From Fentanyl to Friendship

The Missing Link for SLPs Podcast Full Transcript Mattie Murrey 00:04 Hi, everyone, and welcome to the Missing Link for SLPs podcast. I’m Mattie, your host, speaker, and very passionate speech language pathology advocate. You are listening to The Speechless SLP series with Vanessa Abraham, and you get a unique perspective in each one of these episodes on her journey being the speechless SLP in the ICU bed, unable to talk. So, welcome to this series of the Missing Link for SLPs podcast. Glad you are here. Sit back, take a listen. Welcome to this episode of the Missing Link for SLPs podcast. This is another in our series of the Speechless SLP with Vanessa Abraham, and we have a special guest with her tonight. We have Laura Davis, who was one of her ICU nurses, and she's going to talk about what it's like treating a critically ill SLP. So, welcome, both of you. Vanessa Abraham 00:56 Hi, thank you. Laura Davis/Vanessa Abraham 00:57 Thank you for having us. Yeah, thank you. Mattie Murrey 01:01 So, Laura, let's hear about who you are, and why you do what you do. Laura Davis/Vanessa Abraham 01:04 Why I do what I do. Well, I've been an ICU nurse for the last 10 years. I graduated in 2012, during the recession. I started my career in organ procurement. Then swiftly went into bedside nursing – which organ procurement, what I did also was bedside nursing, it’s just a little bit different. Knowing as like a newer nurse, I did not want to lose my skills, I worked up in the Bay area at a level two trauma hospital. I learned a lot up there, but once I came to my current hospital, UCSD, I just knew this is where I wanted to be. I mean, serving the public, also utilizing my brain, my knowledge, growing autonomy, independence. Nursing was definitely an avenue for myself as – I mean, I was older getting my nursing career started. I was single at the time, and I knew that no matter what, this is going to be an amazing career to pursue. So, that's one reason why I got into nursing. But also, I mean, I just fell in love with that. I've only been an ICU nurse. I do know how to do all the other different roles in nursing, lower acuity type nursing. However, working at UCSD, a teaching hospital, again, utilizing my brain, constantly learning. Mattie Murrey 02:25 Mhm. Laura Davis 02:26 It's always a chance to learn, reflect on what you do. And knowing that not only am I touching my patients lives, and my patients family's lives, the doctors lives, my coworkers lives. It is very involved, and it's very self-gratifying. I’m proud of what I do. I serve my community, and that's really what it comes down to. It's a selfless job. It's a job that – so, I wouldn't say job. It's a career, a career path that if I wanted to go further in it, I can. I choose to stay at bedside and work with, again, the public, my people, my community, all different age ranges. We don't work with children where I'm at, it is an adult ICU. But it's a very fulfilling and honorable job, and to be able to know I'm giving back to the community. Mattie Murrey 03:17 Mhm. Laura Davis 03:17 I don’t need the praise for it. A lot of people, especially during these COVID times, ”Oh, thank you for what you do. Thank you for what you do”. It's like I guess I'm just kind of born to be – I’m a natural nurturer. I care for what's going on. I want people to be able to do better in their lives so they can live a fulfilled life. And I guess it's kind of – it’s become my passion. And I get very excited when I do hear students, or people and they’re changing careers, that they would love to do nursing. I'm very, very passionate about like educating and influencing anyone who ever wanted to follow that career, so. But it has been very fulfilling. Being able to just leave it at work, and come home. I still live a fulfilled life. I don't harbor any negatives. I don't harbor any burnout. I know nurses get a lot of burnout. But it is something that I love going to my job every day. And it's not just because of what I do, it’s who I work with, the environment I’m in, knowing everything that I get to see on the daily, and in all – and like I said, again, it's not just I close my eyes, and then be at a job pushing papers. And I'm not downplaying anybody's career or job choice or whatever. But for me, I'm challenged every day. And knowing that I see a difference with these patients that are in their most vulnerable state, it’s very rewarding. Very, very rewarding that, to have a hand in that. Mattie Murrey 04:41 Vanessa, do you remember what it was like when you first met Laura? Vanessa Abraham 04:44 I know I remember her – my initial memory of her is being my night nurse. Mattie Murrey 04:52 Okay. Vanessa Abraham 04:53 I know there were times before that, but due to sedation and medication I don't remember. But I remember her at night, helping me off a cliff. Like to the point that I was so highly anxious. That she was always there just offering comfort. That was my initial memory. Laura Davis 05:13 Oh! Mattie Murrey 05:14 That’s a good memory. Somebody there in the middle of the night in the dark. Vanessa Abraham 05:20 Mhm. Absolutely, in the middle of the night, dark, 2:00 a.m. She was just so comforting to me during those moments that you wake up, and you're like, “Where am I, and what am I doing here?” She was there. Laura Davis/Vanessa Abraham 05:32 Well, and that’s – so, this is Laura. If I just speak to that. Vanessa, coming into – again, I know we were very, very close in age, just a couple of years off – but coming into your room, knowing that you knew everything that was going on. ICU can be very scary. They say we're scared of what we don't know, and what we're not familiar with. And even myself, until I had my own daughter, I didn't – I wasn't familiar with the hospital setting. I mean, yes, being an ICU nurse, but I’d never been in the hospital. And at that time, I still didn't have a child myself. So, I had never been admitted to the hospital as sick as Vanessa was. To be able to be her nurse, and only understanding the environment that she's in, I wanted to be able to give you some comfort, and some like, “Hey, it's going to be okay, and we are here to help you”. And it's very scary, but to be able to talk to her and explain to her like these are – “This is why you have this going on. This is why we're doing this. This is why the doctors keep coming in”. I mean, Vanessa, you took it like a soldier. I mean, you really did. You were so – you communicated so well with us, even when you couldn't talk. And for you to stay as calm as you did, not having your family around at the time, because I know that your husband had to deal with your little one at the time and whatnot, but trusting us to be able to take care of you. I mean, the one thing I could do is try to make your environment feel comfortable, and not so scary, and that it's going to be okay. That you're not going to be here forever, and just getting some sort of hope. And it's not false hope. It wasn't false hope whatsoever. I mean, I knew you had probably a really long road. Again, I don't see any of my patients that leave the ICU. I don't know what happens to them. So, to see you come back full fledged is – I mean, it's a miracle, because a lot of people don't have that recovery. Mattie Murrey 07:29 Mhm. Laura Davis 07:29 But your perseverance, and your recovery was amazing. And if there's a little small part that I can add to that, I mean, I'm going to try to make it as comfortable as possible. And I think I was scared for you. I would have been scared myself. And so, to be able to kind of be that little like light at the beginning of the tunnel, the end of the tunnel, wherever you were in your recovery. I mean, if I could provide that comfort, that's – I mean, it's all part of it. But, again, because we were so close in age, it's like I couldn't imagine myself being in the situation that you were in. Mattie Murrey 08:06 So, a lot of your drive, Laura, comes from the passion and the empathy – compassion and the empathy you have for the person that you're treating. Laura Davis 08:16 Oh, yes. Most definitely. Most definitely. Speaking of just other different types of patients that we get. We get some homeless patients. We get patients who are addicted to drugs. And for whatever walks of life, we all have a story, right? We all have trauma. We all have whatever. We're not there to judge. Mattie Murrey 08:32 Mhm. Laura Davis 08:32 We're not there to make anybody feel bad about their situation. That's not why people get into nursing. I mean, yes, we take an oath, but it's also about the character of like who you are. And again, you come in, maybe you have a drug overdose, somebody may have a drug overdose, and somebody may just be down on their luck, and in the worst possible health conditions, but we're not there to judge. Mattie Murrey 08:56 Mhm. Laura Davis 08:56 We're there to help you get better. To help you get to a point where you can at least walk out of the hospital, or at least get better to go to the lower acuity unit, meaning a less sick unit, and still live your life. Things happen. And that's like one great thing about health care in California, we don't turn away anybody who comes to the ER. It doesn't matter if you have – if you're the richest person in the country, or the poorest person in the country, what your walk of life is. It doesn't matter. We're there to help you. And I think that that's like compassion for all nurses. I mean, they have it all. They have this, “Hey, this is what's happening. This is how we can help you”. I mean, you can only lead a horse to water but you can't make them drink it. However, we still fight the good fight to help those people, and get them to at least the baseline that they were at before they came to us in their situation. So, having that compassion. It's not our place to judge. It's not our place to have negative thoughts or a negative attitude. It's there literally just to help, and to be that, I guess, guiding light, and maybe that support that these patients don't have. Even, I mean, Vanessa, I know you had tons of support. You had your family. But in that instance, even at night, and those lonely nights when your family couldn't be there, we're your support. We're those patients’ support. It's a very intimate job. It really is. Mattie Murrey 10:18 How did you do that, Laura? How did you provide that support in the middle of the night when she was alone in ICU and didn't have that family or friends? Laura Davis 10:25 Well, I remember coming in – and I mean, I do do this with most of my – with all my patients, especially – I mean, again, she was – we didn't know what was wrong with her. Mattie Murrey 10:35 Mhm. Laura Davis 10:35 We didn't know. And so, she was intubated. She couldn't talk. She started having the use of one of her left hands to be able to write a little bit. But I come in there, and she was awake. She wasn't on any sedation the night that I had her, so she was awake with this ventilator in her mouth, which is a very uncomfortable thing, and she was so calm to be able to like control her breathing, her mental state. And just coming in very calmly we tried to keep the room very calm for her. Mattie Murrey 11:06 Mhm. Laura Davis 11:07 Putting signs on the door saying, “Please be quiet, patient resting”. But going in and introducing myself, and letting her know that I'm here. That I understand the situation she's in. If she needs anything, please don't feel scared that you're bothering me. I just tried to reassure her that I was there for her in any way or manner that she needed. I remember, I think I was starting to give her a foot massage at one point, trying to relax her little bit, and there was one of the nurses starting putting lavender oil in the lotion, because [crosstalk] – Mattie Murrey 11:39 Vanessa was thumbs up! Laura Davis 11:40 Yes, she was. She was, and she was pointing to like over on the counter, and I’m like “Oh, the lavender lotion”. [crosstalk] Mattie Murrey 11:46 Oh, nice! Laura Davis 11:48 And like making sure she had like her little stuffy teddy bear there. Mattie Murrey 11:53 Wow. Laura Davis 11:54 I mean, just anything. I mean, if her head was kinked, if she didn't like it. I mean, she couldn't move her body. So, being able to make her as comfortable as possible. Turning the lights on. Making sure she had her phone within arm's reach. Making sure she had her little writing board and her eraser, her call light. If she wanted music, or not music, if it was loud, or too much light. Letting her know, “Hey, if I have to draw these labs, do you want me to do this when you're more awake? Do you want me to do this now?” Mattie Murrey 12:19 Ah. Laura Davis 12:19 Really just giving her the power, and like – Mattie Murrey 12:23 The choice. Laura Davis 12:24 – she was my only patient that night. Mattie Murrey 12:25 The perspective. Laura Davis 12:25 Yeah, the choices. Yeah. She is a patient, and we're there to, yes, like do the things that we need to do medically, but also make her feel like you – just because she was awake, and again, in her state, a lot of patients are not awake. They don't really know what's going on, just because of like medically induced comas. But she wasn't in a medically induced coma, she was fully awake, and I think that she actually wanted to be that way. So, she understood what was going on. And it is a little bit harder to recover when you are sedated in that sense. And waking up out of sedation, it's just a lot harder on your body to wake up. And I think that she was a trooper, and to be able to keep her in that calm, relaxed state naturally. I tried the best I could do – Mattie Murrey 13:10 Yeah. Laura Davis 13:10 – giving her little sleep covers for her eyes, and things like that, and it's part of it. Mattie Murrey 13:16 How did you overcome some of the communication challenges you had with her being nonverbal? Laura Davis 13:22 So, again, we work with this all the time. Let's see. And when I worked with her, she was using her hands. But if I didn't – I mean she was using one of her hands. She could write with it. I think she even started writing with her left hand because she couldn't write with her right hand, if I remember. Or regardless, so since she was awake, a lot of times we will – if patients don't have use of the dexterity of being able to hold a pen, we get really good at following mouthing of words, nodding the head, blinking of eyes. I didn't start this with her, but I can only imagine it started with her before she got the use of her hand again, but you know, we do ABC boards, we do picture boards. We’ll even start narrowing it down to does it – pointing to the body part. Does it have to do with your foot? Does it have to do with your back? Does it have to do with this arm? Is it this, this, and then we start guessing. And, I mean, being in that environment for so long, you can kind of start narrowing it down. Blink twice for yes and once for no. But, again, she was able to use her – she was able to write, which was nice. But when working with other patients, they don't have that ability sometimes, or the medic-, they may be awake – Mattie Murrey 14:35 Right, right. Laura Davis 14:36 – but they're kind of like in a lucid state. So, just seeing them being able to write like a J. Just like the downwards, the hook, or like a T, and then they write a W. And you really just kind of – it's kind of like a game of charades. Mattie Murrey 14:51 What would you do to improve the augmentative communication, or communication in the medical ICU setting, or just the medical setting? Laura Davis 14:59 Communication? I mean, we do have, again, like these letter boards. A lot of patients, we do use – for patients that can speak, and things like that we do use these second language devices. They're called the Martti device, which is a video device. Mattie Murrey 15:16 Mhm. Laura Davis 15:16 And it has, I don't know, over like 200 languages. But patients who can't talk, who are intubated, again, we use nonverbal communication. We try to point. We try to use common things that we may think that they need. Pain medication, give us a thumbs up if they can. We use a lot of physical therapy. I mean, our physical therapists and speech pathologist, once patients can speak – I believe that when Vanessa was able to get the tube out of her throat – because a lot of patients, they can't have that tube in their throat for too long. It starts breaking down the tissue and things like that. It's not meant long term. So, patients do have to end up getting a tracheostomy in their throat. Which a lot of patients, and family members, are very scared about doing but it's not necessarily a permanent thing. It can always be reversed, like in Vanessa's case. If you're on a ventilator for so long, and then trying to go to – if you do get a tracheostomy, all of that atrophy and your muscles start – they start getting weak, and you have to retrain. And, I mean, our speech pathologists, our physical therapy, I mean, they work diligently to rehabilitate our patients. Vanessa was a soldier. Like I tell you, she – again, when she was communicating, she could write on her board with me, but she couldn't move her feet. She couldn't move, whatever. She would kind of point a little bit or write it down. So, that was really nice. But I remember hearing physical therapy coming in and like working with her, and her just like – well, she was so determined to get her function back that she – like I said, she excelled so quickly. She just had that mindset. But when – I remember she did have to get a tracheostomy, and I wasn't there that day because it was during day shift, but they had her going through our unit on a ventilator – Mattie Murrey 17:12 [Laughter] Laura Davis 17:13 – attached to her throat. After working with physical therapy enough times, doing squats and walking around our unit. Mattie Murrey 17:22 Wow. Laura Davis 17:22 I mean, I've never seen that in the 10 years of being a nurse. I have never seen that. We always talk about like ICU liberating. Like getting patients to get up and walk around on the ventilator. Yeah, right. That never happens. Our one thing is trying to get them off the ventilator, and then let's start working with PT, OT, and speech therapy. But one thing with speech therapy that's really nice is if they do have to get a tracheotomy, then we start working with – it’s called a Passy Muir Valve, which is like the little cuff that goes over your tracheostomy, if you can tolerate it, to where you can [crosstalk] – Mattie Murrey 17:55 I worked with one today. Laura Davis 17:56 – vocal cords. Yep, yep. And then a lot of patients with tracheostomy that they can't necessarily speak, or they can, we could uncuff it. So, I mean, it's still in your throat, but you can start passing food and eating and drinking or swallowing. But it's all about repetition of the muscles – Mattie Murrey 18:15 Mhm. Laura Davis 18:15 – and that's, again, speech therapy. We really don't mess around with it at the hospital. If you have any type of asymmetrical tongue deviation, mouth deviation, if you're just – we have it with a lot of stroke patients. If there's anything that's wrong with like the mechanics of your mouth and voice – Mattie Murrey 18:33 Mhm. Laura Davis 18:33 – we rehab it, and we don't – we take it very slow. So, you don't aspirate and get things in your lungs and cause pneumonia, and then you have to go back on the ventilator because now you have pneumonia and you're sick again. I mean, it just can be catastrophic to like the down side if we rush it too fast. But with Vanessa, again, she was so determined, and she was so determined for her little girl and her family. Like she kept on saying every time, I mean, even when I was [inaudible], I'd come in and be like, “How are you doing, girl?” She's like, “I'm working for her. I'm working for her”, and that's exactly it. It's like that was her determination. And I've never seen somebody turn around with what was going on with her so fast. But I mean, we have to also thank our speech pathologists, and all of our speech and language therapists that take their time. They know what they're doing. Our PT, OT, physical therapy, occupational therapy, getting – brushing your teeth, because none of her muscles worked. None of them. And to be able to get that function back, I mean, the neurons take forever. They're some of the slowest things to like rehab. And her mind just said that I'm getting out of here. I'm getting out of here. I need to get back to my little girl. So, it was really nice to see all that. All that happened for her so fastly, so swiftly, and how determined she was. Mattie Murrey 19:58 This whole episode is flying by. We only have like 10 minutes left. Vanessa, we've hardly taken a breath. Is there anything you want to add? Because I have like two more questions for Laura. Vanessa Abraham 20:10 Yeah, it just kind of brings a smile to my face when she says that I was a soldier, because I felt like I was the furthest thing from being a soldier. I felt so [inaudible] and terrified. And I think I even mentioned this in one other podcast about just everybody was always there for me. Laura, definitely was always there for me. And I never wanted to let anyone down. The team there was so phenomenal, that every time they came into my room I always wanted to rise to the challenge. Not only because I didn't want to be there, and I knew as an SLP, and Laura, you always said this too, it's the curse of the nurse. Well, it’s kind of like the curse of being an SLP is, hey, you know that in order to get out of here, you’ve got to work. And I wanted to get out of there, and I knew I had to work for it, but I also didn't want to let my team down. Mattie Murrey 21:04 Mhm. Vanessa Abraham 21:04 I didn't want to let my nurses down. They were working so hard to keep me comfortable, and keep my mood lifted, and I just didn't want to let them down. Every time that PT, OT, speech, everybody came into my room, I was just like, “Okay, I've got to fight hard”, because I know from a speech therapist point that hey, look, it's a lot of work to – I know, it's part of the job, but to come in there, and like Laura says, putting lavender on my feet. They were going above and beyond in every way to make me comfortable that I didn't want to fail them. I didn't want them to think, “Oh, there's that one patient in the room, whatever, that just sits there in her bed all day, and she doesn't do anything”. I wanted to be the one that's like, “Alright, you guys get in here. Let's get out of his chair”. I never wanted to let them down. I wanted everybody to like be proud of me. It was really weird how that is, but I think that – Laura Davis 21:54 Well, we – and we were, Vanessa. We totally were. Like I say, I still talk about your story to this day. I still talk about your story to this day. And what has it been, like almost four years or something like that? Like, it's amazing. It's amazing. I mean, we were so proud of you. And anyways, it's just you didn't let any of us down. For one, we were just like jaw dropping when like you're sitting there doing squats. [crosstalk] And, I mean, I wish I was there. I wish I was there to like see it, actually. Mattie Murrey 22:24 Are you going to have pictures in your book, Vanessa, Speechless, when it comes out? Vanessa Abraham 22:27 Well, I don't really have any ICU pictures. It's kind of weird. Because I insisted whenever anybody would bring out the camera just the way – I knew how I looked. I hadn't showered in weeks. And I knew that, “Oh, I'm not going to want to look back on these pictures”. But now that it's in the past, I kind of wish there were some pictures, just to see how bad. I do remember how bad I was, but just to see the pictures. I do have pictures with my team when I did come back to ICU after the fact – Mattie Murrey 22:58 Those will be in the book. Vanessa Abraham 23:02 – a big homecoming with speech, and some of my doctors, and stuff like that, but. Mattie Murrey 23:07 We want to do a lightning round before we run out of time. All right. In one minute or less, are you ready, Laura, are you up for the challenge? Laura Davis 23:14 Okay. Okay. What's a lightning round? [crosstalk] Mattie Murrey 23:16 We’ve just – we’ve got a minute to answer. Laura Davis 23:19 Okay. Mattie Murrey 23:19 So, when we planned for this podcast, Vanessa and I put together all these questions. And so, I want to make sure that we get through them because there's a lot of listeners on here who are like I've got some of these questions. So, in a minute or less, how – any strategies for working effectively alongside an SLP from the nursing perspective? Laura Davis 23:37 Any strategies? Mattie Murrey 23:38 Mhm. Laura Davis 23:38 Definitely if you do have to work with an SLP, I mean always communicate with their nurse first. You don't know how tired that patient's been. You don't know what they've done during the night, if they slept. And then also communicate what the patient's done. If they're, like refusing treatment. If they're – if they've had an issue. If there's anything that's wrong. I mean, if there's anything that – any other type of like interventions that they can think of to help the patient. Like, “Hey, we tried ABC and D. We can't – we don't know where else to go”. But definitely collaborate with the team. Collaborate with your nurses. Collaborate with your doctors. Put a note. There's always like a good note that we can like go back to. Because, I mean, it may be a week, a week and a half before someone else comes around. And also, have like the SLPs on every single day. It's a bummer when they're only there Monday through Friday – Mattie Murrey 24:30 Mhm. Laura Davis 24:30 – because then the work that like a patient's done, they can lose it within two days. Especially if they've come so far. It's like one step forward, two steps back. So, that's definitely another thing. It's like it's something that needs to be in the hospital that needs to be addressed every day. If somebody's not passing their swallow eval, or they're having some sort of like verbal issues, whatever. I mean, it needs to be addressed right away, not until Monday, not until whenever, but. And then definitely collaborate with everybody, all other team members, because there may be something else going on that we don't know, and they're just – they're one part of it, but they're also a huge part of it. Mattie Murrey 25:09 Mhm. Laura Davis 25:09 That's what I would think, or suggest. Mattie Murrey 25:12 So, next question, what does the typical interaction between a nurse and an SLP look like? Laura Davis 25:17 Oh. Well, most of the times they come during the daytime. Generally, they're very – the ones that we work with at UCSD, they're very polite. They definitely want to help everybody. We try to forewarn them if patients are being very verbally abusive, or if they're depressed in some way and they don't want treatment. But, again, we collaborate. Sometimes we have to go down and do like video swallows. So, working side by side, I mean, it's just they’re another one of our team members. It’s like it’s just another part of nursing without having the title of being a nurse. I mean, that's the same thing with like respiratory therapists, physical therapy, occupational therapy. All of the different ancillary teams, they're still part of the team. And so, they're there exactly for the same reasons, and they do their job. It’s just a specified job. So, I mean, I get my hat off to them, because they do do so much that I don't, I can't do. I can do, if I learned the skill, but I can't do everything as a nurse, as a bedside nurse. I’m there for specific jobs. So, having their skill, their expertise, is definitely – I mean, it is a huge part of like recovering in ICU. Mattie Murrey 26:29 So, we've made it through all of the questions, except one. The last question is what advice do you have for a new SLP, or a graduate student on working with nurses? You kind of already answered that. [crosstalk] Laura Davis 26:43 Definitely get to know your team. I mean – exactly. I mean, anybody new grad, it's very scary to go into certain environments with people that you don't know, but always have an open mind. Always know that some nurses are not going to be as friendly as others, but it doesn't mean that it's anything personal. Do your job. Always know that there's learning points that you're going to come across. You're not going to know everything. I mean healthcare in general, you learn something new every single day. Definitely know your team. And know your outlets. Like if something does happen, like do you know how to call code? Mattie Murrey 27:20 Oh, yeah. Laura Davis 27:21 Do you know how to call for help? Know your resources. Because, I mean, when you're working with someone's airway, they can have a mucus plug and you're the only one in there, and you don't know who to call. So, that's like what I always tell any new grads, or anybody who's new to like ICU, always have a plan B of what you would do in an emergency – who to call, who to look for. And if you don't, you yell out to the room. Because, yes, these are my two patients in the ICU, but not really. Every single patient on my ICU is my patient. They're not – we're all there to help. And make sure that you have your resources. Just your resources are very important, but what to do in an emergency is very important because, again, working with that – those airways, it’s not just speech and language. Mattie Murrey 28:06 Mhm. Laura Davis 28:06 I mean, it's the whole – the trachea, the esophagus, everything that – anything can happen at any time. Mattie Murrey 28:13 Mhm. Laura Davis 28:13 And instead of clamming up, always know how to call for help, and who to go to. Just good communication, basically. Mattie Murrey 28:24 That’s excellent. Excellent advice. I'm glad we did that deeper dive. I wasn't sure if I wanted to loop around to that question. And I did, and you just gave me so much with that answer. Thank you. Laura Davis 28:33 Oh, good. Good. I'm glad. Yes, definitely. Mattie Murrey 28:35 Mhm. Final comments, Vanessa? Vanessa Abraham 28:39 No, I just – I love hearing her speak. Mattie Murrey 28:41 I think everything she says about the relationship between SLPs and nurses, now that I've lived the other side of it, it was fascinating for me in a terrible situation to see the interaction, and hearing Laura's comments and thoughts on how the two disciplines work together. I was fortunately unfortunate to be able to see that relationship unfold, and it was really fascinating for me to see that relationship and see them collaborating with each other, and I thought it was just really remarkable what they did as a team for me. Laura Davis 29:17 Yeah. Mattie Murrey 29:17 So, from your perspective, what advice would you give to SLPs working with nurses? Vanessa Abraham 29:23 Oh, everything Laura just said. Keep that communication going. The nurses have so much valuable input. They have – because the nurses are there 12 hours a day with the patient. They're there. Mattie Murrey 29:34 Mhm. Vanessa Abraham 29:34 The nurses are primarily the ones talking with the families. They're doing a lot of communication with families, so they know the family dynamic. They know what the patient's goals are. Obviously, speech can figure that out as well, but the nurses are there so often. Mattie Murrey 29:48 Mhm. Vanessa Abraham 29:49 They get to – Laura and I, we were more on a personal level. She knew that I wanted the lavender lotion. Well, speech didn't want that. Well, not that they want that, but they didn't know that and that’s nothing against them, but Laura was there all night long. Mattie Murrey 30:05 Right, right. Vanessa Abrahamy 30:05 And when you’re with somebody all night long you get to really intimately know them. Mattie Murrey 30:09 Right. Vanessa Abraham 30:11 So, my advice would just be to keep that communication, keep those nurses on your side, because they are amazing people. Mattie Murrey 30:17 Mhm. Yeah. In my training, when we go up on a medical floor, the first place we go after the chart review is to talk to the nurse. We do the chart review to figure out where – what we can gather from the chart, how they're doing and everything else, and then we go and we check in with the nurse. We don't need to have the nurse tell us things that we can find in the chart. We go look at what we need to. But that nurse just puts the finishing touches on everything, and here's how your patient is doing – or “Here's how our patient’s doing. Here's what they have lined up for tests this morning. They're NPO until here or there”. But that communication is just so, so important as part of the team. Vanessa Abraham 30:51 And how – nurses know how the patient's doing emotionally. Mattie Murrey 30:55 Yeah. Vanessa Abraham 30:55 There were many highs and lows within an hour period for me, and my nurses would know that, okay, it's 2:00 a.m. and she's feeling this, or it's 2:00 p.m. and she's feeling this. So, they definitely connect – are connected with that patient. Mattie Murrey 31:14 Yeah. Well, thank you both for coming on. Vanessa Abraham 31:16 Thank you. Laura Davis 31:17 Yes, you're very welcome. Anytime. Great. All right, thank you. Mattie Murrey 31:19 Thanks, Laura. We may pull you back another time. Thanks. Laura Davis 31:25 That’s okay. I'm here, I’m here. Hey, use me, I’m good! Mattie Murrey 31:27 So, hey, SLPs, that concludes this episode of the Missing Link for SLPs podcast. Please visit my website at fresh slp.com. Follow me on Instagram, or jump on Facebook to connect in our safe and friendly Fresh SLP community where we are empowering new and transitioning SLPs. If you found value in this episode, or in any way had an aha moment, or I gave you a fresh perspective, please show me some SLP love, and support me on iTunes or the Apple podcast app or subscribe to me on YouTube. You got this!