Random Reflections Related to Reader Requests--Round 2

So, to understand the title of this post you'll have to go back and read my last post.  Then it will make sense.  My old boss, Randy--and he is old--told me I should write about how I got into hospice.  Actually his exact words were that I should tell about "the awesome man who helped launch my hospice career."  So, here you go Randy.  This one is for you.

Before I tell about the awesome guy who helped launch my hospice career I should give a little back story. I have to take you back to when I was in college getting my nursing degree though.  A friend and I were on our way to clinicals (for you non-medical people, that's the part where they actually let us touch the patients and learn on them) and we were talking about what areas of nursing we wanted to pursue.  I was set on being either in the OR or in Labor and Delivery because "that's where the action was."  Those were the words I would always say.  I recall telling my friend Andrea that there were three things I wouldn't do when I was a nurse and they went like this:  "I will never work with anyone who has cancer, old people, or anyone who is dying."  Talk about eating your words and God giving me the what for later on.  This conversation must have taken place before my pediatrics rotation, my day spent at dialysis, or my time on the burn unit; because I added those to my list of things I would not do before I graduated.  What it really boiled down to with those three areas was that I learned quickly that I could not stand seeing anyone in pain, especially if I was expected to inflict more pain on them.  So, inserting an 18 gauge--read a big, honking needle--into someone's arm or taking care of kids in pain or performing all the treatments required for burn patients was not my cup of tea.  I was terrified of needles for that reason and had to give my very first injection to my nursing instructor in another room because the other students wouldn't let me near them.  It was the bright, shining start to a brilliant nursing career!!  Oh, add to that list psych nursing.  I found out I couldn't do that either after....  OK, maybe I won't tell that story.

I graduated with my BSN and set about studying for my boards.  I started interviewing for positions and realized right away that my dreams of working in OR or L&D might not come to fruition.  I graduated in a time of a nursing surplus and the job I was offered had six nurses competing for it.  Where was it?  Oncology/Neurology.  That's right, my friend.  I was going to work with cancer patients and old people--some of whom were dying.  Fortunately, I worked in the hospital back in the time when nurses were pampered, at least at this hospital.  I didn't have to place IVs--we had an IV team.  I didn't have to change dressings--we had a wound care department.  I didn't have to take care of male catheters--it was a Catholic hospital and female nurses were not allowed to touch male catheters.  I know!!  We were pampered.  I did have to give my own IM injections and do my own finger sticks for the diabetics.  I literally had to give myself a pep talk every morning to go stick those poor patients' fingers.  I'm a total sissy.  I would actually smile to myself if none of my assigned patients for that day were diabetics.  Sometimes I would trade out these unsavory tasks with another nurse and I would place her Foley catheter.  I was really good at that.  It seems really crazy that I would rather place a Foley than stick someone with a needle, but I had issues.  Issues, I tell you!!

I worked in Tulsa in inpatient oncology until Lindy and I got engaged and I moved to St. Louis.  He was a youth pastor so I really wanted to be off on weekends with him and set about looking for a job that would allow that.  Since I was already familiar with taking care of cancer patients, old people, and people who were sometimes dying; it seemed that the transition to hospice wouldn't be too difficult.  I had friends who made the same transition after working in oncology.  Since I didn't want to do shift work in the hospital I didn't pursue too vigorously any positions in the OR or L&D.  We were still in a nursing surplus so jobs still weren't so readily available.  I found an ad in the paper (this was back before the internet was in full operation) for a PRN (as needed) position in hospice.  I went to interview with a lovely, wonderful woman named Mindy.  Her particular office didn't have an open position but she said that the smaller office where her husband was the supervisor had an open position.  She said she would give him a call and ask him to call me for an interview.

OK, Randy, here's the part where you come in.  He called me to interview and it was right before Thanksgiving 1995.  (He won't remember that).  The part I haven't mentioned yet was that I lived in St. Charles and his office was in Washington.  It was a 43 mile drive to the office and the position I was interviewing for would mean that I would also travel all day in my car and the closest patient was in Washington.  I arrived at the office and met Randy.  There were two other men there; Ken and Mike.  Mike was the Administrator in the office and Ken was the Executive Director of the hospice company.  The three of them decided that since they were all there they would just all interview me together.  I don't remember all the questions they asked but I remember talking about pain management and what I knew from working in oncology.  Randy showed me the map of their territory which didn't mean a lot to me because I had just moved to the St. Louis area three weeks before.  What I did realize was that I was going to be tooling around in a rural area.  (Ask me today and I can probably get you around on the back roads between New Haven and Cuba and Gerald and Leslie and New Florence and Hermann and....  I knew all of that before I ever knew how to get around in the St. Louis metro area).  Now I'm getting ahead of myself.  Well, the interview ended and we all stood up, they offered me the job, and asked me how soon I could start.  I told them I could start right away after Thanksgiving, but then asked them if they thought I should fill out an application first.  Ha!!!  That's hilarious to me now after spending the last 15 years in management.  I can't imagine bringing a nurse in for an interview and offering her the job before the application and the references and the drug test and the criminal background check and the EDL and the OIG and the....  You get the picture.

So, I started the job as a PRN nurse which meant that I would only work when they needed me, but they ended up needing me 40 hours/week from the first week so I wasn't PRN very long.  I was thankful for that because I really needed a full-time job.  Over the next several months I got to know Randy and realized that he was a really nice guy.  He always treated me well and was a very caring person.  Mike didn't last very long and his employment ended and he moved away.  I didn't see Ken very often.  He had just happened to be there that day.  He also eventually left the company but I don't remember if it was before or after I left.  I did eventually leave, but it was because of Randy.  It was all his fault!!!  He accepted a job with a company in the St. Louis area called Home Health Plus.  It was a company that did rehabilitative home care and private duty and they had hired him to start up a new hospice program.  When he left, he told me he would call me when he got it up and running and needed a nursing supervisor.  I kind of thought, "OK.  Whatever.  I'm 23 years old.  Why on earth would he hire me to be a supervisor?"  But, about four months later he called and said, "OK.  I'm ready for you.  When can you come to work here?"  It was a bit of a leap of faith for me--following Randy, that is--since it was a brand new program but the attractive part for me was going to be the I won't be driving all over creation anymore part.  You see, navigating the back roads of rural Missouri had put 36,000 miles on my little Nissan Sentra in ten months.  I was ready to drive a little less, but it would mean not having as much opportunity to do patient care anymore.

I took the plunge and started at Home Health Plus on September 16, 1996.  I so enjoyed the fact that the office was only 11 miles from my house.  Lindy and I have moved three times since then, even to Illinois for three years, and I just drive to work from a different home.  We've lived in our house now for nearly ten years and I drive 22 miles to work.

We had 15 patients on that, my first day, as a supervisor.  (Randy won't remember that either.  The company I came from had only reached a max of around 20 patients in that location so this census wasn't so foreign to me).  The 15 patients were between our St. Louis office which had ten patients and our Fairview Heights, IL office which had a whopping five patients.  It was pretty small and Randy and I were almost the whole operation.  We had one staff member that was solely ours.  Her name was "Kitten" and she was the chaplain, bereavement coordinator, and volunteer coordinator all rolled into one.  Our nurses, nurse aides, social workers, and team coordinator were all borrowed from home care and didn't have a lot of hospice knowledge.  Since there were so few of them I guess they didn't mind too much having a supervisor who had just turned 24.   I never had any issues with not being respected, at least I don't think I did.  I was challenged on occasion but you can't be in any supervisory/management position and not be challenged by your employees.  That's just life.  So, Randy and I were a good team.  He stayed in the office or went out and did marketing and I did all of the hospice admissions and other tasks in this newly created position.  My position wasn't only new in that office but new to the company as they had just started branching out in that area.  The home care and private duty divisions ran like well-oiled machines.  They were big and bad and managed very well.  Randy and I were truly the red-headed stepchildren--him more than me because he has red hair, or used to.  It might have turned all gray by now since he's gotten so old.  I remember asking the home care supervisor that I shared an office with if she thought I was doing everything I should.  She kind of whispered to me, "No.  There's a lot of stuff you guys aren't doing."  She didn't ever elaborate.  One of my favorite memories of Randy doing something really sweet, but exasperating at the same time, was on Valentine's Day 1997.  I was out in the field doing three admissions that day (yeah, my current staff, you read that right) and Randy sent me a page and told me that there was a state surveyor in the office and I had better get back there quick.  I drove to the office as quickly as I could and there was Randy in the lobby with this huge grin on his face.  Lindy had sent me roses and Randy just wanted me to come back so that I could see them.  It was such a sweet gesture, yet I wanted to punch him at the same time as having a surveyor show up in your office is NEVER a recipe for a fun time.

We had a general manager at that time named Ann (she was over the whole shebang); and she was very supportive of hospice.  She really had an affinity for Randy, not in that way, and she would give him these little yellow coupons for "Free Half Days."  I'm not sure if she kept giving them to him or if he just copied them but he took a lot of "Coupon Days" so he could work on fixing up his house.  What was that all about, Randy, and why did I never get any "Coupon Days?"  I held down the fort while Randy was gone and eight months after I started there Randy resigned. That's right, folks, he left me again.  He accepted another start-up hospice position in a neighboring state and he started traveling back and forth.  I've figured out over the years, as I've followed Randy a little bit and the path his career has taken, that he has to be challenged or he gets bored.  I wouldn't dare to count the number of positions Randy has worked in and the vast experience he has gained while I've been plugging away at the same office.

So, back to the story.  Randy left me and at that time we had grown to an amazing 20 patients!!  We had a new boss and she interviewed me for Randy's old position.  This was in June of 1997.  In spite of the fact that I was 24 years old, I had the most hospice experience, and she and her boss must have decided that I couldn't possibly mess it up too bad since we only had 20 hospice patients.  (I've learned since then that they were wrong if that was really their reasoning.  One person really can completely destroy an operation, even one that small).  We all laughed in the interview because I wasn't even yet old enough to rent my own car if I had to travel.  I told them that my ten-year goal was to be at home with my then non-existent children.  That didn't quite work out, but my current boss, Carrie, use to ask me how many more years she had me for because she knew about that.

I was promoted to Hospice Division Manager--that was the title at that time--and it has changed several times over the years.  While I continue in the same position for a company that has since changed ownership, sort of, and has changed names; my title has changed many times.  Currently, it's Director of Professional Services, and I think they are set on that for now.  My duties have certainly changed over the years.  We've grown from 15 patients back in those early days to an average daily census of around 375 patients in four offices instead of two.  (We've opened the other two offices in the last five years).  One of them is in Washington so it's like deja vu when I visit that office.  We've grown to the point over the years where I don't really have any responsibilities in the other offices.  For years I split my time between our St. Louis and Fairview Heights offices.  My location just keeps getting smaller as we open more offices and hand off more patients to them so that we can expand the number of patients and families we reach.  The private duty division closed about eight years ago and the home care division closed last year.  We are hospice only and no longer the red-headed stepchild.  We are a force to be reckoned with and it's because of our amazing staff.

I've been privileged to work with the same boss now for more than 13 years and a number of other staff who have stayed for ten years or longer.  We are truly a family and everyone I work with is very dear to me.  They are my "patients" and I love taking care of them as I really don't come very close to actual patients anymore.  The joke a few years ago was if I was at your bedside then you had truly scraped the bottom of the barrel when it comes to nurses.  You have to get through several layers of nurses before you find me smiling down at you.  I don't have many cool stories anymore like I had when I was a "real nurse" as my kids have referred to me.  The best one is my "coughed up lung" story and it always wins against every other story, hands down.  Don't even try to challenge me.

But, this story isn't complete without explaining why I'm so grateful to that "awesome man who helped launch my hospice career."  First of all, I've always referred to it as an "accidental career" because I never set out in nursing to be in management; yet I know that nothing in our lives is ever an accident with God when we entrust our lives to Him and let Him be in control of every major decision.  I truly just wanted to take care of patients, but God saw things differently for me.  I sometimes refer to my year spent as drum major in high school as being the "head band geek."  I guess you could say that now, in Missouri, I am the "hospice nerd in waiting" as this accidental career has led me to the place where I am now the Vice-President/President-Elect of the Missouri Hospice and Palliative Care Association.  I guess if you're going to set out to be somebody in hospice, that's one of the things you might set your sights on.  I didn't set my sights on it, but I've just been looking for ways to serve and, honestly, for a little variety after working at the same place for so many years.  I'm also a Past President of the Greater St. Louis Hospice Organization.  Yet another hospice nerd position.

None of this would have been possible without Randy.  He probably doesn't fully realize this, but God used him in my life to direct the path I was to go down.  Like I said in the beginning, this is not really what I wanted to do but God's plans are bigger than ours and He really does want to give us the desires of our hearts.  We just have to keep our end of the bargain by delighting ourselves in Him.  I hope I keep up my end of the bargain, and I hope that in the brief time I was able to work with Randy that I made a difference in his life.  He made a big difference in mine.  Randy, if this post made you laugh or cry or get veclemped, then I've done my job.  You'll always hold a special place in my heart and I'll always pray God's best for you.  Thanks for all you did for that young, bright-eyed girl who was just looking for a job to pay the bills.  You changed my life.