The Perspective of Treating One of Our Own Through Conversations with ICU and OP SLPs

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. Hello, and welcome to this episode of the Missing Link for SLPs Podcast. We are deeply, and wonderfully entrenched in our Speechless SLP series with Vanessa Abraham, and we are here with two of her very special guests, and you're going to hear why in a minute. We relabeled this episode, One of Our Own. So, welcome, everybody. Vanessa Abraham 00:58 Thank you, Mattie. Danielle Torrez 00:59 My name is Danielle Torrez. Thank you for having me. I'm happy to be here. Sherry Ewing 01:03 Hi, I’m Sherry Ewing, thank you for having me. Vanessa Abraham 01:05 Hi, and I'm Vanessa Abraham, speech therapist, and patient. Mattie Murrey 01:09 We've got everybody here. We were just chatting before we pressed the record button on how much I'm enjoying meeting Vanessa's friends. And the journey that she's been on has indeed been a unique one, and today is a unique episode because we are talking with Sherry, you are her outpatient speech language pathologist, and Danielle, you were her ICU speech pathologist. So, we are getting your perspectives. So, welcome, welcome. Before we really get into the conversation, Danielle, we'll start with you, and then Sherry, in one to two sentences, what were your very first thoughts when you first learned that Vanessa was one of our own? Danielle Torrez 01:53 So, my initial thought, I had a little bit of background information, just given that my friend Ashley was her friend as well, but I knew she had a rare diagnosis, and that hadn't really been fully worked up yet. So, my initial thoughts were what is she going to present like, and what am I going to be able to help her with? I want to make sure that I'm able to give her the tools that she needs to either communicate, and eat and drink. Typically, in an acute care setting, those are some of the main areas that we're targeting. So, those were kind of my initial thoughts. And then being an SLP, I just think it could be any of us. And so, making sure that I had the tools that she would need to help her feel comfortable and supported during her hospital stay because it can be a really scary time when you're in an ICU. Mattie Murrey 02:42 Mhm. Sherry? Sherry Ewing 02:44 For me, honestly, I thought, gosh, the pressure is on – Mattie Murrey 02:49 Mhm. Sherry Ewing 02:49 – I mean, if I'm being totally honest. I too had some background information. I too had received a phone call. “Hey, my friend is in the ICU”. So, I kind of heard about her well before I saw her, but, so yeah, the pressure was on. But at some point, I had to remind myself that she is an SLP, but she's also a patient, and you can't assume that she knows all of the things involved at the time because she's a patient. So, it’s a tough situation. Mattie Murrey 03:23 Well, when I – I wrote these questions because I tried to put myself in your shoes. I have not treated an SLP in an intensive care unit setting. Sherry, I love your perspective where you're like, “Oh, the pressure was on”, because I would feel the pressure. And Danielle, I love your objectivity. I would have a harder –. I don't know, how were you guys able to keep the objectivity working with Vanessa? Danielle Torrez 03:45 Yeah, so I think, and I learned this early on in my career because I've been in acute care from the start, and Jeff actually would call it, the term was “clinical distancing”. And I teach all my students, and in prac, try to do the best with this myself, but you have to make sure that you're putting your best foot forward and not – try your best to not let emotions get in the way because you want to be able – like Sherry said, at the end of the day, Vanessa was our patient, and we need to be able to give her the best services that she needs, and look at her from a patient perspective so that we're not missing anything. Of course, that's incredibly hard when you know that it's one of your really good friend’s friend’s. And you think about her age, and what she was going through. And in the very beginning stages when she transferred to UCSD it was for a higher level of care because they really didn't know what was going on – Mattie Murrey 04:35 Mhm. Danielle Torrez 04:35 – and they needed additional workup. So, I think practicing what we call – what I teach my students is clinical distancing, where you don’t let yourself get too close, but you try not to let yourself get too far away from the patients that are harder to work with. And trying to just make sure that I was able to maintain that. But there were days where I would take it home with me. I felt so awful because I was working with her, and she wasn't able to do some of the things we were trying to work on, just given the acuity of her illness. And I know my coworker and I, Lindsey, shared Vanessa's case during that hospitalization, and it was hard on both of us to try to keep ourselves separate from the emotional aspect of it. And then also getting to know her, and her husband. And we had some other situations come up where she wanted her daughter to visit, but the hospital is a scary environment. So, kind of separating the emotions, but also being able to keep it clinical and professional. But it was definitely a challenge, and one I haven't ever experienced before. Mattie Murrey 05:36 Vanessa, what was it like for you knowing you had team members coming in and out? You were in the bed, but you knew that a speech pathologist was going to come and work with you, and I mean, we trust our fellow SLPs. What was that like for you? Vanessa Abraham 05:50 It was extremely comforting. When they walked in the door, it was “Hallelujah, they’re here”. It was, “Yay, they're going to help me communicate. They're going to help me eat. They're going to help me get out of here”, I just knew as an SLP, that I was going to be in good hands. It was just very reassuring for me. Mattie Murrey 06:08 Mhm. So, from a patient's perspective, when they walk in the door, your world is like, “Here I am. I'm ready to work with you”. And sometimes, I know, in hospital settings and productivity, and we just have our list of patients. We try to be the best that we can, a hundred percent focused on our patients, and sometimes our mind can be on other things that we have to manage in a medical setting. How were you able to focus, Danielle, and Sherry, on Vanessa as much as you'd put in those settings that you worked with her in? Sherry Ewing 06:43 Well, I think that she – as she said, she kind of welcomed us with open arms and what we have to offer, and not all patients are able to do that. I've had patients sometimes say, “Well, what's a speech therapist going to help me with?”, because they have no idea the kinds of things that we do. But I would say that I definitely kept her on the forefront. It was hard not to keep her on the forefront of my mind. But managing a busy schedule, and taking care of all of your patients equally is important. You can't give anybody extra preference, though I probably did. But yeah, it's tough in a busy work day. Mattie Murrey 07:27 Yeah. Danielle Torrez 07:28 Yeah. I think in acute care too, of course, productivity is the big buzz around in terms of like a manager's perspective. For me, once I build a caseload, we're able to stay on the same floors for a couple of weeks at a time, so we really aren't rotating units. And so, besides my new consults that I was getting on a daily basis, I knew her case. I knew what we were working on. We were able to keep up that continuity of care. So, it made coming in every day much easier, because I was able to really see areas that she was progressing in, areas that maybe were a little bit more challenging, depending on what she had going on medically. So, some days, you're not productive, but I always just think I'm always going to spend more time and make sure that the patient got what they needed that day, and then the following day, I'll just pick up the slack that I didn't get the first day. There's just a balance in acute care. Mattie Murrey 08:19 One of the things that I've learned talking with Vanessa is how important it is that we do what we do. She's been a firsthand, just a reminder of the importance of what we do. Did you have any struggles with HIPAA when friends came to ask? Because I know SLPs, we sometimes talk about clients’, patients’ cases. But how were you able to – any recommendations for SLPs who have that fine HIPAA line they have to adhere to? Danielle Torrez 08:52 So, HIPAA is very important, and you never want to be in a position where you're violating that for any patient case, friend. Mattie Murrey 09:00 Mhm. Danielle Torrez 09:00 And even though – I think my biggest piece of advice is even though the patient may be willing to share a lot, it's their story and their story to share. So, you have to be very careful about what you're discussing with other SLPs. And oftentimes, up until out, like after her hospitalization, I was very careful on what I told anyone. And then I always made sure that I followed the rules, especially when it comes to an inpatient setting. You’ve got to just be – it's really important. And it's important for Vanessa. She was going through such a serious critical time in her life, where maybe at the moment she felt like she wanted to share, but it wasn't our decision to make for her. So, I really didn't have much discussions beyond with our medical team and our SLPs in our department until after, when she was out of the hospital and on her road to recovery, and was – made it very clear that she wanted her story shared, so. Sherry Ewing 09:53 I like what you said. It's her story to share. Mattie Murrey 09:57 Mhm. Sherry Ewing 09:57 So, I just kept focused on treating Vanessa. And then she could tell any of her SLP friends, or our mutual friends, whatever she wanted to tell them, and I just stayed focused on her. Because you're right, HIPAA – if we don't have HIPAA, we really don't have a safe health care system. So, yeah, I just stayed quiet. Mattie Murrey 10:20 And let Vanessa tell her story? Sherry Ewing 10:23 Yes. Mattie Murrey 10:23 Excellent advice. Vanessa, do you have any thoughts on that? Vanessa Abraham 10:29 No. If anything, it gave me great comfort knowing that Danielle and Sherry both knew various people in my little circle of SLPs. At the time, I was so sedated I didn't know what was going on. But now looking back, it gives me comfort knowing that there was communication within HIPAA guidelines, appropriate communication. But just from my personal standpoint, it was very comforting to me to know that everybody kind of knew each other. Everybody – not necessarily even Danielle and Sherry, but just SLPs that I work with, that they were all communicating. They all had experience and knowledge with various things that I had going on. So, again, it just gave me comfort knowing that there was so much communication going on about me. Everybody had valuable input into my recovery. Everybody brought different pieces of information and knowledge. So, I felt like it was a very collaborative approach to helping me through my journey. So, overall, I'm very grateful for that communication, and the fact that everybody kind of knew each other, and that they were talking, so. Sherry Ewing 11:41 It was also wonderful to see some of your coworkers, your SLP coworkers, bring you to therapy. So, sometimes she’d get a ride, and one of them would bring her, and it really warms my heart to see the friendships and the love that she had with her SLP coworkers. Mattie Murrey 11:58 I love that. Vanessa Abraham 12:00 Sherry knows a lot of the people that I work with just because we're in the same town. And a lot of the people that I have worked with, or that I currently work with, have worked with her over the years. So, yeah, a lot of them would bring me to therapy. So, it was kind of like somewhat of a reunion. Everybody could see each other and talk, and it was just very reassuring for me. It gave me a lot of comfort, even brought down some anxiety. My anxiety was high. It brought that down a few notches knowing that there were people out there that cared and were genuinely concerned Mattie Murrey 12:32 And spoke the same language. Vanessa Abraham 12:37 Absolutely. Mattie Murrey 12:39 As SLPs, we just have our own language, our own way we do things. So, Vanessa, you've changed my career. You've had an impact on how I view the work that I do, and taking it to a deeper level. Sherry and Danielle, can you share with us how working with another SLP, and Vanessa, has had an impact on your careers? Sherry Ewing 13:01 I think for me, the level of gratitude that she has verbalized to me, and about all of her other providers, makes me realize how important we are. And, of course, I've always known that. I have been a speech pathologist for 27 years. So, I've always known that, and I've always appreciated when people thank me. But getting to know her like I did, just the level of gratitude that she has, it just makes me realize even more so how important my career is, and how we can impact people's lives, and just touch their heart. And the littlest things we may do or say, they just may never forget. And there's not a whole lot of professions out there that can state the same. Mattie Murrey 13:50 Mhm. I think that's an important piece to remember when SLPs are dealing in stressful settings, and burnout is a risk, and things like that. Addressing the burnout risks, but also remembering our big why. And you’re right, Sherry, we do have a very – we can have a very emotionally rewarding career. Sherry Ewing 14:12 Mhm. For sure. Mattie Murrey 14:13 Danielle? Danielle Torrez 14:13 For me, I agree with what Sherry said. I think Vanessa's gratitude just towards her services, and her – just that she's been able to keep in touch, and keep us in the loop, and give us updates. And seeing how impactful our time together was is – it means everything. We love when patients give us feedback, and are able to come back and visit and let us know how they're doing. And just to talk with them, and to hear, like Sherry said, their gratitude, it really makes you think like “Okay, this job, I'm touching someone's life and I’m helping them”. And then also, I think being in acute care, our – and just, in general, speech pathology, the field is so large and you can have a very specialized skill set. And I think even though Vanessa is a speech pathologist, and she went through the same training that we did, there's a lot of things that we went over in the beginning that she needed me to go over multiple times, and she was so cute. She always would say, “I need – okay, next time, I want my husband to be here so then we can talk about it after”. So, I guess just recognizing that the field is so large. There's so many different areas of specialties. And when you – and if this ever were to happen with anyone else, you’ve got to make sure you're spending the time and really breaking it down in a way that a patient is going to be able to understand it, speech pathologist or not. I think that was a huge part of our beginning journey in the hospital, is kind of just going over the trach and vent, and what that means, and speaking valves, and coordination with swallowing. It was all things that she'd heard about, but really needed a review on. And it was an amazing experience for me, and I know it was for her too, and we talk about it often, so. Mattie Murrey 15:52 Well, Vanessa has often talked about the trust that she has in you two, just implicit, unending trust. What did you do to build that trust? Sherry Ewing 16:02 Well, I think, with all patients, it's always important that connection that you establish, day one. I call it the “buy-in” – Mattie Murrey 16:13 Mhm. Sherry Ewing 16:13 – trying to get them to buy-in. And I don't mean buy into you as a person, but buy-in to the situation and the therapy. And, you certainly – if you don't have that connection, I don't think you're going to establish trust. But I think she’s previously mentioned, she was willing and able, as soon as she saw speech pathology enter the door. But I think just kind of giving feedback, and talking about all the little baby steps involved, and keeping her eye on short term goals instead of long term goals, per se. And I think, once she could see a little bit of progress, every little step established trust. And I think that's kind of an ongoing, trust is ongoing, and it may change. And it's certainly different in inpatient versus outpatient, and in different types of patients. Mattie Murrey 17:09 Danielle, how about you? Danielle Torrez 17:11 Yeah. I think in the initial phase, like Sherry said, you’ve just got to work on building rapport, introducing yourself, taking the time to introduce yourself to her family. It was a really scary time in her life when she was there, and she shared that. And I think too, just kind of with the progression of her disease, it started off with her being able to move her head and neck and arms, and then it got progressively worse. So, making sure that you were there to listen to what she was saying, provide the tools that she needed to best communicate with you and then celebrate the baby steps, because it's hard when you're in that position. And I think just taking the time. I know a lot of times, like you mentioned earlier, productivity is mentioned, but you’ve got to just make sure that you're spending the time that the patient really needs. And it may be more upfront, but it's going to definitely help build that relationship and trust, and I think patients always do better when they're given that. Mattie Murrey 18:08 Vanessa, how about your perspective? Vanessa Abraham 18:10 I think these two women did an unbelievably amazing job at gaining the trust and respect that we needed. Danielle from the acute phase, and I think I said this in Dr. Rosen's podcast as well, that them taking the time – and Danielle and the team at UCSD taking the time to explain things to me. She was talking about needing to talk to me and explain things to me when my husband was there, because I was just in such a state of shock and despair and my anxiety was so high, that for her to sit down and explain things to us, explain what these procedures were. Even though I was an SLP, I don't know when you're in such a state of shock and disbelief, you tend to forget what all these procedures are, what they do, or what the point is. I don’t know. It was just so clear, beyond belief, for Danielle and the team at UCSD to sit down and talk with us, and bring visuals. That just, for me, brought such relief and immediate trust. Like okay, they're taking the time. They're holding my husband's hand for this too, because I was also worried about my husband. Like, he's got to be scared beyond belief right now as well. So, that, for me, gained a lot of trust. Just that time, and then going above and beyond. For Sherry, when I went in to see her, and her positive attitude, her “We’ll get through this. You can do this” kind of attitude. I think I said in a previous episode that she was the sunshine. Mattie Murrey 19:46 Mhm. Vanessa Abraham 19:47 And she also took my husband under her wing, and educated him, told them what to do, what techniques to be doing at home and educated him on things that he could be doing. Just took that whole family approach to helping us, and that to me was huge in gaining our trust. Sherry Ewing 20:06 I want to say that I've worked with SLPs before that don't want family members in the room with them while they're doing treatment, or in the ICU room. I won’t judge that. But, for me, if you don't address the whole family, and I don't mean six family members, but certainly the spouse, and the parent, or whatever it may be, I think it's crucial. And I think that we can do a disservice, and probably in my younger years, I may have done the same thing, “Please leave the room”, but really, you need them there, and they need to see what's happening. And then, again, if they trust you, the patient will trust you. Mattie Murrey 20:44 Mhm. Vanessa Abraham 20:44 I appreciated the fact that they wanted my husband there. I remember at UCSD, the nurses, the team, everybody there being relieved when he was there because he could help not only communicate, but he could provide information to the team. He could let them know what was going on. And the fact that, again, that they wanted him there, shows a lot too. That they weren't trying to hide anything. They weren't trying to do anything behind our backs. They loved the fact that he was there 10, 12, 14 hours a day. And Sherry too, he would be there at my therapy appointments. And I know that she was pleased and happy to see him there, that he was involved, and that we weren't just a patient that was going to come to 30 minutes of therapy once a week and then go home and not do anything. We weren't going to be that patient that wasn't going to go home and do [activities], and whatever. Sherry knew that we were – I was a patient that came home, and for example, I have my breathing treatments here, still. My NMST neuromuscular training and my straws, Sherry sent me home with all sorts of little tools. And both of us, we'd go home and make sure that we were checking off what we were doing, and just those types of things said a lot about their level of care. Mattie Murrey 22:16 So, for counseling, it's come in at the patient's level, involve family members, as much as you can, involve the patient’s input, be positive, empower them with tools and activities, education, visual and repetitive and clear and straightforward. Anything else with the counseling? Sherry Ewing 22:40 I think sometimes too, just asking the family member, “Are you okay? Are you sleeping?” Just kind of letting them know you care about them as a person as well, and they're dealing with things on all different levels, depending on where the patient is in their illness. And I will say that Dale was one of the best spouses I've ever worked with, the most loving, caring – on it. He was on it from the moment I met him. And, obviously, he was prior to me seeing him as well. Mattie Murrey 23:10 Mhm. Danielle Torrez 23:11 Yeah, I would agree. Just making sure that you're checking in with family members that are also caring for the patient, and that are there for a lot of hours. They need to eat, and sleep, and make sure that they're separating themselves at times too. And they were traveling, so making sure that they had the resources that they need. I'm not sure if you accessed Bannister housing at all, Vanessa, but there's different services that hospitals offer. So, if you find yourself in that situation, you can always forward along the case to the social worker or case manager to help better support the family. Mattie Murrey 23:41 Good advice. So, since this is the Speechless SLP Podcast, let’s segue over, before we're done with our time, about what it was like bringing on an AAC system for Vanessa. I think that's in your ballpark, Daniel? Danielle Torrez 23:54 Yes. It was challenging. I think it really shed light on the fact that AAC, people think, typically, is this really nice high functioning device, when in reality, we're working with low tech AAC boards, picture boards, communication boards. And I will say although Vanessa was sedated, it was light enough, even at the time when she was intubated, that she was still able to follow directions and try – she was trying to communicate with us. But before she received her tracheostomy tube, with the intubation tube it's just too hard for anyone to mouth words, or even for us to really understand what she was saying. So, what we ended up starting off with initially was picture boards, and we would – they were kind of set up by needs. So, personal needs, emotions, nursing needs, pain, different scales, and I remember her having a little bit of thumb and wrist flexion, so she was able to hold something between her thumb in her palm of her hand to try to point. But then as her strength got a little worse, and she wasn't able to do that, we did try eye gaze. She never lost eye movement. And so, she was able to always kind of blink with us. But it was challenging to be able to make sure that we had enough tools for her to communicate with us, and I know at times we didn't. I know at times her anxiety was really high, and she had a lot of things she wanted to say, and questions she wanted to ask, and it just was difficult to do with the limited resources. I think since then we've kind of taken a look at it in our ICUs, and we've developed just better picture boards and communication boards. And we've actually finally got iPads and we’re going to be able to start uploading better apps on them for patients that are in the kind of position that she was in, but it was definitely a challenge, because there was times when I just felt like I wasn't able to give her the tools she needed. Mattie Murrey 25:53 Mh. Do you have any app recommendations for people listening? That would be my question. Danielle Torrez 25:58 Yeah. So, there's free apps that you can download. So, Patient Communicator, and I think Vanessa actually told me about that one. It's great for an ICU setting, and it has several different languages. So, it's really nice for all different types of patients that speak different languages. There's one by Tactus Therapy. I believe it's AAC Bestie, you can kind of customize that one. And then just downloading a text to speech app. And I can email you pictures of these, the icons, but they're all free to download. And depending on where the patient's at, if they have dexterity to type, or they just need to have like a pointer to hit the icon that they need. Those are all great free apps that you can download onto a tablet or iPad. Mattie Murrey 26:40 Yeah, if you send those, we'll put them in our show notes and people can go look at the show notes. Danielle Torrez 26:44 Sure. Mattie Murrey 26:45 And Sherry, the same with you. If you have any cognitive comm work that's resources, we'd love to have some of those too. Sherry Ewing 26:54 Okay, sure. I want to say to Danielle, I'm impressed with what you guys did with her, and with AAC. Having worked in several different hospitals, and none the level of UCSD, of course, but it just rarely happens in the ICU setting. Mattie Murrey 27:10 Mhm. Sherry Ewing 27:11 And we've all tried basic comm boards with our aphasia, our apraxia patients, and it's really tough, and they rarely have worked with – in my experience. So, I think it's really wonderful that you guys were able to do that for her. And I know the time that that takes to create it, to think about it, and then to get it moving. So, that's exciting. Danielle Torrez 27:38 Yeah. I can also send over just – it's a very generic ideas board, but it has step by step instructions for future clinicians that find themselves in a position where they have a patient that’s sedated, but not fully sedated. So, they're very awake. They're trying to communicate, but they're intubated. So, it's a good tool to use. And then based on what you find out with a patient, you can adjust it. I can send those along as well. Mattie Murrey 28:00 That’d be great. Danielle Torrez 28:02 Especially if they don't have their upper extremities, they're not working, and all you have is eye gaze. Yeah, I will email those out to you. Mattie Murrey 28:10 Great. Vanessa, anything you want to add? Vanessa Abraham 28:12 No, I think Danielle pretty much covered it. The use of AAC was definitely one of the challenges of the ICU experience. I had a lot to say and a lot of questions because I knew enough, but I still had so many questions as an SLP. Like Danielle was saying before, doctors and various people would come in and start talking about procedures, and I was like, “Well, I remember reading about that in grad school, but I am a school based SLP. So, refresh my memory on what these terms mean”. Mattie Murrey 28:48 Mhm. Vanessa Abraham 28:48 Not only have I forgotten, but I'm also a patient now and I'm scared out of my mind, so I can't process everything that's going on. So, I had endless questions and just so much to communicate, so many things to ask, but yet I couldn't do it. So, often, I would just kind of be like, well, refer to my husband, and then they'll figure out a way to tell me, and that was terrifying. Mattie Murrey 29:17 Mhm. Vanessa Murrey 29:17 That’s just a terrifying position to be in. But I had a team that, in my mind, I kept telling myself I trust them, they know what I need, and my husband's here for me. They're all communicating and they're going to rounds, I'm in a good place. But nonetheless, it was still very terrifying. Mattie Murrey 29:33 Last question, actually two questions left. What is one piece of advice that somebody gave you, that you are glad you did not follow? Long pauses here. [crosstalk and laughter] Sherry Ewing 29:47 I mean, I think I referenced it earlier, that I had been told don't let family members in the room – Mattie Murrey 29:55 Mhm. Sherry Ewing 29:55 – keep them out. I think that really is something. Another piece of advice, patients that come to us, again, as outpatients, and maybe they're a year post stroke, or whatever their injury, and in my younger years, I was told they're – it's past their time that they’re going to progress, and you can't see them. Like unless they've had a change in function or a decline in function, we can't say that. What I've learned is that obviously you can still make a difference, and you can still treat them and you can still make some progress, and they're at a different level. So, I think that's something important for me. Mattie Murrey 30:32 Mhm. Danielle Torrez 30:33 I think for me, I'm so big on early intervention in the ICU, and making sure that you're getting in there, and you're getting in there early, even if the patient isn't quite at the point when you're able to start doing some evaluations and therapy with them, and making sure that all – you know, we're a teaching hospital, so, ultimately, the attending has to agree to the plan. Mattie Murrey 30:52 Mhm. Danielle Torrez 30:52 And making sure that you're advocating, and even if they think that the patient's not ready, if you're able to just really justify why you think your service is needed, even if it is early on in the stay, you can really help someone. So, with Vanessa, they were like, “Oh, she can't do PND yet. She's on the ventilator”. I'm like, ”Well, her settings are within parameters. Even if we're only giving her five minutes of talking time, that's five minutes when she’s able to tell us something”. So, just advocating for services if you think the patient's at a point when they're able to work with you. Even if it’s free, it's still important. Mattie Murrey 31:25 Mhm. Vanessa, words of advice you are glad you did not follow? Vanessa Abraham 31:29 Oh, gosh. I wasn't expecting that one. Um -. Mattie Murrey 31:33 This is one of my favorite questions, for the reasons that Sherry And Danielle just gave me. Vanessa Abraham 31:38 I think both of them have some very good points. Words of advice. I don't – I wasn't even not told this, but the mental state. Maybe as new grads, maybe as clinicians, or may be told not – that it's not within our scope to maybe look at the mental side of a critical illness, or to provide that patient education, or that support to the family. Maybe because the counseling component is not within our scope, and maybe we're not trained in that. Technically, we don't have a degree in counseling. But I think that component is so big to patient recovery, patient satisfaction, being there for them, encouraging them. I think those are very important areas that should be addressed. And Sherry, and Danielle, and my team did an amazing job at that. But I would think that maybe that might be an area, looking back, that wasn't really talked about in school. It wasn't something that was heavily emphasized, I should say. Mattie Murrey 32:48 And thank goodness it is now, that we're able to have episodes, discussions, courses where we learn more of a comprehensive – counseling is still mental health. It’s still mental health, but how we can supplement and augment within our scope of care. Vanessa Abraham 33:05 Yeah. And it’s hard to put another layer of responsibility on SLPs, in both the school and the medical setting, and saying, okay, you’re going to treat this, this, this, this, this, this, this, this and this, and now you're going to also be responsible for counseling and the education and all of that. Counseling, remember we talked about PICS, the Post Intensive Care Syndrome. But I think it's such a crucial piece of the overall picture. Mattie Murrey 33:31 So, to our graduate students who are sitting out there, what one word of advice would you give to grad students or clinical fellows? It doesn't have to be about AACs or speechless anything, just one word of advice for your career. Sherry Ewing 33:44 I would say be a lifelong learner in speech pathology, and I don't mean that you need to go back to grad school. or get another degree, but take some graduate students because you'll learn from them. Mattie Murrey 33:58 Mhm. Sherry Ewing 33:58 Terminology changes. You'll learn something from them. If you're offered to come speak at a senior center, or speak to a specific group, even if it may not be your level of expertise, if you study and research, and ASHA has so many wonderful publications out there to just keep you on top of your game. And your toolbox gets boring if you just stick with what you know from graduate school. So, be a lifelong learner. Danielle Torrez 34:28 I also can't stress the importance of being a lifelong learner as well. Our field is young and it's evolving, and you need to make sure that you're keeping up with the evidence and adjusting your practice to follow best practice guidelines. And it's awesome to see just changes even since I've been a speech pathologist, it's been six years, seven years. But yeah, learning, changing your practice, following what the evidence says, and growing as a clinician for your whole career. And taking graduate students is amazing. Multiple Speakers Mhm. Yeah. Mattie Murrey 34:56 They have a place in my heart, that's for sure. Danielle Torrez 35:00 Yeah. Mattie Murrey 35:01 All right, Miss Vanessa, final word from you. Vanessa Abraham 35:05 Advice for new grads would be to keep them hopeful. Try to find a way to keep your patient hopeful, or keep them looking to the future. Some of the things that were started for me in ICU, Dr. Rosen got me a journal. One of the things to help me stay positive and hopeful, and maybe reduce my anxiety, is things just like writing down your progress. I don't know if Danielle remembers, but in my room I got a list of goals and accomplishments. Trying to remember where you were yesterday, a month ago, a year ago. So, as a new grad, or a practicing therapist, you want to try to find a way to give that patient hope to continue to fight, to continue to press forward. Make their vision board. We've talked about those. Vision boards, and where you want to go. Where do you see yourself so you're not living in this state of depression and anxiety. Gratitude journals – try to rewire your brain. For patient’s, it’s not easy, I'll be honest. But my advice for a new grad would just be, try to help your patients to just be hopeful, and keep fighting. Keep that fight on, because it's hard and it's long. It can be very long, and very depressing, and really isolating. So, be the sunshine and find the hope, help them find the hope. Mattie Murrey 36:24 Be the sunshine. Well, this is how we take care of one of our own. Thank you very much for coming on this episode with us. Vanessa Abraham/Sherry Ewing/Danielle Torres 36:32 Thanks. Mattie Murrey 36:34 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. 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