Typical Day
Lynn Gwistik opens the door to Loud & Proud Speech Therapy, and says hello to her receptionist, Sylla Bull.
“Hi, Lynn! Oh, I have a note here for you--Trevor’s mom just called to cancel his 8:30AM appointment. She says he is sick today.”
Lynn sticks her head out of the break room. “Thanks, Sylla. I can use that hour to catch up on paperwork. I do need to see Trevor this week, though. I don’t want to wait longer or he may relapse.”
“I’m way ahead of you. We rescheduled for Thursday, unless he’s still under the weather.”
“Sylla, you’re a treasure.” Lynn heads to her desk and boots up her computer. Time to input some insurance claims. A big part of Lynn’s job involves submitting exam reports to insurance companies for approval. Most insurance companies cover basic speech therapy, but a few of Lynn's clients encounter a difficult time getting benefits for the services they require. Some companies only allow a certain number of visits, or refuse to pay for impaired children who don't meet their requirements. Government-funded Medicaid provides limited screening for low-income students, but many families fall through the cracks, or are left paying out of pocket for more in-depth care.
At 9:50, Lynn stretches and yawns. She downs a V-8 and walks into the exam room to meet her 10AM patient. Christian is a third-grader with a stutter. She spends 10 minutes asking questions about his vacation to Hawaii, and is pleased to see that he speaks relatively smoothly. His stutter returns a bit when they go to the story cards, and Lynn reminds him to relax his shoulders, let the sentence go, and slowly begin again. It has been rewarding to see Christian gain confidence from their sessions...he went from a quiet, timid child who hated school to a chatterbox who can express himself like his peers. These days, she has trouble getting a word in edge-wise!
Lynn has some unscheduled time after Christian's session, so she calls the Ramirez household to check in. She has been working with Mrs. Ramirez to find a suitable diet for Miguel, a 4 year old with Down's syndrome. Miguel has difficulty swallowing, combined with a serious sweet tooth. Though Miguel would happily live on candy bar smoothies, Lynn is trying to introduce other sweet foods, like vitamin-laced yogurt and fruit dipped in nutella.
"Hi, Maria. How did Miguel do this week?"
"Lynn! Hang on..." Lynn listens to a muffled argument in the background. She can barely make out the words "cookie jar," "Get down!" and, "Time out!" When Mrs. Ramirez returns, she sounds frazzled. "Lynn, I just don't know what to do with this kid! He didn’t eat his breakfast, but he just knocked over the cookie jar trying to get into the oatmeal bars our neighbor brought over."
"Don't worry, we'll get there. My son ate nothing but chicken nuggets and corn for months, and he turned out just fine. If Miguel likes the taste of those cookies, we might get him to eat cinnamon raisin oatmeal as a sneaky dessert. I've also got a really yummy pumpkin pudding recipe that's surprisingly healthy. If you have the time to make it from scratch, he could help you smush the cooked pumpkin. I'm sure he'd be really good at that, right?"
Lynn recommends keeping Miguel on a daily nutrition drink (chocolate, of course) to keep up his nutrient intake, and says goodbye to a somewhat calmer Mrs. Ramirez. Sometimes the most important part of Lynn's job is being there for the parents. Or at least, talking them down off the ledge.
After lunch, Lynn walks out to open the door for her next patient, Maya, who zooms into the office in a motorized chair. Maya has Amyotrophic Lateral Sclerosis (also called ALS, or Lou Gehrig's disease) which interferes with her ability to speak clearly. The majority of Lynn’s patients are children, but she also pairs adults with assistive technology as needed. Today she plans to introduce Maya to a few different kinds of "augmentation" methods, which can help ALS sufferers communicate with others. Most of her clients prefer a simple white board or tablet to write messages on, but today Lynn also has a new model of touchscreen which is lightweight and easy to use for patients who cannot control their fingers. Lynn wants Maya to be comfortable with alternative methods of communication, as these will be a lifeline for her as her speech begins to deteriorate.
Maya responds positively to the computer: “Does this make me look like Stephen Hawking?" Lynn laughs, and tucks rental paperwork into Maya’s wheelchair “carryall.” Maya's insurance coverage doesn't include assistive technology, which can cost thousands of dollars. In these cases, Lynn usually recommends a local agency which rents equipment for a trial period. If the device is a good fit, Lynn will work with Maya to find a payment option, perhaps a bank loan or grant from a charitable organization.
After daredevil Maya screeches into the parking lot, Lynn heads to the group therapy room to check in on Rhea. Rhea P. Taftermee is completing her clinical fellowship by helping out at Loud & Proud Speech Therapy. This afternoon she is conducting a class for teenagers with autism. When Lynn walks in, she sees that the kids are creating Lego robots. Rhea is handing out blocks a few at a time, but each student must interact with her to request a block or wheel. Nonverbal students must point to the correct words on their Picture Exchange Communication System (PECS), a laminated book of pictures. The teens really seem to be enjoying themselves, and Lynn makes a mental note to praise Rhea for her choice of activity.
At the end of the day, Lynn usually devotes at least an hour to organizing her patient notes and opening new insurance claims. After this, she checks the clock and sees that she has just enough time to lock up the office and grab dinner before heading to Tyreese's school play. Tyreese graduated from speech therapy last year, and Lynn looks forward to seeing him steal the stage as Humpty Dumpty in Jefferson Elementary School’s dramatic production of Mother Goose. She plans to sit right up front, so she can hear each and every "r" ringing clear as a bell.