Wellness for your career, for your life

It's no secret that I am a veteran of the professions. From preschool to senior living environments; from time practicing from health care, community and educational perspectives, to finding the commonalities among all the settings; from fee for service to PPS; - what a strange, long trip it has been to stay well and contribute to the professions. The changes in what we do, and how we do the work of the professions over the last thirty years have steadily demanded more and more focus by its practitioners. Advances in the basic science of communication and swallowing; in the technology available to treat our persons served, and the development of a wide range of practice settings for persons across the life span; - very cool, right? You won't hear me knocking our professions' increased visibility, but the products of growth can be growing pains.

For each of these advances, there are imposing barriers to our providing  quality service. There are higher demands for productivity, stricter controls on the spending of third party dollars,  and greater insistence upon customer value for persons we serve. My mentors, my colleagues, and even those young SLP's who i have encouraged and supported: all of them i have overheard saying, how can we survive?

 I can assure the reader of this blog that: staying well and productive is possible, that burnout can be prevented, and that there are proven ways for the SLP at risk for burnout,  to meet her/his career and life goals.

Burnout: loosely defined as exhaustion that comes as the byproduct of soul - grinding stress. I have been affected by burnout twice in my career. In both cases I survived by taking a job outside the professions, until I knew for myself I needed to work as an SLP.  I needed and received healing and recharging. Though i felt initially i had been defeated by my burnout, there were instead lessons to be learned. What were the lessons I learned that made chronic burnout less likely?

Most SLP professionals beginning or near the mid point of their careers, may not give much attention to can staying healthy and focused. You are in your 20's or 30's, in relatively good health, with graduate school and your CF (clinical fellowship) each fresh in your memory. You devote your days to learning work site routines, building expertise with disorders, and making increasingly sophisticated judgements about what the persons served need.

My first burnout period came soon after I finished a year as a doctoral student in Iowa. I was a year removed from receiving the master's degree. The critical factors were easy to see: I had had no research background;  I was attempting a very high level of competition with my peers; and I had not previously lived outside my southern birthplace. When the perigee of my graduate career had arrived, - did I fall into the abyss? No. I secured a job as a CNA at the University hospital, first in ENT then in General Surgery. What worked to keep me alive?

* no animosity - I left the doctoral program, but was not shut out of the community within the communication sciences and disorders department. I then made a place for myself in the community of the university hospital.
* physical activity - doing CNA work is physically demanding through the shift, so completing a day is a matter of pride as well as nourishing for mind and body.
*reminded of who I am: the interactions with medical, nursing and other professionals caring for our patients; they all told me that I was ready to re-enter the professions;

Nineteen years elapsed, and my career took me to grade school and residential DD programs in Louisiana, community DD programs in Idaho, and a hospital program in Iowa. Managed care had crashed through the edifice of health care financing, and we had started to see that the world had changed. SLP was charged in my hospital with covering services for early intervention, acute, SNF, acute rehab, outpatient, home care and hospice. Wow! Work was going home every night. Days working with persons with traumatic brain injury found me cursed, kicked, slapped, punched, urinated upon and bitten. I did not have the gas in my tank needed for the demands of the job. A local human service agency needed a service coordinator, for adults with traumatic brain injury. What saved me then?

* not living in my head - there was little time to get lost in paperwork or pity parties: Many varied tasks were the order of the day - staffing a group home; giving consumers rides to community appointments (school, work, medical, vocational); staff meetings; care conferences; getting residents into/out of the law enforcement or mental health systems;
* learning different skill sets and knowledge bases - switching and sustaining focus is not only healthy for the persons we serve, but also for us. Learning the intricacies of SSI/SSDI filings alone - sheesh! Managing group home residents' drug administration records - critical!
* using my SLP training - when group home staff appeared to overload the information processing capabilities of the adults with TBI, I could help them devise personalized strategies for verbal expression, memory processing and emotional control - and other things, too. The success we had told me that, I needed to be back in clinical SLP.

Sixteen years have passed since that period, and I appear to have retained many of the lessons learned from my burnout periods. Since this blog is a personal view, some occupational hazards may be less scary than they appear in your rear view mirror:
* Have a life outside the job.
* Pursue physical and mental activity that keep you well not only for the job, but for all the parts of your life that keep you healthy.
* Develop career goals for the short and long term. Have concise plans to achieve all these goals.
* Use mentors and peers to advise you on your goals. Be part of a supportive community.
* As Max Ehrmann wrote in 'Desiderata',  Beyond a wholesome discipline, be gentle with yourself. You are a child of the universe no less than the trees and the stars; you have a right to be here.

Slouching towards spring: to be born in the garden

"Hi, Bob. Thanks for coming. We're here for another day of speech therapy for your stroke. But you notice, the therapy room is (looks around) set up differently than what you've seen. We have here (points)....a hydroponic - yes, say it with me (says the word chorally), hy-dro-po-nic, good! - planter. You know what the word means, don't you?"

 "YES, The plants grow in water! I was a fan of the show "Lost in Space", back in the 60's, and the Robinsons were growing hydroponic vegetables outside their stranded spaceship. Well...today, we're going to start growing vegetables in here! Ah, I see that puzzled look on your face. Don't worry. During the whole time we plant vegetable seed today,  we'll be practicing the speech skills you've been working on - that sound OK?"

There is a lot going on, with the introduction given by the speech-language pathologist to the session. Supported conversation strategies, like gesturing, pantomime, concrete visual stimuli and facial expressions, are continually used throughout the initial minutes of the session. They become equally important as your patient begins to help start the hydroponic seeds.

"OK, Bob; let's start. You see that we have the planter (points to black manuscript text written on white unlined index card), seed cartridges (label), lights (label), distilled water (label), and the electric cord (label). Now, let's say each of the words: I will say the word, then I want you to say it, OK? Ready? PLANTER....try again, PLANTER, that's right; SEEDS, right! LIGHTS, again, LIGHTS, good!....WATER, yes; PLUG, that's right. Now, we know the parts of our gardening system. Let me show you how we start the seeds, to grow what we like to grow".

Starting a hydroponic garden seems an ideal activity for training language and cognition. For example, vocabulary that may be unfamiliar to many persons (e.g. legume, nitrogen, loam), as well as familiar words can be trained.  Following directions can be easily achieved through demonstration, then by the patient following your model to demonstrate its understanding. Objectives written to improve skills for attention, memory, problem solving, executive function,  visual perception, speech perception, language comprehension and expression, motor speech, fluency, voice, and even swallowing (after all, you are growing food) can be addressed in hydroponic gardening fun. And, in the case of a university or community clinic, activities can occur all year round!

"Bob, that looks great! We have gotten all the seed cartridges in place, so that in about a week all the young plants should be sprouted. We will be caring for the plants during your program, and use the plants to help you meet your goals. I hope you enjoy this approach, and have some fun in the process! We'll see you next time!".

Your servant

{Chart reads: 62 y/o woman s/p LMCA stroke five days; severe expressive aphasia with lethargic sensorium; clinical swallow eval revealed moderately flaccid oral-facial muscle complex on the right side, affecting lip seal, bolus formation and propulsion, residue clearance; also, impaired strength and timing of swallow trigger, impaired airway protection, seen as gurgly phonation after swallow, yielding high aspiration risk: VFSS study brings recommendation of nothing by mouth for nutrition/hydration}

"Hello, Mary. I'm Carey, from speech therapy. We met the other day - ?  I am here to help you swallow better. The stroke affected your swallowing, so that now the doctor does not want you to eat normal food and drink for awhile. What we will do today may help you resume eating and drinking. Can we do that now?"

[Use statements, not questions, OK? That last one lets you show respect to her, but your non verbals of standing tall and nodding/smiling, while moving very slightly toward her may encourage her buy-in].

"First, Mary; let's warm up the mouth. You have to use the mouth in many ways when you chew and swallow. Let's start by stretching out the mouth muscles, so - please do what I do".

[Pointing to your mouth, then Mary's - stick out your tongue as FAR as you can; do it ten times then rest; move laterally in either direction, then rest; - she follows you better when you give her nonverbal cues, SO - teach her with your eyes, and of course you mouth, but also your WHOLE BODY - !  Yes, even your whole body!! When she doesn't have a lot of energy or focus, exaggerating the movements, going over the top can keep her engaged and relaxed, - even getting her to laugh near the end of the trials can help maintain the rapport you worked hard to attain].

"I'm clapping because I am happy for you, Mary! These stretches you are doing with your mouth may help you swallow more strongly, more quickly and more safely! And LOOK!  Your lunch here. I will be your coach during your meal and try to turn your improving skill into easier eating."

[I may dress and carry myself as an important, smart, skilled person to her. That may be true, but the bottom line reads that - I am her servant. I can take pride in what I help her do, and feel secure about the living I am making for my family; - but what need be remembered by this patient and her family is that, she got better. I promote myself and my profession much more, when I am to her a selfless servant.]