Assigning Blame

ER Nurses, Doctors and Techs. Can you tell the difference?

A classic example of how "shit rolls downhill"...

DALLAS (AP) - A Dallas emergency room sent a man with Ebola home last week, even though he told a nurse that he had been in disease-ravaged West Africa, and officials at the hospital are considering if they would have acted differently had the entire medical staff been aware.

The patient explained to a nurse last Thursday that he was visiting the U.S. from Africa, but that information was not widely shared, said Dr. Mark Lester, who works for the hospital's parent company.  "Regretfully, that information was not fully communicated" throughout the medical team, Lester said. Instead, the man was diagnosed with a low-risk infection and sent home.

When in doubt, when trying to cover your ass...blame the nurse.

I 'get' that hospital spokespersons are under a great deal of pressure to explain how Ebola was not suspected in the first ER visit. I  'get' that the community has a right to know where the lapse occurred. However, I doubt seriously that in 24 hours, there was time for an in depth review of this case before making the nurse a scapegoat.

For those of you who are not familiar with working in an ER... It is comprised of a multidisciplinary team of nurses, doctors, techs, clerks and therapists who work together in order to accomplish their goal. They literally risk their lives caring for the physically, mentally and emotionally ill, 12 hours a day,every day they work.  Exposure to physical violence and a host of communicable diseases such as Tuberculosis, Hepatitis, HIV (and now, Ebola) keeps everyone on their toes in this dynamic and many times chaotic environment.

True Story...
In the first hour of a 12 hour night shift,  I recall approaching the triage desk when my arm was grabbed by a strange man who came from behind me. He threw me up against the wall as he demanded to know where his "kid was at". Security soon intervened but despite the fact that I had been assaulted, I continued my task and called my next patient. After completing my nursing assessment and documenting the details, I stepped outside of the room where I assisted in apprehending a naked woman running down the hallway. Walking away from that scene and attempting to shake off the bad ju-ju of the night, I was confronted by Dallas Fire Rescue Paramedics who presented me with a huge man, actively spewing bright red blood...it was going to be a long night.

Can you spot where a communication failure could happen here? And this was my experience only. It does not detail the experience of the doctor, techs or therapists in that same hour.Failures in communication happen. It's the nature of the ER beast.

Assigning blame to any one member of the ER team is a slippery-slope. It creates an 'us' against 'them' mentality and has the potential to fracture a department.

Instead of finger-pointing, perhaps a response that included an explanation of the complexities involved in this volatile case and support of the Presby Dallas ER Team would have been most appropriate as I am confident that the intent was to deliver the best care possible.

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Update: ...After further investigation, Presbyterian Dallas hospital cites the failure in communication to be the Electronic Health Record ...not the nurse (ahem).  WFAA.com: Texas Health Presbyterian Officials Explain Patient Release
WFAA:Janet St. James8:12 a.m. CDT October 4, 2014

And Yet Another Update: ... and now, the administration admits that the ER Doc "did have access to his travel history after all" . Presby Dallas Hospital Administration...You're killing me.

Hospital: Ebola Patient in Critical Condition
AP: Jamie StengleOct 4th 2014 8:11PM     

(In part)

"The hospital's explanation about what they knew about his travel history has changed in the time since his diagnosis was revealed on Tuesday. Federal health officials have advised hospitals to take a travel history for patients with any Ebola-like symptoms.

When Duncan's diagnosis was first disclosed, the hospital said it wasn't till he came back Sunday that they discovered he had been in West Africa. The hospital later acknowledged that Duncan had told a nurse his travel history on his first visit but said the information hadn't been fully communicated to the whole team.

On Thursday, the hospital elaborated by saying that a flaw in the electronic health records systems led to separate physician and nursing workflows and that the doctor hadn't had access to Duncan's travel history.

But the hospital issued a statement late Friday saying that the doctor who initially treated Duncan did have access to his travel history after all.

Hospital spokesman Wendell Watson said Saturday he could provide no further details, saying, "We're still looking into the entire chain of events."

Hot Yoga?

Yoga. A gentle way to stay flexible and toned.

Who knew that finding an air conditioned Yoga class in Texas was close to impossible?

The trend today is for Yoga devotees to suffer in room temperatures reaching 100 degrees Fahrenheit (38 C) while assuming their poses. Word on the street has it that the increased room temperature assists one in being able to stretch more effectively.

I'm calling B.S. 

Granted, as one who experiences hot flashes on a good day, I should have known that Hot Yoga was not for me but I soldiered on thinking, "I'm hot anyway, it's doubtful I'll notice the difference."

I was wrong.

One hour in a dark, hot, humid room - thermostat set at 98 degrees - gave me first-person insight into Hot Yoga ...It gives one the feeling that they have just worked out - hard. After assuming a few poses, you are soaking wet in sweat, your face is flushed and your body temperature is jacked up. Whew! What a workout! But - in reality...when the sweat settles...you realize that it was just a smokescreen.

I am aware that there are Hot Yoga devotees out there who swear by the health benefits of this practice (and I feel certain I will hear from them) but in the interim... does anybody know where I can find an old fashioned Yoga class offered in an air conditioned environment?

Namaste.

The Chinese Lantern Festival

Admittedly, I am a little nuts about seeing lit up Chinese lanterns. 

Every year, at about this time, I literally ache to attend The Chinese New Year Parade in San Francisco - but even I have to admit that my rationale for traveling over 1.700 miles to attend a parade - is a little weak.

OK, call me obsessed interested by all things Asian.  

When I heard The Chinese Lantern Festival was in town, I was all over it.

At Dallas' Fair Park, it continues until February 17th.

The Main Entrance

The Imperial Dragon Boat

The Porcelain Pagoda

Over 52 feet high

Built entirely from porcelain plates, cups, saucers, spoons and bowls

The 'Wish' Tree

Write your wish and attach to the tree...the wind will carry it to the Gods

Except for the fact that the event food was scarce and of poor quality, The Chinese Lantern Festival was all I had hoped for and (at least, temporarily) soothed the San Francisco Chinese New Year Parade ache within my soul.

For this year, anyway.

The Unfortunate Incident - Part One

The subject matter of this post is unpleasant but I feel strongly that this episode in my life be shared.

 ____________________________________________________________

It was a sunny spring afternoon in Dallas, 1986 when the care-free, happy-go-lucky, "here-for-a-good-time, not-a-long-time", twenty-six-year-old, party-girl grew up.

I was at work when another nurse told me that I had a phone call... "It's the Dallas Police" she whispered with urgency as she covered the receiver with her hand.

I guess there was no way of candy-coating what he was about to say. The officer on the line identified himself and said "Are you Diane Smith's (not her real name) roommate?" I told him that I was. "Well Ma'am, I'm sorry to say, Diane's been raped and is at Parkland's ER" he said. When I asked if she was alright, he just said,  "she asked that I call you". I knew her ability to speak was a good sign.

Parkland Memorial Hospital was the only Trauma Center in Dallas County at the time and although they had not yet installed metal detectors, from the looks of things...they could have used a few. A consistently overcrowded county hospital, it was known for treating the hoards of indigent and President John F. Kennedy. When I finally found Diane, she was curled up on a stretcher in the hallway. Alive, alone and crumpled into a heaping mess of tears, blood and dirt.

Adult Lesson #1

Always listen to your inner voice.

Diane had been riding her bike around White Rock Lake. She told me that on her first loop of the lake, she saw a guy that "didn't look like he belonged there". "Everyone else was walking, running, skating, whatever, but they were doing something. He was just standing there". "I should have known". It was on her second loop of the lake that the same guy hid in a thicket of bushes, kicked her bike over and dragged her into a wooded area where he proceeded to rape and beat her.

With a hunting knife held to her throat, Diane's assailant threatened he would kill her if she made a sound. She said that she was stunned, shocked and could barely breathe with his weight on her. During the rape, she told me that her mind "went to another place. It was like I wasn't really there. I remember thinking of how my body would be found, what the newspaper headlines would say, how mom and dad would take it, when would you find out what happened to me" she said. "I guess I must have been moaning or something because he punched me hard in the face. That's when I 'woke up' and knew that I had to think of a way to get away." Eventually, Diane was able to talk her rapist into allowing her to sit up "just to get my breath" she said. It was then that she took the opportunity to "run like hell".

Bleeding, dirty and naked from the waist down, she ran out into an open area of the park. Screaming for help. She said, "Everybody ignored me. I guess you couldn't really blame them, because I looked crazy, but...a lady with a baby in a stroller literally turned in the opposite direction when I begged her to help me" she said.

Adult Lesson #2

"Be not forgetful to entertain strangers for by doing so, some have unwittingly entertained Angels." HEBREWS 13:2

"It was a Wino" who finally came to her rescue. He retrieved newspapers from a trash basket for Diane to cover herself with, then brought her to his "Winette" who stayed with her as he went to get help.
 

Walkin' Our Baby Back Home

I was reminded the other day of a time when I was young, poor and in need of a sofa.

Unlike our many of the current generation - I was, (and remain to be) totally OK with hand-me-downs, thrift-shop purchases and used merchandise.

I recall it being a typical hot and sunny Saturday morning in Dallas when my roommate, Susan and I decided that our living room needed more than one Papasan chair and a TV set.

Since the Papasan chair belonged to Susan, I took it upon myself to spear-head the search for additional seating in our duplex apartment.

Susan and I were 'cut from the same cloth' so-to-speak and could care less about style - we were looking for cheap.

Retail was ruled out - a garage-sale was the way to go. Within a couple of hours and about a mile away, our well-used but workable sofa found us - for the low, low price of twenty-five dollars! That's what I'm talking about! Ka Ching! Sold!

Not the sofa we chose - but a close enough representation

Not a 'looker' and a definitely a little worn but it was nothing that a good vacuuming, insecticide and a colorful throw couldn't fix.

But, ... "How do we get it home?" My 1976 Ford Pinto & her Mazda GLC weren't up to the task so, necessity being the mother of invention, our the only realistic option was 'walk it' home.

Bracing ourselves for catching awkward glances and a catcall (or two) from passing motorists, we stood tall, shoulders back, heads held high and picked up each end of the sofa beginning our trek home through the streets of Big D.

Occasionally stopping to take a break, we would gingerly place our new purchase down on the sidewalk and take a seat. All the while, watching the world go by while taking the taunts of rubber-neckers in stride.

A small price to pay.

Texas Bluebonnets

We are spoiled rotten.

By these people...

As guests of our dear friends (B&K) we got to hang out at a real Texas Ranch, smack dab in the middle of Texas Hill Country during the Bluebonnet season.

Imagine campfires with the best friends ever, great wine, food and company.

I told you we were spoiled.

Bluebonnets are the State flower of Texas and legacy of Lady Bird Johnson who requested that the Texas State government scatter the seeds of bluebonnets and other wildflowers along Texas highways and fields back in the day.

Speaking of,  "back in the day" ... I was in my early twenties and in dire need of a bouquet of bluebonnets for my kitchen table. It was dusk when I decided to head out to White Rock Lake in Dallas. Armed with a pair of scissors and under the cloak of darkness, I drove the park for a while, carefully ensuring there would not be any witnesses to my crime. Pulling up to a thick grove of beautiful bluebonnets, I snipped rapidly and with surgical precision. Not daring to look back, I sped away from the scene in my '76 Pinto.

It turns out that the drama was for not.

It is not illegal to pick bluebonnets in Texas after all.

Acting

So, I head out to the somewhat artsy/bohemian/seedy/scuzzy section of downtown Dallas on Saturday morning to attend an all-day actor’s workshop.

Some people fish, some people bowl and some people just like taking classes. I like taking classes. Within the past few years, I have attended classes in party planning, computer software, acrylic painting, ‘taking’ tea, digital photography and whatever else was out there that interested me..

Feeling oh-so-out-of-place, I walked into the classroom like I belonged there and took my seat in class. The workshop consisted of mostly professional actors, a smattering of actor wannabees and a few clueless people (like me) scattered here and there. It was a relief to find out that I wasn’t the only newbie in the group and soon linked up with an outgoing forty-something woman who responded to my question “So, are you pursuing a career in acting?” with, “my husband is a workaholic, my boys are grown and my daughter died – I don’t know what I’m going to do with my life.” Whoa. Despite her response, I couldn’t help but see a spark of energy that reminded me of Gilda Radner. I hope she continues getting out there and trying new things.

Assigned to read lines with a partner, I was paired with Marjorie, a 79 year-old, white haired “Steel Magnolia” kind of actress with a very pronounced southern accent. Marjorie started her career in acting almost forty years ago by impersonating Minnie Pearl. She still does the nursing home circuit as Minnie and said, “I will be receiving Meals on Wheels in The Deep End – Thursday night on ABC. “ I’ll be watching for her.

Seated beside me in class was a young man named Dan, a recent college graduate with a degree in Fine Arts and represented by “The Campbell Agency.” Dan had to leave class promptly at six because of work. “Where do you work?” I asked, expecting him to tell me about the play that he was in… “I sold out for retail” he replied. I’m thinking Dan’s Mom and Dad really wished he had chosen another career path. But who knows? He is following his dream.

It was a good day. I had fun, learned some new jargon and met some very nice people. Who knows? Maybe they will be stars one day…

Terminology I was Unfamiliar With...

“Flat Read” – intentionally reading the script without emotion
“Cold Read” – reading your lines without seeing them before
“Flip Read” - reading lines with someone else during an audition. You ‘flip’ the paper to signal to the other actor that it’s their turn to read.

“A one-button” camera shot - top of your head to collar
“A two-button” camera shot - top of your head to mid chest
“A cowboy” camera shot – top of the head to mid thigh (named, to ensure the cowboy’s holsters are shown on film)

Gang Night

I was working the 7pm to 7am shift at Baylor’s ER and it was rumored to be “Gang Night” in Dallas. Why Dallas gangs felt the need to show their mettle on a hot & humid night in August was beyond me but….

Was “gang night” for real? We weren’t sure, but the idea of one particular night where opposing gangs from all over Dallas demonstrated their fearlessness and courage by cutting up and shooting one another caught my attention.

So, amidst the usual chaos and cacophony of the ER on a typical Saturday night, we were all on the ‘alert’ for mass casualties to hit the door at any minute.

Around two in the morning, I saw two, tall healthy-looking African American men dressed in hooded, bulky winter jackets enter the ER through our ambulance entrance. Based on their unseasonable dress, I just knew they had to be armed. They looked like they meant business.

Not one for confrontation, I surprised myself when out of nowhere ‘I got up all in their bidness’... “What do you want?” I sternly asked the biggest guy. “My son’s been shot.” He responded. I looked at the other guy who did not appear to be in any distress when he promptly unzipped his jacket and I saw the baby.

The child was about 9 months old. Snatching him, I ran next door into Trauma one. He was barely alive, with a single bullet wound that had entered his right chest and exited out his back.

The ‘story’ was that these two guys were babysitting when they decided to go out for a drive.

The baby was in the back seat of the car when “some mother-f!#*er started shootin’ at us.”

The baby survived. Hopefully his first GSW would be his last but - I kind of doubt it.

Parkland 5: Pedi ER (Part One)

Many moons ago, Children’s Medical Center in Dallas did not have an ER. They did have a clinic that was open during business hours, however. That meant that Parkland’s ER would always take Pediatric Trauma and it would manage all other Pediatric Emergencies daily from 4pm until 8am and 24 hours/day on weekends.


For a nurse with one year of ER experience, Pedi ER was scary but remains as one of the best clinical experiences I have ever had.

Opening daily at 3pm with two RN’s, a Patient Care Assistant (PCA) and a Pediatric Resident, we would prepare for the onslaught of sick children and anxious parents.

The gauntlet of waiting parents and kids sitting on the floor of the long hallway leading up to Peds was daunting. We didn’t have a lot of treatment rooms, so kids with asthma would be corralled into one room, sat side-by-side on two stretchers and hooked up to nebulizer treatments in hopes of an improvement in their condition.

Depending upon the chief complaint, children were seen as quickly as possible. We became expert in a 30 second pediatric assessment - check vital signs, listen to lungs and determine if the kid looked ‘good’ or ‘bad’. That was about it. Documentation was minimal. Starting IV’s and drawing blood even from the tiniest infant was common practice. Infusion pumps were rare back then, so we resorted to the use of controlled fluid administration via a device called a Buretrol that would allow only a specific amount of fluid to be administered – they ‘went dry’ a lot. Pulse Oximetry had not been invented yet (eeek) and our resident would obtain urine specimens by manually withdrawing urine from baby’s bladders via a needle and syringe.

Any Pediatric Trauma patient would be triaged to the Surgery Pit, not Pedi ER. Thank God.

Children that looked ‘bad’ (or worse) would be placed in one of two resuscitation rooms. One RN, a PCA and the doc would work the situation. The other RN would have to manage the rest of the Pedi ER. We would frequently have kids that “looked bad.”
Enough said.

Pedi ER was (at best) nightmarish from about 6pm until 2 am. Compounding an already stressed department with not only the numbers of sick children but also with the persistent crying, overcrowding and rising anxiety level of exhausted parents.


I loved it.

Parkland 6: Pedi ER - Part 2

Parkland 4: Psych

In the 80’s, Parkland’s “Psych Pit” included patients who were mentally ill, suffering from alcohol and/or drug dependency, the homeless, the hungry, and those involved in messy divorces.

Yes. Messy divorces. It was trendy back then that in order to “stick the knife in and twist it” you could have your estranged spouse served with a Mental Illness (MI) Warrant.

The procedure was a simple one…

1. Complete the appropriate paperwork and attest that your spouse is a danger to themselves or others.
2. Have the document signed, before a notary and sealed.
3. Courier the affidavit to the Dallas County judge who would review your claims and then endorse the “MI Warrant” with his/her signature.

Dallas County Sheriff’s Deputies would then be dispatched to your estranged spouse’s home or place of business, handcuff them and take them to Parkland’s Psych Pit. At that time, Texas Law gave the state the right to hold the above-mentioned spouse for 72 hours in order to determine their competency.

Needless to say, we had some very pissed off estranged spouses.

Staffed with one Registered Nurse and one Psychiatric Intake worker – I had been warned by my peers that Psych was "each man for himself". The Psych Intake worker usually hid out in a small booth in the back of the Psych office - the ER Nurse managed the "Psych Pit" and was responsible for ...

• Meeting and Greeting patients, police, sheriff’s, paramedics.
• Crowd control
• Searching pockets, removal of belts, boots, matches, guns, knives and/or anything that could be used for inflicting injury or used as a weapon.
• Initial Psychiatric Nursing Assessment and Documentation
• Medication Administration
• Self Preservation

During my orientation, the topic of “self-preservation” was addressed by the more seasoned ER nurses at lunch…

1. Buy a pack of cigarettes before starting your shift – it will make it easier on you (it was the eighties and smoking was allowed in hospitals).
2. Make friends with your psych patients. They’ll help you out if somebody goes ‘nuts’ on you.

Oh God.

I soon learned that the cigarettes were not for me, but to be used as a way to entice the psychiatric patient into being my friend.

Manipulative? Yes.
What can I say? We did the best we could. We survived.

Parkland: Pedi ER - Part 1

Parkland 1: The Introduction

"WHEN YOU THINK YOU'VE SEEN IT ALL, WE CAN MAKE YOU THINK AGAIN..."

This was the ad campaign for Parkland Memorial Hospital, Dallas Texas circa 1984-1985. The slogan was on T-shirts and ball caps and included the following text “…we think you can do more, learn more in one shift at Parkland, than you can in a month at a lot of other hospitals. The experience is that intense, that demanding. Nursing at Parkland isn’t for everybody. It’s hard work and there are no guarantees. The Parkland nurse knows that. Instinctively. It’s nursing that tests every skill you have. And some you haven’t.”

I was hooked.

With a year of ER Nursing experience embedded in my stethoscope and despite the fact that I was advised to have my head examined, I was willing to ‘suck it up’ and be a Parkland ER nurse. OO-RAH!

My formal orientation to Parkland’s ER included six weeks of combined didactic and hands-on instruction. My ‘preceptor’ a seasoned ER nurse named Cathy C. was tougher than nails. Once, I thought saw her smile, but soon learned it was just a little gas bubble. Ahem. We were joined at the hip for three long months.

In 1984, Parkland’s ER was divided into five separate ‘pits’ or specialties, all under one roof. Each 'Pit' had a doctor in charge - he or she was referred to as "The Pit Boss" and was a senior resident of that specialty.
Upon reporting for duty, I would be assigned to any of the following specialties on any given shift. Each specialty was unique and had their own set of challenges, but that was why I signed up to be a Parkland nurse in the first place.

Triage: 1 RN + 3 clerks Determine level of acuity of every person and ambulance that hit the door, based on chief complaint, vital signs, gut instinct and/or simply vision. The triage process was simple back then: Chief complaint, name, birthdate (which was optional) and level of acuity – emergent, urgent, non-urgent.

Surgery: 3-4 RN's + 2 clerks + 1 Patient Care Assistant (PCA)
All surgical (or potentially surgical) cases including trauma and burns – considered ‘clean’

Pediatrics: 2 RN's + 1 PCA
All children excluding pediatric trauma (they were triaged to surgery)

OB-Gyn: 2 RN's +1 clerk
All women of child-bearing age with complaint of low abdominal pain, gynecologic issues, pregnant women, and female sexual assaults.

Psychiatry: 1 RN + 1 MHMR (psychiatric intake) worker
Enough said.

Medicine: 3-4 RN's + 1 PCA + 1 clerk
Anything that didn’t fit into any of the other specialties – considered ‘dirty’

And so begins my Parkland Experience…and the nurse with the "gas bubble"? I could only aspire to be as good an ER Nurse as she was.

Parkland 2: The Times

Dr. Louis Portera

Within a year, I've lost my Dad, my brother and now a friend and mentor, Dr Louis Portera - so pardon me if I 'yammer' on. What's it all about anyway? The question has been pondered and posed by philosophers, theologians and the like for centuries. So I'm not so certain that we will know the answer. In the interim, there is no law that says we can't 'make up' our own answers as we go along... Take Edward "Bruce" Merritt's obituary... It seems as though the writer (and quite possibly Bruce himself ) had a real grasp on things. Reading it not only made me laugh, but it also gave me an appreciation for who Bruce was and how much he meant to his sisters, the nation, his wives, children, grandchildren and friends. Yesterday, I learned that Dr Louis Portera (Lou) a man who positively impacted my life as a nurse and human being, died. I reflected on how much he meant to his family, the nurses, doctors, techs, firemen, paramedics, police officers, office staff and most importantly, the E.R. patients. But he was so much more than just an E.R. Doc. Initially, Lou was somewhat distant to new ER employees but he always remained professional. It was his very own "probationary period". No one 'failed' probation, it just gave him a 'feel' for your level of skill, decision making and temperament. When Lou's 'probation' had ended, you knew it - as you were invited into his world and that of his family. It was an honour. His wife, Becky was the light of his life. An avid reader and decorator, Becky was featured in a local decorating magazine - you would have thought she had won the Nobel Prize. When his eldest daughter, Lauren was accepted into The Rhode Island School of Design and married...he was so proud. There was a time when Lou didn't have a lot of good things to say about lawyers, but when Joseph, his son became one, he beamed. He got a kick out of telling the story of a teenaged Cameron, his youngest daughter refusing to be seen riding in his new Mazda Miata . The times I saw Lou become a little teary-eyed was when he learned of his brother's promotion at a university and when he spoke of his grandchildren. As an ER Doc, he was the best. I can confidently say that I never saw him sweat. Always professional, grounded and consistent. I loved that about Lou. Never heard a curse from him, no tantrums or grandstanding.

In the few short days before his passing - the ER Family communicated largely by a social network site and we were able to remember some good times with Lou...

• Our system to assign ER docs was simple. We had two ER Doctors. If the Medical Record number ended in an even number - the patient would be assigned to the "Even" doc. If the MR number ended in an odd number, then Lou would get the patient as he was always the"Odd"doc. It fit and he liked it.
• According to Lou... "An Admission = number of allergies + number of complaints x number of miles one lives from the hospital. Anything over 500 = Admit" - Caveat; "Add 200 points to the final total for a positive suitcase sign"
• According to Lou..."Squirrelly-ness is directly proportional to the number of rings one wears on ones hands"
• According to Lou..."Rule Out MI (myocardial infarction) on any IDDM (insulin-dependant diabetic) with vague 'don't feel so good' complaint"
• Lou loved to play. One of our E.R. docs (Colletta) was a little obsessive-compulsive and required order. When Colletta was away from his desk, Lou would tangle up the phone cords and mess up the papers on his desk just to watch him put everything back.
• Upon entering a patient's room, Lou would clasp his hands together, peer over his bifocals and say, "So, tell me your troubles today."
• Most entries were of how much Lou meant to everyone, how he honoured us all with his sincere interest and observations but also with his gentle criticisms.

Although Lou may not have been as 'salty' as Edward "Bruce" Merritt - he was a character in his own right and we all loved him for his knowledge, integrity and skill. A great role model to us all both personally and professionally and for that I consider myself lucky to have known him. So, is that what it's all about? Louis Portera MD

The Red-Headed Strangers

When a friend found four abandoned flea-ridden, hungry and thirsty kittens 'mewing' in the dumpster of her apartment complex, she called and asked if I would consider adopting a couple of them.

At the time, I shared an old duplex on Lower Greenville Avenue in Dallas with a roommate and nursing colleague, Susan.

Convincing her of adding furry friends to the household would normally have been problematic except, I recalled witnessing a petrified, ashen-faced Susan standing on a kitchen chair, screaming bloody murder at the sight of a mouse recently.

This would be a done deal.

Cats are easy. I’ve always liked them and knew that they wouldn’t cramp my style (much). There’s a well-known attitude that differentiates dogs from cats…

Dog: “My people feed me, love me, provide me with a nice warm, dry house, pet me, and take good care of me... They must be Gods!”
Cat:  “My people feed me, love me, provide me with a nice warm, dry house, pet me, and take good care of me... I must be a God.”

Our new kittens “Waylon” and “Willie” were aptly named during my ‘Country Music” phase. It was 1984 and boot scootin’ (aka C&W dancing) was all the rage. Weekend evenings were spent in cowboy boots and Gloria Vanderbilt designer jeans, with big Texas hair, dancing at “Cowboys”, “Diamond Jim’s” and/or “No Whar But Texas”.

I had always thought that Waylon Jennings and Willie Nelson had dubbed themselves “The Red Headed Strangers” but recently learned that they actually were "The Honky-Tonk Cowboys" - whatever. "The Red Headed Strangers" were a nice fit for our boys.

It didn’t take long before both Susan and I fell in love with Waylon and Willie. Their personalities were soon clearly defined. Willie was gentler, cuddlier and sweeter than the more aloof, curious and ‘in-your-face’ Waylon. Characteristics that probably got Waylon into trouble in the first place...Red-Headed Strangers: Part 2

The Big Bang - Part 2

On the night of April 15, 1980, I was in bed, dead asleep.

My apartment in Dallas was a hip,huge,adults-only complex called “The Village.” The Village was ‘Mecca’ to up and coming singles new to the Dallas area. Featuring several swimming pools, a large country club, tennis courts with a Pro-shop, sports fields and hosting social events with local bands, it was the happening place to live. My nearest grocery store was the “Tom Thumb” on Lovers Lane and Greenville Avenue. Monthly, its produce section hosted ‘Singles Night’ complete with games and prizes. Meat, cheese and take-home dinners were packaged in convenient ‘singles’ packaging. Several bars and restaurants were within stumbling distance and in the eighties, Greenville Avenue was where you wanted to be.

Unfortunately, I was completely unaware of these fabulous amenities for singles (with the exception of the swimming pools) as I was a shut-in. My life amounted to work and sleep. Overtime was plentiful and I had no friends so I focused on what I knew best…Work-Eat-Sleep.

It was during one of my ‘sleep’ cycles on April 15th that I heard a big bang and felt my apartment shudder. Rolling over, I blew it off.

A little while later I could have sworn I heard sirens and people talking. It was so real that it sounded like they were standing beside me. Flipping over again, I fell back asleep.

Soon after, I smelled the distinct odor of smoke. So, crawling out of bed in the dark, I walked into my living room where I promptly tripped over a very large sofa chair. “How did that get there?” I asked myself ...as I was lying on my avocado green shag carpeting. The chair was normally placed about four feet away and against my living room wall.

I knew for certain that something was amiss when I spotted very bright lights streaming from my living room wall. Getting up and turning on the lights, I saw that the wall had caved in. What’s up with that? An earthquake?

I made my way (about 3 feet) to my apartment front door (my apartment was about 400 square feet so it wasn’t that far) and I carefully opened the door fearing for the devastation that I would witness on the other side when suddenly someone shouted, “Hey, Look! There was somebody inside!”

With that introduction, my sleepy-faced, pajama-clad self received a loud round of applause from my many new friends who had not slept through the bright yellow 1976 Chevy Camaro slamming into my apartment.

Fortunately, the driver, although drunk - was not injured.

Through this event, I was able to meet and make friends with many neighbors, gaining a certain degree of recognition at “The Village” and eventually becoming roommates with one of The Village’s leasing agents. At work the next day, I finally had something to talk about with my co-workers at break, giving them a taste for my story telling.

With the exception of a short hiatus, I have called Dallas “home” since then.

Some say that “everything happens for a reason” and I tend to agree.

ER 101

In 1983, a doctor that I had worked with suggested I transfer to the Emergency Room at Baylor. I had planned a lengthy tour of Europe and would be gone for a couple of months, so transferring sounded like a good idea. I secured my transfer to the E.R. before leaving for my trip.

When I reported to the E.R. for my first day of duty, I was all bright-eyed and bushy-tailed (so to speak) and didn't get why the E.R. staff weren't exactly thrilled when introduced to me by the nurse educator. I certainly didn't miss the subtle eye roll and yawn when they were told about my (non-ER) nursing experience and I was blown away by the blatant rudeness of a more experienced E.R. nurse when she snapped "get me a real nurse" after I had entered the room where a patient wasn't doing so well.

In the eighties, nursing academics began discussing how ‘nurses eat their young’, a phrase used to describe an epidemic of how many times 'seasoned' nurses would not be kind or helpful to new or young nurses but rather, teach through intimidation, fear and bullying. Believe me, those nurses were most definitely in the ER and gave me a new understanding into the naming of 'nurse sharks'. That being said, without any ER experience, the truth of the matter was that I knew I had to ‘prove’ myself and that I needed them more than they needed me. Fortunately, the practice of 'nurses eating their young' has gone by the wayside. Nurses are generally more supportive and helpful to the newbies.

I accepted the challenge of Emergency Nursing and did my best to present myself as a self confident, skilled and knowledgable nurse and made every effort to befriend even the most bloodthirsty of nurse sharks. Humor helped alot and I learned that when you swim with sharks you'd best not let them see you as bait.

The following are just a few of the new terms and phrases that I had to learn ...

ER Vocabulary

• ABC – Airway, Breathing, Circulation


• Biotel – a central communications center that is staffed with nurses, doctors and paramedics who communicate and advise with various ambulance services. They are also responsible for designating the hospital that receives the patient based upon predetermined criteria.


• Bat Phone – a red telephone in the ER that is a direct line to/from Biotel


• Blunt Trauma – hit with a baseball bat or crunched in a car wreck


• Code - normally a respiratory and/or cardiac arrest but there were many 'codes' used in the hospital. If someone "called a code" it could mean starting or ending CPR


• C-Collar – Cervical Immobilization Collar – neck brace


• DFD – Dallas Fire Department (and ambulance)
  Code 1 – lights only Code 4 – lights and sirens
  Priority 1 – easy Priority 4 – see train wreck


• ETOH – Blood Alcohol or just alcohol as in “ETOH abuser”


• FB – Foreign Body


• GCS – Glasgow Coma Scale


• Gomerade – 1 liter of Normal Saline with Multivitamin, Folic Acid and Vit B12 added – used for ETOH abusers (gomers) - Now the term is "Banana Bag" - much more politically correct.


• GSW – Gun shot wound


• LP – lumbar puncture (spinal tap)


• LOC – Level of Consciousness


• LOL/LOM – Little old lady/man


• MVA – Motor vehicle accident


• MVC – Motor vehicle collision/crash … around 1995 MVA was changed to MVC. According to the Board of Trauma Surgeons “There are no accidents. Every crash is preventable.”


• MCA/MCC – Motor Cycle Accident/Crash


• POPTA – passed out prior to arrival


• Pit – the ER


• PTA - Prior to arrival


• Penetrating Trauma – stab wound, projectile wound, gun shot wound, puncture wound etc.


• Ruptured triple A – see train wreck (ruptured abdominal aortic aneurysm)


• Ruptured ectopic – see train wreck (ruptured pregnancy gestating in a fallopian tube)


• SW – Stab Wound


• Thumper - A mechanism used to deliver chest compressions to a patient in cardiac arrest


• Train wreck – any really bad trauma or pt in really bad condition.


• Tox Screen – Blood or urine specimen to determine presence of opiates, amphetamines, cannabis etc.  

Knife & Gun Club - Part 1

"The Knife and Gun Club" - Part 3

(See: Knife & Gun Club - Part 2)

As a staff nurse, my responsibility was not to contact family members. We had a clinical coordinator and chaplain to do that sort of thing. So I guess I was off the hook. But I did promise that I would “tell Cameron” and that bothered me.

I asked a couple of other nurses, techs and the ER doc what their opinions were of contacting family 'after the fact'. The general consensus was that I would be NUTS to even consider calling. Decision made. No phone calls to Cameron or any other gangster’s family members. This was a time to reinforce those ‘boundaries’ that I had been working on.

A couple of days later, while reading The Dallas Morning News, a story caught my eye about a young man who had been working the evening shift in Dallas when, on his way home, he became involved in a minor ‘fender-bender’. The cars were pulled over on the Dallas Tollway when a drive-by witness saw a tall, black man get out of his vehicle and walk towards two men who pulled out weapons and started shooting him. The man was a 29 year old named Michael Baxter (not his real name – although I clearly remember what his real name was) he left a wife and son.

The story continued to say that a few days before his death, Michael had spoken with his wife, Anna, and told her he felt that he had done what God wanted him to do in this world. She pleaded with him to talk about these feelings with their pastor and on the morning of his death, he did what she had asked. When he kissed her and their son good-bye on that afternoon, Anna said that she had a bad feeling about him going to work, but kept it to herself.

Michael was not a gangster.
According to his obituary, he was a hard worker and dearly loved by many.

Although, I would feel the tug on occasion to “tell Cameron”, I resisted the urge. I had no business in getting involved at this point. After all, these people had been through enough. What would I say to them anyway? Who was Cameron? A man? A mistress? Far too complex. Let it go.

And then, about six months after Michael died, I had a vivid dream. It was Michael’s voice and he simply stated his first and last name. That was it. I knew I just had to try to get in touch with his wife.

Next: Knife & Gun Club - Part 4

Coming to America 4

Moving On...Snuff, chewing tobacco, rifle practice, horseshoes, squirrel killings, pick up trucks, “Wild turkey”, razorbacks and rednecks. A little over a year had passed since I arrived in Fort Smith. I had bought and learned to drive a car, ignorantly chewed ‘a plug’ of Redman” chewing tobacco (and promptly vomited), was getting pretty good at tossing Horseshoes and shot a rifle at some tin cans . It was about all I could take. I was not cut out for this. Several of my nursing class graduates had returned to Canada, one married an American and some traveled to other cities in the U.S. When my roommate announced she would be returning to Canada, I decided to move on.

The thought of returning to The Great White North didn’t interest me at all. I had become accustomed to sunshine and didn’t want to leave it behind so, I hopped in my Chevette and headed for Southwestern Bell Telephone Company (SWB). I presumed that SWB would have telephone books for most major U.S. cities (as this was way pre-internet). My research began and ended with The Yellow Pages for Dallas, Houston and New Orleans. I scribbled down the phone numbers of only those hospitals that displayed the largest ads.

The first hospital that returned my call was Baylor University Medical Center in Dallas, Texas. Baylor arranged for an interview, took care of my air and ground transportation to Dallas and provided a room for me at the Baylor Nursing School Residence. Following my interview, I was introduced to another Canadian nurse, who had been working at Baylor for a couple of years. She invited me out to dinner and brought me to the happening place at the time – TGI Fridays on Greenville Avenue. It was everything I had dreamed of … handsome guys in three-piece suits and cocktails in fancy glasses... Who could ask for more?  Part 5: A Friend in Dallas

Coming to America 5

My New Friend, Earl.
Moving to Dallas was a piece of cake. My new apartment was arranged through the hospital. I sold my car for the first month’s rent and security deposit. After all, I really didn’t need a car anyway as a city the size of Dallas would surely have a super mass transit system a la Toronto, New York, London or Paris. A friend’s Dad offered to drive me to Dallas and off we went.

My new furnished apartment was perfect and located about seven or eight miles from the hospital. Knowing that it would take me a while to get used to the transit system, I called a cab to take me to the grocery store. Dallas was kinda 'spread out' and the nearest grocery store was about three miles away. I had expected neighborhood markets. Oh well. There was a 7-eleven within walking distance.

About one and one-half hours later, the cab arrived. Apparently, cabs were not plentiful in Dallas and according to my gravel-voiced cowboy-hatted cab driver, and new best friend, Earl, “everybody has a car here”. When I asked about Dallas’ transit system, Earl snickered and in heavy southern drawl answered “Ayyy what?” It turns out that Dallas didn’t have a real transit system. It was rudimentary and unreliable, virtually non-existent. I was crushed, broke and car-less. I made a deal with Earl to come back and pick me up from the grocery store in an hour. He did.

Sitting in my new apartment, feeling sorry for myself and without a friend in the world (except for Earl), I started questioning my decision-making abilities. Why did I sell my car when I didn’t know that I would need one in Dallas? Why did I choose a city where I didn’t know a soul? Would I have enough money to last me until I get my first paycheck?

I recall my Fort Smith friends telling me how ‘brave’ I was for moving to Dallas, alone. I realized now that ‘bravery’ didn't have a lot to do with it but that ‘stupidity’ surely did. I was miserable. Part 6: Twist of Fate

Coming to America 7

Banking, American Style
Payday. I thought it would never get here. I didn’t have a bank account yet so I asked around and a couple of the new Filipino nurses told me that a banker had just given them a class on "American Banking". His bank was within walking distance of Baylor (a definite bonus) so they gave me his card.

That afternoon, I told my 'ride' not to wait for me as I planned on walking to the bank, opening an account and cashing my check. I would take a cab back home. When I made it to the bank, I couldn't find an entrance door for the life of me. Well crap, it was a 'drive-thru' bank. So, with my head held high and shoulders back, I walked up to a car bay and pressed the red 'call' button. "I would like to open an account" I said. The teller (who had to be stifling a laugh) said "I'm sorry ma'am, but this bank is a drive-thru only. If you would like to open an account, you will need to visit our bank office." There were two cars now, lining up behind me. I pretended not to notice. "Where might that be?" I asked. Trying my best not to sound sarcastic. "Just turn left on Hall then make a left on Elm. It's about 3/4 miles up on Elm" she said. - Easy for her to say, she was not the one walking alone in downtown Dallas.

That weekend, with cash in my handbag and a smile in my heart, I began my search for wheels. The used car section of The Dallas Morning News had pages of car ads and many dealerships were offering “No Money Down!” Perfect! I had no money to put down on a car anyway so, I’m thinking that this type of deal will work well for me. After calling several of the “No Money Down” dealerships, I soon learned that the “No Money Down” deals were for people who had an established credit history in Texas. My bubble burst. Was it a sign? Should I just pack up and go back to Canada?

On Monday, I contacted the banker whose card I had recieved earlier - 'Mr. Lou Bittner, Vice President, The Texas Bank'. I made an appointment to see him that afternoon "about a loan". The way I looked at it, if he was kind enough to help Filipino nurses learn the American banking system, maybe he would have a soft spot in his heart for a Canadian.

Mr. Bittner was a well-groomed, older man who looked very much the part of ‘the banker’. He invited me into his office and seemed genuinely interested in what I had to say. I took a deep breath and began my semi-rehearsed pitch… “Mr. Bittner, I am twenty years old, I am not an American citizen, I have no collateral and I have only been a nurse at Baylor for three weeks but I am trustworthy and could provide you with personal and professional references from Canada and Arkansas, I don't know anyone here. Anyway, I would like to apply for an unsecured loan to buy a car.” I had remembered being told by my dad that a loan without collateral was called an 'unsecured loan' and I thought that using 'banker-speak' would make me sound like I knew what I was talking about.

Mr. Bittner paused for a few seconds then looked at me intensely and said slowly, “I’ll tell you what... I will loan you $3,000.00. But first, you have to come up with $1000.00 on your own. When you do that, call me and you'll have your loan. Your car cannot amount to more than $4,000.00 including tax and title.”

We had ourselves a deal!   Part 8: Wheels!

Coming to America 11

Blue's Swan Song
Let me begin by saying that "Blue" (my 1979 Ford Pinto) and I were together for four good years. Sure, we had our good days and bad days and there were times that I considered trading him in for a newer model but we were together for the long haul.

It was in the summer of '84 at the height of rush hour traffic and every bit of 100 degrees fahrenheit. I had acclimated to the Dallas heat (as air conditioning was something other people had) and I my perception of merging onto Central Expressway was now a challenge and kind of fun. For several days leading up to Blue's final hours, I could have sworn there was a jet engine flying overhead. In fact, I remember pulling over and looking up on occasion. The roar was actually Blue's Swan Song. The tow-truck driver just shook his head as he gloomily looked at Blue and said, "Lady, cut your losses". I took that to mean that Blue was 'gone'.

Oh, there have been many other cars after Blue went to the great scrapyard out there somewhere...sportier, fancier and faster models , but not one of them earned themselves a name.