I’m still getting a hang of this weekly writing. This week’s story is one that represents a very powerful moment in my career and I’m making sure that I do it justice. Check back in a day or two for the full story.
Edit: 11/8/21 at 11:35 - full story added
When I started my internship with Mike Muprhy in the fall of 2019, there were several “duties as assigned” that were wholly unrelated to speech pathology, or so I thought.
It was planned from the beginning of my internship that I would continue my outpatient rotation for 16 weeks instead of the usual 8 so that Mike’s caseload would have continuity when he left for a month-long vacation.
Another SLP, who primarily worked inpatient rehabilitation, told Mike that she would supervise a student in his clinic as long as they were up and running by the time he left. So, Mike made sure I was ready to continue the treatment of our established patients and evaluate news as they were referred.
This was no easy task as Mike’s caseload was eclectic from aphasia, to dysphonia, dysphagia, cognitive-communication and everything in between and mixed together. But, no matter the diagnosis, Mike had a way of making an impression on all of his patients in both big and small ways; he was able to make a connection.
During the first week of my internship Mike told me that to work in this field, at a baseline, you have to really care about other people. And when a patient sits down across the table from you, you ought to ask yourself, and even them out loud, “what do you need? What can I do to help you?” Most importantly, Mike would add, “what is it that the patients are trying to tell you?”
That part of the job, the soft skills, that’s something I’m still working on and will continue to work hard at for many years. But the hard skills, knowledge of disorders and how to treat them, that part I understood and felt prepared to carry out in Mike’s absence.
Other than maintaining Mike’s treatment caseload, he left me with an equally important task: caring for the collection of plants in his office. Now, this doesn’t seem like a big deal, and it really shouldn’t have been but I am a notorious plant killer. Really, I just forget to water them until it’s too late.
Some of the plants were sentimental for Mike; not only had they survived several seasons of growth but they had weathered seasons in his career. One such plant was fairly unassuming. It had leaves like a hosta and sat in an old, yellow pot to which the planter saucer was affixed due to years of water and dirt mixing together and hardening.
Prior to leaving for his trip, Mike told me to keep an extra eye on that plant as he had been gifted it by a patient (who received it from her great-grandmother) as a thank-you nearly 20 years prior. Since that time, he’d never once changed the soil or repotted the plant. I found this peculiar but it had obviously worked for nearly two decades.
And so, Mike did eventually depart for his trip essentially leaving me in charge of his patients and his pseudo-greenhouse. While nervous, Mike told me I was ready and I took it to heart.
Halfway through Mike’s absence, a new patient was referred to the clinic after experiencing several TBIs related to her active lifestyle. A few months out from her most recent incident, she found herself struggling to keep up with her work and frequently got lost while driving from location to location for her horticultural job. She was also a single mother and worried about how she would be able to support her family should her memory difficulties persist. While her boss had previously been lenient regarding her performance and work hours, he was starting to cast a more watchful eye.
In the first week of therapy, after her evaluation was completed, my supervisor and I began to walk the patient through all of the normal treatment modalities. We worked on utilizing external memory aids, simplifying her daily schedule, sleep hygiene, etc. While she reported some improvement, it felt like we couldn’t fully get her to the place she needed or wanted to be. One day, she said that she was worried that “this was it” that she’d never get better and she would continue to feel isolated.
While we had attempted every treatment strategy in the book, we weren’t able to make the connection she needed. Thankfully, for the both of us, Mike’s return was only a few days away.
When he returned, and before her next session, I made sure to discuss her evaluation and our treatment goals to which Mike seemed displeased in a way that said, “why’d you pick her up for therapy?” Trying to save face, I reiterated her assessment scores and said it was well within the range that would benefit from intervention. Mike didn’t disagree but I felt that he also understood what I had discovered without ever meeting the patient.
So, when she showed up for her appointment we got right to it. We reviewed what we had previously instructed her on and she and Mike went through the usual pleasantries. In the process, she told Mike of her horticultural occupation and the little potted plant came up.
She asked, “why haven’t you repotted that plant after so many years?”
Mike looked at her, glanced towards me, and then began the telling of the story of how he acquired the plant from an early patient of his, but, when the story was supposed to be over, he continued and said (something to the degree of):
“No matter what happens to that little plant, it keeps surviving, just keeps going” he paused, “a lot like my patients.”
During this telling, my eyes were fixed on Mike. And as he said that line, I looked towards our patient who was now sitting tearfully in her seat. She said, “just like me..I’m good, I’ll be okay.” She then wiped her eyes and asked to hug both Mike and I. Soon after, she stood up, and I walked her out of the office into the waiting room.
When I got back to the room, Mike was still sitting in his chair in the same position he always did while talking to patients: leaned back with a leg crossed and his interlaced fingers wrapped around the front of his crossed knee.
He looked towards me and said, “we’re going to be thinking about that one for a while, aren’t we?”
Since that day, I reflect often on that therapeutic moment. Now, in the early stages of my career, I can be obsessed with the research and ensuring my practice is up to date and evidenced-based; however, it’s important to remember that, really, most patients don’t need a journal article. What they need is to make a connection with someone.