The Shoe

Fresh out of ER orientation and really wanting to prove myself to be a competent nurse. An unconscious petite young woman was brought in by DFD* ambulance.

She had a high fever and had experienced a seizure PTA*. She stood about 5 feet tall and may have weighed 100 lbs. As a team, we stabilized her condition and were preparing to send her to the ICU when a resident announced that he had to perform a spinal tap first.

Well hell.

The spirit of the ER was to “Treat & Street” meaning…“Stabilize them and get them out of the ER”. Our rationale was (since you never know what will come through the ER doors at any time) a bed must be available for the care of the next patient. It made sense to me and was a priority of the ER nurse to facilitate transfer to another area of the hospital as quickly as possible.

So, I (reluctantly) set up an LP* Tray for the resident and left him and three other residents to their own devices while I took care of other patients – this was my first mistake. About a half hour later, I couldn’t help but notice that they hadn’t finished the LP yet – the procedure usually just takes a few minutes. So, I poked my head in the door and saw that all four of them were still inside. “What’s up?” I asked. The senior resident replied, “Dr Surly (a pseudonym) is coming down do it.”  Another delay.

On a good day, Dr Surly, a tall, imposing doc was grumpy. Today, he was grumpier. Being summoned to ‘the pit’ because no one on his service was successful in performing a simple L.P. put him in ‘a mood’ to be sure. He walked into my patient’s room, and without saying a word, rolled up his sleeves and began the procedure. The tension in the room was palpable. Everyone, including myself remained in the room, silent.

I took this opportunity to quietly create a written inventory of my patient’s belongings - a hospital requirement prior to transfer – and (as I was told) one of the signs of a good ER nurse. I found her bag and began my list…

• 1 pair of shorts
• 1 pair of socks
• 1 towel
• 1 bottle of unmarked blue pills - “I should mention this later – after the tap is done”
• 1 bottle of unmarked white pills - “Wow. This is critical information, but it can wait until after he’s finished” thinking to myself. 

Despite 4 Residents, 1 Staff Doc, myself and a sick lady, the only sound heard in the room was the ticking of the clock. Back to my list...

• 1 set of keys

It was then I made my second mistake.

Reaching into my patient’s bag, I removed a HUGE tennis shoe. It must have been a size 13. Unable to stifle myself, I held the shoe high in the air and blurted out, “Holy Cow! Would you look at the size of her feet!” With that exclamation, everyone looked at our petite patient's feet. Without missing a beat, Dr Surly (with the spinal needle still in the patient’s back) said, “May I ask just what you are doing in my gym bag?”

One by one, the residents filed out of the room. We could hear them howling with laughter in the hallway. Then, Dr Surly’s eyes met mine - I burst out laughing, tears streaming down from my eyes. Dr Surly, ever the professional - successfully completed the LP. All the while, his shoulders quivering and biting his lip. As he was leaving, I handed his bag back to him and without a word, he walked out of the room.

I wonder if he got a kick out of finding the completed "Patient Valuables Record" I had left inside.

#TheIsolationJournals - Glorious Awkwardness

*DFD - Dallas Fire Dept
*PTA - Prior to arrival
*LP - Lumbar Puncture (Spinal Tap)

2020. The Year of the Nurse. As if...

A glimpse of the camaraderie, professionalism and science of Nursing

My inspiration for this post is not to praise my colleagues, although they deserve praise...

but rather to put the call out there for backup. 

I'm talking to the kind, organized, intelligent and compassionate people out there 

 to be the next generation of Nursing.

I'm talking to you.

So, here I am making masks for my friends who are on the front-lines of care during this COVID19 pandemic. 

Nurses in the ER, ICU and Screening Centers. I think of them. And how cool they are. How smart they are. How 'science-based' they are. I've been retired for a few years now and anticipate that there may be a high probability I will get back into the fray - should it be necessary.

The 'calm before the storm' in Dallas has got my head back into 'Nursing Mode' and my training to never quit and to anticipate worst-case scenarios has been revived.

Hence, the masks

Recently, our current Lieutenant-Governor of Texas, Dan Patrick implied that I would gladly give up my life for the US Economy... but I say- hold up there, Dan - not so fast. 
 I take good care of myself and I still have a little life left in me. 

Believing in science and knowing how expert Nurses, Doctors, Techs, Respiratory Therapists and all those in concert, encompassing a wide variety of healthcare disciplines, I'm confident that this virus will be managed safely and effectively with all hands on deck. 

That includes you, Dan. You are in a position that can help move mountains in this crisis. 

Be a Nurse, Dan. Don't be a Dick.

Anticipate worst-case scenarios and work your ass off to prevent them.

Awright... back to Nurse Recruitment...

Who knew that Nurses were not all about bed-baths and pill passing?

Beginning my Nursing career in Toronto, Canada and I became a 'Dialysis Nurse' at age 19. To say that I was scared shit-less would be an understatement. That year in Dialysis was one of great introspection and self-assessment. Not counted as one of the best Nurses in my unit, I had some growing to do but I realized that what I brought to the Nursing table was a passion for learning, and a profound degree of compassion and love for others.

Just a kid, really.

Nursing provided me an opportunity to travel. I made it to the USA from Canada and found myself  'Jones-ing' on 'Cardiac Medicine'. It was a 'Telemetry Unit' where I got a crash course in Organizational Skills, EKG Interpretation and Cardiac Resuscitation. Loved it!

Being young. I had a restless heart. The ER strangely soothed that restlessness. Hard to explain but there ya go.

Advised to be an ER Nurse by a Doc I had met while working in Cardiac Medicine, I loved it. It was exhausting, and difficult, and life-altering and taught me more than I can ever know about the fragility of life.  

Later in life, I anticipated (Hey, Dan) that the pace of ER Nursing might be a little much on my 50 year old body and decided to learn how to be an ICU Nurse. 

Back in the day, our CT scanner was a 0.5 mile trip each way from the ER. Multiple trips to/from CT included running all the way while pushing a stretcher loaded with a sick patient, monitors, defibrillators, IV pumps etc. Good News... since then, I hear things have improved as most ER's have their own CT Scanner in the department now! Yay you!

Although ICU Nursing was no picnic, it was physically hard work as well but you generally had a chance to get a cup of coffee before you took report from the off-going Nurse.
In the ER - this was not always an option as many times CPR/Traumas/Hemmorhagic Emergencies/Crazy/Stoned/Drunk People (the list goes on) required that you immediately step up.

ICU Nurses, et al

ER vs. ICU:
It seemed to me that in ER you relied on your super-keen observation skills & spidey-sense to anticipate if a patient was going to 'crump'. In the ICU? Everybody looks like they are about to 'crump' to begin with - so you have to rely on the numbers to help you prevent 'crumping'. Numbers? That's where it gets really interesting. ICU Nurses use high tech monitors to identify specific values of pressure, rate, volume etc. simultaneously in real time while administering care to their patients. But that's yet another post. Oh, and I was surprised at how 'thankful' families were in the ICU - the 'emergency' was now over and they had time to process what had happened to their loved one. Gifts of cookies, flowers, pizza abounded ...Sorry ER.

In Nursing...you have an instant 'peer-group': The friendships are real and lasting and many times profound. So many memories of the fun (and not-so-fun) times with my Nurse-friends. I could write another post on Nursing-friendships alone...but you get the idea.

At one point, I gave Nurse Management a whirl - it was not well suited to my personality - but is definitely the way to go for some great Nurses out there - I'm talking to you, Susan Rossow RN, Jody Phillips RN, Jessica Wilson RN, Jane Norris RN & Lillie Crain, RN ...to name just a few. I wish I could name them all but after 42 years... it's a lengthy list.

And I kid you not... I was an 'underachiever' in Nursing.

Nurses that I have been honored to work along-side throughout the years, are now...

• Infection Control Nurses
• Cardiac Rehabilitation Nurses
• Nurse Practitioners: Some of their specialties include Emergency, Pediatrics, Psychiatry, Trauma, Critical Care, Family Practice, Gerontology
• CRNA's : Certified Registered Nurse Anesthetists 
• Clinical Nurse Specialists: Critical Care, Pediatrics, Nursing Education
• Professors of Nursing
• Case Managers: They assist patients, families, and the Health Care Team with determining future needs of the patient, prevention of 'issues' and identifying potential barriers to their progress.
• School Nurses
• SANE Nurses: Sexual Assault Nurse Examiners
• Flight Nurses
• OR and Recovery Room Nurses
• Day Surgery Nurses
• Plastic Surgery Nurses
• Home Health Nurses
• Nursing Entrepreneurs
• Neonatal Nurses
• Hospice Nurses
• Palliative Care Nurses
• Oncology Nurses

     So I'm writing this in anticipation that one day soon, we will need you. I will need you. 

ER Nurses, et al

Granted, Nursing is not for everyone. 

A good attitude about dealing with shit that you really don't want to do is necessary for Nursing. But Nursing as a career choice was the best choice for me and I'm here to say... if you think you might have what it takes... do it. If you already have a degree, it will take you about 2 more years (give or take) but that would be 2 years well spent. At the risk of sounding crass, the pay is good - starting around $65,000 in Texas for a new grad. (depending on your area) with health care benefits for you and your family, flexibility in hours and shifts, tons of specialties, incredible job-security and a lifetime of unbelievable experiences.

Any Questions? I'm here for you. 

And for my Nurse-Colleagues, the Techs, RT's, Docs, Unit Clerks out there... I know this is a scary time for you and your families. Please know that I love you, miss you, pray for your safety and thank you. But I also know that you are all over this and will help see us through this difficult time. 

2020. The Year of the Nurse. As if Flo planned it this way.

The Grace of God...

Painting by Richard Prince

Recent events in Dallas surrounding the advent of  the Ebola virus entering our community has set in motion a whirlwind of anger, finger-pointing, and yes, even accusations of racism surrounding the care of Dallas' first Ebola victim, Thomas Duncan.

And now, two of our own front-line caregivers are infected.

Time to pause..and cry...show love to one another and maybe take it down a notch. 

I believe that as professionals, we will stand up for what we believe but we will do it with grace and dignity. 

The world is looking at us.

So, as you get your scrubs on today, kiss your loved ones goodbye and walk through those hospital doors...breathe... and take my very own, personal nursing 'mantra' with you. It is what helped keep me grounded for over 38 years as a nurse... 

"There, but for the grace of God, go I". 

Peace be with you.

A Career in Nursing: The End

 I'm feeling pretty good about the past 38 years as an R.N. and on reflection of my life of service, it was my honour and privilege to have had the opportunity to be the first person to touch a human life at birth and the last to hold the hand of someone as they took their last breath.

How awesome is that?  

\

I've worked with the best of the best and shared experiences in life that few can fathom.

To the nurses, techs, paramedics, EMT's, docs, therapists, chaplains, pharmacists and secretaries that I have had the opportunity to work with throughout my career...Thank You. 

I have been one lucky nurse,

And now, I'm getting on with my life.
I'll keep you posted.

A Career in Nursing: The Beginning

The cap one wore identified your school of nursing.

Decked out in my cap and graduation uniform, my vacant gaze speaks the truth. At nineteen, I was not ready for the tremendous responsibilities inherent to nursing.

My first real job was as a staff nurse on a Metabolic Medicine and Dialysis unit. I hated it.

Our shift would begin by our "Head Nurse", an angry, unpleasant, narrow-minded narcissist who would literally inspect each nurse from head to toe. Should our shoelaces appear dingy or our skirt length be deemed too short, we were subjected to her wrath. Publicly.

To be responsible for 8 to 10 patients each, it was our responsibility to review all medications to be administered, prepare them, identify any outstanding procedures or tests that needed to be done, manage wounds and change dressings, create a plan of care for each patient, administer medications, change linens, feed, bathe and turn our assigned patients and document all nursing assessments, interventions, vital signs etc. If we were really lucky, a Nurse's Aide would help us out. This was a rarity.

Have I already said I hated this job?  

OK - now I'm on a roll... there was no air conditioning. A hospital with sick people in it and no air conditioning? This would be cause for a militant uprising today but back then you just sucked it up.

A memory from 38 years ago comes flooding back to me...

I was seated at the nurse's station, charting. A doctor entered. Everyone stood up - except for me. Suddenly I heard the familiar bellow of my Head Nurse ..."Miss Young!" Her cackle was akin to the sound of fingernails scraping a chalkboard... "Stand when a physician enters this area!" I didn't get it. Then made the mistake of asking, "Why?" One look and I could tell she was about to implode. "Good Nurses stand to offer their seat to a doctor!" she said.

As much as a really hated that job, I was given an opportunity to learn ...

• To hold those in positions of authority accountable. 
• To respect your aides or techs - many times they will have your back when you need it most.
• That your physical discomfort does not even compare to that of your patient.
• Belittling someone doesn't make you look good. It does quite the opposite.

So I forced myself to do my best, be my best and stayed in a job that I despised for one year. A character-building experience, for sure - and (thankfully) not indicative of my future in nursing.

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

Snakebite

It was in the early 90's and I was an ER nurse at Sunnybrook Health Sciences Center in Toronto, Canada.

Sitting at Triage early one Sunday morning, my mind dulled by inadequate sleep the night before, I was interrupted by a young man of the ‘skin-head persuasion’ who was in a panic. “Ya gotta help me!” he shouted. “I've been bitten by a Black Naja Cobra" He showed me his very swollen finger. A red bandana was tightly wrapped around his wrist as a tourniquet. I didn’t know a lot about snake bites back then and had no idea of what a "Black Naja Cobra" was, but I did know that if the bitten area has a gross local reaction, and the snake was called a "cobra" - you've got yourself a big problem.

As I was taking him back into the ER, I learned that ‘Randy’ raised “Black Naja Cobras” as pets and he was "helping" one of them to "him shed his skin" when he was bitten. He didn't happen to have any anti-venom as he procured these snakes illegally from Africa and the seller did not supply him with any. “You know how it is”, he said. I didn’t. I'm no snake expert but I would think snake-lovers everywhere should have some basic rules like Rule #1 - Do not help a venomous snake shed its skin - they 've being doing it for centuries alone. Rule #2 - If you own venomous snakes, and if you must help them shed their skin - have anti-venom available.

Supportive treatment was initiated including oxygen and IV Fluids. When I got the ER doc’s attention, orders for tons of blood work spewed - chemistry, hematology, clotting panels, bleeding studies and ABG’s. Black Naja Cobra…was its venom neurotoxic, hemotoxic, cardiotoxic or what?

At the time, our doctor could choose from text, microfiche or expert resources. He called The Metropolitan Toronto Zoo and knowing that the chances were slim anybody who knew anything about anything would be at the zoo on a Sunday morning, he explained the situation then asked the zoo operator to get a hold of the person in charge of exotic snakes. Within a few minutes, the 'snake person' called back and following a brief conversation, the appropriate anti-venom was secured and The Metro Toronto Police were alerted to deliver it to us.

I got pulled from Triage.

Randy’s blood work had come back and we found out that his pet's venom had a profound anticoagulant effect. His clotting mechanisms were failing rapidly.

When the anti-venom arrived, the ER doc turned to me and casually said, “OK, Joan, go for it." Trying to disguise the 'edge' in my response to that ridiculous statement, I said"How?"

Clueless on how to administer this stuff, we found the directions in the box.

Anti-venom or ‘anti-venin’, (as it was labeled on the packaging) was to be administered via IV drip and based on kilograms of body weight. The anti-venom was derived from various species of cobra. I clearly remember myself and another nurse having to draw up at least ten vials or so and mix them in 500 ml of NS. A skin test was to be performed first in order to check for a possible allergic reaction. “And if he's allergic...then what?’ I asked. The doc ordered steroids and benadryl and told me to skip the skin test as we would have to wait an additional twenty minutes for results to be read accurately. I began the drip. The anti-venom would infuse over thirty minutes and then repeat blood work would be collected.

The response to the anti-venom was truly remarkable. By the time the infusion was completed, Randy’s post anti-venom blood work had improved significantly and within a few hours, it had returned to normal limits. Unfortunately, his finger had become blackened and necrotic. I learned later that week that Randy had lost his hand secondary to gangrene. Plastic surgeons said that the tourniquet he had applied to his arm might possibly have slowed the transport of the venom but that it caused pooling of it in his arm and worsened the tissue damage.

That same day, as I was wheeling him out of the ER, Randy was repositioning himself on stretcher and that’s when I saw the back of his head. Although at first glance, his head appeared clean-shaven, it wasn’t until he sat up that I noticed the hair on the back of his head was shaped in the form of a cobra’s head.

Nice.

Coming to America 1

The Welcoming Committee:
I had completed the college requirements to be a Registered Nurse in Toronto Canada, and was looking forward to my first nursing position.

Unfortunately a hiring freeze was in effect for area hospitals and my graduating class was facing a bleak job market. I was nineteen and one of the youngest graduates in my class. A poor college student, I was ready to start making some cold, hard cash.

The light at the end of the tunnel appeared when a group of nurse recruiters from Fort Smith, Arkansas arrived at our nursing school. They regaled our graduating class with facts, figures and a slide presentation that showed nurses water skiing, disco dancing and sunbathing.

We were hooked.

The ‘sunbathing’ part was the biggest draw as we Canadian nurses typically spent six months of the year in snow and another three months in rain.

Twenty-six of us signed up to work at Sparks Regional Medical Center on the spot. We had no idea where Fort Smith was - but it was in “the states” and the weather had to be a whole lot better.

Our flight to Fort Smith was in August and included three airplane changes. I suppose that should have clued me into what could lay ahead of us but my nineteen-year-old “city-fied’ brain only had visions of handsome men in three piece suits, Wall Street, palm trees. Rodeo Drive and cocktails in fancy glasses.

As the plane was preparing to land in Fort Smith, we were looking out the window of our aircraft and could see nothing but trees. "What did we get ourselves into?” Stepping out of the airplane, the blanket of heat was like no other I’ve ever experienced.

We had never stepped onto a “tarmac” before and (for some unknown reason) really got a kick out of it.

Hospital representatives from Nursing, Dietary, Housekeeping, etc. were waiting for us and standing in a receiving line began introducing themselves. Soon, we were traveling with them to our new apartment complex, “The El Conquistador”.

As we approached "El Con" - we couldn't help but notice the numbers of people lining the driveway with lawn chairs and beer coolers, ‘horseshoe’ games in full tilt. Apparently, they had been waiting for our arrival. They were all men and we were the attraction. Word had gotten out that twenty-six single Canadian nurses were arriving and it looked as though every single guy within a fifty-mile radius was there to check us out.  Part 2: The Welcoming Committee

Coming to America 2

It Could Be Worse...
The Welcoming Committee couldn’t have been nicer. Several of the guys came by our apartments with handwritten “business cards” detailing their names, addresses and phone numbers accompanied with offers to show us around town. The hospital had provided us with sheets and towels, a fruit basket and disposable cutlery and dishware. We were set.

None of us had cars so we became regulars with ‘The Razorback Cab Company’. A “Razorback” is the University of Arkansas’ mascot – a really big mean-looking red pig and oh my God, It gets worse. The pig was so popular that everyone (except for us) knew what ‘calling the hogs’ meant and ‘Pig-Calling Contests’ were fairly popular. ‘Calling the Hogs’ wasn’t very pretty but after a few drinks, it was easy. Ahem.

According to a University of Arkansas Website...."Although historians aren’t exactly sure of the exact date, a group of Arkansas football fans at some point during the 1920s are believed to have been the first to “call the Hogs” during a game. Spontaneous “hog calls” have been known to break out in airports, malls, restaurants and hotels all across the country. The words to the Hog call are simple: 'Woooooooooo, Pig! Sooie! “Woooooooooo, Pig! Sooie! “Woooooooooo, Pig! Sooie! Razorbacks!' Correctly calling the Hogs takes some practice. It starts with [a little alcohol and] both hands raised high into the air, fingers waving as the volume increases during the word Woooooooooo. The arms pump down on the word Pig and then back into the air on the word Sooie."
Speaking of drinking, I ran into a little snag when I first tried to gain entry into one of Fort Smith’s discos. For starters, it was law that you had to be a ‘member’ of any place that offered mixed drinks. For some reason, “Redneck Bars” were exempt. I guess it was because they only served beer. Secondly, the legal drinking age in Arkansas was twenty-one. I, being a Registered Nurse, responsible for the care of cardiac patients and licensed to administer narcotics had to provide fake I.D. to gain admission.

On our days off from work, we would hang out at the pool and/or go to ‘Central Mall” during the day, go disco dancing at night and drink ‘Wild Turkey’and coke. We were assimilating nicely to Fort Smith and soon started to make friends with native Arkansans. It was then that we learned of a few ‘peculiarities?’ I guess ‘squirrel-hunting’ was not peculiar to the natives but when you are raised in the city by a moose hunting Newfoundlander, I would think that those cute little squirrels would be completely obliterated with one rifle shot. When I asked a ‘squirrel-hunter’… “What is left of them after you shoot them?” He answered “Enough to make ‘Squirrel Chili”. Call me prissy but I have yet to eat a squirrel.

Considering the fact that we all spoke English, I noticed several differences. The expressions “Huh-uh and Uh-huh” were two very different things altogether. “Huh-uh means “No” and “Uh-huh” means “Yes” or if elongated “Uh-huhhhhh” means “You’re welcome”. ‘Fixin’ meant ‘preparing’, ‘coke’ was any kind of soft drink, as in…“I’m fixin’ to get me a Coke”. That same person would return with 7-Up. Despite our differences though, the people of Fort Smith will always hold a special place in my heart as they were so warm and welcoming to us, eh?  Part 3: Hang Around Fort Smith Awhile

Coming to America 3

Hang Around Fort Smith A While
We nurses could only do so much sunbathing and drinking without ending up looking like leather bags with bloodshot eyes so, on occasion we would ‘soak in’ the local culture.

Fort Smith was known for Judge Parker “The Hanging Judge”. Over the years, Judge Parker sentenced 160 men to death by hanging. The slogan, “Hang Around Fort Smith A While” was actually posted on billboards, T-shirts and mugs as part of the city’s ad campaign. Eww. Points of interest in Ft. Smith included The Courthouse and Gallows where there was room for three hangings to occur simultaneously. Nice. Another claim to fame was the fact that Belle Starr a notorious outlaw and sometime 'madam' owned a house of ill repute located on the train line conveniently very near to The Ft. Smith Train Depot. Reportedly, Jesse James and his gang frequented it regularly.The military base of Fort Chaffee also called Fort Smith home and was where a young Elvis Presley was inducted into the Army and recieved his military haircut.

So much for the culture and history of Fort Smith.


Elvis' haircut at Ft. Chaffee and the outlaw, Belle Starr

Alrighty then, back to drinking at the pool.

Sparks Regional Medical Center, was wonderful. We were given positions in the areas that interested us most and were oriented thoroughly. I was on a Telemetry floor and was caring for heart patients. One morning, during my orientation my preceptor (trainer) asked me to administer a mouthwash of hydrogen peroxide and water to a little old lady. She was unsure as to why this had to be done but that it was ordered none-the-less. When I explained to the patient that she was to swish the liquid around in her mouth and then spit it out, she did as I had instructed. When I saw what she had spat out – I panicked. The little lady was African-American and the contents in the basin were black! Did she have a tumor? Was the inside of her mouth sloughing off? I thought she looked OK - but at this rate, I just knew it was only a matter of time. I raced back to the nurse’s station with basin in hand showing the sludge to anyone who would look... my preceptor gently put her arm around me and sweetly said, “Honey, have you never seen snuff before?” Seen it? I had never even heard of it.

Ground Snuff Tobacco

My real education had begun.

My Arkansas nursing colleagues were so incredibly helpful and kind. They demonstrated as much care and compassion towards me as they did their patients. I thank them for being such incredible role models and setting a high standard for me during a very impressionable period of my life.  Part 4: Moving On

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 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!