★ And now for something completely different.

It’s been over one year since I last wrote here. In that time, I have experienced joy, sadness, exhiliration, exhaustion, and more, some in greater amounts than others. As seems to be common among medical SLPs, I have ended up on the wrong side of burnout. I’ve been working in acute care for going on five years, and it’s finally worn me out.

In this process, I’ve begun exploring new areas and trying new things. After years of talking about it, I’ve finally worked up the courage and the confidence to start developing my own niche. I’ve long wanted to work with adults with hearing loss, in many areas of their communication and swallowing needs, but I wanted first to have the experience working in my native language before doing so in my second language.

In order to pursue this new goal, I have left the hospital I’ve called home for the past three years and am in the process of getting set up at an outpatient clinic. The outpatient world is vastly different from inpatient, and though the paperwork and billing are daunting, I am very excited to be making this change. It’s taken a long time to get here, and I aim to do it right.

The hardest part of such a big change is figuring out where to start. Starting fresh is both exciting and terrifying; it’s amazing how comfortable you can get in one situation, and how hard it is, while in it, to imagine being anywhere else. As I think about how challenging this change is for me, I am reminded of many of my patients, who had no say in the sudden and dramatic changes which confronted them. Their resilience and determination inspire me. I have many ideas, and have slowly been collecting my thoughts, organizing them, and discussing them with colleagues.

Writing has long been something that brings enjoyment, and this website has always been a nice side project to work on. For the past year, I have been too exhausted to put any effort into side projects, and I have even found little energy for continuing education, which I value greatly. The questions have been there, but the energy to pursue them has not. Coming to this realization was helpful in accepting that the time for change is now.

So much is uncertain right now, though in time I know I will gain renewed confidence and vigor. For now, I will be working diligently to meet new goals which have me excited about the work I do. I will find new questions to ask, new things I want to learn, new challenges to overcome.

The unfamiliarity of my new world has left me with a drive I thought was lost. And yet, I still impatiently wait for things to be familiar once again.

★ Making it a point to live.

In light of the recent news out of Newtown, I've been thinking a lot about what it means to be alive. My department had a holiday party last Saturday, and I brought my camera along for the occasion. I uploaded the photos to my computer today, and looking at them made me realize something: I love the people I work with, and I love that an excuse for a group dinner was filled with so much life. Even in those moments, I didn't realize how much fun everyone was having. It took me removing myself for a bit and looking at life through the lens of a camera to really make it clear to me.

Plates, wine glasses, strings of lights, silverware. All served as the backdrop for a scene now just a memory. It was my first time wielding my camera in front of a group of people, and my first time using it to really capture moments in time. The graininess of the shots bother me less than I imagined they would; I like the way it reminds me of what it felt like to be there. I like how the colors of clothes are changed by the soft lighting. I like seeing pictures of people laughing, or thinking, or clearly lost in thought or in conversation. I like these things more than simple smiles into the camera, because nothing was paused for the sake of a snapshot.

I see these moments and I cherish them. I think of the children whose lives were taken from them, and it takes my breath away. My heart goes out to all those touched by this tragedy.

★ Some Words About Performance

I had my first annual performance evaluation at work a few weeks ago. In nearly every way, it was good. It was very constructive, and I got ideas for what I can do, and genuine goals to work toward, from people who care about my professional growth. It’s a foreign feeling, previously coming from a place that valued only the ‘product’ (service) I provided and cared little about the quality. Still, the perfectionist in me struggles. And I just have to smack that guy down, because he’s anything but helpful.

  • The perfectionist sees suggestions and critiques as flaws, rather than seeing the potential.
  • The perfectionist gets down on himself for not knowing more, rather than acknowledging that everything takes time.
  • The perfectionist wants to be awesome now, rather than accepting that the only way to get awesome is to start at the beginning and work hard to reach new heights.
  • The perfectionist wants to be good at everything right away, instead of focusing on 1-2 things at a time and really honing those skills before moving on.

I have to remind myself that I’m still only just beginning. I have to tell myself that, in time, things will truly ‘click’ and I will come into my own. In the meantime, I have to keep myself from being my own worst critic, embrace the journey, and cherish the little victories.

★ On Making Strides

One of the great things about the field of speech-language pathology, and incidentally one of its biggest challenges, is that you never really stop learning. Just when you think you've gotten the hang of something, a new idea or presentation comes along that turns your understanding on its head and makes you rethink just about everything. This is always a good thing, but that doesn't mean it isn't frustrating. I've been following my own learning path with video swallow studies. I had minimal exposure during my CF, and at that they weren't even proper fluoro, so when I took this position I asked that I be retrained so I could learn "from the ground up" to do them well. My learning curve has gone roughly as follows:

  • Observe the process and work with supervisor to interpret results.
  • Learn procedure and setup, as well as progression of studies.
  • Start to perform studies with supervision, and notice that they're agonizingly slow when you do them.
  • Notice that you gradually start to get the hang of things.
  • Feel comfortable going through the motions, and starting to also catch more instances of penetration and aspiration.
  • Realize that there's more to swallowing than those two favorite things.
  • As you start to observe the "bigger picture" of swallowing, realize that you're slipping in terms of efficiency.
  • Work to integrate knowledge of swallowing function into study to make for more complete evaluation.

I have had to remind myself in recent weeks that this is perfectly normal. It helps to lay it out as I have above, to really see the trajectory and remind myself that I am, indeed, making progress. I had found I was getting down on myself for things that, when I look at them this way, are not actually issues. As my supervisor said very well, "We've all been there".

When she said that, it made me think back to my days learning ASL and on the road to becoming an interpreter. I've been an interpreter for going on six years now, and realize now just how far I've come.

I was thinking about learning my second language. It dawned on me that as I was learning, I would take things in, acknowledge them, and try to incorporate it into my use of the language. I could go through the motions, but I didn't really *get it*. After some time (days, week, or even months later), it would suddenly click, and I would find myself actually *over*using it. Eventually, I would tone it down as it fully sank in and use it appropriately.

With regard to my clinical skills as an SLP, and to video swallow studies in this case, I'm still in the middle of this process. Nothing happens overnight. I think back to nearly one year ago, at the ASHA Convention in San Diego last year, and conversations I had with Tiffani Wallace from Dysphagia Ramblings. She helped me rethink my perspective, encouraged me to keep going out and doing and re-learning. Nearly one year later, I realize that I *have* made progress. I'm on the right track. I keep challenging what I think I know, and when I don't, a new patient puts me in check to keep thinking critically.

It's a process. A difficult one with an enormous learning curve, but one that is very much worth the time and effort. I can only imagine where I'll be in another year.

★ Extra Xtra: Why some "entertaining" videos may do more harm than good.

Perhaps it's the result of being bi-professional, but I have developed a pet peeve regarding the use of a tool called xtranormal to portray what our professional lives are like. Every so often I receive an email, or read a facebook post or tweet, with a link to a video about "how true" some video is about life as an educational interpreter, community interpreter, educational speech pathologist, medical speech pathologist, etc. After seeing them enough times, I recognized a pattern:

  1. Introduce two parties in an "Us vs. Them" situation.
  2. Create dialogue regarding a specific problem or question common to a duty or knowledge.
  3. Portray the "Us" profession positively while simultaneously denigrating the "Them" profession.
  4. Carry on for 1-2 minutes in this fashion.

I have seen videos that portrayed teachers as unable to figure out that a deaf student is asking to use the restroom. I've seen others that suggest nurses are inflexible and know nothing about swallowing disorders, or outright refuse to let SLPs do their jobs. Pick your issue: use of thickened liquids, instrumental assessments, language or cognitive disorders, stuttering. Chances are there is a video of it out there, festering with frustration and negativity.

Are these videos cathartic? Perhaps. I am not suggesting our professional lives are a picnic. I really have had people ask me if my deaf client reads Braille, or is he able to drive. Not too long ago, I had to get a patient a new trach because his nurse washed the inner cannula with tap water. These things happen.

What all these videos have in common, though, is that they foster stereotypes. Often, the maker describes it as "based on an actual event", only instead of offering up a title that clearly defines it as a solitary incident, it is branded as defining ALL TEACHERS/EAs/NURSES EVER.

What is fundamentally wrong, though, is that we are not in competition with any of these people. We are meant to work as a team, and teams only get stronger when we don't work against one another. It isn't about proving you know more about something than the people you have to work with. It's about sharing your knowledge thoughtfully and being open about explaining what your goals are and what you have to offer.

By all means, please vent your frustrations when you have them. They are legitimate, and I will be right there to hear you out. But please be courteous and respectful. And please, when you come across these videos, challenge the negativity they foster, and know that we--as individuals and a community of professionals--are better than that.