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.

That's not my name! That's not my name!

The first day of my internship, my supervisor introduced me to the first 20 people I met as Amber. My stack of notes and papers even had a bright green post-it with Amber scrawled across it.

To my dementia patient, I'm Lady. I'm You. I'm Whooeru? I'm a nameless face.

To one of my favorite elderly men, I'm Amanda Acres. Apparently, as a brick mason, he helped build a neighborhood named after the planner's daughter, Amanda. Since he remembers building the neighborhood, calling me Amanda Acres helps him remember Amanda the Intern.

To my young brain tumor patient, I'm Student Visitor. Even with virtually no short-term memory, she still had a quick wit. My name tag is a generic student badge that says Student Visitor so that's what she called me when she had to "cheat" and look at my name tag.

To my newest man patient, I'm Kid. Honey. He's kind of a flirt, but overall pretty nice. Today, he told his visitor that out of any of the nurses, CNA's, or therapists, I'm also his Favorite.

To my favorite white haired ladies, I'm Dear.

To my 90 year old peach of a woman, I'm Nice To Hug. She needed to be repositioned in her bed and no CNA's or nurses were available, so I told her to put her arms around my neck like she was giving me a hug so I could move her. She sweetly told me in my ear, in her high, whispery voice, that I was nice to hug.

To the family of my dysphagia (swallowing disorder) patient, I'm a Good Girl. He passed his swallowing test (and I got to be there when he did) and got to go home today. Through tears and gratitude, a member of his family embraced me and told me over and over how greatful she was for what we had done to help. She is a nurse and, just like all the friends and family who came to visit, was very involved in our patient's treatment course. She told me I was going to do great as an SLP and am such a Good Girl. She shed some tears. And so did I.

And as it turns out--

To most of my patients, I'm a lovely and kind young lady who they enjoy seeing every day. So, even if no one can remember my name, at least they remember what I do, which is really the most important part :)

Bethany, this is for you...but really, not :)

I was talking to my good friend (and fellow BYU ComD-er) Bethany online earlier today. We were commiserating about Praxis woes and such, and of course, the topic of Aaron came up. She asked how we're doing, etc and commented about enjoying reading my blogs about the A-team (Aaron and Amanda).

So Bethany, this blog was inspired (and written) with you in mind...

What I realized as I was telling B some snippets from the 7 month long adventure of dating Aaron is really, Aaron and I have shared quite a bit together and it made me smile, complete with warm a fuzzy feelings in my guts.

There was that time we drove 4 hours to Mel and Terry's wedding reception in Deming. My car was full of stuff I was bringing back up to Utah and his car, well...it's probably best not to let it wander too far from home. So we tried to rent one. Tried, and failed. There were complications with debit cards with a VISA logo vs a full-fledged credit card, a mother with no driver's license, and rapid fire discussions in Spanish at the Enterprise counter. There may have also been a particular Enterprise employee behind the counter who impeded our efforts with a snooty air of self-importance. What we all thought of him involves using some selective "french" words. Because Aaron's cousin had dropped us off and disappeared to parts unknown, Aaron's parents had to come pick us up. They took us to lunch, which apparently was a huge milestone because Aaron doesn't really do family outtings. As we were leaving, the cashier asked Aaron's mom (a hispanic woman who is about 5 feet tall) if I, the 5'10" huera were her daughter. We all laughed all the way to the car. We had resigned to taking Aaron's car when a silent but understood agreement between the Sanchez party transpired and I found myself with the keys his dad's car. Apparently, no one is allowed to even look at it, let alone take it unsupervised to a far-off destination. When we met up with Aaron's brother in Deming, he looked at me in disbelief. He's never been allowed to borrow the car and he's 28 yrs old. And family. Warm fuzzies :) There was also the part where I found out Aaron gets so nervous about long-distance driving that he gets sick...so he slept most of the drive back up.

Then there was the time before we ever started dating and Aaron, our good friend DeAnn, and I all met up at the Albuquerque International Balloon Fiesta. DeAnn and I arrived on time (5:45 am-ish) and Aaron...well we had to hunt for him...for nearly an hour. It was too windy for any of the balloons to launch, so we went to the Hot Air Balloon Museum instead. Aaron paid our admission prices and we toured the place. It was interesting, and given that all of us were extremely tired, it was much more hilarious than normal. At one point, DeAnn and I contributed to the Breast Cancer cause by getting massages at a booth. Aaron was a trooper and sat in the corner, the lonely source of the highest concentration of testosterone in the room. He was patient while we looked through the purses, the scarves, and the cancer patient hats. He kept us company through the Breast Cancer Awareness Exhibit. But he had a small melt-down in full, red-faced giggly fashion, when DeAnn found the silicon demo boobs for self-breast exams and put one on his leg. I like that he gets embarrassed about stuff like that :)

Because no one at work knew we were dating (except for DeAnn), we gossiped about it in code during our shift. We didn't want the clients or other staff meddling. We also didn't want to end up getting Aaron or I transferred to another unit. So, Aaron became "Rico Suave." This alias was inspired by one of our first few dates. We were at Village Inn (or some other 24 hr breakfast serving establishment), and our food had just arrived. Aaron's was dripping, drowning, deluged with gravy. Can anyone predict what will happen when you put a clumsy-when-nervous man in front of a plate full of gravy on a second date? If your inferencing skills are still in the early developmental stage, I'll paint you an awkwardly adorable picture. First, picture in your mind, as Aaron picks up his fork and in one, painful, slow-motion move, the fork flips out of his hand and does a 2 1/2 twist dive into the gravy. Droplets of gravy are displaced in a radial spray around the plate. As Aaron goes to retrieve the fork, his hands are submersed in the thick, hot goo. Now, with scalded fingers, useless fork, and wounded pride, Aaron attempts to wipe away the embarrassment with his napkin. In doing so, he unknowingly is dipping the other end of his napkin in the gravy while cleaning off his hands and fork. Threat neutralized (for the time being.) I sat there, fighting the urge to laugh out loud and feeling sympathetic to his plight, thinking how adorable it was that in his efforts to be impressive and suave, one mishap after another was intruding on his "manly" display. After a few silent bites, I watched as Aaron picked up his napkin to wipe his mouth. It was like watching a car wreck. You don't really want to see the carnage, but at the same time, you can't quite force yourself to look away. I watched as he brought the gravy-ladden napkin to his face and paused, then began smearing gravy all over his chin and beard. He was frustrated, but we managed to laugh. That's what I love about us--I never feel like I have to take myself so seriously. We're both nerdy and awkward, and it works. I think it makes us more forgiving of each other's faults, too.

Like Thanksgiving Day when Aaron took me out to a movie. We had only been going on dates for about 3 weeks. I didn't know it, but later that night he would ask me to be his girlfriend. But the point of this snippet is in finding joy in always being able to laugh together and be ok with being dorks, even when one of us isn't feeling so awesome about ourselves. I was teasing Aaron about his driving or parking or something, as we were walking through the parking lot toward the theater. I was laughing, which apparently is hazardous for a blonde while walking because my shoe caught on an uneven spot in the sidewalk. I was in the middle of mocking Aaron and about fell flat on my face. He grabbed my hand just in time and saved me from injury. He still teases me about it...and I don't mind one bit.

Aaron is my protector and defender. He always tells me that he would protect me with his life. But, sometimes, I wonder if I need to be protected from my protector. One night, after Aaron had made an amazing crab/chicken/beef/veggie stir-fry at my apartment, he decided he wanted to be manly and show off his brutish strength by sweeping me off my feet. Dinner was over, dishes were done, and we were going to watch a movie. Aaron impulsively decided to carry me to the couch. I'm not a petite girl, at all, which didn't seem to be a problem for Aaron, until we got to the narrow spot between the wall and the counter. I was impressed that he was even able to overcome earth's gravitational pull. Isn't that most girls' fantasy--to make eye contact with her man across a hazy meadow filled with sunflowers and run open-armed toward each other in slow motion until you meet, embrace, and be picked up and twirled in his arms? Maybe a small flock of bluebirds will flit about, crowning you with a chain of blossoms. And fawns and bunnies will sit and sigh at the spectacle, or a wisened owl will congratulate you on your twitterpation. But we weren't in a Disney delusion, we were in my tiny apartment and as he walked me past the counter, I cracked my knee dead-on with the corner and had a large, painful bruise for at least a week.

I think dorkiness is the definition of our understanding each other so well. A few weeks after he asked me to be his girlfriend, Aaron took me to what he now calls, "our restaurant." It's a small, upscale place in Old Town in Albuquerque called Restaurant Antiquity. We dined on a delicious meal, desserted on a shared serving of creme brule, and thoroughly enjoyed each other's company. It was a romantic, intimate setting. The waiter called me Mrs. Sanchez and I blushed and Aaron looked smug. While waiting for our table, couples would come into the front waiting area and sit on the opposite side of the room from us. No one! would sit by us. We were a respectable looking couple, dressed up in a modest dress and suit, but apparently our sweetness is of cavity proportions and no one would sit by us. Some couples even stood, rather than intrude on our side of the room. I think we were barely even holding hands, so it's not like we were that kind of couple. I amused myself with making Aaron blush by suggesting he put his hand on my knee, which of course there was no threat of him actually doing it, but it was cute to watch him blush and giggle at the thought of touching my knee covered in nothing but dress. As we were leaving, Aaron told me he needed to use the restroom, which is a common trend in our relationship. When he gets nervous, he guzzles water. This was our first fancy date, so by the time we left, he was desperate. I waited. And waited. And waited! Guys shouldn't take this long in the bathroom, I thought. Where is he? He finally came out and looked really fidgety and odd. I didn't say anything. We went back to my apartment, where I invited him in to do what new, amorous couples do best...watch TV and make out :) The evening was wonderful and perfect. I found out later that my assumptions about it being a hitch-free evening were very, very wrong. I uncovered the cover-up when I was commenting on how long he always takes in the bathroom at restaurants. For instance, that one time in Old Town was like ten years! Aaron owned up to his delay by revealing that behind that occupied sign, he was having a small melt-down panic attack. His underwear had ripped! And not just a small, uncomfortable tear, but a full-out torn off kind of ripped! He has no idea how or why, but the rip was so severe that he ended up having to ditch them in the trash and go commando in his slacks. No wonder he was such a nervous wreck the rest of the night! He tells me that he was so nervous that somehow I would find out his dilemma, especially when we were cuddling. Now, we are a kosher kind of couple so I don't how in the world I would have ever discovered he was free and breezy in his slacks. Never a dull moment with my boy :)

So Bethany, and anyone else who happens to read the snippets from being loved by my crazy Mexican, I hope you continue to enjoy my adventures. I hope they at least make you smile, because for me, I've never been happier :)

10 things I learned today

1. Elderly men are stubborn.
2. I will always laugh (on the inside) when my patient wants me to help her escape from physical therapy.
3. I can't efficiently blow my nose with one hand while driving.
4. I can steer with my knees.
5. My denture-less patient saying, "my dee-zeeze" will also bring an instantaneous (on the inside) riot of laughter.
6. Some 90 yr-old women may not want you to shout at them to be heard.
7. Don't give a dementia patient a bracelet and then be surprised if it's MIA the next time you cross bewildered paths.
8. If dentures aren't in the mouth or the dresser, check down the blouse.
9. Even after quizzing patients all day, I can't remember the date when I do my paperwork.
10. At the end of a long day, I am easily amused, especially when my boyfriend is rambling about cats, togas, and dominating a nursing home after my demise...and possibly erecting a shrine in my honor resembling the parents' yard in My Big Fat Greek Wedding, but Mexican status.

Just a spoon full of Thickit makes the medicine/OJ/milk/H2O go down...

Week 2 of my internship and my tolerance for thickened liquids and thickened phlegm doesn't seem to have improved much. I am getting the swing of things, though. I'm a little nervous because everyone is getting the flu or pneumonia but I'm sacrificing moisturized hands for the amount of hand sanitizer I lather in frequently throughout my day...

I've seen television specials where local youth detention centers include, as part of their intervention, a trip to a prison or morgue. It's supposed to create a wake-up call for the teens and deter them from the dark, delinquent path they were headed down. I've come to the conclusion that a similar intervention should be used to warn against be imprisoned in your own body by the diseases that come from neglect, over-indulgence, and an under-active lifestyle. Spend a few days watching CNA's changing Depends, nurses pricking fingers for blood sugar levels, insulin injections, O2 respirators, wheel chair confinement, throat cancer from tobacco use, cranes for obesity, thickened foods for safe intake, and so forth, it becomes much more emergent the need to take better care of the body. I know there are so many things that come, regardless of age, circumstance, or how well you take care of your body, but so much of it is preventable.

I have one particular patient who wants "just a cool glass of water" because "this orange juice doesn't taste the same..." and "well, the milk...I've had better." I feel the same way and I don't even drink honey-consistency milk or OJ. I don't blame her one bit for wanting just a simple glass of water. She's caught on though, that I'm mixing something into her water before I give it to her. Poor dear. She's coming along nicely and hopefully one day in the very near future, we'll both have graduated from our morning dose of thickened liquids, pureed french toast, and ice cream scoops of dark gray playdoh-looking sausage.

The things that get me through my day are:

-a smile
-the dear group of white haired ladies who are always so friendly and kind
-my supervisor
-caffeine
-a sense of humor
-looking away when congested patients cough
-breathing through my mouth
-rubber gloves
-kind and willing nurses and CNA's
-the prospect of solid, salted and sweetened foods for dinner
-knowing I can feed myself
-patient humor
-patience. especially when hearing the same 5 stories from the same patient in the same 48 minute session...day after day.
-minutes toward my ASHA 400 hours
-silent prayers
-naptime when I get home
-progress in both myself and my patients
-my paycheck....wait, I'm PAYING to be here. Oh, well.

Pureed Eggs and Ham, Sam I Aren't

I've only been at my internship a week, but it's given me a lot to think about...

Today, as I helped a patient eat ham and eggs, both still in the shape of an ice cream scoop, I decided that there should be a dysphagia-themed Dr. Seuss-esque book. She would not eat them with a cue, she would not could even chew....

And so you know, just because you have to chew your milk, it doesn't mean it's rotten.

Just because the lawn mower shredded your dentures, it doesn't mean you can't still enjoy a majority of your favorite foods...they can be prepared in a variety of textures.

If your patient is going to forget who you are every time she looks away, it's a sign of progress when, upon re-introducing yourself for the 10th time in 30 mins, your patient says, "Amanda? oh. right. You're the funny one."

It's also progress when your elderly memory impaired patient is aware enough to quiz you. Patient, "What's this? (pointing to a blanket)" Amanda, the intern, "Hmm...can you tell me what that is?" Patient (smiling mischievously), "It's a blanket. Just thought I'd through in some humor."

Just because you aren't 5 ft 2 inch Reese Witherspoon, it doesn't mean you can't still be the star of your own awkward moment. Male elderly patient, "[incoherent mumbling]...Wendover or Vegas." Amanda, still the intern, "What's that? I didn't catch what you were saying. Remember to think LOUD!" Male elderly (and married) patient, "Are you married?" Amanda, the unassuming intern, "Nope, I'm not. Ok, so next is 'Deep breath, and OOOOO." Male elderly (and undeterred) patient, "Why not?" Amanda, the sometimes unprepared intern, "Oh, no one has asked me, yet. Ok, let's here a nice, clear OOOO." Male elderly (and you can see it coming now, can't you) patient, "I do! I'll marry ya!" Amanda, the aspiring cool as a cucumber intern, "You already have a wife and that's not what we talk about in speech therapy." Male elderly (and insisitant) patient, "But I love you!" He doesn't have a bus pass, but he does have a motor home...

Chinese is truly a tonal language. If you don't understand the words, you will understand the tone of voice.

Some patients should come with subtitles.

Don't wear undershirts/tank tops under a sweater if it closely matches your skin tone. Without glasses and from a distance, some patient's will deem your outfit scandalous.

Phlegm is not my phavorite.

When inquiring about patient charts, introduce yourself to the head nurse at the nurse's station BEFORE you ask about confidential matters...or else be prepared to be recieved as a wandering patient.

Don't laugh at inspirational quotes posted in your facility. If you must, laugh to yourself.
For example: “Our greatest glory is not in never falling but in rising every time we fall” --Confucius

Above all, remember that moment by unpredictable moment, you are serving God's children. Treat them as such.