Heathcare: The Highs and Lows

Speech Language Pathology stories
Being a Speech-Language Pathologist Has Written Inescapable Words On My heart
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Working in healthcare has always been equal parts heartbreak and hope. Every time you step into your work shoes and start the day, you do so knowing that you have no idea what to expect. Healthcare is hard for the same reasons that it’s wonderful. Each and every patient is, and always will be, a person. Not a number. Not a statistic. A human that has a history, a family, and dreams for the future. Even the ones that feel like there is no future left for them. They had dreams, before they needed you.

My first big reward moment came while I was still in college, studying Speech-Language Pathology. In the shortened semester between our first and second year, my master’s program ran a summer day camp clinic for kids with a higher need for intervention.

I’ll be honest, I’ve never wanted to work with kids. Even before starting school, I knew I would focus on adult healthcare in my career. So, when I was assigned to the preschool classroom with the hardest supervisor, I knew it would be a long summer. We ran the sessions like half-day classes, with 1-2 patients per clinician. My morning class student was a little boy with a chromosome malformation that impacted his hearing, speech, and overall motor function. At around 5 or 6 years old, he hadn’t yet said a word. He’d had several significant surgeries during the prior school year, for both his hearing and his jaw mobility, and was just starting to make verbal sounds.

His mother was a single mom balancing a career and her child’s many appointments. To this day, I remember her face. No matter how busy, tired, or stressed she was, every single day when she came to pick him up she had nothing but this shining love bursting out of a wide smile and open arms. I think about how easy it would be to fold under those circumstances. To feel bitter and defeated and frustrated and isolated. To allow yourself to be weighed down by the many pieces to juggle to make sure your child has the best life. To fight for his rights and opportunities, all alone. Maybe she did feel that way, sometimes. But the only thing I ever saw from her was how much she loved her child, and how grateful she was to have him. That love and security was so obvious in his behavior, too. He was curious, and sweet, and had a ready smile that melted even my adult-focused heart. He wasn’t scared of anything, and with me by his side we explored the playground, learning to interact with the more mobile kids running around.

We worked with a combination of communication modalities. There was a mix of augmentative communication with a speaking icon board, broad American Sign Language use, and encouraging the verbal speech he was becoming stimulable to.

It was just a few short weeks before the camp was set to end when it happened. We’d been making our usual rounds, modeling ‘hi’ and giving big cheery waves to the other kids as we passed them on the playground. They almost always stopped and practiced the social greeting back. One kid, whose bright red hair and exuberant energy had always been especially exciting to my client, stopped and said, “Hi!” back, loud and eager.

My client opened his mouth, took a deep breath… and said it back. His eyes got wide. My eyes got wide. The little red-haired kid laughed and clapped and went back to playing. We said ‘hi’ at least twenty more times that morning, every time celebrating as if he’d won the lottery.

In a way, I had won the lottery. I was the clinician lucky enough to be there when his mom heard her school-aged old son say his first word. Ever. She didn’t know it yet, as she walked up to pick him up. She came up the sidewalk to the gathering area ready for the daily report from me. As she always did, she gave him a big hug. I knelt next to them and prompted him the exact same way I’d been practicing with him all summer. He turned to her, opened his mouth, and said perfectly clearly, “Hi!”

She whooped, picked him up and spun him around, tears streaming down her face as she said it back.

If only every emotional moment that drives you on in healthcare were like that. When I think of that moment, standing in the hot summer sun and watching their faces as they spun, I still tear up. Throughout my decade-long career, there have been many moments that shook my soul, grew me as a person, and left me in tears. Often, the moments that live on with the sharp flood of emotion are the hardest ones.

I was in my third year as a speech therapist in a skilled nursing center when I met my patient. He was a sweet, gentle man with many grandchildren, and a deep love of seafood. He’d come to us after a moderate stroke that impacted his swallowing as well as his walking and ability to complete self-care that utilized fine motor skills, such as dressing. He was old, but he wasn’t that old. There was still gas in that tank. Still plans he had made.

I spent an hour a day with him, for weeks, working on his swallowing safety. During that time, his alternative feeding method, or PEG tube, became clogged and needed to be surgically fixed. When he was in the hospital for that procedure, he contracted C-diff, a highly contagious super-bug that causes diarrhea. He lost weight quickly. We worked hard to get back to eating solids, in the hopes that he would be able to maintain and then regain weight. During our sessions, we spent a lot of time talking about what he wished his first real meal would be.

He wanted fried catfish.

The big day arrived. He went out to the hospital for a Modified Barium Swallow Study to test his safety for returning to oral intake.

He didn’t pass. Between the stroke and the significant muscle mass loss from the infection, he didn’t have the strength to clear the food and liquids well enough to keep his lungs safe. He would have to remain on the PEG tube, likely until he could kick the C-diff infection. He kept losing weight.

Then, the day of his death came. I was providing a trial meal to a patient in the room next to his, around 7:45am. It was a wet day, and everybody’s shoes were squeaking as they walked down the tile halls. I heard a nurse gowning up to go into his room. She was loudly calling his name. My patient was getting distracted, placing her at a choking risk, so I closed the door.

A few minutes later, the intercom called a code blue. The female patient I was treating was chewing her food, happy to have something that required actual chewing. She was chatting with me about her children between bites. I remember responding politely, mechanically assessing her safety. Behind my calm demeanor, I was monitoring the squeal of shoes as they skidded to a halt in the hallway outside. I remember the tightness of my jaw, and the flare of my nostrils as I struggled to keep focused. I had to finish my session with my current patient, whose age and hard of hearing status kept her safe from the chaos happening behind her closed door.

Through the too-thin walls, the sounds of chest compressions and the wail of the approaching ambulance were inescapable. I cleared my patient’s meal tray with shaking hands and reviewed with her, her personalized safe eating strategies in my careful, steady voice. Behind me, I could hear the time of death being called.

As soon as I left the room, I shoved the breakfast tray on the rack and briskly walked to the nearest staff bathroom. I crouched in the corner, careful to keep my back and butt off the floor and walls. Crunched into a germ-free ball, I sobbed for the two minutes I had before it was time to pull myself together. There’s always another scheduled patient waiting.

Now, seven full years later, I don’t remember his name. But I remember his face, before all of the weight loss. And I think about the sounds of the chest compressions every time I see catfish on a menu.

These are two of many stories I carry with me in my heart. They are the moments that remind me to be more kind and more grateful than I feel like. I expect that one day I will be 80 years old, pacing, struggling to remember what year it is, and why I am where I am. But I will remember these moments still.

Healthcare has always been the sort of job that you can’t leave even when you’ve left for the day. It will always be moments connected by heartbreak and hope, slowly being strung together to create a lifeline of scarred hearts doing the best they can, with what they have.

 

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