8 June 1998
Thirty years ago today, at age 16, I became a health care worker when I began a job as a nursing assistant in a small, physician-owned hospital. This was my first contact with the "real world," and the people I came to know there served as archetypes for my later years. In this account, I have changed names, but everything else is true to my recollection.
The hospital workplace in 1968 would be hardly recognizable to anyone entering health care today. At Cooper Hospital, there was no "human resources department," and employees had no formal "orientation." I honestly don't remember even filling out a job application. I got the job through a friend of a friend of my grandfather. It paid $1.25 an hour, and my regular hours were 11 pm to 7 am. I was told to report to the Emergency Room on my first day of training. The training period was 5 days and was done all by word of mouth; there were no handbooks, procedure manuals, or other documents to study. I found this disconcerting, for up to that time my life, from school to Scouts, had been based on figuring out how to do things by reading books. At first I was overwhelmed by the amount of oral tradition I was asked to absorb in such a short period, but I was eventually able to obtain some relief when I uncovered some dusty copies of the Merck Manual and nursing textbooks left forgotten in the back of a cabinet. In my first week, I was taught how to do electrocardiograms, prep and dress wounds, give bed baths, change bed linens (with patient in situ), clean the ER (all blue tile and gleaming stainless steel), fill out forms, collect money, and recognize a variety of arrhythmias.
The last skill was important, because the "Coronary Care Unit" was attached to the ER and attended by ER nursing personnel. By today's standards, the CCU was a joke at best, and a torture chamber at worst. It consisted of a closet-sized, windowless chamber with barely enough room for a bed and the monitoring/resuscitation equipment, which was piled on a massive, six-foot-tall cart. The monitor featured a round oscilloscope screen that displayed the EKG. There was a speaker that emitted a loud "beep" with each heartbeat, and a wailing whine when the heart rate exceeded or dropped below pre-assigned values. Keep in mind there was no remote monitoring equipment; all this racket was being generated a few feet from the patient's head. We had to turn the volume up loud enough to hear it thirty feet away in a noisy emergency room. How the patients survived this experience is beyond me; they probably all came down with what was later dubbed "CCU psychosis." Of course, there were no intra-arterial pressure lines, pulse oximeters, or regulable IV infusion pumps. We had to make all measurements and adjustments manually, and at night there were only two of us to cover both the CCU and the ER. It could get very hairy.
The "boss" of the ER was Sharon Sanders, RN. Mrs. Sanders was in her mid twenties, about 5'2", with a perfect figure, and teased, frosted-blond hair. She was immaculately groomed. Like all the nurses, she wore a skirted white uniform with opaque white hose, white oxford-style shoes, and starched white cap. By 1968, nurses had given up starched cotton uniforms for polyester blends, and even uniform hemlines reflected the miniskirt rage. By all classical criteria, Mrs. Sanders would have been considered a beautiful woman, but even as a testosterone-soaked teen, I never found her attractive. The femininity was all painted on; what was inside was coldly professional and keenly analytical. She spoke in a near whisper and never raised her voice, never laughed, never cried, never showed passion. She was everything a textbook said a modern professional woman should be. This was my first lesson that textbooks are not always right.
A few year later, rummaging around in the ER, I found a copy of one of Mrs. Sanders' textbooks from nursing school. Inside the back cover, she had scribbled this:
Sharon Daniels Sanders
Sharon D. Sanders
Mrs. Sharon Sanders
Mrs. James A. Sanders
I had the vision of a barely postadolescent Sharon Daniels enduring a boring nursing school lecture, daydreaming in anticipation of marital bliss. Was there really a loving woman behind the cold facade? Did Jim Sanders see a woman invisible to everyone else?
Their marriage ended in divorce within a few years.
Elaine Fields, LPN, worked the day shift with Mrs. Sanders. Mrs. Fields was in her forties, tall, big-boned, and leathery. Her features were so long and chiseled that her face almost looked fluted. I remember that at the time I was reading Arthur C. Clarke's classic novel Childhood's End. With a few subtle prosthetics, I thought, Mrs. Fields could play one of the "Overlord" characters if they ever made a movie out of it. Her husband, who owned a gas station, was ruggedly handsome, much like John Derek in his prime, with a Hollywood tan and a swept-back, thick leonine mane of white hair. They owned a nice house and a boat. Although it seemed to the outside observer that she had a lot to be thankful for, she always looked pained and despondent. With so much self-pity, there was little room for compassion for others, and she ended up being not a very good nurse. If I were ever that miserable, I told myself, I hope I would have the courage to put a gun to my head. Sometime later, Mrs. Fields and her husband were riding in their boat, which hit a wake, and when it came down to hit the water, she suffered a compression fracture of a vertebra. "She is in great pain," someone told me.
I thought, "How can you tell?"
Melpomene Cooper, MD, was the founder of the Cooper Clinic, which eventually became Cooper Hospital. It was a family business, as one of his sons served as administrator, and another was an orthopedic surgeon on staff. When I first heard "Dr Mel's" full name, I observed that it was odd that parents would name their male child after a female Muse from Greek mythology. Like many of my observations I made then (and since), it was met with a blank stare.
Since I worked nights, and Dr. Mel (a general surgeon) almost never took call, I rarely saw him, but he had great influence on me. Although he was not particularly handsome and dressed like a barber, he had tremendous presence. It was like an aura around him. He always had something kind to say to everyone he passed, and, as the song says, he never said a discouraging word. He looked forward, never backward, and he never lost his bearing. Like great leaders such as FDR and Reagan, he took the high ground and saw the big picture, eschewing involvement in squabbles and petty issues. Dr. Mel had the stuff of which greatness is made.
Dr Mel's reputation among patients and hospital employees was nothing short of legendary. It was said that an accident victim could come in with his face looking like hamburger meat, and Dr. Mel would get in there with a needle and several yards of thick, black 4-O silk suture, and sew everything up. When the patient was discharged, he would look awful with the wiry sutures sticking out everywhere. Six weeks later, however, you couldn't tell that the patient had been injured at all. It was also said that Dr. Mel could do operations faster than any of his peers, as little as 15 minutes for an appendectomy. I don't know if any of this was true, but even in a hospital full of cynical nurses, dyspeptic peers, and chronically dissatisfied patients, I never heard anyone say a negative word about Dr. Mel.
Willis Stevens worked banker's hours, so he was another Cooper Hospital personality I rarely saw. Still, what I did see of him was very impressive. A short, powerfully built, balding black man, he said little but could do just about anything. The reason he worked 9 to 5 was that the orthopod, Dr. Bill Cooper, considered him indispensable and wanted him there during office hours. Although he had no formal medical training, Willis could do anything a nurse could do, as well as apply and remove casts. He was so good at the latter that the orthopods rarely even had to enter the cast room to check the patient. Willis took care of everything.
Like Dr. Mel, Willis always smiled and never had a negative comment about anyone or a cynical remark about any situation. It struck me years later that had Willis been fortunate enough to obtain a formal education, he would have ended up like Dr. Mel. Perhaps if he had simply been born 20 years later, things would have been different for Willis. I still think of him often and hope his children and grandchildren have done well in a society less hostile to black achievement.
Hamilton Glenn, MD, was a general surgeon on staff. Tall and gaunt, with a lined, sour face, he was said to be in his mid forties but easily looked twenty years older. Fortunately, he rarely worked in the ER, but the times he did were the ones I dreaded the most.
Back then, nursing personnel were much more deferential and attentive to the doctors' presence. We even stood when a doctor entered the room (nowadays, if you appear at a nurses' station, the nurses pretty much ignore you). Accordingly, the doctors, especially the senior partners, did arouse our apprehension in even the most benign encounters. With Dr. Glenn, however, the worst was brought out in almost anyone who had to deal with him. It seemed to me that all he had to do was enter a room, and there would soon follow a loud "clang," as a stainless steel emesis basin or other bell-like metallic object hit the tile. Willis seemed to be the only employee who was immune to the Glenn Effect, which made Willis even more valuable. The rest of us dropped things, spilled stuff, got instruments mixed up, got bandages tangled, ran out of EKG tracing paper, opened the wrong tray, or just simply malfunctioned in Dr. Glenn's presence. He never got used to it though; when one of the foul-ups occurred, Dr. Glenn would stand in the middle of the room, gesticulate with his gloved hands, and whine in a high-pitched southern drawl, "Can't y'all do anything right?!"
My subsequent medical education notwithstanding, I still have not figured out the pathophysiology behind the Glenn Effect. Maybe there is some "New Age" or "karmic" explanation. Whatever the reason, I sure hope he is no longer in practice, for everyone's sake. The lesson I learned from him is that someone in a position of leadership needs to do everything possible to keep the people working for him relaxed and upbeat. Dr. Mel knew this, but Dr. Glenn never learned.
Inez Prejean, NT, was the first person I worked with on the night shift. Only about five feet tall and small-boned, she was encased in a white uniform and hosiery, but since she was a nursing technician, not a nurse, no cap adorned her dark brown, thick, beehived tresses. At the time I met her, Mrs. Prejean was about 36 years old but already had grandchildren. Having married at 16, she did not have the opportunity to go to nursing school to become the outstanding RN she would have doubtlessly been. Breaking the stereotype of teen brides, she had been married to a fine man for 20 years, and they still seemed very fond of each other. As a minister to the sick, she was a natural. Her bedside skills put all the RNs and LPNs to shame. And it wasn't just her manner and approach either. Despite her small size, she had powerful arms and could lift and position the heaviest of patients. She stopped at nothing to make the patient comfortable, and, although I never caught her reading medical literature, she had a grasp of the technical aspects of nursing at a far more sophisticated level than her nine-month training program would have provided. Even after 30 years, I still have not seen her peer as a bedside nurse. All others pale in comparison.
Night work eventually takes its toll on members of our diurnal species. Although very energetic on the job, Mrs. Prejean usually looked tired and drawn and had black circles under her eyes. After I left, I heard that she had been assigned to the day shift. I hope the change agreed with her.
Although it had been four years since passage of the landmark Civil Rights Act, the south of 1968 was still very much segregated. At Cooper Hospital, there were very few blacks on the payroll, and all (except Willis) had menial jobs. One such individual was Hilliard Jameson, who worked as an orderly up on the main floor at night. On our shift, Hilliard and I were the only male employees in the hospital. Thin, with a serene face, bedroom eyes, and long, tapered fingers, Hilliard was ageless in appearance; he could have been anywhere from 35 to 60. God only knows how many other jobs he had, as he spent most of his shift asleep in a wheelchair at the end of the hall, where he could be seen by any employee, patient, or visitor. No one ever complained of this, because whenever he was needed, Hilliard could be aroused at a moment's notice and would do any chore asked of him. He was uneducated and probably illiterate, and he had no fundamental understanding of nursing, or human physiology for that matter. In one early episode, he was asked to "train" me how to put a urinary catheter in a male patient. When he and I and the patient were buttoned up in the tiny treatment room, Hilliard opened the cath tray, first finding the catheter in a sterile wrapping. He opened the wrapper and unceremoniously dumped the catheter into the sink, then rinsed it off with warm tap water. "First you first have to get the catheter nice and clean," he explained.
After the catheter episode, I summarily dismissed Hilliard as a buffoon, albeit a kind and likeable one. Later someone mentioned to me, rather disparagingly, that Hilliard had a gospel group and had made a recording. I asked Hilliard to sell me one of his records, but he insisted I take one free of charge. I took the vinyl "45" home to play on our 1940s-era record player. What emitted from the tinny speaker was the soaring sound of soulful voices lifted up unto heaven, articulated with the unique timbre that has never been reproduced by a Caucasian larynx. Did Hilliard live in a secret spiritual world that would never intersect the quotidian operations of Cooper Hospital? I had to think so.
Although Cooper Hospital functioned at only a rudimentary level on the night shift (no lab, no x-ray, no surgery team), we did have a physician in-house. Night call was a highly undesirable job for the clinic partners, so the clinic paid extra money to any of them who cared to take call. Because the successful doctors rarely had the need for the extra money, the lion's share of call was taken by the few partners whose practices were not robust. After working with these few for a while, it was clear to me why they were not doing so well in the office. Fortunately, most of the time the ER was not covered by partners at all, but by moonlighting residents and fellows from the Vanderbilt training program, so these young physicians were the ones I had the most contact with. Needless to say, having wished for a medical career since I could remember, I was excited to be able to work with guys (there were no females) who were in the position I was hoping to be in a few years hence.
Some of the ER doctors were good-natured and liked to talk, but most were chronically tired and wanted to get as much sleep as possible. To help them with this, we typically would let non-critical patients stack up in the ER until all the beds were filled, get all the wounds hemostased, prepped, and trays set up, then get the doctor up to tend to the patients assemblyline-fashion. For all the effort we expended in maximizing the doctors' sleep time, it was completely taken for granted, and if the doctor could find something to complain about, he never hesitated to do so. Still, it took a lot to put us nursing personnel into revenge mode against a particular doctor. Nowadays, of course, all you have to do is ask an RN to empty a urinal, and they look daggers at you.
In my four-plus years at Cooper Hospital, I worked with dozens of residents and fellows, but one sticks out in my mind. This was Max Clark, MD, a psychiatry resident. Dr. Clark was apparently a victim of polio and walked with a pronounced neuropathic gait. Although his legs were stunted and weak, his arms were thick and powerful; when he did CPR, he couldn't get up on the table to do chest compressions properly, but because he was so strong, he could reach over from a standing position at the bedside and perform the technique one-handed as effectively as I could by putting my entire 140 pounds onto the chest with both hands while straddling the patient on my knees.
For a psychiatrist Dr. Clark was extremely noncommittal. He rarely spoke to anyone, patient or employee, and he spent his free time in the early evening in the little doctor's office reading books he kept in a briefcase. Once I caught a glimpse of the open briefcase; in there he had literally dozens of pulpy science fiction books. Since I was also a sci-fi fan at the time, I would often try to engage him in a conversation on this topic, but, true to character, he never seemed interested in pursuing such a discussion, or any discussion for that matter.
The really weird thing about Dr. Clark was that he was almost impossible to awaken. Sometimes he would answer appropriately and say that he was getting up, only to fall back asleep. Other times he was simply not arousable. He slept in a room that was a part of the respiratory therapy department, and there were oxygen cylinders on either side of the bed. One night I couldn't get him up, and things were getting very difficult in the ER. I went into his room, picked up a wrench, and banged it mightily against one of the oxygen cylinders. Even that earsplitting ring would not wake him up. Finally, one of the nurses came up with what always did the trick: dripping ice water in his ear. This really irritated him, but it did work at least. Dr. Clark's somnolence was so profound that I have since wondered if the polio didn't bollix up his reticular activating system or something.
The bad thing about having to spend a lot of time waking him up was that his feet stank so badly, which was especially noticeable in the tiny, poorly-ventilated sleeping room. To make matters worse, he never bothered to put on shoes, even when he got up to see the patient. He would slowly shuffle, sockfooted, to the treatment room, the nauseating redolence trailing along behind him. One of the nurses in particular found his odor especially offensive and nicknamed him "Ol' Funky Feet."
I have since wondered how Ol' Funky Feet did in his psychiatry career, but I don't have a good feeling about it. Stinky feet and a reluctance to communicate with fellow humans is a poor combination in a psychiatrist, I think.
Cooper Hospital was in a fairly rough part of town, and some of the employees recapitulated the local demographics quite nicely. Two such examples were the mother-and-daughter team of Jean and Shelia Parker. Jean looked like a man who had been working thirty years on an offshore oil rig and just happened to put on a dress and a brassy-blond wig. Shelia weighed in at about twice the poundage of her dissipated mother and capped off her doughy features with an anticlimactic shock of platinum blond hair teased up to about 50 times its native volume. I once asked Shelia why she didn't spell her name "Sheila," since that was how it was pronounced, but all I got back was one of the familiar blank stares. Neither Jean nor Shelia ever evinced an ounce of compassion, and I never saw either one of them treat a patient with anything more than abject disinterest. They enjoyed going out to "party," which, from what I could tell, consisted of visiting beer joints, drinking, smoking, listening to Elvis music, and (allegedly) flirting with men. Whether it ever got beyond flirting was never related to me, a fact for which I am ever grateful. I don't think I could withstand the images my imagination would conjure.
What I found especially exasperating about Jean and Shelia was their uncanny ability to corrupt the innocent. There was a very nice girl my age who worked in the ER. Barbara was attractive, polite and kind, a solid student, and a reliable worker. However, she had a bizarre attraction for Jean and Shelia's lifestyle and often went out with them. Barbara thought they were "fun," which I found completely unfathomable. Fortunately, Barbara turned out OK, I was to find out later. God only knows what happened to Jean and Shelia. By now they shouldn't have one functioning hepatocyte between them.
First the dead.
There is nothing "dignified" about dying in a hospital. The whole time I was there I saw only one "death with dignity." This was an elderly man who came in gasping with pulmonary edema. At the time, one of the drugs used to treat pulmonary edema was intravenous aminophylline, which came in a glass ampule. Up until that time, whenever I had seen aminophylline given, it was diluted in a piggyback IV bottle (this was before IV bags) and added to the main IV, so that the drug would flow in slowly. However, this doctor, who was a pediatrician, ordered that the aminophylline be drawn up into a syringe undiluted. The doctor took the syringe and injected the drug as a "push" bolus. The patient immediately took one last breath, closed his eyes, and died, just like in the movies. Both his daughters were there to witness his last moment. It was extremely touching to me, even though by that time I was as cynical and hardened as the crustiest of nurses.
All the other death scenes were awful. Don't die in a hospital, if at all possible.
As for the living patients, there was as much variety as you could imagine. It is hard to make observations that would describe them as a group. One thing that I did notice to be almost universal was their reluctance to pay for the services they received (boy, thats really changed a lot, hasn't it?) We were required to attempt to collect a $12 ER registration fee at the front desk. The invariable response to this request was, "I guess if I wuz dyin' you'd want your money 'fore you took care of me, right?"
Our equally invariable reply was, "Nope, but you're not dying, right?" (Back then, you could get away with being a lot more sarcastic with the patients, and -- God forgive me -- I was as bad as anyone in that regard)
The most scary thing that happened to me was when I was wheeling a comatose young man to x-ray. Since x-ray was not normally staffed at night, we had had to call in a tech to do the films, but he had not yet arrived. I was told to get the patient up there anyway, so I went ahead. As soon as I got on the elevator, the patient stopped breathing. I was then sealed in the elevator with the patient, trying to decide what to do. I had no Ambu bag or any other type of resuscitation equipment. The only training I could fall back on was what was taught in Boy Scouts, which was far short of that which one learns in a modern Red Cross Basic Life Support course. The patient still had a pulse, but no observable respiration, so I elected to try mouth-to-mouth. Extending his neck and sealing my lips over his, I blew mightily into his mouth, only to receive a huge bolus of snot into my left ear. I had forgotten to pinch his nose closed! Correcting the oversight, I occluded the nose, blew again, and was gratified to see his chest rise. A few more breaths, and he was breathing spontaneously again. Whew!
Cooper Hospital was bought by a large hospital corporation while I was still there. Eventually, the hospital expanded and put in a proper CCU with multiple beds and remote monitoring. The medical group brought in a few more staff physicians, but the good ones eventually moved on, leaving those who were marginal at best. Ultimately the hospital was closed and converted into some sort of rehab/extended care facility. Physician-owned hospitals are virtually extinct in the US, which is fine with me. When the kids own the playground, there's just a little too much temptation to break the rules.