Today, my first grade class put on its first public performance of their stage adaptation of Anansi Does the Impossible by Verna Aardema. We read the story about a month ago, and the students wrote their own play based on the book. They did a great job. We practiced it as a reader's theater for a few days, and eventually we put it away. About two weeks ago, a coworker asked if we would like to perform something in the Celebration of Language program for students in grades K-2. I thought of the play, which seemed like a good fit and had the added benefit of being something on which we had already had hours of practice. Those were my thoughts, but it turned out I was being a bit idealistic.
So over the past two weeks, we practiced the lines. The students were robot-reading instead of using expression, so we practiced without the script. They knew the story inside and out, and they did a pretty good job once they got used to the idea. We made costumes and props and built a slide-show with backgrounds for each scene. There were six main speaking parts, a narrator, someone to run the slide show, and the rest of the class made up the "chorus." The main roles practiced every day, and the extras practiced a few times when we rehearsed as a whole class.
Today was the big event. The "star" of the play was absent. His understudy did a great job, but that left the narrator role unfilled. The next best-rehearsed narrator has processing problems that keep him from readily speaking his thoughts. I also had to replace the person who ran the slide show with someone who has the computer helper job in our classroom. I thought he would be a natural, but he hadn't been present at enough rehearsals to understand the scene changes. Then, one of the actors, who is a bit of a daydreamer on a good day, forgot to speak into the microphone when she remembered to speak at all. The large group of actors got very silly. One girl ran up to the microphone several different times making random comments. One boy jumped off the risers, hit his head on the pull down screen where the background was being projected. The screen rolled up with a bang. The boy fell down on the stage, stunned, and was escorted off by another adult. The campus monitor came up to make sure everything was safe, and instructed the students to speak into the microphones without touching them. I ran around like a crazed person catching up the slide show with the current scene, giving lines to actors caught in the headlights, shushing off-stage actors, prompting the narrator, and handing out props (or sliding them onto the stage when I forgot to hand them to the actors on their way onto the stage).
I am pretty sure only about 10% of the play was actually heard and understood by the audience. I know that it went on at least twice as long as it should have lasted. I doubt my colleague will ever again ask us to participate in such a program. I waffled between feeling mortified, angry, relieved, and exhausted, but my students had a great time. Even though all the while they were silly, grumpy, complaining, wrestling, fighting, shooting the finger, stealing, crying, laughing, running, rolling around, falling down, sliding, and generally causing mayhem, or maybe because they were all of those things, they had a great time.
Friday, April 22, 2011
Wednesday, April 6, 2011
Hospice Care
From the sidelines, I watched my great grandparents age and go through the end of life stage. Now I am on the front lines, trying to help my grandmother through this stage. At first, I just helped her make decisions by doing the legwork and reporting what I'd found. Then, I acted as the go-between when she had trouble communicating with doctors, nurses, or aides. Now, I am making decisions about her medical care, finances, and other factors that affect her well-being, if you could call it that since she certainly is not doing well. I am learning a lot, mostly by happenstance and through the kindness of strangers. For example, every time there is a shift change in a nursing home, the philosophy of treatment also changes. This makes it extremely difficult for a patient to receive a consistent level of care since each charge nurse, med aide, and doctor has his or her own beliefs about how, when, and why to give medication or how quickly and with what degree of patience to respond to patient requests. There is also a wide degree of interpretation as to what constitutes final days and ethical medical treatment during such time. Here are the the milestones I have noticed along this journey:
1. Declining ability to function and independently perform routine tasks;
2. Sudden decrease in function (or traumatic event such as a fall) such that independent living is no longer possible;
3. Rehabilitation stay (20-30 days) in a skilled nursing facility (may be precipitated by hospital stay) presenting many challenges in negotiating new interpersonal relationships;
4. Determination of need for long-term care based on outcome of rehabilitation stay;
5. Placement in nursing home and ensuing adjustments as patient and caregiver struggle to redefine roles, maintain sense of control over life choices and events, manage expectations, and navigate a second round of new relationships and personalities;
6. Slow and steady decline punctuated by sudden changes in condition and function (may include more trips to the hospital to investigate pain, falls, or other complaints such as nausea that accompany declining function);
7. Hospice referral for debility that opens the door for medical management of pain and physical/psychological discomfort brought on by general weakness, physical and mental decline, and loss of control as patient loses ability or interest in self-feeding, entertainment, personal hygiene, toileting, and maintaining personal relationships;
8. Patient regresses to childlike dependence and displays personality traits such as impatience and intense ego-centrism, and begins to show signs of dementia and emotional distress;
9. Medicines are adjusted, increased, and supplemented through hospice care as physical/psychological condition changes occur.
Other important things I have learned are:
1. If the patient has a 3-midnight hospital stay, Medicare will pay for 20 days of skilled nursing care. Hospitals are often willing to help with this if patient's condition will warrant the stay, and if you ask them.
2. Medication that is prescribed PRN means that the patient must request each dose of the medication. This is not an effective way to keep a loved on comfortable if they are experiencing severe pain or discomfort and is not in a condition to keep up with their own medication regimen. Another problem with this is that when a patient asks for medication in a general way, e.g. "pain medication," the nurse will refer to the med. chart for a specific medication and say something like, "It's only been 2 hours since you had [fill in name of specific med.] and you can't have it again for 4 hours." The nurse will rarely say something like, "You've had this med. recently, but you could have this other med. now and maybe that will give you some relief until it's time to take the first med. again."
3. Sometimes you have to take a break for a few days, and sometimes there is just nothing you can do to help them feel better.
1. Declining ability to function and independently perform routine tasks;
2. Sudden decrease in function (or traumatic event such as a fall) such that independent living is no longer possible;
3. Rehabilitation stay (20-30 days) in a skilled nursing facility (may be precipitated by hospital stay) presenting many challenges in negotiating new interpersonal relationships;
4. Determination of need for long-term care based on outcome of rehabilitation stay;
5. Placement in nursing home and ensuing adjustments as patient and caregiver struggle to redefine roles, maintain sense of control over life choices and events, manage expectations, and navigate a second round of new relationships and personalities;
6. Slow and steady decline punctuated by sudden changes in condition and function (may include more trips to the hospital to investigate pain, falls, or other complaints such as nausea that accompany declining function);
7. Hospice referral for debility that opens the door for medical management of pain and physical/psychological discomfort brought on by general weakness, physical and mental decline, and loss of control as patient loses ability or interest in self-feeding, entertainment, personal hygiene, toileting, and maintaining personal relationships;
8. Patient regresses to childlike dependence and displays personality traits such as impatience and intense ego-centrism, and begins to show signs of dementia and emotional distress;
9. Medicines are adjusted, increased, and supplemented through hospice care as physical/psychological condition changes occur.
Other important things I have learned are:
1. If the patient has a 3-midnight hospital stay, Medicare will pay for 20 days of skilled nursing care. Hospitals are often willing to help with this if patient's condition will warrant the stay, and if you ask them.
2. Medication that is prescribed PRN means that the patient must request each dose of the medication. This is not an effective way to keep a loved on comfortable if they are experiencing severe pain or discomfort and is not in a condition to keep up with their own medication regimen. Another problem with this is that when a patient asks for medication in a general way, e.g. "pain medication," the nurse will refer to the med. chart for a specific medication and say something like, "It's only been 2 hours since you had [fill in name of specific med.] and you can't have it again for 4 hours." The nurse will rarely say something like, "You've had this med. recently, but you could have this other med. now and maybe that will give you some relief until it's time to take the first med. again."
3. Sometimes you have to take a break for a few days, and sometimes there is just nothing you can do to help them feel better.
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