Vanessa Abraham: From Fit and Active to Critical Condition in a Week

The Missing Link for SLPs Podcast Full Transcript Mattie Murrey 00:03 So, have you ever wondered what it's like to lay in a bed speechless? I'm talking intensive care, machines beeping, your life is in jeopardy, and you can't ask a single word on what is happening. This is exactly what happened to Vanessa Abraham. She was feeling alright on a Thursday, not feeling so well on a Friday, and by Sunday, she was an inpatient in an ICU setting, and she was speechless. So, welcome to Vanessa Abraham. She is the Speechless SLP, and she's writing a book for our profession, and for the world to read about what it's like being speechless. So, she's agreed to be part of the series here on the Missing Link for SLPs Podcast, and her series is going to be called The Speechless SLP. I'm so excited because all of these episodes are going to unroll with different guests. Vanessa is our primary guest of honor, our main guest of honor, for four of the episodes. In all of the other remaining episodes, we're going to be talking with her doctor, her mother, her husband, her nurses, other speech pathologists. So, it's a really exciting series, and I'm so glad you're here, as she offers such valuable insight. But let me tell you just a little bit about Vanessa's journey so you have a little bit of a background on who she is. Vanessa is a wife, mother and a school-based speech language pathologist. She learned firsthand what it's like to be on the receiving end of speech therapy services after experiencing a sudden onset critical illness that they didn't know what it was for quite a while. It left her with limb and neck paralysis, as well as a PEG tube and a tracheostomy. That's what made her speechless. She was thrown into the rehab world after being an independent, healthy, and vibrant young mother, wife, and speech language pathologist. Through many swallow studies, voice therapy, OT and PT, she's had to learn to eat, talk and move again. Her goal is now to help critically ill patients cope with the grief that they experience after a critical illness. And through speaking up about the topics of things such as post intensive care syndrome, depression and anxiety, she wants to educate families and patients and the general population about the various rehab modalities that have been successful for her – such an important perspective. So, welcome to this episode of the Missing Link for SLPs. This is part of The Speechless SLP series. I would love to take this opportunity to introduce you to Vanessa Abraham, The Speechless SLP. Welcome, Vanessa, to our whole entire Speechless series. Vanessa Abraham 02:55 Thank you for inviting me, Mattie. This is a dream come true, it really is. Mattie Murrey 03:01 We, you and I, are embarking on a 12 course series. It's not a 12 course – a 12 episode series. And it's a dream for me as well because I want my podcast to mean something, and to share stories with other SLPs, and you really, really have a story. Tell us a little bit before we hear why you’re called the Speechlist SLP. What is your big “why” of being an SLP, and how did you get started in our field? Vanessa Abraham 03:31 That's a really great question. I would say that the seed was originally planted by my mom. She worked in the schools for many years, I think probably close to 20 before she retired. And she's kind of what, like I said, where the seed was planted. I started thinking, hmm, you know, maybe a special ed teacher. She worked in special ed – thinking special ed teacher, and one thing led to another. So, I got introduced to the field of speech pathology. I did some observations in both the school and in the medical setting. And, honestly, I was more attracted and fascinated by the idea of working with individuals in the medical field. I thought the thought of helping others with brain injuries and swellings, those things that we take for granted … Mattie Murrey 04:19 Mhm. Vanessa Abraham 04:19 … would be very, very rewarding. And it's funny, because that's kind of the route that I was leading. And it wasn't until I got married, and my husband, he's in the golf profession, and we travel a lot. We are gone in the summers. And that's kind of how I fell into the school side of it all, because of the schedule. The schedule is very flexible. Mattie Murrey 04:43 Mhm. Vanessa Abraham 04:44 And then once I got into the school settings, I thought, you know what, I kind of like this. This is a good place for me. It's a good place for my family. The schedule was great. I liked working with kids with autism. The more I got involved in a career, the more I found a niche working with adolescents. So, that's kind of where I've been ever since. Mattie Murrey 05:06 It's a great story because often when I work with grad students, they’re like – and even – not just grad students, people are like where do I want to go with my career, medical or school? And you can have both. Vanessa Abraham 05:17 Yes. Mattie Murrey 05:18 You can work, possibly not at the same time as easily, but our field is so diverse and dynamic. Vanessa Abraham 05:24 Well, it's interesting, because I started out with preschool, little kids, and I was terrified of the middle school, high school population. Mattie Murrey 05:34 Mhm. Vanessa Abraham 05:35 And then, when I finally started working with them, I thought, wow, this is where I belong. I love that transition component. Mattie Murrey 05:41 Mhm. Vanessa Abraham 05:42 I love working on functional life skills. And I haven't ever gone back to little kids since then. I think that's probably why I was more intrigued too, of working with adults in a medical setting. And this is kind of they're more on the adult route, and working at some of those functional life skills, helping them with job placement, and things like that. So, like I said, that's where I've been ever since, and I totally love it. Mattie Murrey 06:09 Excellent, excellent. It's nice to have a job where you're rewarded like that. Vanessa Abraham 06:13 Mhm. Mattie Murrey 06:15 So, how many years have you been working as a speech pathologist? Vanessa Abraham 06:20 I started out as an SLPA, a Speech Pathology Assistant. Mattie Murrey 06:23 Oh. Vanessa Abraham 06:24 And that's kind of how I got my foot in the door. I got in that realm of work in the schools there. I did that for about five or six years, and then it's been about 10 or 11 years or so since I've been an SLP. Mattie Murrey 06:38 So, let's take a little – not a detour, but let's change our focus just a little bit. You've explained to me why you've become an SLP, and how passionate and rewarding it is for you, but I also know that you have a whole life where you're a mom and a wife. Tell us a little bit about that. Tell us a little bit about the life before you became speechless. Vanessa Abraham 07:02 All right. So, before I would say I was like most working moms. I was very, very busy. Very stressed out. I would say at a point to where, I know you've said and talked about in some previous podcasts, that we get to that point as SLPs that we’re really burnt out. Mattie Murrey 7:25 Mhm. Vanessa Abraham 07:26 I was very active and very healthy. I was an avid – what would be the term? I went to the gym a lot. I was probably at the gym four or five days a week. I did a lot of yoga. Before I became speechless, my husband and I would joke around because we lived in a little community where the grocery stores and all of the kids’ activities, the malls, the parks, were all within walking distance, and I would just always walk to everything with my daughter in a stroller. It was easy and faster than dealing with the car seat, and all of that. So, I would put her in the cart, or in the stroller, and we would walk to the grocery store. And we always joke that, what I wish over all these years, I would have put a pedometer on the stroller to kind of log the miles walking everywhere! In the summers, we would go up to Colorado, and I would walk everywhere there with her. I put her in a baby carrier, I would hike eight, nine to 10,000 foot mountain peaks with her on my back. I was very, very active. Mattie Murrey 08:36 Very active, and very healthy. Vanessa Abraham 08:39 Mhm. I never got any illnesses, beyond just your typical cold or sinus infection. But life was very busy, and I started off the school year in 2018, a very, very busy time. The beginning of the school year, for me, is always more stressful than the end. I don't know why, but maybe it's because all the kids are transferring in, or trying to get caught up on paperwork. Mattie Murrey 09:02 Mhm. Vanessa Abraham 09:03 But one thing that I remember to, was right at the very beginning of the school year, we were – there was a conference that we were asked to go to by district because there were a lot of new AAC assessments coming to the district, and they wanted us to become certified in doing the assessment process on these students. And, honestly, I really didn't want to go. I was so tired. It was the very beginning of the school year, and there's so much going on, and I thought ‘Oh, I really don't want to go do this’. But I went to it. That was at the beginning of the school year, just a stressful period. Then you go from there into the holidays, which is crazy with kids anyways, you know how that can be. Mattie Murrey 09:46 Mhm. Vanessa Abraham 09:47 And then after that period, I think it was about February – actually before that, January. We had a very high profile case brewing at the school. It was … Mattie Murrey 10:02 What year is this? Vanessa Abraham 10:04 This was 2019. Mattie Murrey 10:06 And this is part of your – how you became speechless? Vanessa Abraham 10:09 Yes. Mhm. So, leading up to February. So, we had a very high profile case going on at school. That required me to attend a lot of meetings, a lot of talks with attorneys and advocates, and all of that stuff that makes the job very, very intense and stressful. And then, and I think it was about March, early March, we had our annual speech convention here in the state of California, which I attended. Which, again, I didn't really want to, but I felt like, ‘Oh, I need the points. I really should go. There's going to be a lot of great presenters.’ I pushed myself to go. I didn’t really want to, but it's just one of those things that, on top of the high profile case… Mattie Murrey 10:58 Mhm. Vanessa Abraham 10L59 … everything going on at school, a working mom. And so, I was busy, and that was toddler years. A very busy time, very stressful. So, I went to the convention, and came home, and I just collapsed. Just like something was going on with my body. I think it was just my body telling me, like you're exhausted, you've hit your limit. I kind of thought that maybe this is just what burnout looked like. Mattie Murrey 11:29 Was it like a switch? Or was it a sudden – or was it a gradual onset? Vanessa Abraham 11:35 I would say more like a switch. Mattie Murrey 11:38 Okay. And you're wondering if it was burnout or you were coming down with something? Vanessa Abraham 11:44 Yeah. I thought maybe it was burnout. Definitely. My body just started feeling weird. Something was just not right. The week progressed, and I just – weird symptoms were going on in my body. I was having a really bad neck ache. My neck got really stiff. That wasn't a common symptom of having a flu… Mattie Murrey 12:08 Mm-mm. Vanessa Abraham 11:09 … or a cold, a just real stiff neck. Mattie Murrey 12:13 Or burnout. Vanessa Abraham 12:14 Yes, yes. So, things like that were just a red flag to me that this is just not right. And then I started throwing up. I took a day off of work, and then went in one day to attend another one of these high profile meetings because I didn't want to miss it, but I went to this meeting without a voice. My voice … Mattie Murrey 12:35 So, you’d lost your voice. Vanessa Abraham 12:38 Yes. Mattie Murrey 12:39. Okay. Vanessa Abraham 12:41 And I'm a speech pathologist at a high profile meeting without a voice. So, it was kind of like an icebreaker in the meeting that here's a speech pathologist but can't talk. Her voice is gone. And I didn't feel well, but I felt like I’ve got to be at this meeting. Of course, as speech pathologists, we're always pushing ourselves... Mattie Murrey 12:59 Mhm. Vanessa Abraham 13:00 … putting everything and everyone above our own needs. So, I attended this meeting, and I didn't feel good, obviously. I was just whispering my way through it as I was talking about recommended goals and recommended services. I went home, and then the rest of the week I didn't feel good. I woke up in the middle of the night, and I had to tell my husband to take me to the ER. I just knew that things weren't right at that point. It wasn't getting better. Mattie Murrey 13:27 And he took you to the ER. This is like unfolding over a week's time? Vanessa Abraham 12:35 Yep. Mhm. Mattie Murrey 13:37 And you became more and more concerned, more and more alarmed. Did you reach out to some of your colleagues? Vanessa Abraham 13:45 At this point? No. No, I just figured, you know what, my neck hurting I figured maybe tension or … Mattie Murrey 13:55 Mhm. Vanessa Abraham 13:55 At this point, I didn't reach out to any colleagues. I just called in sick, and just left it at that. But went into the ER in the middle of the night, then it was just kind of – unfortunately, it progressed to the point that I was unconscious. Mattie Murrey 14:12 Oh. Vanessa Abraham 14:12 I didn't know what was going on. I had no awareness of what was going on around me. I do recall seeing double, but after that, I just don't remember anything. I was put on heavy doses of medication, and within a day or so, maybe two days, was transferred to ICU. Mattie Murrey 14:38 That was that – you had red flags, but it seems like it went fast. Vanessa Abraham 14:44 Aha. Mattie Murrey 14:45 So, I know you're writing a book, and your book is going to be called Speechless, and there's going to be a lot more details in the book. But you went from working at work, lots of stress, at what point did you ask – did you realize that I may be burned out, but this is something different? How did you differentiate between that? For those who are listening, and say, ‘I don't feel good, and I'm stiff and I'm sore?’ What was your decision making process? Or realization process? Vanessa Abraham 15:20 I think that point was when I was seeing double. Mattie Murrey 15:25 Mhm. Vanessa Abraham 15:26 The voice – when I lost my voice, I just thought that's just some cold. Mattie Murrey 15:32 Mhm. Vanessa Abraham 15:33 And I remember as a teenager, and in my 20s, every so often I’d lose my voice, and my voice would get raspy too. But I think that was the point that I thought, hmm, this is not burnout. This is something more. Like what could possibly be going on a neurologic level to cause me to be seeing two of everything? Mattie Murrey 15:58 Mhm. Vanessa Abrham 15:59 And after that point, I don't remember anything. Mattie Murrey 16:02 So, you went to the emergency room, and then you were in ICU, and you don't remember that? What is the next thing that you do remember? Vanessa Abraham 16:11 I remember waking up, being so sedated, and not knowing where I was, why I was where I was, in a room that I was unfamiliar with. My anxiety was so high. It was just a surreal feeling wondering why I’m here. Why can’t I talk? Mattie Murrey 16:38 Mm. Vanessa Abraham 16:39 I knew I couldn't talk. But I didn't know it was because at this point I was intubated. Mattie Murrey 16:46 Mm. Vanessa Abraham 16:47 So, it just progressed. When I finally woke up, and they started weaning me off of the medication, is when I started to realize, wow, this is not good. I'm in not a good state. I'm in an ICU setting, and there’s machines and tubes around me. And I, a week ago, was pushing my daughter in a stroller, going to parks and maybe at work. Mattie Murrey 17:14 Mm. So, was your awareness gradual? Over what amount of time did you become more aware of ‘I'm in an ICU, I can't talk’? Vanessa Abraham 17:26 I think it was more than just a gradual. As they weaned me off the medications, that's when I started to become more aware of what was going on, and I saw different providers come into my room. When I saw speech therapists walk into my room… Mattie Murrey 17:48 Mm. Vanessa Abraham 17:48 … and they were weaning me off a lot of the medications, I was very much aware of, ‘Wow. I'm not in a good state right now’. If speech therapy is coming into my room… Mattie Murrey 17:59 Mhm. Vanessa Abraham 18:00 … along with PT, OT, six to 10 different doctors, neurologists, nephrologists, lung doctors, you name it. I knew that this is not good. Mattie Murrey 18:15 [crosstalk] Vanessa Abraham 18:15 If I had a common cold, it wouldn't require this team of people. Mattie Murrey 18:19 Right, right. So, you're like this is – ‘I'm in the bed. This is not a good place to be’. Sneak preview, some of our future episodes have your physician – one of your physicians, your physical therapist, two of your speech therapists. Who else is coming on to talk with us about your journey? Vanessa Abraham 18:38 My nurses will be joining us. You mentioned the speech therapists that were by my side. My physical therapists, they were just so incredible, and so encouraging. My doctor has an incredible story to share. Mattie Murrey 18:54 Mhm. Vanessa Abraham 18:55 He was an incredible person. So kind, and so thoughtful, and really treated my whole family. We'll get to that when that episode airs, but my mom will be joining us. I’m very, very excited about that. He was a huge part in this entire journey. He really helped my family, my husband, and my child. So, yeah. Mattie Murrey 19:25 Your husband's going to be joining us. Vanessa Abraham 19:27 Yes, he will be joining us too, to talk about the role of a caregiver, and how his life was transformed. Mattie Murrey 19:34 Mhm. Vanessa Abraham 19:35 He was going along with his life, very busy working five, six days a week. March of 2019, and March is usually his busiest month of the entire year in the golf business, and he was abruptly ripped from his career too. He took, oh, I don’t know, six-seven months off of his own career to help manage insurance, doctor appointments. So, his life, along with mine, and my entire family’s, was really pretty much flipped upside down in a matter of a week. Mattie Murrey 20:15 And I'm sure people, other people who have been in intensive care units – that's why your story is so valuable. You give us such a unique perspective, being a speech pathologist, working with AAC devices, and now being in a bed and requiring one, understanding that when a therapy team comes, in all three, that something major has happened, and has shifted. What was your perspective of being speechless? Like, how was that like laying in the bed and not being able to communicate? Vanessa Abraham 20:50 The best word I can use to describe that is terrifying, and I don't even know that word correctly sums up the level of fear that comes from being a speech pathologist, and realizing that you can't talk. There is nothing more terrifying than waking up, and looking for your AAC device to talk, and trying to tell your team what you need by using devices such as alphabet boards, and eye gaze devices. It's just – it's indescribable. It's one of those things that you don't learn in grad school. It's not one of those things that's taught in a textbook, what it feels like to need to tell your doctor something, or ask a question about your diagnosis, or your lack of diagnosis. I didn't have a diagnosis. We didn't know what was going on, but I sure wanted to know what my prognosis was. I wanted to know if I was going to be the mom using an AAC device for the rest of her life. I had questions. I wanted to know if I had a future. Would I ever walk again? Would I ever talk again? Would I ever drive? And I couldn't ask these questions. It's terrifying. Mattie Murrey 22:20 [crosstalk[ Vanessa Abraham 22:22 You don't learn these things in grad school. There's no book. Until you walk through this, walk in the shoes of somebody that's been told that the only way you can communicate right now is through eye gaze. Mattie Murrey 22:35 So, if you were a speech pathologist – say your future self is walking back through the door, three-four years later, which is where you are now, and you can see yourself laying in that bed there, being terrified, what words would your future self give your ICU self? Vanessa Abraham 22:55 I was fortunate in the fact that I knew neuroplasticity. I understood that the brain rewires itself. I understood that it takes time. So, when I was in ICU, I kept having to remind myself of that. That I knew even though your brain and your thought process always goes to the negative, and you are constantly always having to fight those negative thoughts of ‘Oh, this is my forever’, I knew that this wasn't my forever. I kept having to fight those thoughts, and tell myself, this isn't forever, this is temporary. But there were many, many sleepless nights. Mattie Murrey 23:36 Mhm. Vanessa Abraham 23:36 I was in ICU a long period of time. There were many sleepless nights that I’d lay there thinking, ‘Wow, this is my future’. But I would want to tell that person in ICU to find hope, find a source of motivation. For me, that was my child. Mattie Murrey 23:54 Very touching. Vanessa Abraham 23:55 Aha. Mattie Murrey 23:56 What message would you give the speech pathologist who walked in that door, that were working with you, from your perspective in the bed? Vanessa Abraham 24:06 My speech pathologists were incredible. They were so kind. And I know it was hard on them to treat another SLP. Mattie Murrey 24:14: Mhm. Vanessa Abraham 24:15 I couldn't imagine. I couldn't imagine walking in, and having a fellow colleague laying in that bed, and being in a profound situation, a very critical situation. I just can't imagine. But I think they were so great, and treating my whole family. Mattie Murrey 24:35 Mhm. Vanessa Abraham 24:36 And there's nothing that I would change with the way that they treated me. They took my husband in, and provided him with information and literature, and they educated him on what was happening with me, and they were just so kind, and so gentle. And I'm sure it was difficult on one of my speech pathologists too, because she had a child that was roughly the same age as my own child. Mattie Murrey 25:06 Mm. Vanessa Murrey 25:07 And I’m sure she really had a difficult time seeing that, ‘Wow, here's a fellow speech pathologist with a young child’. She could be thinking, ‘Wow, that could be me, right now’. Mattie Murrey 25:20 That could be me, right. By the grace of God. Vanessa Abraham 25:23 Absolutely. And being able to maintain professionalism… Mattie Murrey 25:28 Mhm. Vanessa Abraham 25:29 … and do a job, and execute a job with fidelity. I don't know how they did what they did, but I'm so grateful for what they did because they – they were such gifts from God, that when they’d walk in the room, it was such a sense of relief, that I knew ‘Okay, they understand my communication needs because they’re speech pathologists’. Mattie Murrey 25:50 You just gave me goosebumps on that one! Oh, yeah. Vanessa Abraham 25:53 They know that I know that I'm paralyzed. I can't type, or they know I need like an alphabet board because I can't talk. But then as soon as my strength started coming back, that I could use a different kind of device. So, they were so comforting for us. Mattie Murrey 26:14 What was that like? I kind of get the impression from you that the AAC devices in the medical setting were lacking? Vanessa Abraham 26:22 Yeah. Mattie Murrey 26:23 Tell me more about that. Vanessa Abraham 26:25 Well, as I started to gain strength, I needed a different device. The alphabet board wasn't working. Mattie Murrey 26:32 Mhm. Vanessa Abraham 23:33 I needed something a little bit more high tech. I’d used so many AAC devices in the school setting that I knew what I needed, but I couldn't really communicate that. My team didn't really have access to high tech devices. So, I took it upon myself to download text to speech, and use that. Mattie Murrey 26:57 Because you’re a speech pathologist. You knew to do that. Vanessa Abraham 26:59 Yes, and it's only because I'm a speech pathologist. Other patients wouldn't take the time to think, ‘Wow, maybe I could use a text to speech device and download it onto my phone. The only reason I did that is because I was a speech pathologist, and I knew what I needed. I knew this is going to help me communicate to my team. Mattie Murrey 27:20 I think one of the most important things that this series is providing, and is going to provide, is the perspective of what it's like to be the one who's on the receiving end of the services that we provide. That what we do is a job, but it's also who we are. And when we walk into the ICU room, or the outpatient waiting room, or the school room, or classroom, or wherever we're working, that ability to see the communication challenges from that person's perspective, and being able to put ourselves in their shoes, in their bed, in their seat, is paramount in helping us reach the needs of that client with their communication of their basic daily wants and needs. Vanessa Abraham 28:14 Absolutely. I totally agree with that. That hits home, right in my heart too because waking up speechless… Mattie Murrey 28:24 Mhm. Vanessa Abraham 28:25… .. there's just not a word, like I said, to describe that terrible feeling of, ‘Wow, I know what my students, and patients over all of these years feel like when they have their family next to them, and they …”. I just wanted to call my daughter on my phone and tell her I was okay, and I couldn’t do that. I wanted to call my parents and tell them I was okay, and I couldn't do that. I wanted them all to hear my voice, and I couldn't do that. Mattie Murrey 29:00 I cannot imagine. I can't imagine. You are so – I just thank you from the bottom of my heart for coming on and sharing this story, because you, like me, want to make a difference in our field, and we will do that through this series, and other things that we do. How has this experience changed the way you do your job now as a school-based therapist? Vanessa Abraham 29:33 It's changed the way I do my job in profound ways. The first thing I would say is I'm always addressing their mental health. That is such a huge part of the overall recovery, their motivation. Mattie Murrey 29:49 Mhm. Vanessa Abraham 29:50 Their motivation, their want – their desire to want to live. Communication disorders are so debilitating, and so isolating. They're embarrassing. It's humiliating at times. And it brings out a side of you that you never even thought existed. So, I always wonder how my students are doing emotionally. How – what is their mental state? Are they experiencing suicidal ideation? That is a real thing … Mattie Murrey 30:19 Mhm. Vanessa Murrey 30:20 … with communication disorders. And it doesn't even matter if you're treating kids in a school setting, or the medical setting. I have a lot of adolescents that deal with depression, anxiety, and those are the first things that when I have a student come through my door, that's the first thing I think about. I think about my students with fluency disorders, and what it's like for them and they’re 15, 16, 17, and they want to ask a girl out. Mattie Murrey 30:51 Mhm. Vanessa Abraham 30:52 What does that feel like for them? What kind of anxiety do they have over approaching a girl and asking them to prom? I think about the topic of PICS, post intensive care syndrome, with our adults that have been in the medical setting. How are they doing emotionally? Mattie Murrey 31:11 Mhm. Vanessa Abraham 31:12 Do they want to live? I've lived all these things, so it really hits close to home for me. So, that's the first thing when I get a student on my caseload or talk to anybody, even friends or family that are going through a critical illness. The first thing I think about is their mental state. Mattie Murrey 31:31 I too am very aware of that field. I speak a lot with NAMI. I do a lot of work with NAMI, which is the National Alliance on Mental Illness. Because the mental illness, it's the body and the soul, the body and the mind connection. And when your body goes through trauma, your mind can also go through the trauma. And one of the ways we can help our bodies, and ourselves recover, is to be as mentally well as we can be. And I like how you open up the whole perspective of working with the whole student. What’s it like asking somebody out to prom when you have these challenges? And taking it a step further, what if they get turned down for prom? So, excellent. I'm excited about this series, Vanessa. I'm so excited. Vanessa Abraham 32:25 Me too. Me too. It's going to be very therapeutic for me to talk about it, and I hope other SLPs can learn from it. It's a terribly sad story, but it's going to lead to really good things in the future, and I'm grateful for everybody that's joining me on this journey. Mattie Murrey 32:47 Mhm. Our next episode, we're going to be talking about – it’s titled “Into the Dark: The Ugly Truth of Being Speechless” – we're going to talk about your ICU stay, lack of communication, and your AAC limitations. We’re going to talk all the trials, the NG tube, the PEG tube, strider, all of those things that are part of your journey. So, I ‘m looking forward to recording our next episode. Vanessa Abraham 33:15 Thank you so much. Mattie Murrey 33:26 I hope today's conversation has created some aha moments for you, and motivated you to become a better SLP, continuing to connect some of those missing links between what you know and how to use that knowledge. Thank you for downloading The Missing Link for SLP’s Podcast, and if you enjoyed the show, I'd love you to subscribe, rate it, and leave a short review. Also, please share an episode with a friend. Together, we can raise awareness and help more SLPs find and connect those missing links, and get the information needed to help them feel confident in their patient care every step of the way. Follow me on Instagram and join the Fresh SLP community on Facebook. Show Notes are always available. So, come learn more at freshslp.com Let's make those connections. You got this!