An SLP is not a stable pony

 "My ST tells me, you have to type this in...."

"My therapists prefer to do...."

"We've gotten a new swallowing order; I know it's almost the end of the day, but can you do it?"

"We hire speech therapists as PRN only; you get paid for patient contact - no benefits"

"We have three therapists on the case, so your involvement we staged to start last - and you have just 2 visits "

"Others, like OT - they can work on cognition"

"I need to continually educate the nurses and doctors, about what we do"

"Good communication is basic to how the healthcare team works best"

"People need to communicate and swallow continually; if you can't do direct service, do education and counseling until direct service can start; a flat fee can be charged for the service"

"You continually GIVE your time, above and beyond the patient contact time, to do all the work that need be done."

"There's no budget for equipment, materials, supplies; it's rewarding, regardless, to hear and see satisfaction on a consumer's or family's face, when you have given them something that helped"

"Training and experience are stern teachers; the SLP can function well within any worksite, contributing to team management of successful consumer outcomes, and the discipline and focus on function the field can bring". 

 

From therapy garden to test kitchen

We were blessed last year in the upper Midwest (USDA Hardiness Zone 5b), that the summer garden took off like a rocket. The occasional heavy rains needed supplementing a few days a week with my watering labors...a 2 gallon watering can does the trick, because even though more trips are required to give the plants a drink, there's exercise. Clover made its resurgence, after three years of being dormant. More than 95% of all the seed varieties that were sown, were germinating and thriving! I couldn't ask for more from the soil - it's black, moist, and with strata allowing for plentiful movement of root growth, and - after more than ten years of continual amendment, showing signs of proliferation of good organisms that feed the vegetables, flowers and herbs.

But - when all the produce is grown to its best, harvested and processed; what to do with it all! You gardeners who work so hard, year - round to keep the garden ecology viable and productive, how do you make the fruits of your garden work for the greater good? Those clinical programs in SLP that utilize a garden for training staff; - whether they be future clinicians, current staff or those community volunteers who would like to help - they might benefit from your skill set, and they might further the movement of their mission.

What I am saying, is that CSD training programs that support training gardens should develop, alone or in collaboration with other entities, tasting kitchens that serve consumers, their stakeholders and the community. A "tasting kitchen" will provide the practicing speech - language pathologist, who works with persons having swallowing problems, opportunities to directly train the consumer in the set of swallowing skills desired, with fresh food. The tasting kitchen will afford the SLP clinician to balance the needs of consumers to eat safely, against the need of consumers  to eat well.

Of course, cooking and preparing foods for persons with swallowing needs is significantly outside the field's scope of practice. But there are obvious advantages to having this unique service offered to consumers:

* the consumer is reassured that her/his quality of life - in this case - the desires and needs for nutrition and hydration- may more easily be met.

* the SLP can liaison with professionals in many fields, who have an influence over what we can buy and eat: gardeners, farmers, grocery stores, chefs, nutritionists,  dieticians, food anthropologists, cookbook writers and owners, and restaurants, diners and cafes: they can be the food professionals,  providing the real material for direct dysphagia treatment;

* the 900 pound gorilla in the room (who the heck pays for this?) can be assuaged by a fee - for - service arrangement,  or underwritten by grants, fundraisers and other external supports; 

Let's contemplate how the SLP tasting kitchen might increase the odds,  that our consumers might achieve the swallowing outcomes they desire.

An SLP is like a taxi driver

 I think occasionally, of the total number of persons I have served during my SLP career of....thirty-eight years this August. If you had lined up all my consumers over all the years, their standing in line six feet apart, I can imagine the queue would have extended from my home, to the farthest reaches of the galaxy. My practice often has been a far - flung galactic outpost, far from the prestigious healthcare institutions, the University training grounds and the well-funded school campuses. The opportunities that have come along, and the circumstances that have steered the work from job to job, from condition to malady, have steeled me to a realization about a speech-language pathologist:

 

an SLP is a taxi driver, taking the person served from a temporary to a transitory location. But I almost had a lapse of awareness, for the present day. You might also say, an SLP is a ride - share driver. 

Get the call, pick up a fare, head straight for the destination wanted. In spite of the desire of  the professions to make patient care in CSD "person - centered", or "personal", clinical work day - to - day is a series of pick up, travel, disembark; pick - up, travel, disembark. There is no inherent reason to act otherwise, though your job is to help your passenger grow more confident, more independent and more in control. We drivers for better communication and swallowing; we are to get our passengers from Point A to Point B in a timely fashion, and precisely finding the destination.  The consumer wants it. The support circle is waiting. Those who pay the rider fare expect you to arrive on time. The managers of your business have more fares ready to pick up. 

But the journey! Oh, the places you'll go! The courage to be found, and the sights to be seen....those moments of insight, of pain relieved and strength bolstered....the journey is the thing, and it is why you are hired. Your consumer, your passenger shows you the way to go. It's your expertise in piloting, that gets the passenger to the endpoint (s)he wants. The sights on the journey; they make it almost sad that the journey has to soon be over. 

And it does have to end, and it does end. The alliance, the bind forged at the start of the galactic journey is dissolved. But another passenger, another consumer needs you now. The galaxy awaits.