On the Trail of Evil with DICK DARING, Speech Therapist

On that fateful day, he facepalmed to gather his wits and calm himself, stopping the walk down this long hallway in the building he knew intimately, to scrape the slightly clammy flesh down his face and reset his thoughts for the afternoon. A toddler who had come to the clinic some weeks ago, to play games – so he thought – was on the floor, so Dick Daring was on the floor, too! In the process of living his best life with the Fisher – Price doll house, - the wellworn plastic device giving off a slight chemical odor - the toddler noticed that Dick had his back to the window letting in morning sunlight. Brilliant beams cast an outline around the speech therapist’s ear, bearing the signs of middle – aged hirsutism: hair sprigs no more than a ¼ inch from top to bottom of Dick’s outer ear, and the child couldn’t repress his need walk over to the therapist, and play in it with a finger. The mother was tickled – or was she mortified?? DICK WAS MORTIFIED. Make it stop, please! The therapist took a deep breath after resetting and then moved down the hall to his next case.

The walk down this hall seemed to take forever, though. Daring had worked here so long; used all the rooms to see all kinds of people, young and old; talked to his colleagues and managers in their offices over all kinds of cases; - that he tended to get lost in thought. The room on his right he was just passing had the barest remnants of a drywall patch on the far side. Dick had even been a student therapist here, and after a rather contentious meeting with a case supervisor about a report – put his then powerful fist through the clinic room wall, to be followed by a shriek of pain that would have awakened the dead! As Dick paused at that room’s door, he felt the offending hand throb a bit – and he then heard the clinic director calmly speaking with him, a few hours after the incident. Dick had been quickly escorted to the Student Health Center; his hand X-rayed, cleaned and wrapped with an Ace bandage, before he had been plopped in an office chair to learn his fate. “I looked over that report”, she said. “You were right with your calculations. Don’t ever do that again”, she said in a businesslike voice that belied her skill at managing people. Dick felt himself smiling as he moved on. One victory there.

Yes, Daring had been doing what he’s doing for what seemed like forever. He looked on the field of communication sciences and disorders – what the “man in the street” called speech therapy - so much differently than most of his fellow therapists, that he scarcely felt he could talk with them. He actually could talk with them! He could recite data recently published on a journal website, that explained informed consent for an “at – risk” swallowing therapy approach. He could demonstrate to a family member, or to the consumer with family in the treatment room, how blowing bubbles through straws of differing diameters was very similar to using the EMST (expiratory muscle strength training) technology, so popular now. Cost of a package of straws? As little as $3 USD for 100 straws. Cost of an EMST 75 or 150 training kit? $55 USD. Daring moved on down the hall and entered the next room, the case file in a clear plastic bin mounted next to the door.

This 25-year-old woman had initially “presented”, like she was an unlucky invertebrate pinned to a display board with those colored pins, as a case of severe hoarseness – conversational speech marred by sudden “pitch breaks” where her voice just cut out; she was often breathless, and she was increasingly frustrated at work – an educational co-operative – because persons calling her office had trouble understanding her. Today, she reported that her primary care physician had prescribed a proton pump inhibitor, a drug that stifles stomach acid production that seems to be refluxing up into her throat. She went on to say that she had promised to cut down on her beer consumption. After she demonstrated how much clearer her voice was becoming, reading 25 10 – word sentences without a pitch break, Daring scheduled her for a final visit next week, then left to move on to the next case.

“Dick,” a woman passed him by as he moved on. “Hello, Mary”, Darling replied without pausing in his brisk walk to the next case. Mary had been a fellow graduate student with him, but had moved on to becoming a staff supervisor, occasionally managing a case with Dick. There had been that time, he remembered, when he and Mary might have had something – until they had met one day at the materials center on the third floor. You had to check out a toy, or a test, or some specialized equipment to use It during a therapy session. Mary had just procured her toys for use with a child with cleft palate and turned to progress down the hall to the child’s therapy room. KAPOW! Daring, in his style, is barreling down the same hallway but in the opposite direction, lost in thought and carrying his FIFTH cup of strong black coffee without a lid! STUPID. They called it, when people gossiped about the event, the “eruption of Mount Mary”. She publicly forgave Daring for the incident, but on another level, their interactions were that brusque. Hello, move on. Daring opened the door to the next case he had been assigned today, a bit weary for the late afternoon.

Name: _____; Age: 55; Diagnosis: Severe aphasia after left hemisphere stroke, right hemiplegia. The patient held his right arm crooked against his chest, waiting seated behind the table and smiling at Daring, the case file in hand. “One time”, he greeted the veteran therapist with a smile. “Hi, Mr. ____”, Daring replied, resting his well – worn Fedora at the corner of the table. “How is your day today?”, the therapist asked. “One time!”, the client answered with a woeful sound to his voice. “Did you see the game last night?", Daring inquired, knowing that the client’s favorite team had won – and BAM! The patient SLAMMED his strong left hand on the table and exclaimed “ONE! TIME!!”, smiling broadly and then – showed that he could sing a bit of the team’s fight song when Daring started the song. He could actually sing the actual lyrics - !! “Applause!”, Daring cried out with a broad smile and clapped to celebrate the client’s performance. Laughter came from the client’s side of the table: “ONEEEEEEEEEEEE TIMEEEEEEEEEEE!”. Daring wrote down the client’s next scheduled date and time for another singing lesson, what was called in the literature “Melodic Intonation Therapy”.

Fedora back on his head with a slight tug to get the brim just right, Daring gently closed the door of the treatment room. On to the next case – Boy, this corridor seems extra long today.

SHE LAUGHED

That day, I walked past the aged dormitory building at my university – it had been converted about five years prior into a classroom, office and “clinic” building for the Speech and Hearing Center - I knew the person just stepping out of the clinic office door on the West side. My path was along the curb, and on the far side of the parking lot that served the Center building. My colleague took a few steps down the concrete ramp from that door, leaned over the railing at the edge and yelled at me: “HEY B______!” She was a classmate in my master’s level cohort, a little older than me but as driven by success as we all were. I yelled back, “Hey F____! “I even waved. I could tell that, even over the one hundred feet distance between us, she was perplexed by how I responded to her. “I SAID HEYYYYYYYYYY?!?!,” was my retort. What happened next was extremely embarrassing.

F____ and I had both been in a class about treating voice disorders. Usually, we heard in lectures, a speech clinic would get referrals from local doctors for voice evaluations. The people who came to evaluation clinic complained of sore throats, or dry throats, and drastic changes to their voices: tightness where before the voice had been full and resonant; or weak and barely heard when there was any noise in the room; or even a hole in the throat where the voice box had resided. With the evaluation, student speech therapists at our university would gather diagnostic information on how much control the client had over the pitches, the loudness, and the ability to use his/her voice in normal conversation and thereby meet daily needs. I had none of those typical voice problems, F____ had told me, when she led me into an evaluation room to do my own evaluation! She had gotten an order from my doctor for an evaluation!

Yes, F___ told me that she had heard, that day when we called out to each other, that I had poor breath control for my speech. She explained that, when I called out her name, I had so little energy from breath control ready that she could not hear the first word. I got out her name well, but I had to really push out the sound by straining my vocal cords. The sound of my voice, F____ said, was raspy at the end. “You should pronounce my name better than that, B____!” she said before a raucous laugh. Then F____ turned on her voice computer to start the analysis of my own voice quality.

The spectral analysis of my voice was marvelous for its time – the mid 1970’s. Everything is written in code now, with the analysis of a voice done in the Cloud. On that day we had to rely on hardware capability of the device connected to a desktop computer. We finally got an acceptable tracing of my saying the sentence, “The quick brown fox jumped over the lazy dog.” “What do you know?” said F____. “There’s your problem, B____. We have evidence you don’t have enough breath support until you get to the word ‘brown’! How about that!” She smiled broadly, then chortled a bit as she noticed my face – usually milk white – was now tomato red. “B___! Don’t do that!” she said, noticing my embarrassment. “Let’s fix this, OK?” She went on, her smile now soft and reassuring. I agreed, making the semblance of a muffled “OK.”

We started, F____ and I, to retrain my respiratory system so that I could adjust my airflow to every speaking situation I confronted. We used the spectral analyzer as an initial training point, and I read sentences she had selected for the training. I was to take a quick breath, into each corner of my mouth, before pronouncing the first word of the sentence. Since I had been a brass player for my high school orchestra, it was second nature to start a breath stream that way. It worked! Increasingly, I could be heard pronouncing each word of every training sentence clearly, and the spectral analysis captured it – all those squiggles were as fat and frolicking as 1970’s Elvis. I will survive!

F____ cautioned me that the work wasn’t done yet. Not at all, in real life you don’t carry around a small computer to give you instant feedback on how loud and clear your voice was. She then took me around our campus on a brisk Fall Day, to practice speaking to people in different places, doing different things, and in different kinds of listening conditions – quiet and noisy; good and horrible acoustic environments, where my voice might get lost in curtains, or bounce off concrete and end up in Georgia! “You have to depend on your ears, your eyes and your throat now, B____!” she said. “The feedback you get from your own body, and from the person you’re talking with, tells you if you got it right, OK?” F____ was brusque but reliable in treatment sessions. She was a mother outside the clinic, and her attitude she expressed to her kids was “Get with the program!” Another raucous laugh, before I followed her to find a speaking partner.

Needless to say, F____ got me speaking with enough volume for every situation I faced, through our treatment program and through the rest of our time as graduate students. Oh my God, we made it! She gave me a quick hug as we left the Auditorium on graduation day – her family was waiting. Then there was a tug on my gown sleeve, she pulled me close and whispered quickly in my ear – “Don’t screw it up, OK B____?” Flashing that smile, she peeled off quickly to exit with her husband and kids.

And she laughed!