Camp Stories

The moment you've all been waiting for, stories from FEMA Camp! I cannot tell you how many times I heard someone say, "This one time, at FEMA Camp..."

It *was* funny, if quite ridiculous!

So I left on Sunday morning and arrived in Atlanta just after noon. Then I caught a bus for the two-hour ride to Anniston, Alabama. It was HOT. And there were big bugs. Those are the two things I will remember most about 'Bama. But we did manage to have some fun along the way, at Fort McClellan, an Army base in the hills of 'Bama, the site of the Center for Domestic Preparedness.

On Sunday night, everything in the bustling metropolis of Anniston was closed. Everything, that is, except Walmart. So my new friend, Nurse Onomatopoeia, and I chartered a ride from base to Wally World in the hopes of some entertainment. The people watching was just as much fun as checking out the local Wally's merchandise:



I would have bought this shirt, but they were sold out. Seriously. So RN Onomatopoeia and I stocked up on our Alabama Crimson Tide t-shirts. I kept thinking it was the "Crimson Wave," not "Crimson Tide," but I was corrected. That would've been funnier had Alabama been a women's college. :) And I dubbed my friend "Nurse Onomatopoeia" because she had a sound effect for everything. An ER/Trauma nurse from Fort Worth, TX, she used sounds more than words for communicating.

On Monday, we were transported to Noble Army Hospital (busing to and from base), an out-of-commission hospital in which we were going to train. It felt official:



Security was TIGHT. Even though they check your badge against your photo ID when you leave base, they check it all AGAIN when you arrive at the hospital. What's going to happen? Spontaneous evolution of human life on the 4 minute bus ride? Regardless, it was probably one of the safest places to be this past week.

There were 60 administrators, RN's, EMS, and fire chiefs in our class. Day 1 consisted mostly of lecture. Nine hours of lecture. After that, we were desperate for some local culture (read: alcohol), so a group of us chartered a bus to a lovely, sophisticated dining establishment called Cooter Brown's. It redefined "hole in the wall."

Seating about 40 people (tops), this was the view from the minuscule loft:



Being total tourists, our group tried Alabama Slammers. The drinks were the color of river water but tasted like fruit punch. They were perfect to accompany the "tasty butts" Cooter's is known for:



It was simply the best BBQ I've ever had. The pork was smoky and the sauce spicy and tangy. However, it was the BBQ that never ended; regardless of how much I ate, my pile of pork BBQ never went down. It regenerated itself. Like *MAGIC* BBQ. Cooter's lived up to its hype, except when we were reclining after our feast, a cockroach scurried across the table. Making one of her characteristic sound effects (kind of like a crazy rooster), RN Onomatopoeia hailed the table's check in 3.78 seconds. Honestly, I wasn't that surprised, but one of the infection preventionists in our group started hyperventilating.

The next morning and four TUMS later, we returned to the hospital for more lecture. Then we did table-top exercises where you think through what you would do in Disaster A, B, or C. They split us up into groups, so we got to know several other folks.

That night, I returned to my room and JUST ABOUT finished my ethics paper. Yes, this is newsworthy.

The next day, day three, was our first simulation. We actually ran the Army hospital during a crisis. It was a terrorism explosion that turned into a nerve gas event with some anthrax thrown in. As hospital incident command, we had to supervise the decontamination of patients, treat the hazmat situation, accommodate hundreds of ER patients (using mass triage) and somehow work with public health to protect society. We ran and ran for 8 hours and everyone was zonked by the end.

That night, a spontaneous party erupted at the FEMA bar, with about 20 people from my class. There was an outdoor picnic area and everyone congregated to share tales from the day. Fueling this were the $1 draft imports in the FEMA bar subsidized by YOU. Your tax dollars at work!

It was interesting, though, because the whole experience was starting to remind me of college. Everything from the cinderblock dorm rooms to the shared bathrooms to the dining hall food with excellent entrees and even better desserts, it was just like college. Except that most people were married and the bizarre late-adolescent courtship rituals were not occurring, thankfully. This is a shot from the inside of FEMA bar. Even it reminded me of Senior Bar at Notre Dame:



Then on Day 4, the last day of training, we had to run the hospital again. This time, it was a bioterrorism attack with small pox. It was insanity and people really got into the exercise. Here is the administrative command post:



Here is the ER:



So the last night, we again congregated in the picnic area to share our gritty stories from the day. A few days ago, we didn't know each other at all; now we were good friends who survived anthrax and small pox and kamikaze terrorists. We swapped phone numbers and email addresses like kids exchanging friendship bracelets at camp, promising to keep in touch as penpals. It was a cross between camp and college and we all feel better prepared to manage our respective hospitals in a time of mass disaster.

The only hiccup during the trip was thanks to my Citibank credit card. I used it in the Alabama outback and when I tried to upgrade myself to business class for the return flight, it was denied. Turns out Citi didn't think I should have been in 'Bama, buying Crimson Wave t-shirts at Wally World! They said it was "outside my usual spending habits."

How funny. And true (as I adjust the Alabama baseball cap I'm wearing)!

Back to the real world and the 548 emails I have awaiting me. My ethics paper is 98%done, I paid off my student loan yesterday, and travel season has come to a close...I smell a party!

But for the Grace of Kleenex

Ugh. I had my first accreditation survey this week and it was nerve-wracking.

It's always this feared phenomenon, the accreditation surveyor! However, they are really just giving you an open-book exam to which you have already received the questions. But it's scary because of the element of the unknown. We've been preparing for the accreditation survey for two years now (we are accredited for a period of three years...preparation for the next survey starts after approximately six months of peace and quiet).

I was nervous because I was named administrator for five areas. As a complete accreditation newbie, I had no idea what to expect. As a result, I ended up walking numerous hospital hallways, escorting surveyors and racing in front of revised surveyors' plans to visit units. I was absolved from time on the treadmill this week!

On Day 1, I had two of my units surveyed, inpatient dialysis and hospice. I knew we'd have a dialysis survey and did NOT know we'd have a hospice survey. We rent space to a hospice company and they have their own accreditation. So when I tried to be proactive and ask four months ago whether the survey team would visit hospice, I was told "heck no."

I was furious then, when I heard in the mid-afternoon that the survey team HAD visited hospice and that I had two minor citations: a partially-uncovered clean linen cart and an outdated I.V. pump that Biomed had not reviewed lately.

Dangit!!! At least they don't count because they rent the space. But still!!! Dangit!!!

Two other areas surveyed well and then my last big clinic was to be surveyed yesterday afternoon. Again, I was nervous, as I had the "badass" surveyor with me. I held my breath while my clinic staff fielded the questions like pros. I could've hugged my medical director for the way he answered the questions. Actually, I *did* when I returned today with three boxes of the softest Kleenex I could find in the hospital.

Why? Because, three hours earlier, I did a walk-through of this large clinic and found several violations of the 18" rule (any area with sprinklers must have 18 inches in clearance between the highest item and the ceiling tile). So we quickly rearranged a few things and while digging around the medical records room, I found four gross-looking half-used roles of toilet paper. The manager said it was their makeshift kleenex.

Sigh. Seriously? So I stole some premium kleenex from the physician storeroom and supplied the clinic a few boxes. It was the least I could do for them having garnered another perfect survey! I crept across the street to the clinic and, of course, ran into two Sisters from the Corporate Board. Nothing like having a covert Kleenex operation intersected by some nuns inquiring about why you are carrying four boxes of Puffs!

So I survived my first accreditation. As soon as the summation conference ended at 11:30 this morning, I had a massive stress let-down migraine. Fighting through my afternoon (and a totally random visit from a Corporate VP for whom I'm now ghostwriting), I texted my pal, Vera, and asked for chocolate. She's the keeper of chocolate in Administration.

Two minutes later, she appeared in my doorway with a cute bag of these:




They're bath salts shaped and scented like dessert treats (from Lush). She told me it's still Lent and that I need to back off the chocolate and use the bath salts instead. Now there's a friend for you...worried about your stress relief AND your immortal soul! What can I say? She *gets* me.

I have a few more stories to share, but I have a bath to take!

No Queen for Me

I feel like pumping my first in the air and singing "We Are the Champions!"

But I'm too tired!

I survived what I think was the absolute hardest day in my professional career. I've had some rough days where I am a crazy nut for 16 straight hours or get into high-speed chases while navigating the one-way streets in downtown Chicago, or hang out with Fabio, but today was one of those perfect storms where everything just fell on one day.

And I'm getting sick.

I started the day by waking up with a crazy sore throat, one of those where you feel like you're swallowing razor blades and you dread the next time you have to swallow even a sip of water. After an early Quality Improvement meeting, I started my speaking portion of the day with an hour-long presentation on CUSP (Comprehensive Unit-Based Safety Program) to the region's senior leadership. It's...stressful. You want to present yourself as cool and eloquent and remain calm when they pepper you with random questions to test how well you understand whatever project you're proposing. Anyway, they approved it and we now have their commitment to start this cultural change.

Then I dashed to my office, picking up two stale cookies on the way, and teleconferenced into two meetings. Then I lead a two-hour Patient Flow discussion, where I presented the nursing managers (about 30 of them) with throughput myths that we "busted." I used the "Mythbusters" idea in my presentation and had fun with it...but then Nurse Jackie and the Directors poked sticks at the nurse managers so they could air their concerns and start working through things. Then there's me, trying to moderate the dialogue between 30 somewhat-shrill nurse managers as they aired their problems while also trying to capture the thoughts on newsprint.

Luckily, one of my managers was in the meeting and floated me a few throat lozenges (two brownie points for her on her next eval!!)

After winding up that meeting at the very last minute, I dashed across town to give a two-hour "summit" to front-line staff. We have this program where we bring all hospital staff together for two hours and share our hospital's patient satisfaction scores, quality scores, and other tidbits on how to give our patients that "wow" moment that makes them want to return to St. Fozzie's.

It went well, despite the fact that I didn't write the 92 slide Powerpoint (so not kidding. I pretty much skipped slides 78-91). But by the end, I was a worn-out, adrenaline-saturated sickie. I had nothing left. After packing up all the presentation items from our break-out sessions and group activities, I finally headed for my office at 6:10. I stopped by my late-night buddy's office (her name is Zynx) and after taking one look at me, she wordlessly reached into her desk drawer and produced a huge bag of M&M's. Now that's my idea of a good friend! Zynx and I are always the last ones in the office and it actually became a bonding thing for us. And I really do call her "Zynx" in real life, too. :)

We vented at each other while we threw back handfuls of the candy, savoring the last sweets until Easter (apparently, most people at work give up sweets for Lent and today was a weird Mardi Gras of sugary goodness in every department. No beads, though. We tend to frown on that sort of thing!).

Refueled by the M&M's, I was fit to make the commute home. True to form, Jack greeted me at the door with my PJ's and a book I bought that just arrived in the mail.

I don't really know what was so entirely exhausting about today...I like public speaking and don't generally get nervous when I do it. But today, with the tight time lines and self-created pressure of having to have everything organized perfectly, it wore me down.

However, these are the sort of days where, if you survive and flourish, you know you can make it through just about anything.

C'est Finis!

The stroke program is up and running and it's DONE. As the French would say, C'est finis!

THAT's another monkey off my back!

Time Bomb

The last few days have *really* tested my strength. I worked 40 hours just between Sunday and Tuesday; by the time Wednesday rolled around, I was a mess of nerves, knots, and just yuck. I left my all-day meeting at St. Animal's and drove home to SB...

Where Jack showed his undying love for me by taking me out for dinner and letting me vent over a much-needed glass of vino. It was a great break, but it just delayed the inevitable. For me, the inevitable was reading 70 pages of intensive stroke literature by which I was to compare the newest versions of our standing order sets to clinical pathways of treatment. While I have no idea how to explain the etiology of stroke, I can compare the order sets to what the government recommends!

Despite my best efforts, we may only get one order set before the Medical Executive Committee next week. It's the primary set, but still, instead of three brand new sets, we may only have one. And that's only because my partner in crime, Peppermint Patty, got the stomach flu and couldn't do the five hour teleconference on Friday as we planned.

Why a teleconference? Because I was at Muppet Corporate for a meeting on Thursday. It was a systemwide Quality Council meeting and while it's very informative, I don't get broken down the same way I used to. Either I'm getting used to this caliber of meeting or the content is less serious. Hopefully it's the former! Nurse Jackie presented our SBAR activities to the group and she even mentioned me by name for the support I've given the project. Those little mentions go a long way for me.

Regardless, it's hard returning to Muppet Corporate. Even though I spent six years there, it feels like a short, passing phase in my life. Some people haven't changed one bit. People park in the same parking spots. They sit in the same places in the breakroom. It's weird for me to return; the pace of my life seems as though nothing will ever be routine ever again. It's like when you go away to college after your high school years. You read about your high school in the newspaper and think, "Wow, things continue to happen at my high school even though I'm gone? You mean, the world hasn't stopped just because I've left?"

Yeah, I think egocentric things like that, too. At least I realize it and try to uproot it! If anything, it adds wisdom to my perspective, right?

Anyway, at Corporate, some people blow me off completely and ask me why I'm back...while others ask me 39 questions about my life, job, and new environment. It's a mixed bag. I while I answer only to myself these days, I shudder when I think back to that hourly mentality I had only a year ago.

Since then, I've thrown aside all preconceived notions of the work week. If I need to work on nights and weekends, so be it. If I have the five hour teleconference on a Saturday (to squeeze it in and accomplish what I need to accomplish),so be it. I'm in a different place and whenever I return to Corporate, it reminds me of how far I've come and how much I've changed in nine short months.

It's a rebirth of sorts.

Don't worry, I'm still trying to grapple with the work/life balance and I realize that without proper down-time, I could remain a ticking time bomb!

Can I Manage the Colts?

It appears that a second job offer might be on the table. This is all happening so fast. Yet, it encompasses every spare waking minute of mine.

I cornered Elvis the other day and asked for a meeting, since we all had some down-time. He's the type to flop on the couch, crack open a beer (okay, it was an iced tea), and open the conversation by asking what I really thought of the New Orleans Saints' defensive attack on Favre. Were they trying to disable him?

See why I like it at Fozzie's? Football is considered viable (and preferred) conversation-starter. I earned some serious brownie points when, during our informal watching of the BSC championship game, I called Holding, Personal Foul, and Off-Sides. Personally, I think it disarms men when women know football. I have absolutely no idea what we're all going to talk about when the Super Bowl hooplah dies down. The Olympics? I think not.

Again, I digress.

So I talked to Elvis, brought forth my career documents, and was ready to tell him to offer me a job, goshdarnitalltofreakingheck! I had it up to HERE with people quasi-sneaking around me on this job thing. The VP of HR gave me some hints on Monday. EVOO gave me glaring promises last week. Jim Henson (via Elvis) gave me some insights a month ago. Even Edison's been hinting around. I caught sight of the VP of HR's stack of papers in a meeting, during which she was editing the job description EVOO described. Scanning the title, I realized it's a terrific opportunity. People in this type of jobs are usually hand-picked from the nation's best MBA programs. I'm honored, truly I am.

[And I'm not ready to spill the beans about this particular opportunity. Consider it strategic on my part.]

But the more I thought about it, it's not *exactly* what I want to do. Granted, I have no idea what the specifics are, but I'm not crazy about the 30,000 foot view.

Hence the Elvis cornering. I needed to know if this was all I was going to be offered because I was going to seriously contemplate hitting the national job market. In short, it wasn't. After a long and quite candid conversation, he essentially asked me what I want to do. I defined the exact job I want and his next question was "so who do you want to manage?"

I fought the temptation to answer, "The Colts, silly!"

I have no IDEA which departments I should manage in the hospital. Where did that come from? While I certainly NEED to get some hands-on managerial experience, I was counting on someone handing me the departments to manage...not being granted whatever departments I want by the CEO. A wee bit blindsided!

He never really answered me about my "dream" job I described in the meeting. However, I'm studying that organizational chart to figure out which departments exist (then I can figure out which ones I will have a decent shot at not running into the ground!).

Two senior administrators and two very different opportunities. I need that Vegas sign more than ever!!

Feels Like Finals' Week

Have I told you the story about my junior year of undergrad, when I actually built a pyramid out of Diet Mountain Dew cans? I'm not even kidding. It became a piece of art, a conversation piece, a shrine to my perennial stress-filled, sleepless nights.

I'm tempted to resume this practice. Sister Lourdes and I both have a fond affinity for Diet Mountain Dew (DMD). Every time our meeting stretch past the 10-hour mark, one of us always supplies the other with our preferred fuel source.

Something about these last couple weeks makes me feel like I'm in the throes of finals' week. It's crunch time, the meetings are double and triple-booked, and I've had homework lately (stuff I have to read at home before the meetings). Monday was filled with ER meetings, as we met with docs, nursing staff, and other support staff to expound upon our patient throughput issues. Then I led a stroke designation planning meeting and went straight into a four-hour stressfest better known as Budget. Since Muppet Corporate gave us a week extension on our initial deadline, we've had a few additional nights to chew over the budget. The shortfall is decreasing, but it's unfortunately at the expense of departments, seminars, staffing, and even a couple educational programs. Some folks don't understand the gravity involved in some of the administrative decisions. How do you weigh the various programs and hospital factors and make those tough decisions about who or what should be cut?

With lots of discussion. And lots of trail mix and DMD!

I left late on Monday night and walked out of the hospital to a distinctly autumn night, complete with a windy chill whipping leaves around me. Have I been working so hard that I missed the seasons changing? Or did fall come in with that one storm the other night?!

Tuesday was another nutty one as I had my first true marathon. I had 11 straight hours of meetings with no breaks. I had to step out of meetings in order to raid Vendo Land and hit the john. That's just sad. The meetings ranged from Town Hall meetings (where Senior Leadership presents a "state of the hospital" sort of thing to staff...on all three shifts!) to physician recruitment to marketing to revenue cycle to budget. At the end of the day, I excused myself to rip the contact lenses from my poor, red eyes.

A couple of really good things happened, though. First, my secretary popped her head into my office (usually a sign that she needs clarification on something) and presented me with a small flower...because she thinks I'm blossoming in my role and I "get it." I was taken aback, but really appreciated the gesture. I'm living in a land of no feedback, so her feedback felt great.

Then Sister Lourdes bounced into my office, M&M's rattling in the pocket of her habit, singing the praises of the latest storyboard. I mentioned that I wrote it up in an abstract for that nationwide Quality conference next May. Her eyes lit up in such a way it was if I told her Heaven was made of M&M's. I sent if off to her and she immediately contacted people at Corporate, asking permission to submit on behalf of the system. After suggesting a few minuscule changes, Corporate approved it. So I sent it off to the conference. If, for some reason, the conference accepts our submission, Sister and I will be presenting and facilitating a break-out session. Trying not to get my hopes up but that would be so cool. I'll keep you posted!

Maybe that's why I feel the crunch; all these deadlines are looming over me. I just hope I get to sleep when it's over.

Perks of Womanhood

I often complain about being one of few (or the only!) women in the Boardroom. Hence, I present to you (in stereo, where available) the Perks of Being the Only Woman:

There's no line for the restroom at corporate meetings (there is for the men).

There's always plenty of Diet Coke (the guys all seem to prefer iced tea).

Everyone always holds the door open for you (politeness is universal).

I can leave a tube of concealor or hairbrush in the restroom and no one touches it.

I can wear a skirt and become the biggest distraction in the room.

I can fully assess someone by just looking at their shoes.

They think I'm the coolest woman ever, since I religiously follow college football.
…And know the pro football teams' affiliations with the various US cities.

Last, but not least, no one ever questions if you step out of a meeting…you may be tending to a mysterious gynecological issue!

My Calendar and an Honor

Is it bad when you glance at your desk calendar and see that it's Monday, July 13? The Edge bought me this wonderful, tropically-nuanced desk calendar and I've WASTED nine days' of pretty photos!

In other news, I received a notice that I was nominated as an Early Careerist for the Indiana Healthcare Executive Network! This is huge, as I get to represent northern Indiana at the state level for the American College of Healthcare Executives! At this point in my career, I'm doing anything and everything that crosses my path. Unless they send me an invitation to join the Voodoo Appreciation League or Ladies' Terrorism Society!

No time to party, though. I'm drowning in file folders and committee notes that I have to synthesize in my brain. And weather permitting, I have a softball game tonight. When I last checked the doppler, there was a big mass of green, yellow, and orange heading this way...so we'll see! Then again, I could use a "night off" to catch up on my reading, house cleaning, laundry, exercise, cooking....

Word of the Day: Transcendentalism

My daily Caribbean calendar has this quote today: "Do not be too timid and squeamish about your actions. All life is an experiment" by Ralph Waldo Emerson. The picture is of two people snorkeling in crystal-clear turquoise waters, just offshore from a white-sand beach. Kinda like the above picture of me, Jack, and another fellow-snorkeler in Stingray City. A couple folks stayed back on the boat and took the liberty of capturing the moment for us.

I have always been struck by Emerson's transcendental philosophies. At first, it was probably because "transcendental" made me sound cool when I was talking about it to my high school friends at parties. My English class studied these concepts from mid-19th century American Literature. Then I realized the truth in this philosophy, where we can literally transcend some of the daily baggage with which we live.

For instance, I've been reading a lot on confidence lately. I'm trying to get over the fears and insecurities that have been built into my head during the way. While it's practical to "fake it 'til ya make it," confidence-wise, there's a deeper element to confidence. In regard to speaking up in meetings, in class, or even trying something new, I realized that everyone has some fear on the inside. Everyone's afraid of looking like a doofus at one time or another. When I started to speak up and voice my opinions in meetings and classes, my thoughts came out mostly-coherent. Sometimes I babble like a clown. I think it's one of those practice-makes-perfect things.

I'm off to go rollerblading; it's morally offensive to be inside today!

House Philosophy

I was struck down with a terrible migraine a few days ago. I think it’s partially due to the weather (hello, 74 degrees chased away by Canadian cold front) and my insane stress lately. For me, migraines are thunderstorms that wreak havoc in my brain. They make me stop and rest. So when I bailed on class last week because of said migraine, I had a couple free hours. The show “House” was on television and I gave it a whirl.

Lots of my friends keep comparing me to that Dr. Cuddy character on the show. I guess she’s the administrator who disciplines House, but I'm not sold on her yet. She and House discussed House’s diagnostic procedures and legally-questionable courses of action he planned to take. Instead of Cuddy holding him accountable and suggesting he modify his actions to conform to legal and ethical standards, she said something like: “Oh, it’s okay. When I hired you, I set aside $50,000 per year for your legal fees.”

What kind of crap is that? No administrator would ever admit to that, nor would any administrator voluntarily set aside $50k from the bottom line. Most hospitals are severely struggling right now, even the ritzy ones, and a $50k hit to the bottom line is massive. Okay, maybe not massive, but it certainly counts.

I’ve also decided that House is a pompous, arrogant SOB. The writers decided to make his character one who can bluff like a poker star, unabashedly betray the legal system, and do absurd things like lay on his office floor and listen to jazz. Admittedly, I could see myself doing that. Jazz can be quite calming!

I like House’s arrogance, but I’ve been struggling with this issue lately in my real life…the divide between arrogance and confidence. Where is that line when one’s confidence crosses over the line and transforms them into an arrogant jerk? While medicine (and administration) requires confident people, arrogance is always an issue. You’ve heard about the cocky physicians who have God-complexes. It’s a fine line between confident conviction and overconfident boastfulness.

On the other side of the same coin, you can talk about humility. I think humility only means you’re honest. You know your strengths, your weaknesses, and from a religious standpoint, that your talents come from God. Humility is not negative self-doubt; self-doubt never helped anyone. I also decided that after vacation, I’m renting a season or two of House from the library!