By Heather O.
I know a lot about swallowing. It sounds weird, I know, but swallowing is actually kind of complicated, and, well, kind of important. It’s one of the first instincts that you develop in utero, and it’s one of the first indicators that your life is near its end. I’ve been consulted on a lot of death beds, because when people stop swallowing, they don’t have long to live. It’s just one of those circle of life kind of things.
There are lots of ways to evaluate a person’s swallowing function. When I was in graduate school, I learned about and was trained to do all of them. But my professor, who worked at NIH and knew everything there was about swallowing, also told us about a ‘new’ technique for evaluating swallowing, and she made no bones about the fact that she found it completely ridiculous. It’s called FEES, or Fiber Endoscopic Evaluation of Swallowing. Hence, we learned the basics as she rolled her eyes, and we moved on.
I won’t bore you with details (too late?), but basically this technique involves shoving a tube with a camera on the end of it up someone’s nose, threading it down past their soft palate, and taking pictures of their throat while they swallow. For a variety of reasons this is not the “gold standard” in terms of evaluating swallowing, but I’ve since come to learn it has its place.
I’ve done this procedure once. On a fellow trainee, who then did it on me. I made her nose bleed. It wasn’t pretty.
I’ve had to make judgement calls that were shaky at best based on information I received from others doing this procedure, and I didn’t like it. But I felt okay about my recommendations, because everybody was new at this, and everybody’s judgement calls were shaky at best. We were shaking together, doing the best we knew how for our patients. I hate to break it to y’all, but a lot of time, that’s how medicine works.
This week, I attended a conference about neurological emergencies as part of my continuing education requirements to keep my license as a speech language pathologist. Most of the people there were nurses who worked in a neuro unit. There was a lot of info that I didn’t understand and probably will never use, as it went way out of my own scope of practice. But there was a fair number of speech therapists there, and one therapist was even asked to discuss how she trains nurses in her hospital when it comes to swallowing. She described the process, and then said that most of the patients would need full instrumental evaluation before being allowed to swallow anything. She said that she does FEES at their hospital. And everybody nodded sagely.
It was that moment that I realized something very important.
I’m old. And I’m out of date.
It’s been 2 years since I’ve set foot in a hospital as a professional. At this point, I could not read a FEES eval if someone’s life depended on it, and, unfortunately, sometimes it does. This is the cost of being a SAHM mom.
It’s a tough pill to swallow when you look at women who are your age who you know have better experience than you do, who can offer more to a patient than you can, who are more confident with their skills than you are. It’s a REALLY tough pill to swallow when you see kids right out of grad school who could walk circles around you with their skills, and you are supposed to be the one with experience. And all along, you wonder, “How long can I fake it before somebody notices, or worse, before somebody gets hurt?”
(Another scary thought–I wonder how many doctors feel that way? [shudder])
I love being a SAHM, and my 4 years of struggling to have another child taught me that children are not a given, they are a gift. My days are slow, I don’t get out much, and I spend a lot of time picking up after a toddler who can trash my kitchen in 2.5 seconds. It’s not exactly exciting, but it’s the life I’ve chosen, and most days, I’m really glad I did it.
But it means that I’m old and out of date.
This is not a unique discussion, I know. The choices that we make, by definition, limit our lives, and so we make choices that hopefully give us the life we want. I wanted this life, I chose it, and I don’t take anything for granted. I know it’s not possible to be a full time speech therapist who can solve all the world’s problems and still be the kind of mother I want to be.
But sometimes, just sometimes, I wish that it was.
Thanks for letting me ramble. And my kids are WAY cute. Just so you know.
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