Day one.
After wrestling my toddler into her dress, inhaling my jar of overnight oats, and kissing my wife goodbye, I’m out the door and on my way to my inpatient rehab facility. I’ve been an SLP for nearly 10 years now and I’ve reached the point in my career where I’m almost on autopilot. I’ve done a little bit of everything; K-12 school SLP, acute care, outpatient, inpatient rehab, led a brain injury team, trained and sold AAC devices, worked out of state, did in home consults. Everything. I grew the most as a clinician working in the Central West End in St. Louis on a brain injury unit for many years. For a while, every day way chaos. Then, after a while, the chaos became everyday. And then everyday seemed ordinary. Occasionally things would surprise me but eventually I grew comfortable with this patient population. Covid happened. Covid sucked. I took some time off, and now I’m back to my safe spot.
The joke I’ve made (that I’m sure annoys some of my type A coworkers) is “if you can eat and talk, you’re good.” Speech therapy is a spectrum and everyone needs our help. However, I have found that I get the biggest sense of accomplishment and joy working with the most severe, complex types of patients. The patients that make me stop in the doorway of their room and think, “shit, what do I do?” My most memorable patient ever fell off a roof six years ago right on his face. When I met him, he couldn’t talk, walk, eat, or see. On his last day, we walked to Chik-Fil-A, he ordered a sandwich, and we got to have lunch together. Those are my favorite cases.
Today I got to work, literally five minutes before my first appointment. I was off yesterday so I didn’t know who I was working with. Within minutes I was gloved up, walking with a graduate student into a patient’s room to perform an instrumental swallow evaluation. This patient hadn’t had a bite to eat since November and was long overdue. After a few persistent texts to his neurologist, I got the green light to try and advance his diet. I haven’t had a student in a few years and it was great chatting with her and teaching her about flexible endoscopy. Good news - the patient was able to advance his diet! Hot take: I don’t believe that you can “pass” or “fail” a swallow assessment. It’s truly just a snapshot of what they’re able to do and how to plan accordingly you treatment approach.
Many rounds of hand hygiene later I was on to the rest of my caseload for the day. In the span of 6 hours, I got the chance to work with a patient with a total laryngectomy (and started her on the road to her very own augmentative communication device!), a grandmother that survived a massive stroke (she swallowed an ice chip for the first time with me today), and a guy with aphasia who was recovery after a rollover car accident. Every patient was different; every patient had a life before getting a very stylish hospital bracelet and being our guest for an unknown amount of time. Some are going home with family. Others, to a new, different facility. Some, who really knows. But while their name pops up on my EMR, I get to hang out with them for 30-60 mins a day. We work on everyday skills; communicating, eating, making jokes, learning about their lives. A few years ago, I was really burnt out on the field. Now I’m back - at first begrudgingly, but now happily. I enjoy the work and I’m excited to use a little part of my brain to help other people that are going through the worst time in their lives. My plan is to share stories, share resources, and to make life a little easier for whoever stumbles across this corner of the internet.