A few years ago, my late father-in-law put an idea into my head that I have recently considered going forward with. As I was finishing up graduate school in speech-language pathology, I use to tell him stories about the people I worked with...about their histories and progress in therapy, big events that happened in or out of therapy that were worth celebrating, the good and the bad stories about prognosis, and my own adventure of becoming a skilled clinician. He encouraged me to write a book about all my experiences, but I just brushed it off like "Who would want to know about my stories?" Since finishing graduate school, I have been practicing for three and a half years and a lot of things have happened or a lot of interesting cases have come my way that are worth documenting, even if only for myself to look back upon. Instead of writing a book (at least for now), I have decided to start a blog to document when things come up.
To start off, I want to provide a background of how I got myself into this awesome career field. When I was a kid, my younger sister was diagnosed with a unilateral moderate-to-profound hearing loss. The audiologist pretty much told my parents there was nothing they could do for her since she had one ear that was fully functional for developing speech and language skills and communicating in her environment. She received speech therapy services to correct some of her articulation errors which were eventually discontinued and she participated fully in mainstream, general education classes. When she was younger, she struggled with having good grades and attending to the teacher and her peers during classroom discussions. Since then, she has learned strategies to improve communication, mostly receptively, such as positioning herself in a location where she can use her "good" ear with her communication partners, using captioning for television/movies, and utilizing volume control when possible. She ended up graduating high school with honors and going to college part-time. Because of this, I always wondered if this congenital hearing loss would occur in my nieces/nephews, or my own children....and what if the loss was bilateral? How would that child learn to communicate? Would that child end up having the success of my sister?
While I was working on my bachelor's degree, I became a certified nursing assistant (CNA). This is just a glorified title for probably one of the most disgusting jobs in the healthcare industry. CNAs are the eyes, nose, and ears of nursing; they are the first to see, small, or hear when abnormalities come up in patients. I was unable to find a staff job at the local hospitals or nursing homes because of my fluctuating schedule as a student, so I became employed with a contract company. Through the company, I had the opportunity to work in many different settings and with a variety of patients. I saw some of the worst things about healthcare in these situations. I saw staff that did just enough of their job to get by and not get fired, but not even close to what was in the best interest for the patients. I saw patients who were left unattended for hours at a time and call lights that were completely ignored because the staff was tired of responding to that patient. One common theme that I noticed was there were patients that were unable to communicate their basic needs. When I asked the staff why the patient was in this state, I was told that the patient had a stroke or multiple strokes and never received therapy to get those skills back. When I did more research about why these patients had not received appropriate rehabilitation, the response was there is a shortage in the field and too many patients to be given adequate amounts of therapy. That was it! I had to help out this shortage and become a speech-language pathologist!
As part of my undergraduate degree, I was required to take a foreign language. The University of Florida (Go Gators!) offers many different languages, but because of my sister's hearing loss, I was attracted to American Sign Language. I signed up to be on the waiting list my freshman year and finally got registered for the class my senior year. I took ASL 1 and 2 and passed both classes with A's, but left feeling like I could not even hold a conversation in the language. When I graduated, I moved home for the summer and worked as a server at a fine dining Italian restaurant. There were two Deaf employees at the restaurant that I could practice my newly learned skills with. By all means, even after a summer of daily interaction, I still had no confidence in my ability to communicate with other members of the Deaf community.
I started graduate school at the University of Florida in the department of Communications Sciences and Disorders the next fall. Our program had about 20 students and we were set on a track of classes to take all together and complete the program in a little less than two years. During each semester, we were to select which practicum site so we could get some hands-on experience in the field. My first semester, I was enrolled in "Developmental Disabilities" where we learned about cerebral palsy, a variety of syndromes, and we touched on autism. My first client was a 5-year-old boy who was diagnosed with cerebral palsy who was suspected to have a speech and language delays. I was given some guidance, and then I was expected to complete a full evaluation, write up the report, and make recommendations for therapy. WHAT?! How was I supposed to know what I was doing? I was barely into graduate school and had only learned the basics of the foundations for language and some of the disabilities. I was very nervous, but go through it. The little boy had no idea when I didn't go in the right order or had to go back and repeat things when I didn't do them right the first time. I started up a therapy plan, discussed it with the parents, and agreed to one-on-one therapy (with supervision from the clinic supervisor) twice a week.
A couple weeks later, the clinic supervisor emailed all of us in the program about a new client that would be coming to our clinic. She described him as a non-traditional student with bilateral, profound hearing loss who uses ASL to communicate and wants to practice on his spoken language skills. I was immediately interested not only to learn how to do therapy in this manner, but to continue with my use of ASL because as you know "if you don't use it, you lose it!" I responded saying that I wouldn't mind taking on another client (most of my classmates had at least two clients at the time) and asked when we could start. With the rule of new clinicians needing supervision 100% of the time for the first 10 hours, and with my supervisor having 3 new clinicians, she asked that we wait until we all had our 10 hours until we initiated services with the new client. I got the client's email address, introduced myself and explained that we would be able to start working together in the next few weeks.
Over the course of those weeks before he started coming to therapy, I had asked some basic questions via email. He was a student commuting from a town about 30 minutes away majoring in finance. He worked part-time near his home and was only on campus two days a week. At that time, when I heard the term "non-traditional student", I thought of someone who entered a career field in the past and has recently changed careers and went back to school. So, when the day finally arrived and we were going to start services, my supervisor had agreed to a trial period to see if it was worth any of our time. She had never worked with a Deaf person before, so this was uncharted territory for her and she was unable to provide me specific recommendations for therapy. I was nervous with using a language that I had no confidence in, but luckily his interpreter would be joining us today to help with communicating. When the time came, I walked up and down the hallway of the clinic, taking care of things, but really just keeping an eye out for an unfamiliar client....my new client. Then, in walks a young, good-looking guy who I did not recognize and I asked in my awkward, slow signs "Are you Martin?" somewhat hoping it was not him. When he replied "yes", I gestured to for him to follow me to the room that was set up for us to work. Now, not only am I nervous about using this language, but this guy is my age and good looking! NOT FAIR!
We ended up working together for the remainder of that semester (finally getting started at the end of October) and I requested to continue working with him the following semester, even though I was given a different practicum assignment. We had finally gotten into the swing of things and were making progress so I wasn't ready to interrupt that and pass him on to one of my classmates, who most were unfamiliar with ASL and had as much knowledge of therapy ideas as I did when we first started. I was learning how to use Visi-Pitch and utilize my knowledge from phonetic class about voice, place, and manner to help with production of each sound. I encouraged my client (Martin) to get hearing aids to help monitor his own productions. When the spring semester concluded, it was time for my classmates to have the opportunity to learn how to do therapy like this.
By this time, I had developed a nice relationship with Martin; we emailed back and forth weekly with therapy follow-up activities and feedback about the sessions. I could tell he was a genuinely nice person who was ambitious, motivated, and of course, good looking! I thought about trying to set him up with some of my friends, but no one would be able to communicate with him, so that didn't work out. When we stopped seeing each other in the clinic, we began to meet up as friends. We would meet up at the campus gym and take turns using machines and encouraging each other to do more reps. We would save each other a computer or table space in the labs on campus to do homework or study. Sometimes we would eat at the Plaza of Americas on campus for the $3 lunch from the Hare Krishnas. Eventually we became more than friends and decided to take our relationship to the next step. This was a whole new world for me; I was learning more about Deaf culture and improving in my skill of communicating through ASL. Things got serious and we started discussing plans after graduation. He mentioned he had always wanted to live in the Washington DC area. At that time, one of my college roommates from undergrad was living in DC attending Gallaudet University for their audiology program. I grew up and went to college within a 60 mile radius and yearned for more life experience. Six weeks after getting my master's degree, we packed up everything we owned and moved in together in an apartment in Silver Spring, Maryland. One year later, we eloped to Las Vegas with 15 of our closest family and friends to celebrate our marriage in front of God and Elvis! Two and a half years later, neither one of us have looked back!
During Graudate School, I was convinced that I wanted to help those people in hospitals and skilled nursing facilities so that's where I invested all my time for practicum. I got the opportunity to get some hands-on experience in an in-patient rehabilitation hospital and with acute care patients in a hospital plus some experience with modified barium swallow studies. After I got more knowledge about the Deaf community, this area sparked my interest as a clinician. I wanted to work with Deaf children in their development of communication skills so I got the opportunity to do my final internship at the National Deaf Academy in Mt. Dora, Florida. I worked in their "special needs" classroom with children who were "deaf plus" or autistic with severe communication delays. While this was a great learning experience, I wasn't convinced this was my calling.
After graduation, we moved to Maryland and I started working during ESY (extended school year) in a middle school within a self-contained classroom for students with autism. I had not prepared myself for this at all! Talk about learning on the job...I had to quickly learn how to respond when these students had "episodes" or "breakdowns". I had to learn how to present the chronological age-appropriate information in manner that was instructionally appropriate for them. Once I finally got the swing of things, the four week session was over.
In the fall, I started working in a comprehensive special education program within an elementary school. This was more my "thing". I got to work on language and articulation skills and learn how to collaborate with teachers. One big thing was that the previous SLP had left all the files a complete mess. There were many students' files "out of compliance" and testing that needed to be done yesterday. By the end of my first year, things were finally at a place that we would not be scolded by the state and goals and services were written appropriately to match the students' needs. I requested not to be transferred to another school because I knew the beginning of the next year would have a clean start.
That summer I got the opportunity to work in Los Angeles Unified School District doing compensatory services from 9am to noon, Monday through Friday. Perfect! My company paid all the expenses for travel, rental car, and lodging and I went to work in the morning and hit the pool or beach each afternoon. That was the summer we decided to drive to Las Vegas and get married. Talk about fun!
About one week after we returned from California, I got a frantic phone call from my mother reporting that my "Momaw" (maternal grandmother) had just had a massive stroke and was being admitted to the hospital. I initially freaked out and became very concerned about her. I was out of school for the next week (luckily) so I purchased plane tickets to be with my family for the next week. My Momaw was unable to speak, move the entire right side of her body, or swallow. After some work with her, I could tell her receptive language skills were mostly intact and her cognitive skills too. She was stuck in her body that could not move, swallow, or communicate! As a contribution to the family, I spent an entire day driving around to local skilled nursing facilities (SNF) trying to find a place that met my standards (and would take care of my Momaw in the way I knew was appropriate). After 10 days in the hospital, she was discharged to the SNF where she spent the next 6 weeks making a miraculous recovery by doing daily rehabilitation with physical therapists, occupational therapists, and speech therapists. To this day, she has made almost a 90% recovery to her prior level of functioning and is the success story I tell to all my patients. After this happened, I decided I wanted to give back to the whole reason I got into this field, and I do PRN work at an SLP in an in-patient rehabilitation hospital and a SNF.
When the regular school year started in August, I was back at my school, getting back to work with the same students I had the previous year. About one month into school, I got a phone call requesting me to work at another school with a Deaf and Hard of Hearing program in addition to the school I was currently working. I had a caseload of about 50 students and they wanted me to add on about 20 more students with the same resources and amount of time. If it had been any other program, I don't think I would have agreed to it, but I was happy to get my foot in the door with working in the DHH program. I finished up the school year splitting myself between the two schools and I worked ESY full-time with the DHH program.
For the next school year, I requested to be full time with the program. I like the students and the people I worked with; I have been there full time ever since. I have faced some situations where I have questioned my ethics and have done a TON of learning in the field, in the classrooms, and even learning while doing therapy. I'm happy where I'm at and I look forward to continuously learning more about the specialty area of speech-language pathology.
I hope to post more blogs as interesting things happen in my career. More to come...
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