I always got paid in cash for my teenage jobs like baby-sittin' and lifeguarding so it was a big shock to gaze at the first paystub I received from the county hospital that hired me. $4.92 an hour for a brand new college grad home again in the 'burg. Actually, I had accepted a job in the "big city" because that's where my longtime boyfriend lived. After Daddy and the crew had the U-Haul loaded to the max, I confessed that fact to him and cried and said I wanna stay here. He didn't argue any.

This was when there were decent raises awarded to those who went above and beyond. Doctors still made housecalls like Marcus Welby and stuff. We all marveled over the tenacity of the ones who had managed to attain the ten or fifteen year mark serving mankind. We played jokes on each other at the worst possible moments and sat as silent witness to a river of tears. Some joyous, many sad and painful. The first joyful passing over that I remember was that of my paternal grandmother Lottie. A colon cancer patient, she had not been diagnosed until it was too late...probably due to her own stubborn nature. Lottie was used to "acting as if" as a way of surviving the hard years of the Great Depression married to a poor Southern sharecropper named Wilmer. I wandered down the 2Main section of the building until I round my way to her room. Ginner and Sister were there, and Dr. Fred. MeMama lay still on the bed. This particular vigil was a short one for me because she was pronounced shortly thereafter. Dead, that is. Daddy was at work or something, and I called him with the news he was expecting.

Next was Bill, Mama's and Nancy's younger brother. Our ICU consisted of a single room with four curtained beds scrunched together like sardines in a shiny can. I had seen him off and on the year before he ended up there...always gray and haggard looking. He was 36 and dead both inside and out. Gaga was out of pocket so it was Poops on the phone, once again callin' in the family. A mental picture of his two young daughters standing in the October breeze at the cemetary is burned onto my brain forever. Sad, sad stuff.

Our day began as everybody showed up around seven and divided stacks for pick-up. We were equally responsible, techs and phlebs alike, for drawing blood on pateints that the docs had ordered the day or night before when they made rounds. STAT meant somebody's dying...all the rest of it would wait. I was only about 22 then so I managed nights on end of call which started at 11pm, in addition to the day job. Somebody always went out to get breakfast at Burger Queen, rain or shine..off the clock. The cafeteria was only open for lunch in a little bitty basement room that is now filled with old x-rays. The food was free.

My wake-up call came when the bidding was between the two "not-for-profit" hospital systems that wanted our place real bad. We were a logical dot on the map for Hospital B because they operated every other one on the highway from Memphis to Obion County. The other Memphis sytem, M Hospital was seeking to take over the West Tennessee market and funnel the patients south as well. After much public woohoo and a lot of hard feelings the big M won the battle for about ten million over market value for the physical property. Before it was over they owned seven of us in West Tennessee. It was a twenty year love hate relationship for me as a member of the church that hospital M used on their logo. When their "mission" changed, we all got sold, again.

Next was Uncle Leland, aka Bud. At one time he was chief of police but in his later years he moved into a position as traffic man over truckin' at the local rubber plant. His wishes were specifically not to be hooked up to a ventilator but it happened anyway. Daddy went up there in the ICU and sat with him for hours on end. After a day or so Bud ripped the tubes out and, thankfully, there was a compassionate doc on call who said no more and refused to re-intubate. His funeral was the first one I had ever attended with a military presence. Fairview cemetary sits right next to what used to be the Dyer County Fairgrounds, and it just so happened that it was fair week. The ferris wheel was lit up all gaudy like, turning around and around with carnival music blaring in the background. The shooters took positions and fired with precision. The horn player took his place and played taps with everything he had. All of them were dressed in the uniforms of US servicemen.

Jimbo was my favorite uncle, hands down. He was a music man from way back when and worked as a band and stage director until he died. Twenty something of those years were right here at Dyersburg High School but he got tired of the political emphasis on sports and such and moved over to Obion County where they adored him for his talent on the football field with the marching band. He and Aunt Nancy gifted me with my love for music, beginning with piano lessons at an early age. His diagnosis with cancer of the prostate came only after it had moved into his bones and shot his alk phos off the chart. Prostate cancer begins down low and moves into the bones, squeezing out the blood making capabilities of the marrow. The last six months of his life, he was dependent on transfusions of blood and platelets to stay alive. After several units of platlets, he started to severe reactions to the HLA antigens....fever, chills and shakin'. I made housecalls to Newbern to draw blood and check his platelet count and H&H. On his deathbed, Jimbo was makin' platelets in his sleep.

I was Gaga's oldest grandchild of, ummm...about seven. Her hub died at the age of 45 with the riches of his empire at her fingertips. I reckon she had a good time spending all that money on trips and stuff after he passed. I have a mental picture of Papa laying in bed up in the front room of the house on College Street....a vigil of sorts. There were three bedrooms and a bath on the right side of the house with a living room, dining room, breakfast room and cool kitchen on the left. Upstairs there were more rooms and an attic stuffed with memories and cool stuff. She built a new house and moved a few blocks over leaving the homestead for her son and his wife. As the years flew by, the money that my Papa had worked so hard to earn went by the wayside as well as all of the real estate. Gaga ended up first in a rented duplex and then an assisted living facility, penniless. We always had some kind of special bond, partly because I was the oldest grandchild and partly because she too worked at the hospital until hospital M forced her to retire from the emergency room at the age of 70.

She was 83 when they found that she had a mass in her colon. It was removed via colon resection and she went to the nursing home next door to recover for a few weeks before returning to assisted living. Due to the large size of her belly the re-section evidently pulled loose, and she developed peritonitis. Her surgeon had just left on vacation, so his partner was in charge of the proceedings from this point. He took her BACK to the OR to perform an emergency colonostomy but by then her insides were eaten up with the infection. After surgery, she went to intensive care on a ventilator, as many COPD pateints do post-op. When it was removed a few days later, her oxygen levels began to drop and that's when the drama started. I think I've told this story before, but it's something that I've had a hard time letting go of so it bears telling again. After a consult with the anesthesiologist, Mom and her sister decided not to re-intubate. Her belly was laced open instead of stiched to allow drainage of the massive infection. She was heavily medicated with morphine to control the pain, which was also supressing respirations. It was a losing battle and they knew it.

I was working away when some angel of a student nurse came and found me and told me to go check on my grandmother. What I found was nothing like the sleeping peaceful old lady I had seen last. She had been given Narcan at the direction of the "surgeon on call" to neutralize the pain killing effects of the morphine and she now felt every bit of the pain that comes from having your belly split wide open. His reasoning? Since the plan was to not put her back on the vent, he was afraid she'd quit breathing on HIS watch. Now she lay writhing and screaming in pain and the Poopster went ballistic on everybody around. What.The.Hell!!!! I raised enough ruckus that she got her pain meds back and some non-invasive help with the breathing. She lasted about two more days, and died peacefully shortly after I held her hand and sang Amazing Grace into her ear. The moral of that story? Doctors are not always right....and sometimes you have to demand that the patient be treated with respect and dignity.

I learned that lesson the hard way one time with a particularly obnoxious and demanding surgeon who forced me to do something that I knew wasn't right simply because of his ego. The patient in question had an aortic aneurysm which tends to be quite a messy affair, blood wise. At the time, we gave whole blood vs the packed red cells that are routinely used now. The catch to using whole blood is that you have to consider not only the type of the patient but the type of the donor and what antibodies are contained in that donor plasma. This particular patient was A negative, and we had only about six or eight of them on hand when all hell broke loose. More A negative was ordered but it was going to be several hours for delivery so the logical step was to switch to O negative HOWEVER, it should be given as packed red cells to avoid reaction between the donor plasma and the patient's red cells. Basic blood bank training for anyone in the biz. That is what I proceeded to recommend when the nasty evil surgeon screamed over the phone that he WOULD NOT accept packed cells. He wanted whole blood by damn! I knew what this would do to the patient, but he wouldn't listen. The pathologist didn't back me up. We proceeded to switch this man's blood type from A negative to O negative and in the end the A neg that was on the way couldn't be given to him. Fifty something units later, plus multiple fresh frozen plasmas, he was transferred to the hospital in Memphis. I got a call from the Blood Bank there the next day wanting to know what the heck we had done with this guy and what was his original blood type. Sheesh. One of the high moments of my career. Moral to THAT story? Stick with your guns when you know a patient's best interest is being served.

Healthcare is huge business in this country, which is not a good thing in my opinion. Politicians with little or no healthcare background and insurance companies call the shots on everything. Doctors still want to wear the white hat and refuse to begin the conversation with their patients about options for end-of-life care. Most communities and hospitals have scarce or non-existant resources to provide education on palliative care and decision making when care is considered "futile." Ask Terri Schiavo's husband about that one.

My degree is a very specialized one which has limited my scope of practice to the clinical laboratory, but 30 years in a hospital and physician office setting have given me a broad view of the entire system, warts and all. It is terribly broken and, as a result, fewer and few young people choose healthcare as a vocation. The pay is not enough to deal with the stress and physical stamina involved. If you are not a doctor or a nurse, your role in the delivery of healthcare is not recognized by anyone. And most importantly, the fiscal restraints imposed by Medicare and private payors prohibit the delivery of good quality care. The number of un-insured persons in this country is astronomical and we who pay premiums for ours pay for theirs as well through our tax dollars. And the whole show is run by politicians who pander with lobbyists who represent those with a financial stake in the whole deal, like phamaceutical giants.

I see no answer to this dilemma, at least not in my lifetime. Until patients realize that doctors are NOT God and sometimes they need to be questioned, nothing will ever change. A healthcare consumer who plays an active part in his or her own care is a smart one, and a rare joy to deal with.

That, my friends, is why you might soon find me serving drinks on a beach somewhere.
At least waitresses get decent tips when they give good service.

^j^