★ On getting over "the ick factor"

Acute care is not for the faint of heart. In graduate school, I was forever repulsed by the things I was sure one encountered working in a medical setting. "Imagine the smells," I would say to friends in class. "And bodily fluids, ugh."

During my interview for an externship placement at a skilled nursing facility, I even went so far as to ask my would-be supervisor how she dealt with "the ick factor". Fortunately, she had a great sense of humor and took my aversion in stride. So much so, in fact, that I left that externship inspired to pursue medical speech pathology full time.

In the end, I made it on my own. Sure it took getting used to, and though two years later I have a considerably higher tolerance for these things than I used to, there's still times when I encounter unpleasantness. It comes with the territory.

My secret now? There is no secret. I just deal with it.

My secret when I was an extern? Tic Tacs.

I kept some in my pocket to use as needed. You'd be amazed how well a good mint can also overwhelm the ol’ olfactory nerve.

And give yourself time. Before long, you won't think twice about all those things you perseveratively feared. If the patients win you over like they did me, you'll be amazed at what you can get used to.

Trust me.

★ Coffee, My Foot

Sometimes this job is interesting in spite of the work itself. Take the following sequence of events that happened to me while I was covering the weekend shift last week:

  • family member spills hot coffee on my foot
  • coffee soaks through shoe and sock, and oh it burns
  • family member says "oh it shouldn't be hot because I put a bit of tap water in it"
  • family member accuses me of low pain tolerance
  • I exit briefly to remove sock, cool foot, and replace sock with hospital gripper sock
  • I conclude evaluation
  • family member asks if I'm a registered democrat
  • I decline to state one way or another
  • family member tries to get me to sign petition so they can run for public office

I wish I was making this up. I wish I didn't have to explain to that person that the discussion should be around patient care only. I wish I could have at least gotten an apology for spilling hot coffee on my foot.

Luckily, I took good care of my foot so it's doing just fine.

★ It's Probably the Weather

Conversation I had in the not-so-distant past with a patient who I thought would be amenable to therapy:

Phil: So how long have you lived here?
Patient: Too long. I have to get out of here.
Phil: Oh? You don't like it anymore?
Patient: Nope. I've had pneumonia four times in the last five months. This weather is killing me.

The pneumonia was actually aspiration-related, and was evidently recurrent. Given how cognizant this patient was, overall, I suspected even that it was primarily silent aspiration. Short of the recurrence of illness, as well as the associated deep, wet cough, this patient had managed to fly under the radar of bedside swallow studies for quite some time.

Rapport was established easily, and I enjoyed the initial eval and first session. By the second session, however, the patient was extremely upset with me. I had referred the patient for a video swallow study, as I needed further information in order to see how further therapy should proceed.

The patient felt everything was fine, and became increasingly agitated with each passing session, to the point that the video swallow study appointment had to be cancelled due to abject refusal, and the patient sought discharge from the facility by the end of the week.

I had spent the week wracking my brain, trying to figure out how to convince this patient that this problem would not go away. I took it very personally that the patient would not cooperate.

It wasn't until well after the fact, post-discharge, that I was finally able to let go. It's easy to forget sometimes that despite all we do, people have the ability, and the right, to make choices about their life.

To my patient, eating was important, and acknowledging that there was a problem was simply not an option. It could be said that blaming the weather was this patient's form of denial, and it might be true. As I've thought it over, with each passing month, I've taken it to mean something different. Perhaps this patient wanted to remain as active as possible, and considered any form of therapy to be something that stood in the way. Perhaps it was fatigue. It could be anything, but in the end, it matters little.

Some patients appreciate what we have to offer, and others may not. It takes time to realize we can't be everything to everyone, and that's okay. The best we can do is to reach out to one and all, and hope that they reach back.

★ Lost For Words

Sometimes you can't help but get attached to the patients you work with. It's only normal, I guess, when you work 4-5 days out of the week with them. But then sometimes they don't get better. They start on a new treatment that worsens their already compromised health, and causes your recent therapy breakthroughs to regress in an instant. And then you hear them say things things like:

"Oh, man, I feel like I'm dying."

And your heart breaks in that moment because you know, deep down, that they're probably right.