Tuesday, June 15, 2021

Mysterious muse-y projects

O for a Muse of words, that would exclaim

The loudest phrases of invention,

A hospital for a website, doctors to act

And nurses to behold the healing scene!

That should the speechie Muses, like themselves

Assist their patients in their thinking, speech,

And swallow.  Pardon us, and gentles all,

The flat unraised doodles that have dared

On this unworthy scaffold to bring forth

So great an object:  can this blank page hold

The vasty halls of healing?  Or may we cram

Within this code-based square the very masks

That did affright the hospital’s wide halls?

O, Pardon!  Since a crooked figure may

Attest a little place a truer story;

And let us, in attempt to show and tell,

On your imaginary forces work.

Suppose within the girdle of this screen

Are now confined three mighty SLPs

Whose words of positivity and truth

Empower patients to communicate,

Embracing imperfections to make progress;

Swallowing their meal with careful pace.

Think when we talk of patients, that you see them

Taking their proud steps safely in the gym;

For ’tis your thoughts that now must deck our Muses,

Evaluating swallows, testing language,

Turning the accomplishment of many years

Into a project:  for the which supply,

Admit me Chorus to this history;

Who prologue-like your humble patience pray,

Gently to hear, kindly to judge, our play.


(Most of the above words borrowed from the ever obliging William Shakespeare)


All this to say the Muses have some big projects in the works!  They’ve decided to step back for a moment from musing on this website.  Their adventures will still appear time to time on our Instagram @speakingwithkiki.  And when they’ve made more progress on their projects, they’ll be sure to update here on the Speaking with Kiki website.


In the meantime, feel free to browse the SLP freebies and the archives and the Writing page, which I am updating with new publications.  Thanks so much for supporting the Muses!


~Aoide, Mneme, and Melete (Muses of Speech, Thinking, and Swallowing Therapy)

Saturday, May 15, 2021

On anger


“I heard what you recommend, and I want you to know I’m not doing any of that.  Ever.”

“This is stupid.  YOU are stupid!”

“You are the problem with the entire medical system in this nation.”

“I won’t be doing any therapy today, so don’t waste your time.”

“I hate you!”


Rehab is hard work.  Just when the body’s natural desire is to rest, patients are asked to participate in several hours of therapy a day—to take advantage of the spontaneous recovery of brain and body to retrain them in a positive way.  It’s hard! 


And it’s frustrating.  Many patients are used to doing things on their own, and now they are asked to take annoying precautions like calling for help to get up (to prevent future falls), or swallowing one little sip at a time (instead of choking or aspirating).


A lot of patients feel deep resentment toward their new situation.  And it’s completely understandable!  They didn’t ask to suddenly acquire physical and/or cognitive disabilities.  They certainly didn’t ask to experience swallowing trouble. 


Sometimes, patients take their anger out on whoever happens to be nearby, especially those responsible for temporary moments of suffering.  Nurses administering shots and medications.  Therapists asking them to do exercises and confront their new disabilities face-to-face.  Family members and friends who encourage them not to give up—when giving up sounds so much easier.


Their anger isn’t really toward the nurses, or the therapists, or their loved ones, no matter what they say.  Their anger is really at their new situation.  Nurses, therapists, and loved ones just happen to be “in the wrong place at the wrong time” to receive the brunt of the anger.


I can think of some people who have supported me through tough times and received the brunt of my anger and resentment—whether to their face or otherwise.  I’m thinking of some teachers and professors who gave me tough love when I was learning how to navigate academic life.  And some supervisors who gave me real advice when I was learning how to be an independent clinician.  And my siblings, who accompanied me in the journey of growing up.  And of course my mom and dad, who have guided me through all my years—toddler, elementary, puberty, and young adult life—a very scary journey.


Who in your life has received the brunt of your situational anger?


Let’s take some time to thank those who have been there for us, especially those we did not show much appreciation for.


And when others lash out at us, let’s remember that sometimes, they’re mad at something bigger than us.


And when we feel like lashing out, let’s pause and choose the kindest words we can find.


PS, a brief housekeeping announcement:  the automatic email service offered by blogger is changing and/or ending in July of this year.  I'm still working on figuring out an alternative.  But I still plan to update on the 15th of every month, so if you don't get an email July 15, check out the website for the post!

Thursday, April 15, 2021

Lack of Insight

Sometimes, the brain doesn’t accurately analyze reality.

Take this scenario:


When this happens for clinical reasons, it’s called “lack of insight.” Patients whose field of vision has been cut in half don’t realize they’re ignoring their clinician sitting to their left. Patients with newly amputated legs try to get up to go to the restroom—and fall.  Patients whose swallow muscles are impaired insist that they can take five pills at a time—and end up coughing and spluttering as something goes down the wrong pipe to the lungs. Patients who can't balance to walk ten feet beg to go home without any help or medical equipment. They fail to recognize their confusion, dysphagia, aphasia, visual impairments….

In my own life, this is called “lack of insight.” I take on tasks far too difficult too handle. I walk into emotionally triggering situations without preparing myself, and I end up exploding. I strike up sensitive conversations, unaware that I’m saying insensitive things and causing a lot of hurt. I fail to recognize my hubris, my weaknesses, my biases and prejudices, my selfishness.

Can you relate?

How can we overcome our lack of insight?

Honestly, I’m not sure I ever will, not really. I imagine I’ll always have biases and prejudices, hubris and weaknesses, and of course selfishness.

But I’d like to be intentional about gaining insight. I try to read articles and books written by people of different perspectives, especially marginalized perspectives. For folks without books and articles to speak for them (I’m thinking of my patients and their families), I have to listen intentionally to their individual needs in the moment. I try to find out what they need me to say or not say, do or not do. And often I find out what I thought was helpful was actually not really so helpful at all—in fact, I’ve been hurtful.

I’m doing a lot of praying for humility these days.

What should I do when I gain some insight? When I realize I’ve been rude or hurtful, I’d like to own up to it and apologize. When I’ve made someone else’s story of suffering about me and my response to it, I’d like to stop and listen. When I’ve put myself on a pedestal, I’d like to step down.

I’m never going to get this exactly right. And my insight will never be perfect. But I can strive for what the Greek philosophers called arĂȘte—always seeking to better myself and knowing that I will never be perfect here on this Earth.

I'm sure I'll always suffer from lack of insight.  But every day I'll pray and try to do a little bit better.  

Monday, March 15, 2021

Sloppy Communication


Me:  “Swallow this.”  

Patient:  “Are the Stars playing today?”  (coughs and splutters)

Me:  “One thing at a time.  Swallow.”

Family member 1:  “Why is it so cold in here?  It’s probably because of that covid virus.”

Family member 2:  “Who’s got covid?”

Me:  “Nobody in this room has covid.” (turning to patient)  “Now swallow.”

Patient:  “I don’t have covid!  They did a test!”  (coughs and splutters)

Me:  “One thing at a time.  Swallow.”

Patient:  “You’re the one who brought up covid.”  (finally swallows)

Me:  “Good.  Now swallow again.”

Family member 2:  “Let’s watch the Stars game.”

Family member 1:  “Can’t you see he’s trying to focus on his swallow?”

Patient:  (with a gurgly voice) “Why do I have to swallow again?”

Me:  “Something seems to be going down the wrong pipe.”

Family member 2:  “I can’t hear the therapist.  What did she say?  Why does she want him to swallow again?  Is it because of covid?”


Family member 1:  (also shouting, simultaneous to me) "HE'S CHOKING."

Patient:  “No, I’d feel it.”


Patient:  “Let’s watch the Stars game.”


Working with patients and families with disabilities has taught me that communication is often messy.  No matter how perfectly I plan my session or how brilliantly I attempt to do patient/family education, something often goes awry.

I see it in my own life too.  Conversations with my family and friends—they’re not optimized; they’re not like the crisp dialogue written in movies and books.  In real life, people talk over each other.  We say what we don’t mean.  Or we say what we mean and are misunderstood.  We misunderstand others.  We apologize (or we don’t).  We get mad.  We interrupt each other.  We fail to listen.  We learn to listen better.  We change our minds and say something different.  We say things in such a roundabout way that nobody can understand what we’re getting at.  We use metaphors that don’t work.  Things get overwhelming.  Nothing goes according to plan.  We all get confused.  We have to work very hard to reach each other.  It’s sloppy.

And you know what?

That’s OK. 

In fact, I think it’s strangely beautiful.

Monday, February 15, 2021

A Valentine Challenge

 Is there someone you’re trying to avoid?  An acquaintance in the community, a neighbor, a coworker, a friend?  Someone whose political opinion or religious beliefs are different than yours, perhaps.  Or maybe someone from a different socioeconomic status, someone with different cultural/linguistic heritage, someone whose social interactions are very different than yours.  Maybe there’s a family member, friend, or acquaintance with a communication or other disability who you have trouble understanding.  Maybe there’s someone at a street corner asking for help that you often pass by without greeting.

When someone takes us out of our comfort zone, sometimes we shy away from them.  We tell ourselves we don’t have time or that someone else could do a better job of it.  We tell ourselves we’ll connect with them another day.  Just not today, not today, not today.

Let’s make that day today.

Here’s a Valentine challenge for all of us:  Let’s connect with someone we wouldn’t usually connect to.  Let’s spread a little love in the world by making the extra effort.

I know this is complicated during the pandemic.  Here are some ideas to get you started:

~Call a family member you don’t usually call.  Even if they don’t pick up, leave them a message telling them Happy Belated Valentine’s Day or Just Saying Hi.

~Write a handwritten note to a friend you haven’t spoken to in a while.  Ask them how they’re doing.  Let them know you’d love to hear from them and let them know how to reach you.

~If someone expresses something you disagree with, listen to them and really try to understand their perspective.  You can respectfully agree to disagree, and even maintain a good friendship!  Our culture sometimes forgets how important it is to respect people whose opinions are different from our own. 

~The next time you see someone asking for money, even if you don’t have anything to give them, at least say “hi.”  I have heard over and over again that one of the challenges of homelessness is the dehumanization felt when everyone avoids your gaze.  (PS, if you do want to give something to them, try filling a quart sized ziplock bag or a pair of tube socks with essential hygiene items like hand sanitizer, toothpaste/toothbrush, soap, and menstrual pads.  Let the package sit for three days before giving it out so it doesn’t expose anyone to covid.  Use hand sanitizer yourself before a safe, contact-free handoff of the care package.)

~Make an extra effort to smile at people you pass by.  We’re all getting pretty good at smiling with our eyes these days.  (Note:  If you’re not a big smiler, you can do the bro head-nod.  Anything to acknowledge the presence and humanity of another can go a long way.)

~Engage in conversation when you would usually seek a way out of it.  You can do this while keeping six feet distance.  This one is especially challenging for me, because I often find myself in a rush to move on to the next thing.

~If you have a family member, friend, or acquaintance with cognitive or communication difficulties, I just posted a handout ofCommunication Tips.  If you find this handout helpful, feel free to share these tips with other family members or friends.  It can feel lonely to experience cognitive and/or communication difficulties, so let’s reach into that loneliness and facilitate positive connections.

~As a bonus challenge, I encourage you to support an organization that facilitates human connection.  How you support them is up to you—whether it’s a five-dollar donation or offering to volunteer or something unique to you!  Look for local, state, or national groups that support education, health, and wellbeing, especially among populations who are often disadvantaged or overlooked by the system.  Supporting equality facilitates human connection in a positive way.  If you want some recommendations, last summer, I posted alist of some empowering organizations.  But I encourage you to find organizations on your own.  Check with your local library for suggestions.  Do they know of a group of English language learners who need conversation partners to practice their English?  Do they know of or offer classes for citizenship?  Do they know of local education initiatives or environmental impact initiatives?  (You’d be surprised how much the environment affects equality!)


Happy Valentine’s Week.  Let’s spread the love, one human connection at a time.

Friday, January 15, 2021

Honor the Process

Each year, I ask the Lord to give me a word to bless the new year.  (Yeah, I'm cheezey like that.)  I was reflecting and meditating with a dear friend on New Year ’s Eve, hoping (as always) for a really positive word heralding achievements and abundance.  Alas, this year, I received a challenging phrase:  “honor the process.”

"Dude, that sounds like some sort of hippie dippie mantra" I thought.  "Are you serious?"

I’m pretty sure He’s serious.

I am not really into “honoring the process.”  I like my results to be fast and measurable.  I’m the kind of person who writes things like “brush teeth” and “finish to-do list” onto my to-do list, so I have something to cross off.  

This is going to be rough.

My patients and their families also express frustration when “the process” doesn’t seem to have a steady upward trend.  “I could to this yesterday!  Why can’t I do it today?”  “Why can’t she just learn this?”  “Why is this week worse than last week?”  I can definitely relate to this impatience, although my struggles are very different from their struggles.

A very wise person shared something with me, and I’m going to share it with you:

Progress does NOT look like this:

True progress looks like this: 

We have to get through the “bad” days to move forward. 

What does this look like?  Accepting when our progress looks like the clichĂ©d one step forward, two steps back.  Allowing ourselves (and others) to mess up.  Practicing patience with ourselves, others, and God.  This is easier said than done, especially in a society that is obsessed with productivity and optimization.

This also means we should be kind to ourselves when we aren’t practicing patience.  Learning to “honor the process” is a process.  (oooh, meta)

I’m including a full page printout of the graphs above in the SLP tab.  SLPs and other therapists, I encourage you to give these to your patients.  The wise sage who taught me about what progress looks like gave me permission to put this printout on the website.

Tuesday, December 15, 2020

Our abilities are _______

I’m trying to figure out a good metaphor for our abilities.  Working in a rehab hospital reminds me daily that abilities are neither static nor intrinsic.  But what are our abilities, exactly?  Are they rights?  Obligations?  Gifts?  None of these metaphors seems to quite fit the experience of being a human with limited abilities.

It’s so tempting treat my abilities as rights.  I feel it’s my right to be able to process information quickly enough to drive a car, to run errands, read and follow a recipe, to process conversational language, to read and write, to work quickly and efficiently.  But then my monthly monster visits and I’m drowning in brain fog, barely able to understand simple sentences, unable to remember basic information or even balance for walking.  I never know how long it will last—sometimes hours, sometimes days.  For over a decade, every time I “misplace” my ability to think straight, I wail and cry like a child that’s lost their favorite toy.  It’s my right to think straight, I moan, pounding the ground with the heavy thud of weak uncoordinated tear-drenched fists.  It’s my right to be “smart.”

I’m lucky that this removal of my cognitive abilities is temporary and somewhat predictable.  As a therapist, I know many people whose cognitive abilities have been more severely damaged by stroke, brain injury, dementia….  If abilities are rights, then Someone upstairs isn’t playing fair.  And yet so many of my patients, family, and friends with disabilities find moments of extreme grace, even in their suffering.  This doesn’t make sense if they have been stripped of their rights.

No, our abilities aren’t rights.  Not in the cosmic sense, anyway.

Then come the nagging doubts.  If these abilities aren’t my right, maybe they’re my responsibility.  If I fail, I have to try harder—I’m supposed to be able to do these things.  I have to strive as hard as I can to optimize my abilities until I’m burnt out and exhausted.

This never works.

So are my abilities gifts?  Have I been given the gift of language, the gift of balance, the gift of whatever my IQ is, the gift of breathing?  But what about when these “gifts” are rescinded?  A true gift-giver doesn’t ask for the gift back.

Again, the guilt.  Maybe it’s my fault.  Maybe I’ve damaged the gift/ability through some sort of negligence.  Maybe I deserve to lose the ability.

Of course this is a preposterous and very harmful way of thinking.

Maybe I don’t understand the way gifts work.

Some gifts are long-lasting—a book, a ring, warm socks, a beautiful handwritten letter.  I can keep and cherish those gifts for years to come, their presence a constant reminder of the love of the giver. 

Other gifts are ephemeral—a box of chocolates, a ticket to a show, a kiss, a home-cooked meal.  Are these gifts less important or less valuable than longer lasting gifts?  Is the longevity of the gift the correct way to measure the love of the giver?  (If so, what does that say about long-lasting fruitcake?)

Every day we receive gifts.  Perhaps our abilities are more like ephemeral gifts.  We receive them anew each day, each moment.  The ability to breathe.  The ability to stand.  The ability to swallow.  The ability to speak, to read, to write, to do the things we love to do.  Gifts, all.  Given each day.  Never a guarantee.  Not rights, not obligations.  Gifts.

Some days we receive gifts we don’t want to accept.  The “gift” of not being able to stand.  The “gift” of not being able to think straight.  The “gift” of not being in our healthiest prime.  Should we reject these gifts?

Ann Voskamp, author of One Thousand Gifts, writes often about giving thanks for hard gifts and to find little gifts even in suffering.  I love this idea!  It complements beautifully the writings of St. Therese of Lisieux, who teaches us to embrace suffering.  Both authors take this idea a bit farther—we can offer our gifts to others, and to God—each gift in its own way.

So on days when I find it difficult to do the things I am accustomed to, I can choose to reject the gift like an unwanted fruitcake—or I can try to give thanks.

This is easier said than done.  And to be honest, I’m terrible at it.  But perhaps in time I will learn to receive all the gifts I’m given—even the hard ones—with grace and thanks.

This time of year is filled to the brim with gift-giving (much needed in 2020).  Let’s remember to be thankful for the gifts we receive each day—whether they are long-lasting or ephemeral. 

If our abilities are gifts, we receive them moment by moment, day by day—gifts to be cherished even if they burn bright and brief like birthday candles.  And I trust that the Giver of these gifts wants to surprise us with something spectacular each new day, each new moment.