I'm An Excellent Driver...

The commute from Provo to Taylorsville can be brutal. In reality, it's not the 40.2 mile distance, or even the 6:40 (ish) a.m. departure time--it's the raging river of automobiles and the idiots who "drive" them that fuels my frustration. Of course, I am by no means innocent of tailgating, speeding, or even the occasional knee-steer (remember my nose blowing dilemma?), but I have yet to be in or cause an accident. (Vehicle damage I am responsible for has only happened with fixed objects, like posts or railings, or grandma's moving car that one time...) The commute in the mornings can take 30-40 minutes, depending on manueverability between obstacles. It also depends on speed trap quotas, especially in either of the 2 55 mph construction zones.

I try to leave on time in the mornings, I really do. But, sometimes, when I forgot to gas up on the way home, have overslept, or whatever other excuse pops up, I feel the need...the need...for speed. And in those needy situations, I often encounter the worst case scenarios of bad drivers. There's the cop who does 64 in the far left lane with his convoy of hyper-attentive drivers. (Which, by the way, grouped together like that, I feel is more of a hazard.) There's the suspicious unmarked white Crown Victoria with a spotlight on the left mirror....that turns out to be two old men joy riding at 60 mph with a convoy of hyper-attentive and hoodwinked drivers. Then of course, there are the 2 UTA buses that join us somewhere between Lehi and American Fork and slide right on over 4 lanes to the car pool lane. Sliding a bus (or 2) over 4 lanes in morning rush hour traffic is like Augustus getting sucked up the chocolate tube...things are going to get a bit jammed up until the clog moves on down the pipe.

Another delightful aspect of commuting is observing other drivers. My favorites are the drivers who are absorbed in their own reduced speed world in the far left lane and are suddenly jolted back to a 75-80 mph reality when I try to go around. I try my best to be patient and hold off the urge to leap frog for at least 2-3 miles. But, when I'm late and they're slow, I take action. Some mornings I'm absolutely sure I'm passing Houdini or Copperfield (the magician, not of the Dickens notoriety). I bullet around and pass at an exhilirating 5 mph increase and suddenly, my lethargic rival is gone! Disappeared! I check all my mirrors and feeling a thrill of success, like the hare that passed the tortoise, I begin the merge back into the left lane...and swerve right back because my traveling Houdini has matched my speed and has been lurking in my blind spot the entire time. Why do people go slow until you try to pass, then declare the one-sided challenge of speeding up to keep you from getting around? Why?

I also have noticed that people are very confident in what they can accomplish while driving. Cell phones (calling or texting), eating (sometimes with both hands), navigating radio stations or adjusting the in-cabin temperature. Now, these are the standard multi-tasking activities for driving. These are the courses you passed in the underground driver's ed. But what are some other behaviors I've observed? There are, of course, the nose-pickers (some attempting to be discrete, others knuckle-deep and loving it), the steering-wheel drummers rehearsing a stop-light audition, ladies putting on make-up or doing their hair, the notetakers with pen in one hand and paper in the other and ear to the phone, the readers, or the occassional couple that should have just called in instead of taking their Mature exploits on the road. Elderly people are a 50-50. Do you get mad at someone for being old and cautious or do you smile and just let it go? Depends on the day and how late I am.

Here in Utah, there is definitely a higher proportion of "R U LDS" whizzing by at 80+ or "CTR" stickers practically kissing my bumper. Also being that we are in Utah, I would assume that between 6-8 a.m. and 4-6 p.m. M-F, I-15 from Davis County to Provo becomes a highly condensed corridor of prayers. And, if those drivers are anything like me, they are praying to "get there on time," "get there before my boss," "that this idiot I mean sweet spirit in the car in front of me will move," "that the cops are all headed South/North (depending on if I'm headed S/N)." They probably also pray for things like, "no cops," "a justifiable reason for speeding," "my car won't overheat," "the bumper won't fall off," or that "there will be green lights at every intersection."

And on the days when traffic comes to a sudden stop and a truck bearing the slogan "Disaster's Happen" is hurtling toward me, swerving in time for us to both make it home that night, I also say a little prayer of gratitude. Despite the distractions and dangers inherent to driving, somehow I have continued to be shielded from any serious encounters and for that I am very grateful.

A Grim Fairytale

No matter your role in someone's life, it's difficult to watch that person begin to decline. Often, in my personal trials, optimism has been the secret ingredient that flavors an otherwise bland or bitter situation, making it easier to swallow. As an SLP, it's difficult to be optimistic with a chronic or degenerative course of treatment. Some patients can recover nearly full capacity, others will maintain, while others decline. I suppose it's like anybody else in this world. We really are all terminal. But, our rate and level of capacity is as individual as our fingerprint. I've been working with a Dementia patient who we recently determined is slipping more decidedly into a more acute phase. Sometimes, it's like watching a child trapped in some unsettling fairytale. A grim divergence from the reality of family, friends, familiar routines. Losing independence.

Alzheimer's in Wonderland

Some days, the illogical ramblings reveal a mind that fell down a rabbit hole. She knows that there is reality, where order and reason govern. This nonsensical existence is in fact nonsense, but still remains reality. To her, my supervisor and I might as well be the Mad Hatter or the Catepillar, sitting there spouting ideas and notions, giving her exercises and memory aids. We might as well spread our pocket watches with jam and dip our saucers in tea. Or turn into butterflies.

Most days, at meal times, we find our Alice wandering the halls of the facility. Lost. She doesn't know where she's been, where she was going, or why she's even there. We stand at the nursing station, the crossroads of the facility, and debate about which path she was on to determine her destination. I point or escort her in the right direction for a short while, then with a Cheshire grin and a schedule to keep, I leave her to navigate the rest alone. Twenty minutes later, we meet, again. She's lost and confused, wants to go back to her room where it's familiar and secure, but doesn't know how to get there.


Oldie-locks and the Three Beverages

What would happen if Goldie was indecisive, not because she was a spoiled little girl, but because she suffered from some sort of amnesia? What if it were the same bowl of porridge three times, or the same bed three times? What if she simply didn't remember she liked it the first two times? That seems to be the case with my patient. Bring her a cup of cranberry juice. This one's too sour. This one's too sweet. Ooo, That's good. Same cup. Same juice. Three different responses. Offer her a plate of eggs and toast and it's like a meal time with a three year old. I don't think I'll liiike it. Oh, why don't you try a little and make sure you don't like it. Bite. Mmm. That's good stuff. Not to mention, as soon as she decides it's "good stuff," she's always trying to feed me, always wanting me to taste her food or drink. I decline with Oh, this one's yours. I've already had breakfast. You eat it first. I usually get called a chicken. Five minutes later, we rinse, lather, repeat.

Magic Porridge Pot of Ensure

One of the most critical safety concerns with dementia is not only getting lost, confused with medication, or leaving the stove on, it's forgetting about food. The first day I sat with my patient at breakfast, I noticed that she wasn't recognizing her food. Sure wish I knew what that was. Pancake. This stuff, well, it's just...bleh. Sausage and egg. Why don't you try some of your pancake? Oh--where've I got some of that? Try this stuff...that's your sausage. Well, I guess....mmm I like meat.

With a lack of orientation to meal schedules or being unable to recognize food on the plate, the risk of inadequate nutrition increases. My supervisor and I have developed the routine of stopping at the nurse's station and getting a cup of cranberry juice and a cup of Ensure to take to our patient. Especially when she's having a particularly strong dementia day. We employ different strategies to encourage her to drink. Hydration and calories are critical. The advantage of poor short term memory is that she doesn't remember that she thinks she doesn't like the drinks, can't recall that we've already given her two cups worth, and doesn't register that she was refusing to eat today. So, we keep topping off the cup. It's like the magic porridge pot--it keeps refilling because she doesn't know the magic words to make it stop. Everyday, no matter what she's feeling like, we bring drinks, the nurses send a calorie enhanced snack, and the CNA's bring juice and water. Our little magic porridge pot plot is just one way we're optimistically trying to keep her healthy and safe.

Each of these tales has a moral that can describe the harsh realities and the rewards of being an SLP. Maybe it will make you afraid of old age. Perhaps the moral is to make you appreciate the circumstances you enjoy now. Whatever moral you come away with, it's still hard to watch someone living through circumstances you can't change or control. Sometimes the hardest part is realizing that as much as you can do, it won't be enough. Sometimes you can really only do so much and then you, as the giver have reached the max potential of what you have to offer to that situation. But, no matter how long or short the plot, the moral of every story should show your character as unwavering, unfailing in fulfilling your role in someone else's life.