A Day in the Life of a Community NHS Speech and Language Therapist

Speech and Language Therapy is one of those professions where people have many preconceived notions of what we do. Either they have seen the Kings Speech or think we help children pronounce their ‘s’ or are just called to prescribe thickener to people with swallowing difficulties. Whilst it is true that working with people who stammer and children’s pronunciation and swallowing are parts of our profession, speech and language therapists work with so much more than that.

Working on speech sounds in paediatric speech therapy

To note, speech and language therapists (SLTs) work across a number of different settings including early years, autism clinics, hearing impairment, mainstream schools, learning disability, the criminal justice system, elderly medicine, critical care, neurology & neurosurgery and general medicine. There are more but these are the main ones we work in.

I have worked in neurology since I graduated, meaning I see anyone whose brain has been affected by disease, infection or trauma and it is impacting on their communication or swallowing. So, I thought why not take you through my day and see if I can give a bit of perspective on a day in the life of me, your friendly neighbourhood speech and language therapist. Buckle in folks, it was an interesting day!

09:00

As I work in Central London usually we see patients via public transport or if it is sunny I can enjoy a 20-30 minute stroll.

The first person I went to see was a 27 year old man with a traumatic brain injury. To give you some background he was on a scooter and had a road traffic accident with a motorbike. He spent 3 months in hospital, had intensive rehabilitation and he came out as what we often refer to as “The Walking Wounded”. In his case he can walk, has no physical disability, looks very strong due to spending an inordinate amount of time in the gym pre-accident but is now unable to schedule his day, regulate his emotions or speak coherently or in a way that makes sense.

I had been working with him for approx. 6 weeks on his verbosity (he’s been using more words than needed in sentences). Today we were due to do an assessment video to reflect on his progress and see what we still needed to work on. When I entered his flat he appeared very low in mood, crying and said “I thought about killing myself this morning”.

Needless to say we didn’t do any work on verbosity today.

10:30

After a call with our team psychologist and the above gentleman’s GP, I walk to a residential care home 20 mins away to see my next patient. This lady has recently awoken from a coma. She had a massive stroke at a bus stop one day. She’s 53 years old, has 3 kids between the ages of 10-21 and has been in and out of a coma for the last 7 months.

Most people think with a coma you are either in one forever or wake up and are instantaneously great as per every TV programme and movie you have ever seen. The reality of this is much different, people can remain in what is known as a ‘minimally conscious state’ for months or even years. In this state you might be able to move a finger on command or open your eyes and sometimes maybe make sounds.

Looking at the extent of brain damage

This lady however also has significant brain damage as a result of her stroke which does not give her a good prognosis. I have been working with her over the last few weeks trying to aid her communication for when she is alert using a book created for her by my team and her family. She cannot speak verbally but does look at you when she is alert.

Today’s plan was to try and elicit some noise from her vocal chords like a cough or a hum to see if she capable of making noise. As I walked in and said “Hello, how are you today?” as per usual not expecting to hear a response. I reached to get something out of my bag I heard her say “I’m fine”.

I froze and slowly turned around to her.

She looked as surprised as I did.

12:00

I then skipped out of that care home with total and utter delight, having told every nurse in the place that I could find about this lady’s change in status as of today, hopeful she would be able to repeat the same feat tomorrow. I caught a bus, responded to some emails which always seem to be never-ending and made my way down to see another patient have her lunch. This wonderful lady is going to turn 94 tomorrow. Her swallow has deteriorated because she has dementia. It is now safest for her to eat pureed food. She isn’t very aware of her eating problems but her husband is. He is her sole carer and is at the age of 92 himself. I explained to him why and how swallows deteriorate in dementia and why she would likely have to continue with puree food.

Halfway through this explanation he had to leave the room, as after 75 years of marriage this was just one more part of his wife to slip away.

13:15

I ate my lunch on a lovely bench in a big park in Central London. Sometimes I really do love getting to be outside all day. Although ask me in winter and it can be a very different story!

13:45

The next person I saw was a young 32 year old man who has a hypoxic brain injury. He recently went to hospital to have a pancreas transplant due to his diabetes. He died on the table for 14 seconds and as a result he can no longer read or write and finds it difficult to show emotion when he talks.

Today was a goal setting session, to figure out what he wanted to achieve in therapy. His main concern was how these new impairments will come across when he goes back to dating. His parents are highly concerned about his welfare if he does not get married soon. He is worried people will see him as “bored” and “ugly” because of his lack of facial expression. He would also like to focus on online dating because in his words:

“How am I supposed to meet anyone any other way these days?”

14:45

The next person I go to see is the last of the day and is close to the tube station that I can get home from. This is a 57 year old gentleman who has Progressive Supranuclear Palsy. This is a rare neurological disorder that causes a number of difficulties with balance, movement, vision, speech and swallowing. This gentleman also has cognitive difficulties associated with his diagnosis. He has trouble remembering and can sometimes be very rigid with his thoughts.

A video-fluoroscopy is an x-ray of a person swallowing

I have been seeing him for a few months for his swallowing and had organised for him to have a videofluroscopy (an x-ray of his swallowing) at the local hospital. He has been having a lot of difficulty drinking and was at quite a high risk of dehydration and also getting a chest infection.

The hospital have called him twice to book the appointment and both times he has either hung up or said he simply couldn’t attend and unable to tell them why. The phone is difficult for him for a number of reasons so I agreed to see him at home even though we had previously agreed that he wanted his swallow investigated. It turns out after some discussion he normally attends swimming on a Tuesday and for that reason he couldn’t attend as he must go swimming on a Tuesday.

I asked his Mum (77) to attend the apt. to help me explain to him that we could ask the taxi to take him swimming on Wednesday. He said he “hadn’t thought about that” and would ring the taxi now. Once that was sorted he was happy to attend the appointment. I emailed the hospital to confirm there and then as it could be 6 weeks before he gets another appointment.

15:45

Just as I leave the house and I am about to get on the tube I get a call from a different patients wife in tears. These were thankfully tears of joy as her husband who has Motor Neurone Disease has become much more proficient at writing on his device which he controls with his eyes (think like Stephen Hawking except we had managed to put this gentleman’s own voice on there) which speaks for him.

He had been secretly writing a short story dedicated to her. I had helped him store it in the device so she wouldn’t be able to see it. It’s taken him 8 weeks to do in secret whilst she was going out to the supermarket and to work. He was able to read it out to her like he used to do (he is an author and would often read his stories out loud to her to see how they sounded). She just wanted to say thank you to me for being so patient and involved with them and giving him “the tools to just be himself”.

Needless to say I had a huge smile on my face going home from this beautiful phonecall, even in the knowledge that I had so many notes to write tomorrow after what was quite a roller-coaster day.

There you go, a day in the life of a community speech and language therapist. Is it what you thought a speech and language therapist could do?

How are you feeling? Sad? Happy? Elated? Sick? Tired? Stressed? Empathetic? Worried? Frustrated? Like you never knew there were so many things that could go wrong with your brain?!

Yeah, welcome to my day! Its intense right? I routinely pass through all of these emotions on a day to day basis, never totally knowing where any given day will take me. Reflecting on this day in particular it struck me that no one told me at the beginning of this career how much time, energy, care, empathy and emotional intelligence it takes to be a good speech and language therapist. To be totally honest I’m not sure I would have taken this profession on if I had known.

You know what though? I’m so glad they didn’t because I love it. I love every minute of it. I love the quick decisions you have to make during sessions, diffusing family tensions, sharing in the joy as someone reaches their goals and sharing and receiving new perspectives and ideas from patients and their families. Yes there are days when bureaucracy, bad people, poor public transport, British weather and stressful social situations can impinge on your day, of course, but I think most jobs come with a level of that – particularly in the public sector.

What satisfies me about this job is how much of an honour it is to get so intertwined and so close to the very fabric of people’s lives. We learn what makes them tick, show them the way to have a better, more fulfilling life even when sometimes that means helping them to have a meaningful and peaceful death.

I am so proud of what I do every day. We as a profession are not just here for fixing ‘s’s or elocution or as on-call swallow assessment machines.

We are a discipline of people hell bent on giving people access to their basic human rights of communication and eating. Every day we find ourselves in people’s lives and homes and I for one am so grateful and to be honest privileged that people allow me to be part of their journey. Whether it is to be there for the end, ensuring they can still eat malteasers like always or helping them to communicate to get their affairs in order or a path to a new beginning, helping people to have a meaningful life after a stroke or brain injury, showing people how valuable they really are to this world.

*Please note these patient stories occurred pre-covid-19. The work we have been doing since March has looked different and who knows I might write some reflections on that in the coming months. ** Conditions and ages have been edited to maintain confidentiality for these patients. Photos are not of actual patients. ***Please see original my SLT Day tweet here.

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Emma Louise Sinnott - Guest Blogger

Author Bio: I'm Emma Louise and I am a Highly Specialist Speech and Language Therapist (SLT) who works in London but originally from Wexford, Ireland. I qualified from University of Ulster with a BSc Hons in Speech and Language Therapy in 2013 and then completed an MSc at University College London in Neuroscience, Language and Communication in 2015.I have a specialism in neurology and work with a wide variety of clients with neurological disorders including Stroke, Parkinsons Disease, Motor Neurone Disease, Neuro-Oncology, Complex Neurological Trauma and Dementia. I am passionate about research in aphasia and cognitive communication disorder. I am also a little bit obsessed with dogs and oil pastels.