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?”

Me: (shouting) “SOMETHING IS TRYING TO GO DOWN THE WRONG PIPE.”

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

Patient:  “No, I’d feel it.”

Me:  “SWALLOW.”

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.

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.

Redefining Independence

I frequently tell this parable to my patients.  And honestly, I think I could stand to listen to it myself:

Bob was driving to work when his car stopped.  Bob valued independence above all else, so he decided to fix the problem himself.  He opened the hood of the car and tried to determine what had gone wrong.  It was hard to see through the thick smoke, but Bob kept rummaging through the parts of his car until he found an open flame.  Bob’s hands were badly burned and he fell backward in surprise, injuring himself further.  Bob had to go to the hospital.

Was Bob really independent in this story?  Of course not.  Injuring himself and putting others at risk was not true independence.

Paradoxically, to be independent in this circumstance, Bob would have called the fire department and eventually a mechanic.  To be truly independent, he would have relied on someone else’s help.

Our society seems to think “independence” means doing things on our own.  Anyone who can’t is seen as weak or inadequate.  This attitude is pervasive and has been around for generations—I can even hear it in my geriatric patients’ turns of phrase.  So often, my patients express to me that they feel they are “a burden” to their families for needing so much help.  And I myself fall prey to this lie as well. 

I’ve read enough mommy bloggers to know that a woman is supposed to be able to flip gluten-free pancakes in an immaculately kept kitchen while changing her baby’s diaper with one hand, keeping her toddler out of trouble with another, and helping her first grader with his math homework.  So when my menstrual symptoms affect my balance and I can’t even walk the dog, or I’m overwhelmed with house chores and work, or I need help processing my emotions, or I just can’t seem to do it all on my own, I feel inadequate.  I feel like I've lost my dignity, however briefly.

Maybe we all need to redefine “independence.”

True independence means taking charge of our own safety and using our resources.  Sometimes that means asking a friend or family member for help when we’re overwhelmed.  Sometimes it means making sure someone is with us when we get out of bed so we don’t fall.  Sometimes it means going to a support group or attending therapy.  Sometimes it just means using a walker or safety device.  True independence is different for everyone and changes over time.

I’d like to hear that again, because I’m prone to comparing myself to others.  In fact, I’m going to let Mneme, the Muse of Memory, repeat it for us so we can commit this to memory:

 

Thank you, Mneme.

Once upon a time, when I lived briefly in a barrio in the Caribbean, I encountered a family who seemed to really get it.  In this family, there were several family members with disabilities—some children, some adults.  All the family members helped each other out—nieces and aunties, mothers and daughters all worked together.  Now, that’s not to say there wasn’t suffering, and it’s not to say it wasn’t frustrating.  But as a team, they overcame many more obstacles than any of them could have overcome alone.

We can all learn from this family. 

Many of my patients’ families are similar to the family I just described.  They rely on each other.  I have so much to learn from their bravery, compassion, and healthy interdependence.  I hope to accept help with humility and to stop judging myself for relying on my support network.

I’ll leave you with a quote from the old Claymation Rudolph the Red Nosed Reindeer:  Let’s be independent together.

*

I’ve put a new handout in the SLP freebies section.  It’s a simple text-only motivational poster that’s good for SLPs, patients, and everyone else.  (It’s a little wordy, so probably best for higher level patients, especially those with lack of insight into deficits or who are feeling really discouraged.)  Click here to download the handout.  Feel free to modify however you want.  Please print and distribute freely.

To be a Muse

The Muses are taking over the website!  Melete, muse of practice, Aoide, muse of song, and Mneme, muse of memory have been inspiring me in both my speech therapy work and my writing for some time now, so I figured it was time to give them the stage here at the website too.  The Muses inspire and encourage creativity and expression.

I've been thinking:  maybe we're all muses, in one way or another.

A Muse nurtures the creative spark in others, stepping back to watch as they bloom and blossom.  A Muse uses positive language to inspire and encourage.  A Muse is honest, and delivers tough messages with kindness and love.  Like in last month's reflection on strengths and challenges.

Speech Therapists are a lot like Muses.  Our task is to help others to overcome cognitive/linguistic challenges getting in their way of self expression.  (Ok, and to help them swallow and follow safety directions and a bunch of other stuff.)   I think that's why Melete, Aoide, and Mneme are speech therapists--it comes so naturally to them.

Writers, especially journalists, give voice to those they interview.  In more creative genres, writers encourage and inspire connection:  connection with others, with the self, with nature, with the Divine.

And many other roles and professions are best carried out with the mentality of a Muse:  healing professions,  teaching, the restaurant/service industry, working at a library or even a store or business, social activism, religious vocations, marriage, motherhood/parenthood, family relationships, friendship....

Maybe we can all be muses for each other.  Let's make an intentional practice of listening carefully to those around us and encouraging others to be more and more themselves.

If you want to see more of the Muses, follow us on instagram @speakingwithkiki, where their shenanigans get uploaded much more frequently.  I hope the Muses are as inspiring to you as they are to me.

And I encourage you to re-explore the website.  The Muses have made some changes around here!

Let's rely on our strengths and resiliencies

As a speech therapist, I am sometimes tempted to focus only on improving my patients’ deficits.  After all, isn’t that what rehabilitation is about?  Fixing “broken” communication, “broken” cognition, a “broken” swallow?

 

This happens with writing too.  Growing up, I always thought that the best way to help a friend to better their story/poem/essay was to bleed red ink all over the page, pointing out what doesn’t work so they can fix it.

 

And don’t we all do this to ourselves sometimes?  Pull out the red pen, evaluate our shortcomings and limitations, focus on the "bad parts of ourselves" so we can become better, kinder, more efficient?

 

What if it’s just as important—maybe even more important sometimes—to acknowledge and nurture our talents and resiliencies?  Of course we must acknowledge our mistakes, shortcomings, and weaknesses.  But what if shift our language—what if we call them "challenges" instead—calls to action instead of traits we're stuck with?  Maybe we have the ability to overcome these challenges—or find a workaround or at least make some progress—by relying heavily on our STRENGTHS.

When I evaluate a patient’s language, thinking, and swallowing skills, I am sure to discuss their troubles with them.  But now I’m making a conscious effort to also tell them and their families about what they do really well too!  Maybe their memory isn’t working the way they want it to (a challenge), but they’re awesome at paying attention, which is going to help them to use their memory strategies.  Maybe they can’t swallow water well right now (a challenge), but they have a strong cough so we can work with that!  Maybe they have trouble focusing (a challenge), but by golly they are motivated and have a positive attitude.  Maybe they have a LOT of challenges, but their support system is working for their good.

 

Joseph Fink and Jeffrey Cranor, authors of the Welcome to Night Vale podcast and various spinoff novels and podcasts, emphasized once that in writing, a more motivating and helpful way to critique someone’s work is to point out what is working really well so they can bring out more of those aspects in their work.

 

Maybe this could work on a societal level.  When we encounter a negative societal behavior, like racism or sexism or selfishness or unwilling-to-listen-ness, first we must of course acknowledge the problem.  This takes work.  And obviously, merely acknowledging the problem is not enough—we must face it and work to overcome it.  So what's the next step?  

To face these problems, we can draw on our collective compassion and kindness as a society to work to overcome those obstacles.  By exploring and utilizing our positivities, we can fight our societal problems.  Will we ever truly overcome a societal weakness?  Probably not entirely, but a positive human trait I believe in strongly is perseverance.

This is something that I find so encouraging about the Black Lives Matter movement—I'm hearing a lot of rhetoric that readily acknowledges that we are going to make mistakes.  Everyone does.  It's uncomfortable to learn that we've made mistakes, but the emphasis is on apologizing and learning how to use our humility and kindness to do better.  Learning about our mistakes and weaknesses is not about shaming us—and it never was.  It's about creating positive change.  For a really genuine and heartfelt conversation about this, I recommend listening to Brené Brown's conversation with Austin Channing Brown on the podcast Unlocking Us.

 

I’d like to apply this principle to my own life, and I invite you all to as well.  I make TONS of mistakes—maybe even in this post you have found some mistakes.  It's easy for me to dwell on them without moving forward.

So here is my resolution:  when I recognize or am told that I’m behaving impatient or interrupty or selfish or racist or small minded or making silly mistakes or being ignorant, I’d like to label my predisposition toward a “less than ideal” or even just plain "bad" behavior as a CHALLENGE rather than a failure of character.  This way, I can be motivated to change my behaviors in the future.  If I don’t identify with my undesirable behaviors but instead see them as obstacles to overcome, I give them less power.  I’ll probably never be perfect at facing any obstacle.  But I can keep trying.

And how do I face these challenges?  By using my virtues and resiliencies to face the obstacle.  I strongly believe that all of these strengths come from God.  And He is bigger and stronger than any obstacle or challenge I could ever encounter.

 

 

Listening, Learning, and Answering the Call to Change (with links to empowering organizations)

I am sickened by the recent deaths of Breonna Taylor, Ahmaud Arbery, George Floyd, and now Rayshard Brooks—and all similar unnecessary deaths.  I am angry on behalf of my friends, family members, and patients who have been subjected to judgement, put at a disadvantage, or even put in danger because of their race.  I am afraid for patients of color (especially African American) with communication disorders, who are at higher risk of incarceration and being misinterpreted as hostile.

For the last few weeks, I have been extra intentional about listening and learning.  So far, these are the calls to change that I am hearing:  examine our own biases, follow the leadership of communities we wish to help, and support organizations that empower minorities, even when it’s not “trending”. 

Today, I'm posting a list of some empowering organizations led by (or working hard to empower) people of color--most especially African Americans and immigrants/refugees.  This list focuses on education and religious organizations.  

Remember, it’s no single person's job to support every organization; we are not “saviors”!  We are just humans accompanying other humans on a difficult journey.  With that in mind, please consider supporting some of these organizations with me.

Thanking the Whole Person (and a medical SLP freebie)

Whenever I wipe poop off a bottom (or a toilet, or a wall), I make a mental note to say something extra positive to our nurses and sanitation staff.  Sometimes it takes a big mess to draw my attention to the ones who do the most thankless tasks.

Well, we’re in a big mess right now, and our attention is drawn.  

True Love: a Valentine's Day reflection

I have seen in the movies and read in books that true love is about finding joy in each other, about holding hands and giving roses and writing love letters.  I have heard in wedding speeches and sermons that true love is about staying faithful even when it isn’t fun. 

I believe that both of these are true.

And I have seen second-hand that true love is often about wiping dirty bottoms, and spoon-feeding, and encouragement to try one more time, to get up for another day.  True love is about staying faithful even when someone’s personality changes after a brain injury or during the onset of dementia.

This Valentine’s Day, I am reflecting about what I have learned about true love from spouses who take on the role of caregivers—and spouses who take on the role of patient.  Neither role is chosen, but when embraced, both teach us about true love.

Liking my patients, my loved ones, and myself

Some days, I just don’t like myself.  From the outside in, I notice plenty of flaws.  I have acne, my hair is a wild mess, my posture is slouchy, my attitude is grouchy, I’m impatient and rude and arrogant—and I make plenty of mistakes. 

So I remind myself that even if I’m not likeable now, I’ve got potential.  I’m just in the caterpillar stage.  Someday, I’ll be a beautiful, virtuous butterfly.  I should like myself for my potential…right?

That’s not what Mr. Rogers says.

Pruning my Garden: from Tolkien to Pinker and beyond

I sat with my cousin on the floor in the corner of the bookstore, poring over Elvish grammar and the rich world of Tolkien’s languages.  A seed was planted.  Over the next few years, I tended to my little metaphorical garden, writing in Tolkien’s alphabets and languages, learning Spanish, practicing my broken Portuguese, and adding broken German to the mix.

Unfortunately, some of the plants in my garden grew thorns.  My love of words and grammar turned me into the grammar police, trying to “correct” everyone’s sentences, even in my own family.  “Don’t end sentences in prepositions,” I would say, or, “Mark all your adjectives with an LY.”  I wanted everyone to speak Academic English, and I was frustrated by deviations from the rules of Strunk and White.

Then I encountered Steven Pinker.  My friend Sofija lent me The Language Instinct.  Pinker's work exposed my metaphorical garden for what it really was:  full of toxic weeds.

This is Who I Am: an interview with my friend Sydney

"This is Who I am and That's How it's Gonna Be”

An interview with my friend Sydney

My friend Sydney always has something helpful to say when I most need to hear it.  Sydney and I met as coworkers at a pediatric clinic.  The more time I spent with her, the more I learned about her courage and positivity.  Sydney is athletic, courageous, funny, and charming.  She is a great movie buddy—we love watching movies like Wonder Woman and Star Wars together.  Sydney is also very open about her experiences growing up with and living with an intellectual disability.  The other day, I invited her to share some tea and popcorn at my place so she could tell her story.

Communicating when it isn't easy

Communication is connection. For most of us, it's easy. A sideways glance. Hands on hips, feet tapping. A kiss on the cheek.

Sometimes, we use words. "Did you see that?" "Please take out the garbage." "I love you." Like magic, the words we conjure in our brains turn into sound waves, travel through the air, and become words summoned in the brain of another.  The written word is equally mysterious. Arbitrary shapes become stories, poems, proverbs. You are reading my words now, somewhere far from the tapping of my keyboard.

So what happens when there is an interruption to the brain? Imagine a blindfold, cotton in your ears, marbles in your mouth. Not so easy now.