It's Christmas. Eat!

I was working the graveyard shift out of Dysphagia Division. You know how it is before a holiday: the cases pile up, like rhinoceros waste when the zookeepers go on strike. There were so many concerns about people swallowing that I was getting choked up. No recourse existed, but to see all the people I could before being shooed away by managers for the Christmas time off.

I started the day shift (yes; I was asked to cover another shift) helping a lady eat, who was not aware she was having problems. The method was simple: present the spoon to her line of sight, wait for her to open her mouth and accept the utensil, then press lightly down into the tongue body as the spoon is being withdrawn.  The person served had the best chance to swallow her meal without clinical signs of aspiration (CSA). Staff were shown how to pace their feeding style to the strengths of the patient.

There was, then, a woman who was struggling after a diagnosis of cancer to get anything down, even liquids. All material were coming out of her nose, at least 75% of the time. First, the decision was made to change the liquid consistency from THIN to NECTAR, so that the patient might more easily maintain liquid flow in the pharynx. The patient also demonstrated 7 seconds mean duration for expiratory pressure, measured in "blowing bubbles" through a straw into a glass of water, with nostrils pinched shut. There was barely a 1 second duration of bubbles sustained, when nostrils were NOT pinched shut. Luckily this patient had been maintaining her weight through PEG tube feeding.

I barely had time to punch out, after the last case had been completed; dash to my car and head to the international airport, to make my flight to Cancun for the holiday.. Just my luck: someone at the table in the airport restaurant, while I was waiting to board, started to choke on a burger. Someone hurrying, just like I had felt myself hurrying all day to see these swallowing cases. Someone too pressed for time to be in the moment; to listen to her/his body and eat/drink within the limits of her potential. I suffered through the sensations of my own GERD, before talking to each patient about GI PEACE.  Heckuva job, swallowing police. It never stops.

Be a Healer

"Healing" is dramatic; it calls upon that suspension of disbelief, cited in English literature, to give your body, mind and soul to an agent that displays powers you don't understand. You trust the authority of the agent, and your trust in what the agent offers is the voice you hear, above others, in your head. Heal me, please heal me. Far from healing being antiseptic, peaceful or conclusive, it can be raucous, sweaty and wrapped in mystery. I want to be healed; I have to be healed; I will do almost anything to be healed.  I give up my body, or my mind to you to be healed. I will pour out my gratitude and my devotion - my FEALTY to you, when I am healed. Please heal me!                                                                                                                                                                                              

Healing is also seen as cerebral, data-driven. The legacy of disease hunters and their conquest of rabies, polio and measles, is a series of complimenting clinical trials and omnivorous
"running"of subjects, defining cohorts, piling up data, checking hypotheses, building the large "N", deciding if this is the key that fits the lock, determining if this is the trial that allows the word "proof" to be used, and scouring the sources for every spare dime to complete every last task. This is not only the place for lab rats and lab bench jockeys, but for IRB meetings, for grant writers, for bleary eyes staring at computer screens, for family members bringing their loved ones to a trial, for repetition/repetition/repetition, and for building your CV with paper after paper. Heal you? There's an RCT for that. You want to be healed? Hospital A, where I work, has doctors who do that. You're not in network? Too bad. Healing is technical. Healing is business. Heal me! I can pay. Until I see the final bill, I am sure I can pay.

Speech-language pathologists can be and are healers. When they are at their best, "speechies" embody both the technical and the emotive. They exemplify the data-driven and the life-affirming. They appeal to the human need as well as the scientific method. Clinicians do it by playing the games that entail effective treatment plan management: they elicit the goals of the persons served and keep that goal uppermost for each person; they demonstrate continuously evolving project management skills ("Are we on the right track?", you ask. "Are we doing the right thing? Do YOU feel we are making progress?"), using both near-point perception and disinterested data to guide the project towards its planned conclusion; and they follow Covey's commandment, begin with the end in mind; they find the bridge between treating the impairment with component skills training, and using the functional skill in real life environments as soon as possible.

The SLP as healer should not be "puffed up" or oversell her/his skill, product, or project. If you look at Oliver Cromwell's statement to the Church of Scotland, "....think it possible you may be mistaken", converted to a statistical rule named for the English leader, you may see that healing in the clinical sphere is a function of science and faith. You may learn that, to be a clinical healer, you depend as much upon your human connection to the person served, as you do upon the rigor and predictability of your method. You may discover that in serving persons with communication, cognition and swallowing impairments, - that they appreciate your education and training, but they merely want to be healed.

Be a scholar

Above and beyond being "well read", as the August 27, 2017 post for this blog urges ; -
speech-language pathologists must have the constitution to link what they do in the treatment setting, to the grand body of cumulative knowledge on human communication, cognition and swallowing. You don't do that because you want a car on the professional ego train, or that you want to keep up the momentum you had in university for setting the curve. Some scholars can do both - climb the ladder of riches, while working as a clinician/researcher/academic. Basic and applied research in our fields, is regardless, THE reward if you seek to answer a scholarly question. Whether to understand the processes underlying behavior within the population, or to discover valid and reliable, real life solutions for impaired individuals -scholarly endeavor gives us clinicians the credibility we need, in the marketplace for human service.

This post will not teach you nearly enough fundamentals of scholarly research: there are literature reviews, books, convention presentations and courses, post-doctoral fellowships and master's level internships, already in place and accessible to all with interest and drive. There is quantitative research, where discrete data collection and rigorous statistical method allow you to establish proof of a phenomenon in human communication sciences. That school of thought is well represented by training programs such as - https://communication.northwestern.edu/departments/csd/research

Qualitative research will approach human communication phenomena from a largely descriptive perspective: "...a variety of analytic procedures designed to systematically collect and describe authentic, contextualized social phenomena with the goal of interpretive adequacy”. 

Damico, J. S., & Simmons-Mackie, N. N. (2003). Qualitative research and speech-language pathology: A tutorial for the clinical realm. American Journal of Speech-Language Pathology, 12, 131–143.

An example of a training program that affords the budding researcher experience in qualitative research methods is -  http://www.ucs.louisiana.edu/~jsd6498/codi610/codi610page.html

 Regardless of your method, - you will have occasion to use both paradigms in the course of your career, - identifying and attacking a research problem using scholarship can light you up. It can ignite or revitalize your career. It can save the world! It will feel that good.