Conversation with the Rehab Program Manager
Sorry I didn't get around to posting this last night.
I spoke with Paula Leonard yesterday afternoon at 2:30. She is Suzanne McClure's supervisor, and, as it turns out, also manages the physical therapists. Several minutes into the conversation, I found out she isn't actually trained in any of these fields herself (I started the conversation thinking I was talking to another SLP), which, in retrospect, kind of bothers me--if she doesn't have any expertise in these fields, how is she to know if the people she is supervising are giving good advice? I'm in a similar situation at work myself--I'm not a musician or an educator, but I manage a music education program. But I do have outside consultants observing all the artists, providing ongoing professional development, and training them in new programs so that I can get that expert opinion that I lack. I wonder if there is an equivalent at Sinai?
In any event, Paula said that yesterday's meeting had been characterized to her differently than what it turned out to be. She said Irene told her that the meeting was family driven and was to talk about Dad's ongoing treatment (which it was, but I was pressing for it because Suzanne had said it was necessary) and that in light of that and in light of my accusations to Suzanne the day before (where I said she wasn't doing her job and threatened to sue if that's what it took to get action presumably, but I didn't press Paula for what exactly she meant by my accusations), Paula's supervisor determined that the presence of the rehab people wasn't necessary. In fact, no one from rehab was supposed to be there--not speech and not physical therapy. She said that her physical therapist was "devastated" to have been drawn into this meeting with no warning whatsoever. I said that Julia didn't seem at all devastated to me--she was extremely helpful throughout the meeting. If there was no warning, that was probably because Irene called Paula to request their attendance, and Paula probably never passed the word down to Julia. I was flabbergasted at all of this--Suzanne very clearly told me she thought the whole care team needed to meet and also told me of her availability every day after 10 a.m. I offered to send Paula my notes from my conversation with Suzanne, but she declined.
Paula went on to say that Suzanne had told her that swallowing therapy wouldn't do any good without better bodily strength. I told her that I think Suzanne is right in that, but no therapy and three months of muscular atrophy is making things worse and swallowing therapy is part of the whole picture--Dad can't get off the GI tube if he can't swallow, but the GI tube is the source of many of the GI motility problems. I told her that his nutrition is improving (referring to Dr. Okolo's report at the meeting), that PT has agreed to increase services, that the nurses will be getting Dad in a chair twice a day for up to two hours at a time, and that Dr. Morad had said Dad's prognosis is dismal without more aggressive therapy. Speech therapy would have known all of this if they had showed up for the meeting! It was really frustrating for me to have to repeat all of this information to Paula that we discussed in the meeting. I kept getting back to my main point--we need to think of aggressive therapy from the inpatient rehab team as part of Dad's acute care, not as something that can be put off until he is in a rehab facility. Paula suggested that we get the whole team together again for another meeting. Grrrrrr. I mean, I don't want to say no to that, but dammit, that's what we DID already and they didn't show up! It isn't going to be easy to get them all together again!
Paula and I went on to discuss various swallowing therapy options--I mentioned VitalStim and various traditional approaches I've read about. She said she thought VitalStim was available on an outpatient basis only, but I pointed out that if it is a portable therapy (as it seems to be from the descriptions I've read) there doesn't seem to be any reason why it can't be ported to his hospital bed if it'll help him. We didn't get very far in this part of the conversation since neither of us really knows anything about swallowing therapies, and yet again I lamented the lack of participation from Suzanne at the meeting that day since we really needed to hear from a professional. I did reiterate that my understanding is that therapies for swallowing *are* available and that Dr. Morad had said that if something exists that can help, it should be given and that "not my job" is no excuse. When Paula said that Suzanne said that swallowing therapy wouldn't help, I asked her to clarify--did she mean that swallowing therapy would never help (that is, that Dad would never regain his ability to swallow) or only that it wouldn't help right now without better nutrition and physical therapy? She said the latter. I told her what Suzanne had said to me the day before, that Dad was stronger two months ago and agreed that had he gotten swallowing therapy then, he wouldn't be in the hospital now.
I think a lot of our conversation surprised her--I don't think she understood all of Dad's GI problems and how bad his prognosis is without the therapies we're requesting and I know she didn't know that Suzanne had requested a team meeting. At the end of our conversation, Paula said she would do some research, was sorry for the misperceptions on both sides regarding this meeting, and she would get back to me either that afternoon or the next day. It's now the next day and I haven't heard back. But then, it's early and she may well not be at work yet, so I'll give her until this afternoon to call me.
I spoke with Paula Leonard yesterday afternoon at 2:30. She is Suzanne McClure's supervisor, and, as it turns out, also manages the physical therapists. Several minutes into the conversation, I found out she isn't actually trained in any of these fields herself (I started the conversation thinking I was talking to another SLP), which, in retrospect, kind of bothers me--if she doesn't have any expertise in these fields, how is she to know if the people she is supervising are giving good advice? I'm in a similar situation at work myself--I'm not a musician or an educator, but I manage a music education program. But I do have outside consultants observing all the artists, providing ongoing professional development, and training them in new programs so that I can get that expert opinion that I lack. I wonder if there is an equivalent at Sinai?
In any event, Paula said that yesterday's meeting had been characterized to her differently than what it turned out to be. She said Irene told her that the meeting was family driven and was to talk about Dad's ongoing treatment (which it was, but I was pressing for it because Suzanne had said it was necessary) and that in light of that and in light of my accusations to Suzanne the day before (where I said she wasn't doing her job and threatened to sue if that's what it took to get action presumably, but I didn't press Paula for what exactly she meant by my accusations), Paula's supervisor determined that the presence of the rehab people wasn't necessary. In fact, no one from rehab was supposed to be there--not speech and not physical therapy. She said that her physical therapist was "devastated" to have been drawn into this meeting with no warning whatsoever. I said that Julia didn't seem at all devastated to me--she was extremely helpful throughout the meeting. If there was no warning, that was probably because Irene called Paula to request their attendance, and Paula probably never passed the word down to Julia. I was flabbergasted at all of this--Suzanne very clearly told me she thought the whole care team needed to meet and also told me of her availability every day after 10 a.m. I offered to send Paula my notes from my conversation with Suzanne, but she declined.
Paula went on to say that Suzanne had told her that swallowing therapy wouldn't do any good without better bodily strength. I told her that I think Suzanne is right in that, but no therapy and three months of muscular atrophy is making things worse and swallowing therapy is part of the whole picture--Dad can't get off the GI tube if he can't swallow, but the GI tube is the source of many of the GI motility problems. I told her that his nutrition is improving (referring to Dr. Okolo's report at the meeting), that PT has agreed to increase services, that the nurses will be getting Dad in a chair twice a day for up to two hours at a time, and that Dr. Morad had said Dad's prognosis is dismal without more aggressive therapy. Speech therapy would have known all of this if they had showed up for the meeting! It was really frustrating for me to have to repeat all of this information to Paula that we discussed in the meeting. I kept getting back to my main point--we need to think of aggressive therapy from the inpatient rehab team as part of Dad's acute care, not as something that can be put off until he is in a rehab facility. Paula suggested that we get the whole team together again for another meeting. Grrrrrr. I mean, I don't want to say no to that, but dammit, that's what we DID already and they didn't show up! It isn't going to be easy to get them all together again!
Paula and I went on to discuss various swallowing therapy options--I mentioned VitalStim and various traditional approaches I've read about. She said she thought VitalStim was available on an outpatient basis only, but I pointed out that if it is a portable therapy (as it seems to be from the descriptions I've read) there doesn't seem to be any reason why it can't be ported to his hospital bed if it'll help him. We didn't get very far in this part of the conversation since neither of us really knows anything about swallowing therapies, and yet again I lamented the lack of participation from Suzanne at the meeting that day since we really needed to hear from a professional. I did reiterate that my understanding is that therapies for swallowing *are* available and that Dr. Morad had said that if something exists that can help, it should be given and that "not my job" is no excuse. When Paula said that Suzanne said that swallowing therapy wouldn't help, I asked her to clarify--did she mean that swallowing therapy would never help (that is, that Dad would never regain his ability to swallow) or only that it wouldn't help right now without better nutrition and physical therapy? She said the latter. I told her what Suzanne had said to me the day before, that Dad was stronger two months ago and agreed that had he gotten swallowing therapy then, he wouldn't be in the hospital now.
I think a lot of our conversation surprised her--I don't think she understood all of Dad's GI problems and how bad his prognosis is without the therapies we're requesting and I know she didn't know that Suzanne had requested a team meeting. At the end of our conversation, Paula said she would do some research, was sorry for the misperceptions on both sides regarding this meeting, and she would get back to me either that afternoon or the next day. It's now the next day and I haven't heard back. But then, it's early and she may well not be at work yet, so I'll give her until this afternoon to call me.
posted by Sarah @ 8:25 AM
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