ER 101

Monday

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

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

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




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


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


ER Vocabulary


  • ABC – Airway, Breathing, Circulation

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

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

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

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

  • C-Collar – Cervical Immobilization Collar – neck brace

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

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

  • FB – Foreign Body

  • GCS – Glasgow Coma Scale

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

  • GSW – Gun shot wound

  • LP – lumbar puncture (spinal tap)

  • LOC – Level of Consciousness

  • LOL/LOM – Little old lady/man

  • MVA – Motor vehicle accident

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

  • MCA/MCC – Motor Cycle Accident/Crash

  • POPTA – passed out prior to arrival

  • Pit – the ER

  • PTA - Prior to arrival

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

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

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

  • SW – Stab Wound

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

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

  • Tox Screen – Blood or urine specimen to determine presence of opiates, amphetamines, cannabis etc.  
Knife & Gun Club - Part 1

    "The Knife and Gun Club" - Part 1

    Baylor’s ER was located in a less than desirable neighborhood and ‘walk in’ or ‘dump off’ trauma was commonplace. Situated directly across the street from an apartment complex referred to “The Projects”.

    “The Projects” were government assisted housing units where very poor people lived. Understandably, many of the tenants were armed to the teeth. GSW’s (Gun Shot Wound's) that  originated from there were routine and about three blocks away from the ER was “The It’ll Do Club” - notorious for late night stabbings.

    Our geographic location made us proficient in managing penetrating trauma. The weekend night shift in the ER was known as “The Knife and Gun Club.”


    Somebody along the way told me the ‘club’ name began by way of the differentiating members. The weapon of choice and modality of maiming and/or killing were determining factors on whether or not you were a member of the ‘knife club’ vs. the ‘gun club’.

    Generally speaking… American citizens vs. illegal aliens. American citizens could legally purchase a gun to shoot one another and illegal aliens, who were unable to legally purchase guns, would use a knife to stab one another.

    The “Knife and Gun Club” would kick off on Thursday nights (payday) around ‘closing time’ (2 am) and continue until Sunday evening. Most of the victims were drunk or stoned, poor and under-educated.

    It took me years to learn how to create strong boundaries between the patient and myself without losing my sense of compassion for them. After all, many of our ER clients were not the nicest of people.

    The secret was to view their reality separately from mine and treat them as I would want my own brother or sister to be treated. It was the healthiest way for me to deal with some of the most horrific people and witness some of the most disfiguring trauma. But it took some time to get there as they don’t teach you this stuff in nursing school.

    It was just after midnight on a Friday and “The Knife and Gun Club” was running full tilt. The ‘Bat Phone’ rang and we were told to prepare for an unconscious, hypotensive male with multiple GSW’s to chest and abdomen.

    Within minutes, the patient arrived by DFD. An African American male, wearing a African print “doo-rag” and jeans, he was bloody and appeared lifeless. I could tell just by the look of him that he was a gangster.

    Knife & Gun Club - Part 2 

    ER 101

    "The Knife and Gun Club" - Part 2

    Sunday


    Trauma One was stocked with everything needed for a rapid trauma resuscitation … including a machine to transfuse massive amounts of blood and fluids within minutes, a chest ‘cracking’ tray (used for - just what you would think), an abundance of sterile tubes, needles and catheters used for placement in patient’s heads, hearts, chests and nether-regions. Trauma is brutal, no doubt about it and many times, invasive procedures are performed without anesthesia. The life-saving procedure itself trumps pain management. Thankfully, most trauma patients tend not to have memory of their ER experience and that I believe to be and example of God’s grace.

    The trauma team converged on this guy. Multiple gunshot wounds to the chest, abdomen and legs. Doctors, nurses and techs all had, literally, a piece of him. Within sixteen minutes of his arrival to our ER, he was stripped, assessed, monitored, had two tubes that were as big around as some garden hoses inserted into each side of his chest with 'auto-transfusers' attached. Auto-transfusers collect blood coming out of his chest into special sterile, filtered containers so that when they fill, his own blood can be transfused back into him. A foley catheter, multiple IV’s, arterial blood, and other diagnostic blood and urine samples were sent, a quick chest xray and before I knew it, he was out the door (OTD) and en route to the O.R. Although central pulses (groin and neck) were present, at no time were we able to find a peripheral pulse (arms) or get a blood pressure.
    What happened to me during those sixteen minutes were the strangest that I have ever experienced with any patient in this shape. It didn’t (and still doesn’t) make sense.

    As I was preparing to start my gangsta’s IV, I looked at his face. It's a reflex to warn someone that you're about to shove something sharp into them. Normally, when a trauma patient is so profoundly in shock, they are unable to make eye contact with you but this trauma patient did. “What’s your name?” I asked, not expecting a response. His affect was serene and peaceful. His reply, calm and almost musical, “Michael” he said.

    I looked up at a tech who shrugged his shoulders and raised an eyebrow as if to say “go figure”. I then recited a fairly standard statement that I would usually give to frightened, less critical, alert trauma patients…”Michael, I want you to know that we are here to help you, you're in the hospital and you will be feeling better soon. Don’t be afraid OK?”

    Much to my surprise, Michael looked straight at me – all the while being poked and prodded (remember the chest tubes?) by strangers and said “What’s your name?” This was a first. I told him my name was Joan. “Joan.., Joan.., Joan” he said slowly. Then he actually smiled and said, “I know where I am and I know where I’m going. I’m OK. I’m not afraid.” I asked him if he was in pain and he said he was not. Knowing that he may not survive, I asked him if we could call anyone for him. He smiled again and said “Cameron, tell Cameron.” I asked for Cameron’s phone number and unbelievably he gave it to me. I had the ER tech write it down.
    Michael made it to the OR but died 'on the table'. Should I call his family? Do I call Cameron? Do I really want to get involved with a 'gangster's paradise', so to speak?

    Knife & Gun Club - Part 3 

    "The Knife and Gun Club" - Part 3

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

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

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

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

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

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

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

     Knife & Gun Club - Part 4

    Knife & Gun Club - Part 2

    "The Knife and Gun Club" - Part 4

    Saturday


    “Michael Baxter.” His name was spoken loudly and clearly.
    Being raised Catholic, I was always on the lookout for ‘a sign’ . This was “a sign”.

    Ethical decision-making for me has always been based on a simple premise. How would I want my brother, sister, mother or father to be treated? If my brother had been shot and left for dead on the side of the road, I would want to know if he suffered, if he was in pain or if he was afraid. I would at least want to be offered the opportunity to learn that information.

    The following morning I started looking in the Dallas phone book for Michael's address.

    I remembered seeing Michael’s driver’s license on the night that he died and recalling that I was familiar with the street he lived on and that it had several apartment complexes on it. I didn’t have an apartment number but when I found his name and address, I decided to write to his wife anyway…”Dear Mrs. Baxter, I am a nurse in the Emergency Department of Baylor Hospital and cared for your husband, Michael. If you would like to talk with me, I can be contacted at …”

    A few days later, the letter came back, un-opened with ‘return to sender’ stamped on it.

    I did what I had to do. I re-addressed the letter with Michael's name on the envelope. I felt certain that everybody at the apartment complex knew about the guy who was shot and killed in July. Maybe someone will take the time to find his wife and give her the letter.

    On Halloween, my phone rang. It was Anna Baxter and she wanted to meet with me.

    Knife & Gun Club - Part 5 

    Knife & Gun Club - Part 3

    "The Knife and Gun Club" - Part 5

    Friday

    I hadn’t planned on what I would say if Anna Baxter called me.

    After introducing herself, she told me she had received my letter and that she, Michael’s mother and sister would like to meet with me. The date was set for Sunday at an African ladies dress shop that Michael's mother owned, on lower Greenville Avenue.

    I arrived a little nervous but the three ladies were very welcoming towards me. We sat together in the reception area of the shop. A little boy was about 10 feet away from us, busy coloring in a book.

    With all eyes on me, I began… “I’m sure you’re wondering why it has taken me so long to contact you.”

    I went on to explain my apprehension of becoming involved in family matters that may not be of my concern and also the real possibility of being drawn in to a criminal element, given the circumstances of Michael’s death.

    “But, I also know…” addressing Anna directly, “…that I would want to know if my husband was in any pain or afraid prior to his death.”

    I told them about my conversation with Michael that night and how he denied pain, fear or discomfort. How he seemed so tranquil and certain of where he was going.

    Understandably, the ladies cried and expressed relief to know that Michael didn't suffer, they thanked me and hugged me.

    Anna asked me if I had been contacted by the police, as on the day she received my letter, the police called to tell her the men who had killed Michael had been apprehended. I couldn't help but think the loose ends had all come together except, before leaving, I knew I had to honor Michael’s only request of me…“tell Cameron.” 

    I said, “There is one more thing that I have to tell you. On the night that Michael died, I asked him if there was anyone that I could call for him and he said, ‘tell Cameron’.” Within seconds, the little boy, who had not taken his eyes off of his coloring book during my entire visit, raised his head and looked at me.

    I knew who he was, instantly.

    Anna tearfully introduced she and Michael’s 4 year-old son, "Cameron".

    Knife & Gun Club - Part 4

    Shotgun Trauma: Whodunit?

    It was about 5:30 am when the 'Bat Phone' rang. The phone itself was red with photographs of a gun and knife taped to the handset. It was our direct line of communication to an emergency dispatch center… “Baylor, 28 year old male, multiple gunshot wounds, Code 1, Priority 4, five minutes out”, said Biotel.

    A five-minute ‘heads up’ was a blessing.



    Our patient arrived alive. Oxygen, fluid resuscitation, blood and diagnostics were all being done simultaneously. He was shot with was not just a simple handgun but, a shotgun. A shotgun typically uses a ‘shell’ and when fired, shoots a number of pellets which is why his chest and abdominal x-rays looked like stars in the night sky - almost too many pellets to count from the multiple shots. His injuries were devastating and he was drifting in and out of consciousness. The ER doc told me that he would not survive.

    Suddenly it seemed as though everyone lost interest in this case and I was left alone, in the trauma room with a man who was my age and who would most likely die soon. I maintained his blood pressure (and consciousness) with blood transfusions and oxygen until the surgeons arrived to evaluate him. I don’t remember his name but for the purposes of this story, I’ll call him “Lonnie”.

    The police officer investigating the call told me that when Lonnie left for work that morning, someone was waiting for him, across the street, with a shotgun.

    There were at least twenty distraught family members and friends in the ER waiting room and as I didn’t know how much longer he would maintain consciousness, it was critical to me that family be given the opportunity to be with him. The doctor had already explained the gravity of the situation and they were obviously heartbroken. I asked if two people would like to come see him and his parents came forward immediately. When they were at Lonnie’s bedside they told him to “be strong” and that they loved him. He nodded. Over a short period of time, all of his friends and family came into the trauma room. They prayed for him, told him they loved him and offered words of encouragement.

    Lonnie and I were alone again when he weakly asked me to get his wife. I stepped out, into the waiting room, and asked for her. Someone pointed to the woman sitting in the corner, overwhelmed in grief, staring into space and rocking herself in her chair. She was in her nightgown, still wearing pink haircurlers. Knowing that this would be her last time to be with him, I took her hand and said “come with me”.

    When we walked into his room, she stood beside him and continued to stare, tears streaming down her face. She didn’t speak a word and barely moved. Lonnie tenderly told her that he loved her. Standing almost stone-like, she did not respond. After a few minutes I brought her back out to the waiting room where she was comforted by her friends and family.

    Lonnie died later that morning.

    A few weeks later, while out shopping, I saw someone I knew (but I couldn’t figure out from where) - I approached him and said…”You look so familiar, do we know each other?” He paused for a moment and said, “You’re the nurse.” I nodded. He said, “I’m the cop.” The cop from Lonnie's room. I asked, “So did you find out who did it?” I was totally unprepared for his response, “His wife."

    According to the cop, Lonnie’s wife had promised the shooter $500.00 to kill her husband -to be paid when she collected from his Life Insurance policy.


    Snakebite

    Tuesday


    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.

    The Shoe

    Monday

    I was freshly out of ER orientation and really wanting to prove myself to be a competent nurse, when 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 and Street” meaning…“Stabilize them and get them out of the ER”. The rationale was that since you never know what will come through the ER doors at any time a bed must be available for the care of someone else. It made sense to me and it 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 is coming down do it.” (‘Dr. Surly’ is a pseudonym) 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”, I thought.1 bottle of unmarked white pills - “Wow. This is critical information, but it can wait until after he’s finished” thinking to myself. The only sound heard in the room was the ticking of the clock. Back to my list, 1 set of keys, I then 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 resist, 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 the petite woman’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 couldn't take it any more. I sat on the floor in the room, with tears streaming down my face, I was close to convulsing in laughter. Although his shoulders began quivering and he was biting his lip - Dr Surly successfully completed the LP and without a word, walked out of the room after I handed his bag back to him.

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

    Glossary;
    DFD - Dallas Fire Dept
    PTA - Prior to arrival
    LP - Lumbar Puncture

    Coming to America 1

    Friday


    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

    Wednesday




    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

    Tuesday

    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

    Monday

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

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

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


    Coming to America 5

    Sunday

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

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

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

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

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

    Coming to America 6

    Saturday

    Twist of Fate
    By the time I had started my new job at Baylor University Medical Center, I was becoming broker and lonelier by the day. I couldn’t afford taxi service anymore (so much for my new best friend, Earl). Fortunately, the assistant nurse manager of my unit offered to give me a lift to and from work. She was great but I didn’t want to take advantage of her kindness and ask her for any other favors (like driving me to the grocery store), so I became a 7-eleven junkie on my days off and ate at the hospital cafeteria when I worked. I was twenty years old with no friends, no money and with the exception of going to a job that I hated, I was stuck in my apartment day and night. What a loser.

    Then through a twist of fate, things started to turn around.

    My apartment faced a fairly busy street but the sounds of cars passing didn’t bother me as I was a heavy sleeper. One night I was awakened by the sound of a loud “BOOM”. I rolled over and went back to sleep. A little while later I was awakened yet again by the sound of sirens. When I opened my eyes, flashing red lights were outside my bedroom window. Whatever. I went back to sleep. Loud voices and what sounded like 2-way radio communication woke me up again.

    I got up to see what all the ruckus was about when I walked into my living room and tripped over one of my sofa chairs that was normally located about four feet away from my bedroom door. I hadn’t turned any lights on yet so I couldn’t quite figure out what the bright white light was coming from my living room wall. When I did turn on the light I could see that my wall was crushed in and my sofa chairs were thrown across the room. Earthquake? I carefully opened the door to my apartment, fearful of what devastation I would witness on the other side when I heard someone say “Hey! There's somebody in there!” They were referring to me. Clad in my scrubs, sleepy-eyed, bed-headed and barefoot, I stepped outside of my apartment to a round of applause, gaining quasi 'celebrity status' at my apartment complex immediately. They may not have learned my name but I was known as "the girl who slept through a car slamming into her living room."

    I guess Dallas wasn’t so bad after all. I may still be broke and car-less but at least I had someone to talk to at the pool. Part 7: Banking American-Style

    (..the lady who ran into my apartment was fine – minor cuts and bruises only.)

    Coming to America 7

    Wednesday

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

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

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

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

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

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

    We had ourselves a deal!   Part 8: Wheels!

    Coming to America 8

    Tuesday

    Wheels:
    Nursing has always has always held a certain charm for me as... a) You can always get a job and, b) You can always work overtime if you need extra money. It’s not uncommon for a nurse to calculate the number of shifts vs. the dollar amount of what it would take to purchase a little sumpin'-sumpin'. It’s just our way.

    Hospital and unit orientation was finished and I started working on the 3pm to 11pm shift. Overtime shifts were not hard to come by so I would frequently work 16-hour shifts “doubles” in order to save for my down payment.

    Within a few weeks, I had the cash in hand and called Mr. Bittner to tell him. Enthusiastically, he replied, "Go find yourself a car!” Easier said than done. Since I didn’t have a car, I didn't have a way to go find one. I thanked him for his help but before I hung up the phone, he asked “Do you have a way to get out and find a car?" Not only was he kind, he was psychic. “No, sir” I replied. Mr. Bittner then offered up his son, Danny to me. Danny was a salesman for a used car dealership. He told me that his son would call me and arrange to pick me up and take me to his car lot the upcoming weekend.

    On Saturday morning, a very handsome Danny came by as arranged and brought me to his dealership. He started his sales pitch in the show room. The cars inside were so shiny and new but a lot more expensive than what I could afford. “Your Dad told me that I can only spend $4,000.00 – including tax, title and license” I said. With that, an obviously dejected Danny walked way into the back lot. It was there that he introduced me to a baby blue 1979 Ford Pinto with racing stripes, standard transmission and no air conditioning.

    Danny: “$4000.00 even.”
    Me: “No, I don’t think so, I need A/C”
    Danny: “OK, I’ll throw in after-market A/C”
    Me: “Yeah but your Dad said I could only spend a total of $4000.00”
    Danny: “OK, let me cut you a deal for $3500.00”
    Me: “Thanks but I don’t know how to drive a standard."
    Danny: “I’ll tell you what, you buy this car and I will come over to your place every day for a week, take you back here and teach you how to drive a stick.”
    Me: "A what?"
    Danny: (perplexed) "A stick - a car with standard transmission."
    Me: “OK”

    Tragically, Ford Pintos were known to explode after minor rear end collisions and thousands of people were killed or severely injured as a result. A national inquest had been in progress for several years and if I had thought to watch the nightly news or pick up a newspaper and read the headlines on occasion, I too would have known about this serious problem. I don't think that Danny was intentionally putting me in harm's way as I doubt he had watched the news or picked up a newspaper in a while either. He was just 'moving the inventory' and was most likely was encouraged to get rid of the Pintos.

    Remaining clueless, I excitedly accepted the terms of our deal.   Part 9: Stylin' in My Pinto

    Coming to America 11

    Monday

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

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

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

    Coming to America 10


    "Blue"

    As a miserable and lonely Dallas newcomer, I had a way to get around town now with my new best friend, "Blue". Cab drivers were so yesterday. My unimaginatively named Ford Pinto possessed many characteristics of a best friend... he was somewhat reliable (and even if he wasn't - I refused to see it), was always there for me and wasn't embarrassed or shy about coughing, stuttering, gagging, squealing and occasionally (ahem) farting.

    Initially, Blue and I experienced a few 'getting to know you' challenges.

    To this day, mastering the art of gear-shifting was never my strong suit. I've never understood why anyone would want a car with standard transmission. Too much to think about while you're trying to drink a cup of coffee, smoke a cigarette and apply eyeliner all while travelling at 40 mph in the city was almost an impossibility.

    Blue was a 'no frills' sort of car and was not taking to the "after-market" air-conditioner very well. This proved to be a wee bit of a problem in the spring, summer and fall of Dallas, Texas.
    I soon learned that when the AC was turned on, Blue would 'die' at the most inopportune times -during heavy traffic, while downshifting or as we were perched on a steep incline. In fear of our lives, I chose to drive without AC for the rest of Blue's life and just let my hair go it's naturally frizzy self.

    Blue could also be a little 'sluggish' and this would prove to be problematic for us.
    In the 80's, Central Expressway, (Dallas' main thoroughfare) was designed in such a way that traffic lights were installed at the entrance ramps.
    Imagine this... we are at a full stop on the very short entrance ramp. Suddenly, the light turns green. With full foot force, I would put Blue's 'pedal to the metal' in anticipation of accelerating from 0 mph to 70 mph (within say... 30 seconds) so that we could merge onto the most inanely designed and dangerous expressway in the world. Blue was never up to the challenge but we would eventually reach 70 mph. Judging by the cacophony of horn honking, my fellow Dallasites were not amused. I would like to report getting shot some dirty looks and being able to read mouthed expletives from scornful faces but... remember the Ford Pinto's reputation for rear end collision explosions? My eyes were glued to the rear-view mirror, in anticipation of "The Big Bang". Part 11: Blue's Swan Song

    Coming to America 9

    Stylin’ in My Pinto…
    As promised, every day, Danny, (the used car salesman) would pick me up and take me to his dealership. On the first day, he started out as an enthusiastic driving instructor but by the end of that first session, I sensed he had lost his eagerness to teach. And what was the deal with that grating sound whenever I would change gears anyway? Did he sell me a lemon? Admittedly, I was not the most apt pupil so I was not offended when I had a different driving instructor (salesman) each day.

    On the final day of my driving lessons I was supposed to drive my Pinto home. I wasn’t ready. One of the older salesmen, Bill, gave me the keys and in a wise, fatherly manner said, “Look, I know you’re scared to drive it by yourself but just take it out for a spin and when you come back, we’ll have you ready to go – You’ll be fine” as he slapped me on the back.

    I returned to the dealership inconsolable. I had stalled out at every complete stop and ended up getting lost. Bill took one look at my mascara-smeared, tear-streaked face and brought me to the back Staff Break Room. “I’ve made a terrible mistake” I cried. He had me sit down and tell him “all about it”. Pouring a glass of whiskey and passing me a lit, filter-less cigarette, (I am not kidding) “Your nerves are shot.” he said, handing me the whiskey.

    Sobbing on a worn naugahyde sofa, smoking and drinking in the back room with an old used car salesman, my litany of despair and self doubt began..."I should never have bought this car in the first place – I don’t even know how to drive it.” My blabbering continued on endlessly to Bill's sympathetic ear about my lousy decision making abilities, coming to Dallas alone, not having a car, hating my job, blah, blah, blah, blah. It was clear that he had taken all he could stand from a twenty-one year old, cheap drunk. As I continued to yammer on, he silently led me outside and into my car. “Go home” he said handing the car keys to me. I was braver now and did as I was told.  Part 10: Blue

    Paranoid in South America

    Anticipating travel to South America was both exciting and scary. Admittedly, reports of muggings, kidnappings and police corruption go...