Life After a Craniotomy: Supporting Patients and Families in the Healing Process

This is a transcript from our podcast episode published January 16th, 2023. The podcast episode is offered for .1 ASHA CEU (introductory level, related area). This transcript is made available as a course accommodation for and is supplementary to this episode / course. This transcript is not intended to be used in place of the podcast episode with the exception of course accommodation. Please note: This transcript was created by robots. We do our best to proof read but there is always a chance we miss something. Find a typo? Email us anytime.

A special thanks to our Contributing Editor, Caitlin Akier, for reviewing and editing drafts of our transcripts. Her work helps keep our material accessible.

[00:00:00] Kate Grandbois: Welcome to SLP nerd cast, the number one professional resource for evidence based practice in speech, language pathology. I'm Kate Grandbois 

[00:00:09] Amy Wonkka: and I'm Amy Wonka. We are both speech, language pathologists working in the field and co-founders of SLP nerd cast. 

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[00:01:43] Kate Grandbois: Welcome everyone to today's episode. During this episode, we had the great pleasure of welcoming Christi Donovan onto our podcast. Christi is a fellow speech and language pathologist. She is also a traumatic brain injury survivor. [00:02:00] We really feel strongly that as speech and language pathologists, as part of our professional education and professional development, we need to continually be listening to and learning from the experiences of others.

And in focusing on those experiences and listening to those stories, we can refocus our clinical lens and continue to incorporate aspects of person centered care, patient centered care. And one of the three triads of our evidence based practice triangle, which is client perspectives and values. We hope that you enjoy this story that Christie is here to share with us and continue to reflect on your own clinical work and how you are supporting and centering the values and needs of our patients and clients. We are so grateful to have had Christy as part of the show, and we hope you enjoy.

Welcome everyone to this week's episode, we are so excited to welcome today's guest [00:03:00] Christie O'Donovan welcome, Christie. 

[00:03:03] Christi O'Donovan: Thank you. 

[00:03:05] Amy Wonkka: Christy you are here to discuss life after a craniotomy, supporting patients and families in the healing process. Now, before we get started, can you please tell us a little bit about yourself?

[00:03:17] Christi O'Donovan: Sure. My name's Christi O’Donovan. I am, um, a speech pathologist. Uh, I own my own private practice leading therapy home on the south shore of Massachusetts. I'm a mom of two little kids, uh, liver of a crazy busy lifestyle. Um, and I have had a brain injury through, um, craniotomy. 

[00:03:37] Kate Grandbois: We've only heard right before I thought we were preparing for this episode.

You got halfway through telling us your story. And then I said, this is too good. It's too good. You have to, you have to wait. So I'm, I'm on the edge of my seat. Now, wanting to hear more from you and, um, and giving you an opportunity to tell us your story. But before we do that, I have to read our learning [00:04:00] objectives and our financial and non financial disclosures because ASHA makes me do it.

So I will, um, get through those quickly. And then we can hear more about what brought you here. Learning objective number one, describe at least two aspects of the physical, psychological, or emotional healing process following a brain injury. Learning objective number two, identify at least two ways in which a brain injury can impact return to work school or integrating into the community and learning objective number three,indicate at least two non-clinical ways to support patients and their families following a brain injury. Disclosures: Christi O’Donovan's financial disclosures.

Christie is the owner of a private practice, Leading therapy home, Christie received an honorarium for participating in this. Christi o’Donovan non-financial disclosures. Christi has no non-financial relationships to disclose. Kate that's me, financial disclosures. I am the owner and founder of Grandbois [00:05:00] therapy and consulting LLC and co-founder of SLP nerd cast. My non-financial disclosures. I am a member of ASHA, sig 12 and serve on the AAC advisory group for Massachusetts advocates for children. I'm also a member of the Berkshire association for behavior analysis and therapy and the association for behavior analysis, international and their corresponding speech pathology and applied behavior analysis special interest group. 

[00:05:23] Amy Wonkka: Alright, Amy, my financial disclosures. Um, I am an employee of a public school system and co-founder of SLP nerd cast. And my non-financial disclosures are that I am a member of ASHA, um, member of SIG 12, and I serve on the AAC advisory group for Massachusetts advocates, for children.

All right. Onto the good stuff. Christy, why don't you start off by telling us your craniotomy story? 

[00:05:48] Kate Grandbois: I'm on the edge of my seat. I know I can't. Go for it

[00:05:51] Christi O'Donovan:. It's a really interesting one. So my senior year of college studying to be a speech pathologist on the way to an internship and I was in a car accident, [00:06:00] um, minor whiplash hit and behind I went, I had submit neck pain, went for a scan, um, after a while not getting better.

And I was sat down and told you have a brain injury. You have what's called a chiari malformation. I probably have had it my whole life. They said, no bungee jumping, no skydiving, all things I've already done. And they said just, no, you have it. And then I moved off to, uh, Thailand actually in between college and graduate school.

Got some extra massages for my neck pain, went about my life. So 

[00:06:39] Kate Grandbois: can you define what that is? Can you tell us, um,? Uh, yeah. Yeah. Chiari malformation, a chiarimalformation I couldn't say it back to you. I couldn't remember. that's my, my graduate school neurology failing me. But if you could tell, um, tell us what, what that is.

[00:06:48] Christi O'Donovan: Yeah, I'll do my best. So from real layman's terms that it's a slight elongation of the tonsils of my cerebellum are slightly elongated beyond, Um, so it's often, [00:07:00] uh, uh, causes ataxia and typically you'd see patients with like type two type three who may need surgery to remediate. Mine was mostly asymptomatic.

Um, Could have caused some of my kind of clumsiness that, or I walk into walls sometimes. Um, but really it was just something they said, just keep, keep an eye on this. Um, so this isn't how I obviously how the craniotomy happened. So, um, kind of fast forward there, I came back. I was, did my CF as a speech pathologist, um, and a busy outpatient center.

Um,  got my C’s working and things were starting to settle down into my life. And I went to my PCP once, um, and said, you know, no one follows me for that brain injury that I have. And she said, oh, I'll send you for some updated scans. And then you can have a neur, uh, relationship with a neurologist up, up here in Massachusetts, because previously I was in Maryland when I first was diagnosed and they sent me for some scans.

I did [00:08:00] it. No problem. Um, then I get a call after saying you need to see a neurologist immediately and they wouldn't tell me why. And she said, there's some kind thing widening the arteries of your brain. There's something going on with the arteries of your brain. We need to get you in. So I start calling around, have no idea what's going on.

I have a slight understanding of neuroanatomy at this point. It wasn't one of my best college, uh, classes in college, but I bring my then fiance. I'm 26, I'm engaged, I'm working a couple jobs, you know, as we all are as new clinicians, I bring my fiance with me and I'm nervous and the doctor didn't get my scans.

She's like, I don't know why you're here. They don't, you don't need to follow up for a chiari malformation. And they never, she never got my stand. She's like, I have to go. She sends me away. We're at the elevator doors and she comes. She's like, I need you to come back in my office right away. I got your scans.

Oh, she sits me down. She says you have an aneurysm. I need you to see my [00:09:00] colleague. I'm gonna have my receptionist. Um, put you in touch, but I have to go. So that I, I go back and get on the T. I'll never forget this. I miss my stop. I have three stops and I get a call an hour later from neurosurgery booking me, uh, a consult for the next day or something sometime very soon thereafter.

So I go to neurosurgery and I have one doctor who says, yep, I'm quite confident. This is the, the treatment for you. Um, it was a minor treatment going up through my groin. Um, a couple, it was gonna be scheduled right away. Uh, so they can go in, take pictures of the aneurysm, get a better understanding of it and then treat it.

[00:09:39] Kate Grandbois: Okay. So let me just recap this for you. You found an aneurysm by accident after an unfortunate experience where there was a massive pump fake where the neurologist was like, eh, go home, wait, just kidding. You're in my hallway. Also, you're gonna be booked in neurosurgery in an hour. That must have been. a [00:10:00] very intense period of time.

Uh, you mentioned that you missed several stops on the T I, I am. I, I can only imagine what must have been going through your mind at that point in time. So you go to, I assume you get booked with a neurologist next for your, for neurosurgery and, and what did they, what did they say? Were they helpful? 

[00:10:23] Christi O'Donovan: He said, You're lucky you found this when you did. Um, I need, we need to take care of this right away because. They're significant. You're at significant risk of an aneurysm rupture. He said, I know I'm going to book you for something. I think it was two weeks out where they go in through my groin, take a picture of the aneurysm to get a better view of it so that they could see it.

And then he wanted, I dunno, was it another week later or two weeks beyond that to go in and treat it through, um, again, through the groin to go up, fill it up with coils. And he said, He said to me, you're young, you're a pretty [00:11:00] girl. The other option is a craniotomy and there's much more significant risks and you're gonna be disfigured.

And then he said, so I need you to stay calm. I need no don't lift anything over 10 pounds. Um, and let's take care of this right away for you. So this is behind you. And I went back 

[00:11:20] Kate Grandbois: and I a pause for a second and reflect on the insane, the insane advice, stay calm. I understand the neurology and biology behind that recommendation, but that seems, that seems impossible.

[00:11:35] Amy Wonkka: It seems impossible. I, I feel like that is, that is a lot of stress happening. 

[00:11:43] Christi O'Donovan: I remember we stepped out and I was with my fiance at the time and I bursted into tears and he was so panicked because all of a sudden he was worried that I was going to have a stroke right there in the cafeteria, 

Kate Grandbois: because you were crying 

Christi O'Donovan: the hospital. Yeah. Yeah. Just from the stress. And we were in the [00:12:00] process of moving and it suddenly became a don't lift the box don't bend we're we're worried that we have no idea because that was the impression that the first doctor had. 

[00:12:09] Kate Grandbois: So what, so you, I assume, by the way, you're telling this story, when you're saying the first doctor, something about that experience motivated you to find a second opinion.

[00:12:18] Christi O'Donovan: I was sitting around the lunch table. Fortunately, as a therapist, I was surrounded by very smart therapists who were much more seasoned than I was. And one of my friends at the time said, you'll have to get a second opinion. Yep. I guess I should do that quickly. So I booked myself with another local doctor.

We did some research and found someone really good because at first it. I didn't even realize I had to be seen by neurosurgery. This was all happening so fast. So I booked myself a follow up or a second opinion. And the next doctor said, I can see this aneurysm just fine. I don't need pictures for it. And no, what the first doctor didn't tell you was that we've only been coiling aneurysms at the time [00:13:00] for nine years.

We don't have a lot of research and we don't have much, very little research on your particular aneurysm in the way it was shaped. He said, craniotomy. You have to, you're the ideal candidate for a craniotomy. We'll go in. You'll be fine. Four weeks. You’ll be back to work. 

[00:13:17] Kate Grandbois: All right. That's a very different message.

[00:13:19] Christi O'Donovan: Wow. Mm-hmm and he said you could live with this indefinitely. We don't know. And you'll be, we can book this out six months if you want. 

[00:13:27] Kate Grandbois: So I'm, I'm, I'm reframing this and thinking about it from the, from, from your experience, but also from, in terms of how you advocate. For what to do next, in terms of the trust that you feel with the medical team that is, is treating you, that's a really big difference.

[00:13:48] Christi O'Donovan: That was huge. It was really frightening. Could be a, what felt like a life or death decision, you know, do I go with one that would keep, that was just this minor [00:14:00] quick fix, but then this other doctor was telling me you actually can't trust that this will be around. That this, that this, uh, that there's enough research on this or that this will be a long, a long term fix, or do I go for the long term fix once and for all that had a lot of risk? I went into a surgery, you know, a really scary big surgery, but it would be taken care of once. And for all, there might be risks associated with it. There may, I was told disfigurement, I was told brain injury, but then the second doctor said, no, you’re fine. You're you're young, you're healthy, you're educated.

You're you're the perfect candidate go with this. And to them, it's just, he's an neurosurgeon. It's just another day. Right? And to me, I had to make this huge decision and figure out which one to trust. 

[00:14:49] Amy Wonkka: How do youeven begin to sort through something  like that? 

[00:14:54] Kate Grandbois: Well, you're not allowed to cry. Okay. We've established that.

[00:14:57] Amy Wonkka: You're not allowed to cry. Thanks. You're not allowed to feel [00:15:00] anxious, bend, lift anything. 

[00:15:03] Kate Grandbois: Oh my goodness. Okay. So what happened? 

[00:15:07] Christi O'Donovan: So ultimately decided to take the risk and fix it once and for all the, the thought of at the tennis 26, 9 years, not knowing what could happen in nine years, this colleague said to me, you could still be having babies in nine years.

Could you be delivering and could your aneurysm, could the coils dislodge or, you know, there just, it felt like there wasn't enough research on it for me to make that decision. So I decided to go with the craniotomy and I was told you'll be to work for, for four to six weeks. You’ll be back. Good as new

[00:15:45] Kate Grandbois: So science is amazing and wild, but continue. 

[00:15:49] Christi O'Donovan: So I booked my surgery with that second doctor who wanted to do the craniotomy. Um, and I took a, you know, temporary leave from my [00:16:00] job at the very busy outpatient center. Um, I went through the surgery, it, um, what my recovery, I honestly don't remember a lot from right before the surgery and right after my memory loss around that time was really significant.

Um, I just, I try, I was barely sleeping. My sleep was really impacted. Um, I had a lot of trouble with my emotions. I had a lot of trouble with noise. My sound sensitivity was really significant. I was not at all prepared for that. If we were, uh, out, we, if we were out to eat, I remember trying to go out to eat a lot because I wanted to feel normal.

And if there was any kind of noise, I would be really disturbed by it. Um, I would, if a sudden noise happened, like my whole body would go into sweats. I decision making became. Impossible. Just multistep directions became really hard. I remember [00:17:00] trying to cook a meal. Um, I remember trying to watch television shows.

There was this intense show that we, we tried to ever watch breaking bad. We tried to watch that after I was recovered for my surgery, 

Kate Grandbois: I tried but I couldn't, I couldn't watch it. That was too intense. 

Christi O'Donovan:I couldn't, I couldn't handle anything. Oh, it was really difficult. So I was just going through, um, I guess I should have mentioned right in the afterwards I did ask if I needed to be evaluated by a speech pathologist, did I need someone to evaluate me?

And I think I had a quick screen in the hospital in, in the neuro ICU. Um, and they decided. No further evaluations were necessary and I was discharged. So that's, um, what led me to this point, but I got home and in my early days of recovery, I reached out to my friends from graduate school, speech pathologists, and I, and I asked them to come over and test me.

And they brought some, they found some tests from wherever they were working at the time and they came over and did a screen and some of them had specialized in this. So I had another [00:18:00] friend who worked at Spalding and I asked her if she would do an evaluation. And I remember going in and she kind of tried to put together an assessment for me at the time.

Um, and, but really no one felt like intervention was warranted. Nobody felt like I needed therapy. Uh, it was just kind of, you need time. Um, so I. Took a little time, couple, think about a month. And I tried to go back to work. I was told, go back part-time for one week, and then you could ramp up to full the following.

So I told my supervisor at the time, that's what I was going to do. And she was a seasoned SLP with a lot of experience in brain injury. And she was the only person in my life who was like, sure, you try this. So I went back to my busy outpatient, and I went to work and I tried to treat a couple patients and I had a symptom that I could have never understood before having this surgery.

And now speaking about it, it's like it's called brain fog, cognitive, [00:19:00] cognitive fatigue. And I thought that meant you're tired and it's not, you're tired. It's that your brain to me felt incapable of function of like intentional function. I would just stare off into space and I just, I have this, like, I would be incapacitated.

I couldn't formulate my thoughts. I couldn't explain myself. I would just cry. And the harder I tried to work, the harder I tried to get back in, the more the cog fatigue would hit, I would just glaze over. But like still try to perform my functions. Right. I felt like I should be able to, and most people wouldn't notice.

It was just my husband who was really who had noticed then my fiance or, um, a couple of my colleagues who had known me before the surgery and met me after. So I would try to go into my office and turn the lights off and try to have brain rest, whatever that meant. But all the while, um, it just kept getting harder and harder [00:20:00] as I tried to push myself.

[00:20:02] Amy Wonkka: And this is sorry, this is after you've been screened and you've been told everything's fine. You're good to go. 

[00:20:09] Christi O'Donovan: Yeah, you can go back to work. Yeah. I remember going back to the neurosurgeon. He was like, you look great. You're fine. 

[00:20:18] Kate Grandbois:Oh, and I, I also am just imagining. The emotional burden that this, I mean, you're experiencing physical brain fog.

I mean, I say physical because it's not a manifestation of something. It's an actual brain fatigue. You're experiencing a physical symptom, but you are in an indirect way sort of expected to just go back to life when. And there, there, there must have been a, a huge toll that that took in terms of, I don't know, feeling, not just from feeling tired, but feeling like you, you should, you said it earlier, you should be able to do these things.

You should go back to [00:21:00] work, but not being able to, to the, at the capacity that you were before. Was that was that hard. I'm imagining that for myself as being a really psychologically and emotionally difficult period, 

[00:21:12] Christi O'Donovan: It was, it, you know, we’re, as therapists we’re trained to identify and treat and we all know you can't turn that off.

And then all of a sudden you're looking at yourself and you realize I'm not right, but I looked okay. Right. The swelling went down and I was, I was treating patients who had brain injuries, pediatric patients who had brain injuries. And here I am still very much recovering from my own, but I think because I was able to self, I was so self-aware and I was able to self-advocate it almost maybe made the therapist who evaluated me or, um, the doctors look at me differently and they felt it wasn't necessary. Um, so it, it would be subtle [00:22:00] deficits that really took a toll emotionally that I was aware of, that I couldn't quite get anyone else to acknowledge. And just that I wanted to be done with, to be honest. 

[00:22:11] Amy Wonkka: Well, and that feels like when you're approaching professionals and advocating for yourself and they're telling you that you're, that nothing's wrong.

You know, I know one of our learning objectives I'm jumping ahead a little bit is around person-centered care. But to me that doesn't, I, that doesn't sound like it's an example of super person-centered care. When someone is coming to you, when your client is coming to you talking about the, the challenges that they're facing.

Um, and you're like, Shshsh, everything is fine. You're you're good. Um, I, I don't know. I don't know if you had the opportunity to ever experience kind of the opposite of that, where you felt like you went in for an appointment and somebody was more supportive of you or was that just kind of consistent across the board?

[00:22:59] Christi O'Donovan: Oh, that's [00:23:00] a, um, I think it was more the people that were part of my daily life that some were really starting to notice, speech pathologists. Fortunately, I was around them, you know, my supervisor at the time, or my friends who, you know, my colleagues, they were starting to really notice. And they were helping me to kind of advocate for when I need to be a little bit more.

And kind of take the time. I think I really needed that permission that like, you actually do need time to recover from this brain injury. It, it's not gonna be like what you were told. 

[00:23:33] Kate Grandbois: And you mentioned that you got a, you probably had a screening in the, in the ICU or, you know, post, post craniotomy. And you know, I know you mentioned that you have some memory loss from that.

Do you remember any other supports that you wish you had had in terms of setting your expectations? So not just to return to work, but you know, this is a resource you can use. If [00:24:00] you are feeling frustrated or sad or you may experience brain fog. Was there any, were there any resources to help you transition, I guess is my question.

[00:24:10] Christi O'Donovan: Oh, you know what, as you're saying this, I wish there were. I really wish there were, I don't know that I was really given many tools besides just, it's gonna take time. I remember I was trying to do like Sodoku. I was trying to find apps at the time that I could work on. And what I was told is really, you're just taxing your brain so much by trying to work by trying to treat that you don't need more.

You don't need to tax it any further. What you need is rest, but that felt really hard. 

[00:24:44] Amy Wonkka: In that healing process. I think that's something maybe we can talk a little bit about too, because it sounds like that rest is a really important piece.

I don't know if there are other things that you either did or maybe shouldn't shouldn't do [00:25:00] to kind of help facilitate that healing. 

[00:25:04] Christi O'Donovan: Yeah, I, I think there, I, shouldn't sort of certainly been encouraged to do a little bit more and maybe it was me not taking the direction, you know, but just, um, I think I was just, for me, I was focused.

I was planning a wedding and I was just focused on getting back to work and bringing an income back. Um, so I just kept going forward. Um, and. Uh, yeah, I, I think I just, it just took a lot. I just remember taking a lot more time than I thought it would. 

[00:25:35] Kate Grandbois: Did. Do you find that you got most of your support from people who knew you best?

You mentioned your husband, you mentioned your coworkers and I'm imagining, you know, in reframing this through a professional lens for our listeners who may be treating someone with a brain injury for the first time, or, you know, our scope of practice is so wide. Maybe they're interested in learning more about treating someone with a brain [00:26:00] injury and thinking of these person centered care components.

Um, you as a speech pathologist had this sense to self advocate and to, and to use the resources that were available to you. Um, I'm wondering about. For those who are not in that position for the speech pathologists who are listening, how can they help advocate for, for, for patients, um, in terms of either setting their expectations or I don't know, having open conversations about feelings.

I mean, even that is something that I, I think tends to be difficult in a, in an intense clinical setting. 

[00:26:40] Christi O'Donovan: Yeah, but as therapists so much, what we do is really counseling and support. And I think that's where we need to focus more, is really getting to know our patients, truly getting to know them and not just their, their scoring on a standardized test, right?

Like how they [00:27:00] activities of daily living are being affected by this brain injury, despite scoring really. You know, and how much of a struggle it is and what their specific needs are and goals and desires. My, I was pretty in tune. Um, but I'm sure there could have been work that I could have done or in the, maybe in those early stages and looking back at now nine years ago, had I done more work or had I received some sort of additional supports would I still be facing when I'm facing?

[00:27:31] Kate Grandbois: And I wanna talk about that too in a bit, but I'm also thinking about. What this is a soapbox, we get on almost every episode for different reasons, but it's so applicable here. And that is that our evidence based practice model is three pronged. And one of those one third of our evidence based practice model is client perspectives and values. So even if in, in, as we frame this [00:28:00] through your experience, even if you had been screened, even if you had passed all the tests and for those who can't see me, I have air quotes going here. Right? So you quote look okay. Right? The swelling went down, you look fine. Your experience is evidence.

Your experience as a TBI survivor is valid evidence. It is evidence based practice to consider those variables and if necessary design interventions, or, or find supports and resources to help the person as they define their best outcome. as opposed to, eh, you're within the quote average, eh, you passed the, you, you scored, you know, you scored within one standard deviation of the mean on the test.

Mm-hmm , that is not always evidence based practice. And as I'm hearing you talk about these presumably subtle quote, subtle differences that only you and your closest, um, family and friends [00:29:00] were able to discuss or identify, it's still evidence. It's still really important. 

[00:29:07] Amy Wonkka: Well, and it makes me think about the importance of a comprehensive assessment, right?

So this is yet another soapbox, I guess, that we get on, but you know, thinking about. When we make all of our decisions or 90% of our decisions are informed by norm referenced measures. We are missing all of these pieces. We're missing the pieces that would come out, you know, the client perspectives piece that would come out in a comprehensive interview we're missing, you know, maybe the more subtle deficits that would come out in, um, more informal diagnostic measures.

So I think, you know, that's something that I've been reflecting on in hearing your story, Christie is, it sounds like a lot of these decisions were sort of driven by more of that. Like, well, we do, we did the test, we looked here. Good, good to go. You got the right score out the door, you know? Um, and that's unfortunate too.[00:30:00] 

[00:30:00] Kate Grandbois: So you mentioned experiencing some brain fog, you mentioned, you know, experiencing what I have to assume is psychological or emotional discomfort. And in that transition, um, I'm wondering if you can tell us about how else your. TBI impacted your return to life. I mean, across work, across participating in your community, you mentioned you had a wedding around the corner.

I mean, those are some really big life events. Can you tell us a little bit about that? 

[00:30:31] Christi O'Donovan: Yeah. So my symptoms were really interesting. Uh, just like I said, working memory, language formulation, um, a lot of executive functioning decision making. Uh, I don't think that was my strong suit before for sure, but, uh, certainly was compounded significantly, but the, and the, um, well, I remember I have a few really unique ones and they're still lasting sound sensitivity.

Large sudden sounds still to this day [00:31:00] and at places employment I've had. They'll always let me know before there's a fire drill because if the fire alarm suddenly goes off my whole body, I have a whole body reaction. Or if my kids pop one of those Amazon pop those pillows, those air pillows suddenly, and I'm not expecting it.

I, I get so emotional. Like I could actually cry from it. It's really strange sensation. Like I just, my whole body feels rocked. It's a really strange sensation. Um, even like, I'd be still to this day, if I'm trying to have a conversation and I am listening or thinking about something else, I cannot. Oh, that's hard.

It's, it's impossible for me. I can't be typing and listening. I'm just, and um, I think it's just the, the. Um, quick brain processes. Like I really needed a slower pace for a while. So I kept building in more breaks at the outpatient center and [00:32:00] hoping that with breaks in between I would be okay. Um, and it, unfortunately I kept ramping up my hours and then decreasing, decreasing, decreasing.

It took about a full, say about a full year before I was fully back to work. When I had been told it would be four to six weeks. And 

[00:32:16] Kate Grandbois: I think that just goes to show the different definitions that we all have of, and again, I'm using air quotes for people who can't see me, but the different definitions we have of wellness.

Right. So neurologist looking at, you know, your swelling has gone down, you're outside of the statistically significant window for additional complications after surgery, right? So that's the, the neurosurgeon’s threshold, um, and thinking of our audience as SLP, who are supporting people in your position, you know, the threshold for what is well or what is wellness is to be determined by the patient, not by us.

That is, you know, that is not where we are in a position to be inserting [00:33:00] our opinions as we support people. Who are experiencing, who have experienced a TBI. It's making me think of, um, we did an interview last year with a woman named Jenna Mary Rosenthal, who is a speech pathologist, but also a physical trainer and a lot of people who, um, she was explaining that people who have experienced TBI and have lost their mobility.

As soon as they have some level of independence, they get discharged, but that person might still want to learn to run again. That person might still want to learn to walk with a different level of ability. Again, that person might want to learn to pick up groceries off, off the, off the ground and put them on the counter.

You know, and I, I just hearing you speak about the, the difficulties that you faced while your medical team identified them as, eh, mild or whatever, descriptive word you wanna use, they were still really significant to you. [00:34:00] 

[00:34:00] Christi O'Donovan: Yeah. Yeah. It, it was, it was life changing for me, for sure. And certainly, like, as you mentioned before, you know, planning a wedding in this young stage of my life and it just, everything got so much harder for a long time.

And I ended up making a career decision to leave that, that busy practice. For a quieter, uh, slower pace. And so I started my own practice 

[00:34:27] Kate Grandbois: um, for those of us who can't see us, we're all laughing because I think everyone knows owning and running a business is not necessarily slow pace.

[00:34:33] Christi O'Donovan: Yeah. My, my grew very quickly too.

I mean, this was a few years out, so I started my practice in 2016. My surgery was in 2013. Maybe it's not that much time in between, but it wasn't originally started with the intention of slower pace of life. But I think what I realized more was that patient care focus. And that's why I set out for this.

And that's been one of our, our driving forces is can we [00:35:00] make a difference in our community by providing more comprehensive patient centered care, really getting to know our patients and their families beyond just what the standardized scores tell us. Um, because that's what I feel like was maybe missed from my, in my case.

[00:35:19] Kate Grandbois: I love that so much. I wonder if you could, so we've, we've gone over your, um, acute period. So you experienced your TBI, you recovered in those first four to six weeks. It sounds like there was a slow transition through that first year until you really felt like things were back, back to work, as you said for you, um, how, how, what happened after that?

How has the long term. Um, how has your long term, what's your long term healing process been like? 

[00:35:51] Christi O'Donovan: Um, that's a really great, it's really nice to think about this. I've just accepted it. Right. And it's hard to understand. I think I still have a lot of the [00:36:00] deficits that I say my language formulation is certainly not what I used to be.

And I have these paraphasias still all the time and most people don't know about my brain injury. So here I am, as this educated speech pathologist who owns my own business I'm CEO, you know, who says these words, that just don't make sense. Um, like I'll just in insert or like I'll use the, the person's name, like the wrong name.

I've I've referred to my own children with the wrong name and not like, like recently I referred to my child as my friend's kid. I know my little girl. Um, I can't handwrite anymore. Ever since my surgery and they haven't been able to explain this to me, when I am writing by hand, I insert letters incorrectly. So I might be spelling something as simple as, and maybe not my name, but I might be writing a word school.

And if I'm [00:37:00] thinking of the next word, I'll put a letter where it doesn't belong. So I might be, if I'm thinking ahead, I'll insert letters incorrectly. If I'm thinking school day, I might put a D in the word school somewhere only when I hand write, not when I type 

[00:37:17] Kate Grandbois: I would, that was gonna be my next question.

Is this, does that happen when you type? 

[00:37:20] Christi O'Donovan: No. So I can't provide handwritten notes to my families because I look like I'm spelling errors everywhere. Cause I have to cross out my letters really strange. Wow. 

[00:37:33] Kate Grandbois: That's very, it's a very interesting intersection of executive functioning, motor connection.

Phenology. Probably. I don't know. That's a lot. That's a lot of things. I'm I'm just not talking, cuz I'm gonna describe it shortly. 

[00:37:47] Christi O'Donovan: I know I'm sure there's therapists that'll have a field day over that one.

[00:37:51] Kate Grandbois:  Oh my goodness gracious. So the point, I guess the, the takeaway here is even if, as your neurologist said, ah, [00:38:00] you're fine.

Even if, even when all a lot of indicators are positive, there are still lasting effects that you experience that you have successfully navigated around. Um, but it's important to take that into consideration from, it's important for the professional to take that into consideration. 

[00:38:23] Christi O'Donovan: I think, I mean, there's still a lot, there's, you know, big like decision making still really challenging for me.

Um, emotional regulation, then it's funny, I, people recently have described me as really calm as a really calm presence. And like, I've worked so hard on that because internally emotion, like with that frontal lobe injury that I have, my emotional regulation, it, it requires a lot of work to stay calm and steady.

Um, there's just a lot of things. And then as. As a mom, as a busy mom of two kids and a working professional, as a business owner, there's a lot of these skills that I can't help, but wonder [00:39:00] had I not had this brain injury or had I had some more therapy afterwards? Would I still be, I'd still be struggling through them or would I have to put all this extra effort into kind of running a company that, that requires a lot of S and, um, am I faced with this additional hardship?

Possibly.

[00:39:23] Amy Wonkka: I wonder, I mean, you talk about how you've had to put a lot of work in with your emotional regulation and all of these pieces. And are you just seeking all of that out yourself? You're using your expertise just as somebody in an allied health field to kind of make that determination around what, what would be a better fit for you to help support you on this journey?

[00:39:42] Christi O'Donovan: Yeah, it's been all self-study and I think that that says something because we. As I am able to, I am aware and I'm able to access the resources, but most of our patients don't have a background in this, right. They, they have [00:40:00] completely different skill sets and they wouldn't necessarily have those same tools and resources that I've had to seek out, or they wouldn't even have that awareness necessarily.

[00:40:09] Amy Wonkka: Yeah. I mean, I'm just, I'm just thinking even your ability to identify, okay, I've got a frontal lobe. I've got, I had a frontal lobe injury, which is going to affect my ability to regulate my emotions and respond to this type of stress. These are things I need to be able to do because I'm a mom, I'm a business owner, I'm all of these things.

And I just think about how many people who, who must be in your same position, where somebody determined that they were, they were fine. They were good enough, but they don't know even where to go to start looking for this. They don't, they maybe all they know is like I'm feeling really angry. Well that doesn't help connect you with a solution that's gonna help you like move forward, um, on your healing journey.

So that, yeah, I think that's a, that's a big missed area right there. 

[00:40:53] Kate Grandbois: And that I was gonna, I was gonna say something exactly in that same vein is that it's making me think of [00:41:00] this intersection between the healing journey, but also the limitations of our infrastructure. So as SLPs, as any clinician, what threshold of eligibility do you have to prove to get services covered?

You know, to your point, if, I mean, you're a private practice owner, I'm a private practice owner. We understand the limitations of billing and submitting for funding for the work that we do. Um, and to your point, you know, when you reflected on it and said, what would have happened if you had gotten therapy, just the limitations of our infrastructure to provide therapy for those who might quote don't meet that threshold, even though they've identified areas of need.

um, and what SLP can do to advocate in those, in those instances for our patients to either get funding or create documentation that better supports funding, [00:42:00] um, based on the assessment measures they did by focusing on patient centered care.

[00:42:05] Amy Wonkka: I mean, I think even more, more broadly, and I won't go too hard on my soapbox here, but I, I do think it's sort of a uniquely third payer party centered healthcare problem. Um, so that, so that's another piece too, is just thinking about all of the barriers that our healthcare system puts in place, um, to kind of gate keep services for people based upon their unique insurance plan or what they have access to.

Um, so those are also things to think about much, much bigger, much bigger 

[00:42:41] Kate Grandbois: I'm wondering, um, what you can tell us about what you wish SLP having had this experience personally, what would you say you would want SLPs to know about treating individuals with brain injury across any phase [00:43:00] of their recovery? 

[00:43:03] Christi O'Donovan: I think cAs speech pathologists we do a lot of talking, right? We do a lot of talking to fill the room and make everybody feel comfortable and show that we know our stuff, but I think there's, we have to really listen. And, and read between the lines and really get to know our patients and how things are going. I think as therapists, we need to put more emphasis on the counseling side of our educations.

Um, I think there should definitely be more done, more work done so that we know how to ask the right questions and really understand how our patients are functioning and how they are perceiving their own journey. Um, so I think if I could leave everyone with one me, like one really strong message that would be, uh, that would be it for.

[00:43:59] Kate Grandbois: I, [00:44:00] we, we, I'm just gonna go ahead and speak for both of us. We totally agree. I think that aspects of counseling touch so many aspects of our field, um, and most of us don't get explicit training in counseling. Um, I'm also gonna. Sort of in, in a similar vein thinking about the person-centered care and the counseling aspects, this goes back to something else that we've talked about briefly is the idea of a comprehensive assessment.

So comprehensive assessment techniques can involve a lot of listening. A lot of interviews, a lot of collecting the evidence that is rooted in a person's experience instead of just the scores on a test. That is, again, I know I've said it once already, but that is the evidence that we might need. And you can infuse counseling into those aspects to better support someone in the [00:45:00] longer journey in terms of thinking about, um, how they could be best supported to reach how they define their long term goals.

[00:45:11] Christi O'Donovan: Absolutely. 

[00:45:11] Kate Grandbois: It's very important. Um, we did have the pleasure of interviewing, um, for those who are listening. We did have the pleasure of interviewing Dr. David Luterman on the importance of counseling and communication, sciences, and disorders. Um, and it's free. It's listed on our YouTube channel. I was there for the interview and I've listened to it like five times after that the man changed my life.

you're listening Dr. Luterman, which I'm sure you're not. Thank you so much for sharing all of that with us. Um, but yes, I, I just seconded all of those thoughts about counseling and how important that is, um, in all of this.

[00:45:46] Amy Wonkka: as somebody with the lift experience of having a brain injury, are there any important pieces that you would wish providers or even other communication partners would understand about what that [00:46:00] experience has been like for you? 

[00:46:03] Christi O'Donovan: Yeah, they, I think there's actually a lot. Um, it's funny.

There's so many deficits. There's so many things that are challenging for me now that I'll mention, or I'll try to speak about, and I get such quick responses, all that happens to everybody. So, you know, everyone is forgetful or they feel like they get scattered or they get overwhelmed easily. I get, and it's actually, I wasn't like this before it wasn't to this magnitude before.

It it's challenging when it, it is just dismissed as you know, but look what you've done. Look, what you have accomplished, look at where you are. And like everybody gets overwhelmed or everybody, you know, all of these things, but you know, I could be at, or I could be together. We can all be having dinner. And I'm having a conversation with the two of you, if even for a moment to listen to the conversation of the person who's sitting right next to me, I, [00:47:00] I shut down.

I can't do them both. And what that looks like then to the people I'm speaking to. Or if I'm in a professional setting and I'm taking notes and someone asks me a question, I cannot shift back to them because I did not take in even a word that they had said. And yes, it's hard for all of us, these are things that are, I think, characteristic, but.

This impacts my every single day, it impact impacts my professional image. Um, and so I think it's really important that we all recognize that, um, there are, there's so much happening beneath the surface. There are so many challenges that we are all working through and we can never understand, uh, them all, really, and for what our, our providers to really, again, listen and understand, and, um, kind of dive into and spend some time on, I think would be really beneficial.

[00:47:59] Kate Grandbois: I also think [00:48:00] based on, you know, the story that you're telling, it's really important to remember that your lived experience is different than someone else's lived experience. So you can never truly know what it is like to be in someone else's skin, how they are experiencing sensory information, how they are experiencing life.

And as Amy said earlier today, when you're treating a person you're treating them with, what did you say? All their human parts, all of their personness. So that person is a, a wife or a husband or a daughter or someone who is a student. I mean, with kids, without kids, lover of dogs loves to ice skate. I mean, people are, are multifaceted and multidimensional.

And when you have an injury, like a TBI that affects so many aspects based on the story that you're telling so many, it touches everything you do, as you said. So taking [00:49:00] a look and actively listening and not making assumptions about someone else's experience or dismissing their experience, um, is so important.

And I feel like as a clinician, if you do bring that bias to the table, if you do bring that assumption to the table, you're going to miss really important pieces. Of clinical evidence to help you in your job, you will prevent that person from sharing things with you. You will prevent your client from trusting you to explain that it's really difficult to do certain things because you know, everybody else says, oh, you, oh, it was, oh, it's no big deal. Oh, you're fine.

[00:49:43] Christi O'Donovan: Absolutely. So perfectly said. Yeah. Yeah. It's really, it's really comforting to hear all of this now I'll have to tell you that. Oh, that's the acknowledgement. Maybe I was waiting nine years for that. 

[00:49:57] Kate Grandbois: well, I'm, I'm glad we were able, we were able to do [00:50:00] that for you. That's not really the point, but that's, that's a nice benefit, I guess.

[00:50:04] Christi O'Donovan: Um, But if therapists are passing that message along to their patients, right. That's what it is. Can have that conversation if they could have taken those notes and right. 

[00:50:15] Amy Wonkka:  And it shouldn't have taken nine years for someone to have that conversation with you. Um, and I think, you know, it, it's still, I know I've said this a couple of times, I think it, to me, it comes back to when we're doing our client interviews and having that interview process happen on an ongoing basis and really thinking about the questions that we're asking and the way that we're asking those questions. Um, so that, because I could, you know, I could frame a question about going out to eat and switching attention and how that experience is for you in a way that makes it more likely you're going to share your actual challenges and describe those for me. And through that I'll know more about also how it seems like emotionally, you might be feeling about that. Um, rather than, you know, [00:51:00] having you just check a box and having me look and say, it looks like sometimes, you know, switching between conversations, it's hard.

So I think that's also a takeaway. Clinically for me is to really try and be thoughtful about what questions we're asking and how we're, how we're opening the door to those conversations, um, with our clients. 

[00:51:23] Kate Grandbois: So to recap in terms of our listeners who, and in, in thinking about our third learning objective and how we can better support patients and families who are recovering and healing from a TBI, the importance of not only actively doing some actively listening, actively listening, you get my point purposefully engaging in active listening.

Purposefully infusing per person-centered care and active listening through a comprehensive assessment to really let the patient drives some of the treatment outcomes, [00:52:00] but also advocacy, making sure that there are additional transitional supports in place, making sure that all of those components of the healing process, the physical, the psychological, the emotional, all of those are, um, are addressed and the whole person is being is in the center of, of all of your treatment.

Um, I, I, it did make me just think of a question. What were the helpful components of, of the support that you received? What was really posit, what was the positive impact for you across those different domains? 

[00:52:41] Christi O'Donovan: You know, what was a really interesting one? Exercise. Exercise was one of the things that helped me the most, especially when I was having cognitive fatigue and I had never been a runner before, but I suddenly got into running and I found it really helped.

Um, so a therapist had recommended that to me, or maybe it was a friend of mine had recommended [00:53:00] trying it. And that, that was a really helpful, um, strategy that I had never would've come, never thought of on my own. 

[00:53:08] Kate Grandbois: Interesting. And again, I'm thinking back to, um, a conversation. We had Amy, for those of us who, those of you who aren't watching, Amy's nodding up and down.

She knows what I'm about to say. We did an episode with Jenna Murray Rosenthal that I've already mentioned about, um, recovery and, um, The, the, the connection between fitness and movement and neurological recovery. And there is a lot of neuroscience about the brain plasticity and, and movement and, and neurology.

So that makes a lot of sense. 

Um, well, we so appreciate you joining us today. We're so grateful for your time. Um, is there anything else that you would like to leave us with? Any words of wisdom for all the SLPs out there, listening who wanna learn more about supporting patients and families with brain injury? [00:54:00] 

[00:54:00] Christi O'Donovan: Yeah, this has been such a great experience.

Thank you. I think if the, the biggest thing is looking beyond the surface, right? There's so much of that in our culture right now of things look so perfect. And like that we have it all under control. I shared this with them before I'm in this, like, Fairly professional looking room and right below my camera is my kid's train table, full of a hundred different toys.

Um, there's so much going on. I looked like I had a therapist that pediatric therapist was pretty good at her job, and I did a great job in front of my patients. Um, but then beneath the surface, it was still, I was recovering from a brain injury. And so I was able to, sometimes I think, fool, some of my physicians or some of my, the people who are evaluating me.

And so looking beneath the surface and really understanding that full picture of the patient and all of their ever changing needs, right. Meeting them where they are, but looking for their future too. I would've never, in my wildest dreams thought I'd [00:55:00] be starting a business, but here I am, I run a company of 14 people and I help I change our community and there's, I have a really important, very privileged role in doing so.

But, um, so if, you know, maybe if therapists had looked at me a little differently, who knows? Right. Thank you so much

[00:55:18] Kate Grandbois: So I love that perspective. I absolutely love that perspective. And I have just one more thing to add, and I know we were just gonna wrap up, but I promise it'll be short. The importance of being vulnerable and open with our clients to create an atmosphere of trust.

So when you said you were putting on a brave face and sort of fooling some of your physicians, I think that there is a lot of vulnerability that goes into not only asking for help, but talking about. This isn't going well for me, this is painful. I, I, I'm having a hard time and it's really hard to do that in a therapeutic environment.

If the therapist working with you, isn't [00:56:00] also creating space of safety for you to have those vulnerable moments. So if you are an SLP or other professional listening, and you have an opportunity to support patients and families, experience, recovering from and healing from a TBI. Not only keeping that person centered that person in the center of your clinical decision making, but creating safe spaces to share that vulnerability and, and allow them to let you look beneath the surface, because at the end of the day, that is something that the patient needs to choose to do.

And it's a privilege to, to help someone and support them in that role. Mm-hmm . And that's all I'll say, thank you, so much. Thank you for joining us. This was really wonderful and we so appreciate having you and we hope everyone enjoyed everything today. Thanks so much, Christy. 

[00:56:55] Amy Wonkka: Thank you so much. 

[00:56:56] Christi O'Donovan: Thank you.

[00:56:57] Kate Grandbois: Thank you again, everyone so much for joining us [00:57:00] today, we are so grateful that we had the opportunity to have Christi O’Donovan. Join us. Again, we really encourage all of our listeners to spend the time, listen to the stories of the patients and families that you work with. Continue to refocus your lens on person centered client centered patient centered care.

Make sure you remember that patient centered care and client perspectives and values are part of our evidence based practice triangle. And we have so much to learn from the stories and experiences of the people that we serve. A big, thank you again to Christi O’Donovan for joining us today and sharing her story.

We learned so much from her. We always learned so much from all of our guests. Um, if you have any questions about anything that we covered today, please don't ever hesitate to reach out to us. You can reach us at info@slpnerdcast.com. We love hearing from our listeners and we are so grateful that you've joined us today for this episode.

 [00:58:00] Thank you so much for joining us in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this episode for other credits, depending on the regulations of your governing body. To determine if this episode will count towards professional development in your area of study.

Please check in with your governing bodies or you can go to our website, www.slpnerdcast.com. All of the references and information listed throughout the course of the episode will be listed in the show notes. And as always, if you have any questions, please email us at info@slpnerdcast.com

Thank you so much for joining us and we hope to welcome you back here again soon.

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