Week 7, 8, and THE END!
Note to readers - I started this post 2 weeks ago, and saved it as draft. Now I'm adding to it week 8 and my final thoughts. Sorry about such a delay!!! I've had a lot on my mind lately, which I'll probably write about in my other blog, xanga.com... I'll try to fill out info later when I"m more free. I just watned to give a final update about graduation and my hours. =)
Week 7
It's been an interesting week. I'd better go day-by-day.
Monday
Saw the usual caseload of patients for cognitive-linguistic evals and therapy. Oral-mech-ed one guy. He was in the psych department for other things, but had gradual onset dysarthria. Kim and Caroline said we'd go see him together, but when we got to the room and stepped in, they didn't say anything like usual (that is, introduce themselves and me, explain why we're here, etc.) We all walked in, and then they looked at me expectantly. So I catch on, and start to feel flustered. Anyway, they said I did fine, even though they jumped in a couple times with tasks that I forgot, and explained for him in more detail why we were sent to see him. Afterward, I was asked to describe what I saw and thought by going through the subsystems (resonance, respiration, phonation, articulation, prosody). Felt like a quiz!
The psych ward was a creepy place to be in. They don't have the hand sanitizers attached to the walls in the hallway like the rest of the hospital, and there were several other things missing (like trash cans, gloves containers, etc.) in the area because of concerns that the patients can use them to harm themselves or others. In fact, the entire area is closed off under lock and key - we had to wait by the door for someone to let us out!
Tuesday
morning - L BG infarct - why do you think she had it?
aneurysm?
if it were aneurysm, where is it usually?
subarachnoid
what else? stroke
I should've expected it. I should've been prepared. We did another bedside swallow on a guy in the surgical intensive care unit. Had right facial weakness in the past, and was in the hospital again for a new lesion which caused left facial weakness. Speech was almost 0% intelligible, flat affect, slow movement of articulators, strained-strangled voice. Unable to raise his eyebrows. Anyway, after I did the oral mech on him and gave him an ice chip, he coughed several times. Caroline asked me what we should do next. Well, I clearly remember being examined by Karen Bryant, Michael Karnell, and Alice Smith about bedside swalllows, not even mentioning info by Jeri Logemann herself, who all say to do two (2!!) trials of everything. So I said we should give him another try with a second ice chip.
Then Caroline asked if I thought it would tell me anything else about his abilities if we gave another, and (based on the way she asked the question) I said no. "What should we do next?" she asked. Again, based on the way she asked, I said we should do a video study. ::PHEW:: that was the right answer. Good gravy I hate being asked pop questions like that on-the-spot!!!! Then she says to go ahead and explain that to him. Which I do. Then she steps in to explain also that we'd like to help him with his speech. Darn it I should've remembered that.
So, we finish and step out of his room into the hallway. This time I was prepared to talk about what I saw on the oral mech based on subsystems. But I wasn't at all ready for the grilling that was to follow. I was honestly near tears. I never gave a second thought to reviewing the dysarthrias for PRAXIS, and truthfully, I only gave it a once-over for the COMPS. I know that Caroline in her heart wants me to understand the information and get to it on my own, but I don't do well under pressure at all. And I know she is not trying to pressure me or quiz me or anything. But the way she talks is hard and fast, like a Chicagoan, I guess, so it comes out sounding harsh. She asked me to give detailed info about cranial nerves, where they decussate, what innervates what, how does his etiology correlate with what we saw, if XYZ then what kind of dysarthria... AHHHHH! I mean, in the end, it really helped me to put it all together and understand, but I was already frazzled from that morning's conversation.
Week 8
Just Caroline and me. Among the noteworthy patients I saw: oral motor exercises with man who had R medullary hemorrhage (therefore, resulting right facial hemiparalysis) and a tracheostomy, 13 year old girl in the psych ward for a language eval, infant VFSS...
THE END
Graduated yesterday!! The ceremony took 2.5 hours and was seriously quite boring. But important to note for the first years (that is, the new SECOND YEARS!! Congrats guys!!) -- all the speech path girls sat together in the A-L section of all the graduates. That's right, even though a ton of us were in the wrong alphabetical section, we wanted to sit together as tradition (apparently the class before us did it, too). Besides, it was so great to sit and chat together as we waited (and waited and waited...) our turn. hehe.
Final hours count:
Eval speech (adult): 0.75
Tmt speech (adult): 2.0
Eval lang (child): 1.0
Eval lang (adult): 25.75
Tmt lang (adult): 40.5
Swallowing: 5.25
Total: 75.25
I guess that's really not that much.