Lemons Are Smelling Like Garbage: Reflection from an Early Career SLP in Health Care During COVID-19

The first time I treated someone with known COVID-19, a patient in the ICU, I distinctly remember thinking, It’s here, right now. It’s here in this room with us. Another entity: The patient, myself, the speech-language pathologist who was orienting me as a new hospital employee, and the Newly Described Thing. Despite a definite diagnosis, despite knowing that diagnosis before entering the room, there was nonetheless a slow moment of reconciliation for me, where I had read about the Thing, I had heard about it, but to be in a room with it was wholly other. There was a feeling of matter for me then, of the voluminousthat is, this invisible Thing was crowding inand inevitably that matter, that feeling of the voluminous, they ached and continue to ache with multiple meanings.

I used that word, “slow,” last time I wrote about COVID. Why does pace cut me so deeply when it comes to COVID? Does the fact that it does speak more to my perception of the progression of the disease, or am I reacting to our unpreparedness for this Thing, for the Description of this Thing?

The last time I wrote about COVID, I was working in a skilled nursing facility. In that period, one resident, a resident I did not have reason to treat, had tested positive. Now I work in a hospital, seeing people with COVID at all stages of the illness.

The SNF was in Lake Placid; I lived in Saranac Lake, which is proud of having been a haven for those seeking treatment for tuberculosis in the late 19th/early 20th centuries. It was called “taking the cure,” and patients flocked to receive the fresh air cure in a place largely free of stigma toward the sick. With my husband, I rented a former “cure cottage,” as they came to be known. These were otherwise normal houses with large porches added on to provide plenty of air and sunlight for the lengthy bed rest required for curing. Regular townsfolk, not just medical professionals, made these changes to their homes and their lives to do their part for the cure. Béla Bartók is said to have lived in the cottage we rented. As COVID emerged, the significance of living in this house in this town with such a peculiar backstory was not lost on me.

In that era of curing of TB, there was cousining, a term coined for romantic involvement between patients, or nurses or doctors and patients, who were sometimes entirely cast off by family when they fell ill and sent far away to heal, sometimes sorely missing a spouse back home. Just like that we borrowed a word for a relationship (cousin) and activated it, we changed the behavior of the word and the words related to behaviors, we allowed new relationships and destroyed old ones. Another Newly Described Thing, cousins. And how is it that all we have for descriptions are words, mostly words we already know when things like this (like new cousins, like COVID) develop? Or maybe it’s not so much that all we have are words, that words fail, as people are so fond of saying; maybe we haven’t clearly enough defined our goal in talking about these matters or acknowledged the intelligence of, the process of talking about them, that we are in a way actually creating affairs with these symbols.

What is the difference between creating and naming?

Speaking of pace and place, which speaks of time and Descriptions, I’m starting to see COVID now in people’s medical history. As in, another thing (Thing) that happened, but in the past, something notable in relation to the big picture and whose effect we can never quite be certain of, an inauguration, an industry, a meeting ending in a signed document. A decision (and just how far is a decision from a description, really? We might call them cousins). More information on a lung or cognition or olfaction than we initially agreed to. The small town on the map we can now locate, where we had not ever heard its name before, because of the tragedy that took place there.

Now, for some lemons are smelling like garbage, relevance is outlasting attention span, and everyday people without warning know alveoli.

That’s part of it with illness or injury, for me, the devastating subtraction of choice in learning, the imposition of information. The sudden focus once a name is named. COVID. Before we had x/y/z illness, we weren’t seeking these descriptions. Unwanted vocabulary, accompanied by the offense of stolen pursuit, burgled joy of leaping through acquisitions. I want to learn about COVID because I don’t personally have to learn about COVID, for example; instead, it is my privilege and of course my professional responsibility (which again, is my privilege). This represents a different avenue of learning, a different way of facing information, than when I am unwanting yet needing. It occurs to me that this distinction is important to keep in mind when we’re educating patients and families about the conditions we treat. Not everyone, I remind myself, finds talking about cognition fascinating, when it’s so painfully personal.

COVID is pervading our narratives. Another of my patients admitted to the ICU for cardiac trouble, insisted he was there for COVID when he had no history of COVID per documentation or the team. And yet in a sense, he found it to be part of his historyand in a sense it was.

I find that I’m unsure of how to close, and I’m tempted to leave it dissatisfying, ugly, unfinished, with many elaborating Descriptions possible and needed, wanted and unwanted, because that runs parallel with the confusion of COVID, which at present refuses endings. So here I will end. Another workdayCOVID and not, with all it entailswaits for me tomorrow.



Bio: Jenny Fortin, MFA, M.S., CCC-SLP, is a speech-language pathologist at an academic medical center in Syracuse, New York. She has a special interest in poetry and adults with neurogenic communication disorders; new interests in enhancing communication with patients in the ICU and the SLP’s role in addressing delirium are emerging.

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