One of the most talented writers on the web is right here on WordPress. Of course, now she is all ta ta wi wi with her own self hosted site since she has so much traffic, but I knew her when. Whether she is writing about backpacking across Southeast Asia, her deranged psycho-stalker ex-boyfriend, or her crazy co-workers in the psychiatric hospital, Aussa Lorens knows how to spin a good yarn.
I am going to be perfectly honest and tell you when I first met her in my comments, I did not like her. I thought, “Who the hell is this ‘HackerNinjaHookerSpy’ biatch talking about her psycho ex-boyfriend and getting wasted on wine on my comments. Has she gone mad?”
Then I went to her blog and got the whole story. I stayed there a while and read her exceptionally well written adventures in Southeast Asia. And more about her hilarious life in the nut house. Now I just love her and you will too. If you have not met her already, drop by and get the scoop. Her latest post (http://aussalorens.com/2014/08/07/firing-stories/) had me in stitches. You must read the comments also. They are as laughable as the posts.
I promised you posts in a new category called Nurses Notes. Aussa reminded me about that when she spoke of the nurses she works with, which she often does. Since I was one of the good nurses, and not one of the weirdoes just working for a pay check, I didn’t relate, at first, and I resented her remarks. Then I thought about my own co-workers. The ones I escaped from when I retired.
With her last post I also asked myself about my personal motivations as a nurse. I wanted to help people avoid pain and suffering. Nursing school was tough. I thought if I just saved one person, it would all be worth it. But God’s honest truth…if I wanted to work for free I would have become a nun.
There was; however, one time I recall taking an assignment for no other reason than the pay offered, and that is what I will tell you about today.
I had a job once where it was ALL about the numbers and the dollar signs. Not for me, but for my employer. It was about ten years before my retirement, when I was working for a Hospice organization. It was a for-profit organization and my bosses, Mario and Leanna, were brutal. (They’re married now BTW.)
I did the job for a year. It was the most challenging and most rewarding year of my thirty year career.
I worked in Marketing and Admissions…selling dignified death. It is the only marketing position I’ve ever held and there is a whole different climate on that side of the fence. I was a Palliative Care Liaison (PCL).
There were five of us PCLs, all registered nurses. We were expected to knock down four admissions in an eight hour day. Basic math tells you this is a full day, but there should be travel time and meal time and an occasional break. Also, being the compassionate person that I am, I would often feel the need to spend more than two hours with a family. After all, this was their loved one dying. Sometimes (doctors be damned) we were the first ones telling the patient that they were terminal. That’s not news to deliver lightly. Most days turned into at least ten or twelve hours.
We went to homes, nursing homes, and hospitals explaining services, ordering oxygen and durable medical equipment, arranging transportation, getting tons of paperwork signed for a payee source, usually Medicaid with its myriad of complex forms, conferring with physicians and team members. Sometimes we schmoozed doctors over dinner and cocktails (company paid) and sometimes we delivered donuts to nursing home staff when admissions were slow.
Hospice, common in Europe for eons, was a relatively new concept back then in the U.S., so the marketing aspect was crucial. It was all about appearances and we were expected to dress professionally in suits and heels, despite the heat and the loamy terrain we often had to trudge through. We had rolling offices we lugged around in the trunks of our cars.
This particular day, I had slept only about four hours, having been up till 2am the previous night faxing paperwork to insurance companies, Medicaid, and HMOs. I arose with sun, showered and suited up.
By 7am there was already a fax from the referral office. My first appointment was in Yeehaw Junction, fifty-five miles south…in the center of swampy cow country. The only establishment in Yeehaw Junction is a restaurant with what was formerly a bordello upstairs that serves as a hotel. The historic Desert Inn dates back to the 1800s as the first working hotel in Florida.
Roadkill hash and vulture eggs were the only thing on the breakfast menu so I had a few cups of coffee while waiting on my 8:30 am appointment time. The family and patient I was visiting with were already prepared for Hospice services so all I really had to do was get the paperwork done, make a few phone calls and be on my way.
As I hit the turnpike and headed north my pager went off and the text message from Mario said I needed to be at Orlando Regional Medical Center (ORMC) by noon. Passing through Kissimmee at 11:30 am I felt I needed to swing through the drive-thru at McDonalds and grab some lunch to eat on the way. It was sweltering hot in that suit and I was thirsty so I swigged down about two thirds of the super-sized diet coke in a hurry.
On to the ramp at Osceola Parkway; the next exit would take me straight down OBT to Orange Avenue and ORMC. I was making good time. Not going to happen. Ten miles south of the exit, I topped the bridge to see traffic backed up for miles. No exit between me and OBT and no turning back. This was going to be a long one. I waited.
An hour later, I was still waiting. Knowing we were supposed to stay calm, cool, collected and maintain a professional composure, I texted Mario to call the family and explained what was happening. I could see the helicopters transporting accident victims up ahead.
Calm, cool and collected was a challenge to maintain when you have had to give your lunch over to an old man tapping on your window and pee in a McDonald’s cup in broad daylight. (Not an easy task for a woman guys.) Bless his heart, he had given himself insulin and was on his way to meet his son for lunch. Without food he could have gone into seizures, or worse. Four cups of coffee had to go somewhere.
Mario texted me again, “Where the hell are you?” I explained everything. “That’s TMI over lunch.”
“You asked,” was all I could reply.
By 2:00 pm I was at the hospital and the lady and her daughter were most cordial. They were glad I was there as the plan was to have Mama go home to the daughter’s house and all of the necessary paperwork was signed and arrangements were made.
4:00 pm and I was texted to be at Florida Hospital (FH). I am not happy because, while I have only had two appointments, I have been on the go since 6am on 4 hours sleep. My day should have been over an hour ago or more, and I still haven’t had breakfast or lunch. I grabbed a tuna wrap and a tall iced tea to go at the restaurant café.
I beat rush hour traffic and made it to the FH parking garage in thirty minutes. Just enough time for that supersized soda and that large iced tea to mingle and I was on the tenth floor. The nearest breezeway, and bathroom, was across the garage and down seven floors. All I can say is thank goodness for heels. This is NOT a small building.
With aching feet and a throbbing shoulder from hauling my office across two counties, a ten story parking garage, and up ten more stories in the neighboring building, I made it to the ICU.
My patient, while relatively young, had a horrible clinical picture. I reviewed the chart, made some notes and met privately with the family. The fairly young woman had two children present, a young man and woman in their twenties. They were divided over what to do. Mother was unconscious and had been since brain surgery fourteen days ago. Mother had two terminal diagnoses, brain cancer and inoperable liver cancer. She also had a colostomy, a foley catheter, total parenteral nutrition (TPN) where she was fed intravenously through a central venous line, and was on a respirator.
There were two more children in college, so it was necessary to make a conference call, a difficult thing to accomplish through AT & T at that time. Using my little flip chart, I explained the services a second time. I was hoping for a tie breaker, but again, they were divided.
About that time, the doctor shows up. We ended up in a sparring match with us both citing statistics and lab values. The hospital staff, nurses, respiratory therapists, social workers and two of the children favored terminating most of the life saving measures and sending her home. Two children and the doctor (who had known the woman for years through their church) were at odds. The doctor was adamant, “If you take a woman right out of brain surgery and throw her in a wheel barrow and cart her across town she IS going to die!”
I couldn’t argue with that. I must have repeated a thousand times, “You all think about it and give us a call when you decide.” Each time, I was met with another barrage of questions which the doctor disputed, but the staff supported. It was horrible for the family. I insisted they had been well informed and did not have to decide at that moment (another thousand times). After 7:30 pm, I walked away.
Lifting my rolling office into the trunk I split my pants. About that time I received another page telling me to be at M.D. Anderson Cancer Clinic by 8:00 pm to do a formal presentation for a staff meeting. I explained my dilemma. I was NOT excused because three other PCLS were still on appointments and one had gone home sick. I had ONLY done three appointments.
The Salvation Army was on the way and they were still open when I got there. I grabbed the first pair of black pants that fit. I was wasted by the time I finished that presentation a half hour later and it was pouring rain when I left the parking garage. I drove home and called in reports to the various Team Leaders simultaneously. Getting out of the car in my own garage an hour later my Salvation Army pants zipper busted…but I was finally home.
10:00 pm and I am thinking my long day is over. I slipped into my PJs and made myself a frozen pizza. The fax machine had already spit out tomorrow’s four appointments. I tore them off and started going through my paperwork faxing signed forms to their respective agencies.
By 11:00 pm I was done with that and crawled between the sheets. My pager went off with a notice to call Mario at home. What?
There was a patient on the south side of Orlando at Dr. Phillip’s Hospital that we needed to hook up a CAD pump (Continuous Analgesia Delivery system) for so he could get out of there before midnight. It required and RN. There was no team nurse or PCL available. All of the Team Leaders had gone to Miami for a conference and I was their last hope. It was imperative that this patient be out of the hospital by midnight and the ambulance for transport was already waiting. The hospital staff was not allowed to touch our equipment and the agency pharmacy had already dropped off the narcotics.
It would be a ten minute deal. The patient was already admitted to the program and was just awaiting transport. Normally we were paid $75.00 per visit, Mario offered $150.00. I knew this was a make or break moment, but I was exhausted. “How much is it going to cost our company if we wait until tomorrow?”
“More than $3000.00.”
“I’ll do it for $1500.00”
So this was the one time that I can recall actually taking a nursing assignment for no other reason than the money offered. By 2:00 am, I was back in my bed preparing to do it all again the next day.