Humility

Sometimes you can lose your focus, in the heat of the day. One Friday not so long ago, it was a typical Friday at the adult nursing facility. Patients out for appointments, but the information was not readily available....you double check on the electronic health record or ask nurses, before the shift starts. Surprise discharges, three the night before. There was then the remaining caseload to schedule, with competition for treatment times with the other therapy services abutting your plans. The times at which therapists start their day are staggered, so you may or may not communicate with all your peers immediately. So many progress reports, and updated plans of care to be done. Then it started.

Amongst the treatment sessions, there are new consults to be screened. Family,  requesting meeting times to clarify treatment issues. Reminders that a written status update on some patients is needed, for the insurance companies. When your schedule tells you that a patient is available but the patient is not there, - Is she in therapy? Outdoors/indoors relaxing? Sequestered in the bathroom? Saying "leave me alone; I've had my therapy already". In the beauty salon? At bingo? Taking a shower? Nap time? Family has taken her out for a meal? So many things could be happening.

Then, when all your visits for the day are completed, you are expected to demonstrate that you maintained maximum productivity while seeing all your patients. Your written documentation is meant to portray all that has happened for each person served that day. It should lay out your daily execution of the plan so well, that the parties that pay the bills should not quibble about reimbursement for your services.

If you let this craziness, to any degree, capture and overwhelm your workday - if you let any feelings of anxiety or fear about how complex and random seeming the day is; if you let it infest your work - you are sunk. Dead meat. Yesterday's news. Up the river without a web browser, much less a paddle. A question mark in your supervisor's balance sheet. A worse insult than that one slung by one Presidential candidate against another. It is so hard to keep your head some days, when all about are losing theirs, thank you Mr. Kipling.

How do you combat the urge to run from such a treatment day, if you are the speech-language pathologist on duty in this adult nursing facility? Your training and your experience will tell the tale. How well you live in the moment during your treatment day; that will help you string a successful moment upon a sequence of successful moments. How well you keep to mind, and hold close to your heart, that all this energy is not swirling about for YOUR benefit, but for your patient's benefit - that will lead you to bring that person the best service. Stay humble, stay focused, stay doing what you do.

How I Became A Speech-Language Pathologist

January – from Janus, the Roman god of two faces, looking backward and forwards, probably a prototypical visage for the gardener; another year of growing ends while a new one begins. Gardening is a “yearlong” or continuous cycling of growth and decay; the veteran gardener knows that there is no absolute end to a growing season, but instead there are transitions upon transitions.

A blizzard big enough to leave 23 inches of fine white powder about homes and businesses, is nonetheless paying it forward by providing the ground water as solace for the next season. January is a beginning, yet only an arbitrary beginning. We could be starting the calendar year in November, or even in July.

 But I digress; we have our start to the gardening year in January. We also have now, the start of my story of how I began my career of speech-language pathology (SLP). It was nothing I had ever expected in my quest for a job and a future. But like the gardening year, we don’t know what will be the end of a career until it is the end. Yet In the spirit of this opening, it is also the beginning. Where to start??

I became a speech-language pathologist because – how to say it simply? – It is the helping profession that taps my skills better than any other. I had known I would be in an important profession from an early age. But, Fred Mc Murray couldn’t turn me on to aeronautical engineering, even after I had watched seasons of MY THREE SONS. Neither could Robert Vaughn make me into an espionage operative, after THE MAN FROM UNCLE grabbed my attention for guns and geek stuff. Dick Tracy: could he have helped make me a copper? I flashed my Dick Tracy Fan Club badge to almost a hundred members of a receiving line, after a family friend was married. I was about six, and the receiving line was not impressed.  Nurses are thick among my family members: older sister, cousin, aunt, maternal grandmother...but i neither saw myself as either nurse or physician...In real life, I had changed majors from chemistry to English in my sophomore year. The prospect of a double major in English and history did not dilute the anxiety I felt for the future I had to make.

What made the choice of a career doubly HARD – was that I did well in everything in school, and found that, strictly on the strength of an academic transcript, I could have gone in so many career directions. A depressing situation – but when I had attempted to push through for a BA in English and a secondary teaching certificate, I had learned I had to address a personal problem that had bound my energy and outlined my personality since grade school. I had to undertake treatment for my stuttering. Teacher education students had to pass “general speech”, and my initial presentation to that class bought me little more than notoriety. Get it fixed or your career options have been narrowed, I thought.

The summer session brought my miracle. SLP services had not been available in my local school system. When the evaluation was completed at the university clinic, I was told I had a mild fluency disorder. The feelings I had about myself, and about my ability to communicate and assert myself - they were not mild. I was a Janus creature in my own right. Could I stop being pulled by habits, attitudes and the weight of my past,  learning instead to face only forward, with courage and confidence?

 I learned fundamentals of controlling fluency, and desensitization to speaking situations, then - it was all about putting the skills to work. I acted in a play that same summer! When I found I could change myself and be a bigger me, it seemed natural that - I could learn to do this for the benefit of others. The B.A. was followed by acceptance to a master's degree program in communication disorders, on the same campus.

It was only the beginning of how the career shaped me, and vice versa. More later, on how this SLP career has evolved.

Bag o' tricks

I feel I need to preface all my blog posts with a caveat; with a dead skunk in the middle of the road, or even an "objects may be larger than they appear" warning. When I talk about clinical practice, I speak with the confidence one has after decades of working with - predominantly - adults. Even though I have paid my dues in public school (K-12), preschool and community/residential DD and university settings, it is the folks within the age span from 21-99+ years that have captivated me, clinically. OK. Enough!

Many times I need a special material, or small piece of equipment that can yield data I need to make decisions. The material or equipment is not a capital expense. An SLP will never make enough! But you can't wait, or rather - your person served can't wait to have the advantage you see with this small purchase. Bottom line: impaired communication, as we have seen on many levels in this world, is the compost for evil. To fight evil, you need the right tools.

 
This all started for me, when I took a job for a senior living corporation that provided no work space for the therapy staff. None! There were invariably, needs for my 'wonderful toys' but no place to keep them. Since I ultimately visited eight different buildings in eight communities with this job, the tools needed to travel. Ergo, the bag of tricks.

But, what's in it? Here is a list of what is in my bag today. It grows and evolves. What is in your bag of tricks, clinicians? Please share when you can. Who knows what Santa might bring, to add to your bag of tricks.

 
Opening the bag we see - oh yeah, thank you Ziploc! -

* toy wind instruments (from the party store): harmonica, slide whistle, kazoo; most used? Kazoo!
* toothbrushes for kids
* plastic eating utensils (from take out meals)
* thin plastic balloons
* sugar free Life Savers (individually wrapped), assorted flavors bagged with a box of waxed mint dental floss
* Life Savers GUMMIES - assorted flavors and sugared but, hey, whatever works -
* liquid water enhancer, various flavors
* a package of poker size playing cards
* pen light + otoscope
* a strong and durable pen light - I like the Mag Lite, and preferably in an outrageous color so it's hard to misplace
* individually wrapped tongue depressors
* stereo headphones
* Radio Shack Stereo Amplified Listener w/ 3 band equalizer; SKU #3301097
* stethoscope
* 9 volt, AA and AAA batteries
* quartz electronic metronome
* bottle of bubble soap with wand (lid on tight)
* foam oral swabs
* drierase markers
* assorted pens and pencils
* bottle of hand sanitizer

* infrared thermometer 

* pulse oximeter

* wrist BP cuff

In the grand tradition of SLP's being cost-conscious, creative and indefatigable foragers, I give you the bag of tricks. BUT - get your own!