Rainbow Bridge

It's been two weeks, and the tragic shooting in Orlando is still strong in my mind, and I know I'm not alone. A few years ago, I met Crom Saunders at an interpreting conference, where I attended a few of his workshops. His poetry is captivating, and he created a beautiful and sad poem in memory of Orlando.

Thank you, Crom, for your heartfelt and heartbreaking poem. May it remind us to always keep the Rainbow Bridge strong.


As with many things in life, the people to listen to in difficult times is the people who have first-hand experience. From Gabby Giffords:

The victims are young and old — but always with so much life ahead of them. They are white and black, Latino and Asian, and Native American. They are lesbian, gay, bisexual, transgender, queer, and straight. They are Christian and Muslim, Jewish and Sikh. They are veterans and government workers and union members. They are rich and poor. They die by murder, they die by suicide, and they die by negligence. Often, they don’t die, but they carry the scars, and their lives change forever.

For many SLPs, injuries by guns are not unfamiliar. Whether you work in medical settings or in the schools, many of our patients have been affected by gun violence. One of the best things we can hope for in our work is that our patients are able to go on and make a difference. Gabby Giffords inspires me both with her activism and her continued determination to keep talking.

Speaking is difficult for me. But I haven’t been silenced. And neither should the American people. Their Representatives must vote to prevent gun violence.


On Saturday, I was celebrating Pride with my beloved LGBTQ community. From the moment I attended my first Pride celebration over ten years ago, I was awash with the feelings of genuine love, acceptance, and beauty I found there. For someone who spent a lifetime never knowing where I belonged, it was overwhelming to be in a place that felt so completely like home. Whenever and wherever I am with my community, I am at peace.

That peace was shattered on Sunday, when I awoke to the horrific news of a shooting at a gay club in Orlando. That evening, my partner and I attended a vigil to be surrounded by friends, family, and the community.

A day later, I am still reeling.

I wanted to take a moment out from my usual range of topics here to express my sorrow, and to remember that we all come from so many walks of life, religions, cultures, experiences, and identities. Our differences are what make life a richer and more beautiful experience. For up to date information, Equality Florida will keep you informed. If you would like to make a contribution, blood donations are very much needed (if you live in Florida, you can find out more at OneBlood.org) and there is also an official GoFundMe page set up by Equality Florida.


When I worked in acute care, I was a strong advocate for the idea that everyone deserves a chance to get therapy. I still believe that strongly, but having now worked in both home health and outpatient settings (in addition to previous placements also in skilled nursing facilities during my clinical fellowship), I've come to a new realization:

Not everyone is a good candidate for therapy.

As a new clinician, and working in such an intense setting, it didn't occur to me that not everyone responds well to therapy, and more than that, not everyone even wants therapy.

Many folks want to tell clinicians what they think they want to hear. Keep an eye on body language, and consistency with attending appointments, and motivation (or lack thereof) will become readily apparent.

See enough people do the same, and you'll get better at recognizing motivation in the moment. Part of patient-centered care is respecting when patients don't want our help.

Response Time

Some days, one patient encounter gone awry can feel like it throws off the entire day. Give it some distance, though, and zoom out for better perspective, and suddenly it's clear that there are many ways to respond to the same problem.

If every patient we encounter has the same problem, how many ways can they respond?

  • Relief. Every so often, having a name for what you're experiencing helps to find the strength to acknowledge it and want to address it.
  • Validation. This might be the first time someone really listens to, and confirms, what has been a problem.
  • Disappointment. So much for hoping it was no big deal, or just a figment of the imagination.
  • Frustration. Why does something always have to happen? Why now? And why is everything so hard?
  • Anxiousness. More stress on top of stress, and stress about all the stress.
  • Exhaustion. Here's yet another problem in a long list of problems.
  • Depression. Life is hard, and this makes for more than can be handled. Treatment for depression in the wake of acquired communication deficits can be especially daunting.
  • Apathy. Too much else going on to really take notice or care.
  • Neutrality. Knowing it's there, but not minding it one way or another.
  • Anger. Directing feelings of anxiety, depression, frustration, et al outwardly, towards loved ones, strangers, or clinicians.

One sudden life change can take away everything someone was working toward or enjoying. Sometimes the things not talked about are the things most profoundly affected. Meeting our patients where they are can go a long way to providing the best care we can for them, right here and now.

One thing I like to keep in mind: If I'm angry, the last thing I want to be told is that I shouldn't be angry.