Toot Toot

Wow - I need to update this more. Hopefully I can do better....

Life has been a blur lately - "too busy" seems to be the norm. Hopefully time will slow down a bit.

I'm still a speech therapist and I'm still the boss - managing 5 other therapists. Sometimes the boss stuff gets too overwhelming and I would much rather go back to the days of just treating patients. I love "just" treating patients. You never do this job for the recognition, but sometimes recognition is the little push you need to keep going.

Not to "toot" my own horn, but I was named the Employee of the Quarter for the entire Health System. Not too shabby for someone who has only worked there for 4 years.

I was named Employee of the Quarter because one of my patients wrote my boss a great letter about me. Again, you don't do this job for the thanks, but it sure does feel good to know people recognize how much time, energy, and personal investment you put in to care for your patients.

I love being a speech therapist. I love figuring out what is wrong with people and I love coming up with ways to help them. Most of the time, they've been written off by every doctor you could imagine and been labeled hopeless.

What I love most of all is working with my cancer patients. I developed a comprehensive head and neck cancer program where patients are seen by a speech therapist at the beginning of their cancer journey. They are followed regularly by someone (me) who has expert knowledge about head and neck cancer and its effect on swallowing and communication. They are referred to my by a wonderful, intelligent nurse (my mom!) who identifies them as someone who needs to be seen by a speech therapist.

The doctors may balk at the fact that my mom refers patients to me, but it is the best care out there and it is what got my Employee of the Quarter. Again, don't want to toot my own horn, but it sure does feel good.

My Favorite Little Devil

I think I met my most favorite patient of all time - I'll call him Juan for blogging purposes. Juan is a twin and was most likely deprived of oxygen at birth. He looks nothing like any other members of his Hispanic family; he has a huge head, the thickest hair you have ever seen, almond shaped eyes, big chunky feet, and is the size of a seven-year-old though he is only five. When I first met Juan, I knew he must be mentally retarded - the way he was so friendly, called everyone "mama", and had not a clue that what he was saying made absolutely no sense. He became one of my favorite kids instantly.

The best thing about Juan, but unfortunately the reason why he had to come to therapy, was the way he talked. He literally sounded like the Tasmanian Devil - complete with his tongue hanging out and the hand motions to match! And it wasn't like Juan just turned on his Tasmanian Devil impression for certain people - he talked that way all the time and to every person he met. Everyone in the office loved working with Juan because he was so compliant and fun - and you got to practice your Tasmanian Devil impression (complete with hand gestures!). Juan did progress in therapy and was eventually able to functionally communicate but always seemed to go back to his Tasmanian Devil voice. I wouldn't blame him either, it was the best voice ever!

"Lots" - read "more" - Time on My Hands

I have definitely been MIA for quite a while, dear blog. My apologies. It's not that I don't have any good stories, it's just that I have been so swamped at work. There are no words to describe how busy we have been. But, that's not why I'm back to blogging. I'm back to blogging, at least for the short-term, because I have a little more time on my hands and no time on my feet!

On Tuesday (1/4/11) I had my bunion on my right foot corrected. YEA! Well, not YEA yet, but hopefully soon. I'm off from work at least until the 12th (and maybe later, depending on how I feel) and should have plenty of time to update.

But for now, I'm in quite a bit of pain and am itching like crazy (thank you pain pills!) so I'll be attempting to sleep soon. Tomorrow I plan on telling you about my absolute most favorite Tasmanian Devil. Stay tuned!

Wise Beyond Your Years

Since I was young, people always told me that I was wise beyond my years. Either that or they told me I was a 30-year-old trapped in a teenagers body. But that's not the point.

The point is that lately I've been feeling like I must be wise beyond my years. I have a patient and he is dying. He will probably die tomorrow or the next day. He is young; he has young children and a wife; he has a terrible disease; and he is in pain.

There are things worse than death and this man is living those things. His body is failing him but his mind is intact. He knows he is dying. He has accepted it. His wife has not. She grips to every fiber holding out hope that he will survive. But he won't and he knows that and he is ready to die.

I can't imagine being his wife. I can't imagine a doctor coming to me and asking me if I was ready to let my husband go. If I had brought our children to see their father one last time. I can't imagine....

But I have to imagine that. We all have to imagine that. Because you have to know what you would do in that situation. Have you talked to your spouse or your parents about a living will? Do you know what they would want. You have to do that; you have to know. You have to do it so that you can make those decisions for your loved one when they can't make them for themselves.

I was talking to this patient's nurse today. She lost her husband to cancer when he was 40. He was a nurse as well. She told me about the day before he died - they had a party. He joked with his friends and they celebrated his life. He was pain-free and at home. Had she not known her husband's wishes, how might he have died? Alone? On a ventilator? Without saying goodbye to his family?

If you have never asked your spouse or your parents what they would want in a situation like that, you need to. Do they want a feeding tube? Do they want a tube in their neck if they stop breathing? Do they want someone crushing their chest with CPR?

When I was talking to my patient's nurse she asked me how old I was. I told her and she was shocked. "When I was younger, I thought we were all invincible." "You are wise beyond your years to know that is not the case."

Please, go visit a hospital. If your spouse has never been to the emergency room or intensive care, take them. Show them what it is like. And then tell them what you would want them to do if you were ever the patient.

In a Funk

I'm in a f-u-n-k. I need a vacation - big time. I don't know if it's work or home or a combination of both, but lately I've been feeling pretty pathetic. Now, remember, this blog is for me. So, when I post this list - a list of why I'm feeling pathetic at this particular moment - don't freak out and call my husband or parents. I'm fine - just in a funk.

1. I feel like a crummy wife.
2. I'm crabby a lot of the time.
3. I let little things bother me.
4. I have an amazing husband who takes such good care of me and sometimes I treat him poorly.
5. I feel like some of my friends put zero effort into our friendships.
6. I feel selfish that I want to make a lot of money.
7. I want kids but am terrified that I will be a crazy parent.
8. I worry about saving money but don't want to make the sacrifices required to really save.
9. I feel like crap when people call me bossy (which I am) and I don't know how to change that.
10. I'm scared about my depression and how that will affect me if/when I get pregnant.
11. I am tired - physically and mentally.
12. Sometimes I don't know why my husband stays with me.
13. I suck at life because I gossip too much.
14. It scares me to think that we might live in CS all our lives.
15. It hurts me to know that my husband isn't always compensated/acknowledged for what he does at work.
16. I hate that I can't leave work at work.
17. I'm pissed that my husband didn't like his birthday present when I thought that he would really appreciate it.
18. I feel like I have to put forth extra effort to smile and I feel fake when I do it.
19. I feel like I can't talk about my depression with my husband because he feels that it is a reflection of my feelings for him.
20. I just want to feel happy.

Now remember, this is a list for me. It just feels better to write it down.

It's all just trial and error...

I'm at a Head and Neck Cancer convention this weekend in Houston and I've quickly come to the realization that a whole lot of what we (SLPs) do is trial and error, especially in the head and neck cancer population. Granted, I am learning a lot, but I am also learning that I've been doing a really good job at teaching myself how to treat these patients (not to toot my own horn, mind you).

I think that, even more important than the material you are taught, if you are taught how to find information you can figure out how to treat almost any patient population. Now, what I'm saying isn't rocket science or a brand new theory, but I think that people should know that it can be done with the information you already have.

Ok, I know this doesn't have much content, but for all my SLP readers (yes, I know I only have a few), I think you should know that you've got what it takes to help your patients even if you think you don't.

I just can't seem to find the words...

I just can't seem to find the words these days to Blog about my work experiences. Whenever I see my patients I'm always thinking "I need to blog about this." but then never do. I need to start back up; it's good for me, it's good for my mind, and I really do enjoy it. So, enough with the pep talk and on to business.

I have been seeing a certain patient for quite a long time now. He has been hospitalized since January and currently resides in our LTAC. This man celebrated his 84th birthday in a hospital bed, which he will probably never leave. I think the one thing that makes treating this man so hard is that his mind is still so sharp. He is up to date on current events and has the quickest, funniest, wit.

I have been treating this man's dysphagia since he entered the hospital for a ruptured appendix (I know, weird combination - appendicitis and dysphagia). But, he has not gotten even the slightest bit better. I have been using VitalStim therapy on him and just recently forced myself to stop. He is still on a feeding tube and cannot take even the smallest bit of PO intake without sounding like a gurgle fish tank. IT JUST MAKES ME SO MAD! I love this little man and I cannot help him.

The other day, I had to have "the talk" with him. It's the talk that I am so good at giving but is truly terrible to give. It's the "your swallowing will never get better so you can now choose to eat and die or never eat again and live" talk. HATE IT! Anyway, my little man made it so hard to give that talk; his mind so clear and his wit so fast. And do you know what he said to me when I finished that talk? "So, should I call you the Obama death squad?!?"

Now that I cannot keep treating this man, I can barely stand to walk past his room. I know that if I enter just to say "hi" he'll ask when we're starting therapy again. I know I should go in, but it is just so hard. What do you do when you know you can't help someone?