our backgrounds or training. And while I never expected my time in the health department to make a big difference in my professional repertoire, today it did.

Tuesday, August 24, 2010

Documentation

It's strange to say this but until this new job, I've never had supervision regarding my documentation. Whether it was fieldwork placements or my hospice job, I've never received feedback about my notes, other than that they were good, great, or the best they've ever read. That could sound like bragging but really I'm just confident in my writing and documentation skills. Still, there's always room to improve.

Now, in a new place, there's a new style. It was an adjustment to figure out a format that worked for me. I looked at old psychosocial templates and reviewed the notes of some other social workers and finally came up with something that works for me. After I finish a note, I save it as a draft, print it out, and then wait for my supervisor to review it before saving it to the chart. This has been going on for about 5 or 6 weeks. I've really appreciated the constructive criticism I've received, especially since it's the first time someone has critically reviewed my documentation. However, I'm ready to start saving notes directly to the chart!

When I met with my supervisor this week, she said she didn't think she'd be reviewing my documentation for much longer! She said I was able to adjust really quickly to this workplace's style and I've been able to organize my notes in a format that's easy to read and concise. She might have also said something along the lines of using my format to create a template (!) but I still had the words "I won't be reviewing this much longer" ringing in my ears. What amazing feedback! It confirms again that this is the right place for me. Now if I could only find time to do all my charting...

Thursday, August 19, 2010

Griefbursts

Some of my blogging buddies have explored the topic of grief in recent weeks. These bloggers are not a part of the palliative care or hospice community but I was struck by their words. I think each post is worth reading and you just might enjoy exploring the rest of their writing.

  • Gberger: First, I must say that Karen has been such a source of encouragement to me since I found her blog this past spring. She is a faithful commenter on this blog and has cheered me as I've started my new job. Her beautiful daughter Katie died 3 years ago this past week. Her continued exploration of loss and openness to growing and giving back is inspiring. This account of her AHA moment is not to be missed.
  • Giving Up on Perfect: After losing a loved one, Mary polled her readers on how to help a friend who's lost a loved one and then featured the helpful responses. You can spot my contributions, of course, but that's not why I'm highlighting this post!
  • Natalie Lloyd: Natalie reminisces about blackberry summers and touchingly honors her granny. "I think people we love, those who've gone on ahead, are thinking about us, celebrating over us, praying for us. I wonder if they get to catch glimpses of what we're into down here. Sometimes I like to picture Granny whooping it up somewhere on a back-porch in Glory, clapping for me and shouting, 'That's my girl!'"
  • Rachel Held Evans: I love Rachel's approach to faith and doubt. The recent loss of a family friend led to today's reflection: Doubt and the Ritual of Grief. "What I loved about the rituals of grief—the viewing, the flowers, the stories, the songs, the laughter, the sobbing, the burial—was that they forced me to keep moving, to avoid getting stuck in a place of despair...I may simply be “going through the motions,” but at least I’m moving."

Grief demands a response

There's a fascinating article in the New York Times titled Coping with Crises Close to Someone Else's Heart, which examines how friends, family, and the community at large respond to trauma. It is a common, while experiencing loss, illness, or difficulty, for friends and even family to fall away. Sometimes your life becomes myopically focused on the tragedy before you; you no longer have time or energy to devote to the people around you and relationships may drift away. Other times, people are unable to be near your pain out of fear that similar circumstances will befall them or because they are emotionally incapable. Maybe they want to help but don't know how or they don't want to say the wrong thing so they don't call or visit anymore. Sometimes it is intentional and others not.
For the most part, we were blessed with support and love; friends ran errands for us, delivered meals, sat in hospital waiting rooms, walked, talked and cried with us. But a couple of friends disappeared entirely. During the year we spent in eating-disorder hell, they called once or twice but otherwise behaved as though we had been transported to Mongolia with no telephones or e-mail...Given our preoccupation with our daughter’s recovery and my husband’s mother’s illness, we were no doubt lousy company. Maybe we’d somehow offended our friends. Or maybe they were just sick of the disasters that now consumed our lives; just because we were stuck with them didn’t mean our friends had to go there, too.
The author examines several common responses to someone else's trauma. As you read through, you may be surprised to self-identify with the responses. It's not enough to consider how other people have abandoned you in your time of need without examining if you have acted in the same way. Feeling grateful because it didn't happen to you and then guilty? I've been there. I'm sure we've all said the wrong thing at a funeral at some point. Before I experienced deep loss, I'm sure at some point I told people their loved one was in a better place. Now, after experiencing loss, I know that it is fine for me to say that my loved one is in a better place. But if anyone else tells me that, I am liable to smack them.

The latter part of the article focuses on "pseudo-care," in which help is offered but never followed up on. The classic "call me if there's anything I can do" when most people are too exhausted to think about what you could do or to even remember to call. While an expert dismisses telling someone you'll pray for them as ineffectual, I do believe in the power of prayer. Perhaps it would be more appropriate to pray for the person in the moment, continue praying for them throughout the weeks ahead, but also do something tangible like a load of laundry or running errands.

This may be the article's biggest point: "True empathy inspires what sociologists call instrumental aid. “There are any number of tasks to be done, and they’re as personal as your thumbprint,” Dr. Rainer said. If you really want to help a family in crisis, offer to do something specific: drive the carpool, weed the garden, bring a meal, do the laundry, go for a walk."

I'll never forget the friend who left a bouquet of flowers outside my apartment with a card the day I returned home from my grandma's funeral. Or the girls I mentored in youth group who dropped off chicken quesadillas and a salad while my great-aunt was declining. (The fact that these teen girls thought of this on their own and followed through was astounding to me!) The cards, the emails, the friends who dragged me out to dinner when I was coping with my grief by becoming a hermit...priceless. I strive to remember these blessings more than the friends and family who dropped away.

How have your loved ones responded to times of difficulty? What do you do to care for others? Does this apply to your professional world at all?

Sunday, August 15, 2010

Hospice Social Work Blog

There's another hospice social work blogger in town. She can be found over at Social Work Helps. She appears to work at a rural hospice and is also getting her Masters in Social Work right now. FYI, you can work as a hospice social worker with just your BSW. All this keeps her busy so she only posts a couple of times a month. Still, I'm sure she would appreciate support from the Palliative and Hospice blogging community.

In one of her first posts, she notes: "there are many things that we can do to prepare ourselves so that the end of our lives are as non-stressful as possible. People on their deathbed shouldn’t have to worry about Medicaid applications. They shouldn’t have to worry about paying for a Notary or appointing a power of attorney. They should all be able to focus their energy on their family, preparing for the next life, and dying peacefully, pain-free, and worry-free. It really is important to figure those things out now, so that we have the time and energy later in life to focus on what really matters at that time." A great observation for someone who was only a month in to the job!

And social workers everywhere, regardless of specialty, will appreciate her response to people who want her to "fix" patients.

Be sure to check her out and leave a comment of support!

Thursday, August 12, 2010

Office Politics

New jobs come with clean slates. However, it doesn't take long for some scuffs to appear. I have thoroughly enjoyed getting to know my co-workers. I work with a great bunch of people and, so far, really get along with everyone. I'm sure I will continue to get along with everyone- that tends to be my nature. Of course, as you're getting to know people, you can't help but learn about who said what, what the cliques are, and find out the latest drama. It's been educational. That said, I don't want any of the office politics to color how I view people or the organization I work for or my patients. I'm keeping the rose-colored glasses on for now.

I think it's possible to affirm where people are coming from without letting affect me and my work. I learned that lesson well when co-workers would start gripe sessions after certain meetings. I realized that I could sit and complain with them and generally feel worse afterward because nothing would change and I would just get angrier. Or I could listen, try to redirect the conversation, and focus on the positive. And when that failed, I just walked away. It definitely helped my attitude stay above board.

What about you? How do you stay above office politics? How long did your rose-colored glasses stay on?

Wednesday, August 11, 2010

Jargon

In a medical setting, many, many terms and acronyms are bandied about as if everyone should understand. There's the easier to figure out ones: afebrile, emesis. There's the tougher ones: PCP, SI. There's the ones you know if you're a doctor: neutropenic, BUN. I could go on and on. As I've adjusted to my job, I've also adjusted to the medical terminology. There were days I felt as lost as the parents! The residents always graciously broke it down into lay terms when a parent would ask or if they happened to notice the glazed over eyes. I know for the sake of rounds, it's easier to use initials and the more "doctorly" jargon. With this new crop of residents (which is a whole other issue- parents adjusting to new doctors every month!), there's been a recurring joke about the jargon. They like to tell some parents that by the time their child's cancer treatment is through, they'll have an unofficial oncology degree. I guess it's true but I'm sure every parent thinks, "that's not the kind of degree I wanted."

Wednesday, August 04, 2010

Palliative Care Grand Rounds 2.8

Thanks for visiting me on this most auspicious PCGR day. Since I moved to a new state and started a new job a couple of months ago, I didn't have time to come up with a fun hosting concept the way I did in September. Nonetheless, I hope you'll enjoy these heartwarming, thought-provoking, and ever interesting posts. These blogs will most likely be new to you, with a few staples thrown in. Be sure to comment on the ones you like or have a response to. We bloggers love feedback!

Hold My Hand follows the life and times of a nursing home social worker. I appreciate that HMH shares the story and reflects on her own actions and reactions. She writes a moving account in The Language of Love about a care conference with a resident and the resident's daughter. Don't be surprised if you find yourself looking for kleenex by the end.

I'm fascinated by OrthoOnc's use of technology! First, he test-drives the iPad in the operating room. Then how the iPhone's FaceTime could be used for telemedicine.

A primary care physician is the brains behind Musings of a Distractible Mind. Dr. Rob's posts are sometimes funny, sometimes serious, and always worth reading. A Letter to Patients with Chronic Disease explores how to improve the patient/doctor relationship and has generated follow-up posts and lots of comments. If that's not enough to make you a subscriber, then read Failure, an examination of whether a patient's death or suffering equals a doctor's failure.

Pallimed, as always, has a wealth of possible PCGR contributions. New Pallimed contributor Holly Yang discusses findings in the Quality of Death report, which ranks end-of-life care from 40 countries. She also wisely links to one of my favorite Pallimed posts from July: the Life Before Death website.

You can't talk about Pallimed without mentioning Pallimed: Arts. A perfect blend of my interests! I was struck by this profile on musician Fred Hersch. Diagnosed with HIV at age 29, he was recently interviewed by NPR's All Things Considered. He notes, ""For at least the first number of albums I made on my own, I really had this kind of dramatic feeling like this is going to be my last statement and I just wanted to create enough of a body of work that if I died I might somehow be remembered." How's that for living as if you were dying?

One of my favorite recent finds is Dr. David's Blog, the musings of a pediatric oncologist. Absolute must-reads: an ethical dilemma ("Who gets to decide if the 5% chance of a cure is worth the risk? Is this chance of success so small as to qualify as futile?") and tackling the hardest question: "How much time do I have left?"

Taking the scenic drive's author is a PICU RN who plans to go to medical school. Read through her ethical dilemmas and ponder what you would advise.

Her profile says she's a family doctor, mother of 3, and relearning life without her son Henry, who died about a year and a half ago. Her posts about grief are raw and honest. Her posts about patients are insightful and compassionate.

An ER nurse writes about the difficulty in have palliative care conversations in the emergency room. This also leads to reflection on the loss of a friend and the conversations she had with his family.

A Memorial Sloan-Kettering Cancer Center intern reflects on this article: Americans are treated, and overtreated, to death. Conveying that hospice or palliative care is not "giving up hope" may be one of our biggest mountains to climb.

Sarah is not a palliative care or hospice blogger. Her mom died 3 years ago. She just found out the FDA revoked her mom's main chemo drug "for not helping patients." Her response, her pain, her anger is not for the faint-hearted. This is the aftermath of grief.

GeriPal draws attention to the Atul Gawande article Letting Go: What should medicine do when it can't save your life? and then offers this response. Take the time to read Gawande's article first. Also of note, Why not palliative oncology?

[Ed. note: A Pastor's Cancer Diary also offers worthy commentary on the aforementioned Atul Gawande article.]

As I've compiled the posts for PCGR this month, it seems an unintentional theme has emerged. We need more conversation. More conversation about treatment options and when it's time to consider palliative care and hospice. More conversation about our wishes during treatment and at the end of life. More conversation about how loss affects us. I can only hope that PCGR enables us all to take time for these conversations, which inevitably will help us do our jobs better. I know this community has helped me. May it also be a blessing to you.

PCGR has subscription options; you can follow by email or RSS feed. An aggregated feed of credible, rotating health and medicine blog carnivals is also available.

Tuesday, August 03, 2010

Let me be your punching bag

Let's say there was a family. Their child has brain cancer that has metastasized. Instead of accepting that the disease has progressed, they look for someone, anyone to blame. They ooze anger. The doctor didn't pay attention to the symptoms. Their appointments weren't booked soon enough. Their insurance won't cover certain procedures. And you can understand. Because in this instance, we might be looking at controlling, not curing, the disease. So when the parents yell, you get it. This is a scary place. Maybe there will be a way to hold the cancer off a little while longer. Maybe you won't have to discuss palliative care or hospice with this family that wants to hold on to their child. But maybe you will. Even though your background prepares you for these conversations on an intellectual level, you will likely never be prepared on an emotional level.

How do you comfort a family that may lose their child? You listen. You let them express their anger. Their fear. The unfathomable grief. You don't defend anyone's actions or delays or the injustices of life. You apologize when you can. You advocate when you can. You listen. You accept. You are the middleman. You are the punching bag.

When they have vented, when they are spent, they will look at you and say thank you for listening. And maybe apologize for some of their words. They don't need to apologize. You'll look at them with compassion and simply say, "that's what I'm here for."