Category: Healthcare

Dysfunction Junction

By the time I left I could barely breathe. The knowledge of where I had been for the past three and a half years set heavily on my shoulders so that I could no longer stand up straight. It crushed my chest so that I fought to inhale and exhale. The smell of it rose like a river of filth under my nose and the dirty truth clung like shit to my shoes. My work environment was toxic and it would kill me if I didn’t leave.

I didn’t notice much at first. People seemed less friendly than they were in other departments of the same organization. People seemed to be working hard and there was plenty to do; data entry that came in a queue of requests for authorization of medical services and phone calls from healthcare offices across the entire state that rang into a queue sometimes 16 calls deep.

I’d worked in the healthcare field most of my life and by the time I transferred to the referral department I had 12 years under my belt. The training was lackluster at best. I was never given any background information about the department or how its function worked with and complemented other departments in the organization. I sat and watched as one of my new colleagues processed requests from a paper printout of part of the queue. She would sometimes explain what she was doing but it was up to me to ask questions and glean any possible knowledge.

Next I would sit with someone on the phones and listen in. The calls were mostly to check the status of pending requests for authorization. Many of the calls were easy—authorization had been given but the patients and doctors offices had not yet received the approval letter—and the call was simply about providing an authorization number. The requests themselves were also sometimes simple. A request for podiatry or massage therapy could be easily approved. But some requests were for procedures that required clinical review or a kind of review by the person processing the request. One had to know what each specific health plan would allow and also what the limitations of each health plan were (as it pertained to the specific service being requested). Some plans covered services or procedures that others would not and the employee working the queue (either phones or data entry) had to know. We had access to the riders of each health insurance plan and the riders helped identify the plan benefits and limitations.

New employees were told the learning curve would be about six months. For many it was longer than that and many would not even see a sixth month anniversary. Turnover was shocking. I saw at least five people come and go during my first year.

Mandatory overtime was frequent and surprising. I’d never been forced to work on the weekends and I thought the union would be able to help and intervene on behalf of the tired and stressed out workers. I learned that there is no union protection from OT and that (according to my colleagues) the union could claim more in dues based on extra hours worked and higher take home pay of staff.

Granted, some wanted overtime and some made a lot of money working OT, I always thought it best to be given the choice. And….why would a department of thirty people working eight hours of overtime each at least once per month not be able to make any headway on the work itself? We could never get ahead.

Management required at least 100 items of work to be completed by each employee every day. It could be 30 phone calls and 70 pieces of data entry or 83 phone calls and 17 pieces of data entry as long as the quantity by quitting time amounted to 100. Staff were assigned the permanent position of either data or phones. All new staff were placed on phones were it was most stressful but also provided the opportunity to learn the most and learn it quickly—a sink or swim kind of experience.

I actually enjoyed the phones (being the consummate customer service rep) and enjoyed talking to medical teams from Seattle to Spokane and everywhere in between. I learned my job and knew it well and found it incredibly interesting. The knowledge base needed to succeed in the referral department was broad and deep and I considered my education in the department to be equal in depth to what is was when I worked at Fred Hutch.

During my third year, with a new batch, of employees on board, and me feeling pretty well settled into the department, I agreed to help a colleague who was struggling. I would switch places with her and go work the data queue. I thought it might be nice to have a break from the constant talking and being talked to of 100 calls per day.
I had a good friend in the department, someone who transferred in just 30 days after I did. We were both being forced out of our previous jobs in Family Practice due to an organizational restructure. We both lamented and laughed about all the absurdities in our new jobs—from the piss poor training to the soul sucking mandatory overtime—to the most obvious and distressing aspect –the back biting and in fighting among staff. We were working in the most dysfunctional department we’d ever experienced. Our immediate supervisor, Gloria, knew very little of the work. If we went to her with a question she would walk us over the Lead who always had an answer. The second supervisor, Latheena, was knowledgeable but mean and seemed to actually enjoy and perpetuate the ongoing dysfunction.

If rules or processes changed , the staff were frequently the last to know and it was usually during a phone call, with a nurse from a doctors office that we would learn of changes in our own criteria. This was a frequent scenario and it left staff feeling angry and distrustful. Another aspect of the work was that if an error was found we were told to send it to the supervisor with the name of the offender. Those who made errors but were popular or feared were not as subject to this as those of us who were disliked or thought of as trouble makers. It’s funny how people will work hard to preserve homeostasis even if it’s destructive and unjust.

In working the data queue and turning in my tic sheet every day I found that I could not always reach the goal of 100 items worked. Some days I came close and produced 88 or 98 and some days only 79 or 80. I turned in my tic sheet every day and documented honestly. During my first review with my supervisor on the data side I was told that if I didn’t get my numbers up I’d be placed on a PIP (performance improvement plan). I worked harder but my numbers did not reach 100 on enough days to keep me from the threat of a PIP.
I began noticing how some people in the department, and one woman, in particular were so very social. Talking and laughing and stopping to chat and gossip at many desks every day and yet she not only is meeting quota but exceeds it every day. She even boasted that if she drank a red bull she could easily work 200 items! Everyone knew she was full of shit. But it was me—not her who was the subject of a possible performance improvement plan. I turned in my sheet every day and recorded my work honestly and with integrity, but clearly this was not happening with everyone.

Since the phone queue was the least desirable area to work but I enjoyed it and was successful there, I asked to be moved back. I only went to the data queue to help someone anyway and on any given day a current phone worker would gladly trade places and take work in data instead. My request was denied. I was being set up to fail and would indeed fail because I refused to pad my numbers.

A few days before giving notice I logged on to my computer and didn’t know what to do. I couldn’t remember my password and froze. I had to open other applications to but couldn’t remember what they were. Was I having a stroke? Was I going crazy? I was under an enormous amount of stress. I took a deep breath and closed my eyes. When I looked at the screen again I was able to proceed and get through the day. In the morning I tendered my resignation and gave six weeks notice. I needed the time to adjust to the idea and to get a jump on job hunting.

I was in free fall. I didn’t care. I could breathe again! The enormous pressure was lifted and I actually enjoyed my remaining six weeks. My former Lead on phones gave me a very nice card and said she’d never known anyone with such exemplary customer service skills and the team gave me going away potluck where almost everyone congratulated me on my “escape.” The supervisor took my company paid transit pass away and I had to ask for enough money from my coworkers to cover the train ride home. The pass could have easily been electronically disabled the next day but it gave Latheena a chance to do something mean and she could never pass up that kind of opportunity.

I enjoyed days of unencumbered freedom. I had enough money to cover my expenses for the month and I knew I’d easily find another healthcare job. What I didn’t expect was to find the job within the organization I’d just left.

I took a two -dollar pay cut and gave up 10 years of seniority. I was now an entry level medical receptionist in a behavioral health clinic. I was no longer subject to mandatory overtime. The work was easy and undemanding. I missed the complexity of my previous job but I was grateful to be out of a toxic and tragic work environment.

My friend remained in the department and has kept me posted on all the sad and ongoing events. The one good thing that came after I left was that staff no longer manually recorded their daily work by using tic sheets. The computer was used to generate a daily report of work completed and the report revealed that no one –not a single person had processed 100 items every day. I felt vindicated at last. Too bad I lost 10 years of seniority and the vacation accrual that goes with it. I’ve reclaimed the two dollar salary loss but cannot shake the memory of what it’s like to work in such dysfunction. I have since witnessed similar evidence of organizational dysfunction in other departments as well. It’s the culture of the company for which I still work. It’s the culture I hope to someday leave and say goodbye to for good. I know it’ll happen soon. I can feel the shit sticking to my boots again. And there’s this odd pressure building on my shoulders….



The Jagged Edge of Her Heart

Short Story (part one)

I knew momma was dying. She’d suffered from COPD and had at least one hospitalization every year for the past three or four years. Sometimes I’d rush to her side with a small vase of flowers, but other times I wouldn’t go and Leif (momma’s common law husband) would call in the evening with an update on her condition.
I felt nothing. Even the image my mind conjured up, with her looking scared and shrunken in the hospital bed, her belly swole up with a big liver from years of drinking, did not sway me to leave the comfort of my life and cross that threshold into hers—even temporarily. But when Leif called the next day I cried.
“The doctor says she only has half a heart left. How can anyone live with half a heart?” His pain and need of compassion left me wilted and by nine PM that night I was on my way to the hospital. Momma was at Harborview Medical Center in what was called ICU holding. It was just a big room in the basement where the sickest patients waited for someone even sicker upstairs –in the regular ICU– to die.
A dozen beds filled the room, six on the left side and six on the right. They were lined up against the wall with the foot of each bed facing inward, creating a corridor of sorts. Each bed had a curtain for privacy hung from a metal track that ran along the ceiling but only momma’s curtain was closed. I was told to wait while a team of nurses tried to tap momma’s femoral artery for blood. Because of her severe diabetes, the veins in her arms were impossible to access. An East Indian nurse pulled the curtain aside, smiled sadly and said, “We must sedate her. She is very combative and not resting for the doctor to draw blood.” That would be momma, combative even in the most dire of circumstances.
When the medical team finished, momma’s curtain was slowly pulled back and I saw her for the first time in nearly a year. She had a breathing tube in her mouth and her whole body shook as the machine forced air into her lungs. The faded bandanna she wore sat high on her forehead revealing a receding hairline that I’d never seen before. Somehow her hair loss gave me more a sense of sadness than the big box-like machine that was keeping her alive. I leaned in close to her ear and shouted, “I’m here momma. It’s me, Purslane. I’m right here!” I had a sudden memory of her ‘fixing her face’ as she called it. I watch as a little girl, fascinated. She’d spit on a cake of Maybelline mascara and transform her eyebrows into beautiful black arches. She was often told she looked like Elizabeth Taylor and even had a mole on the side of her face (like Liz) that she’d darken with the same waxy substance.
I went to work the next day, my emotions still unsettled and my mind not fully accepting of momma’s condition. At five I left and drove to the hospital. Leif met me in the lobby and I could see he was thankful that I’d come. With each step he seemed to unload a bit of boxed up pain and I could almost see it falling from his shoulders; like potatoes dropping from a bag and rolling off in every direction. His posture relaxed and he smiled and took my hand, “I told Poo you’d come. I knew you would.”
“I was actually here last night, I replied, but it was late and I didn’t stay long.”
Leif was Alaskan Native and he and momma had been together nearly 20 years. He’d gained a lot of weight since I’d last seen him and his black hair was cut with bangs straight across like one of the Three Stooges. I followed him across the lobby floor and into an empty elevator. “How ‘s she doing?” I asked.
“Oh, she’s much better since they moved her up from the basement. She seems real peaceful.”
Momma still had the breathing tube but her body was not jerking like before and she did look peaceful. The doctor had given her a paralytic agent and it kept her from fighting so the machine could do its job. After about an hour Leif needed a cigarette and I walked outside with him. The hospital sat on a hill above Downtown Seattle and the city was crisply outlined against a clear November sky. We stood across the street and leaned against a cold metal guardrail as I-5 roared beneath us.
The moist air smelled of salt and felt good to breathe. I watched the smoke from Leif’s cigarette swirl and break apart in the black sky. I looked at his profile and wondered what he must be thinking.
“You took real good care of her, Leif.”
He squished the butt of his Marlboro against the railing and wiped the black residue off with his hand, “Well, I loved her you know…”
And I knew he did. He told me how mad he was when the State approved payment for her oxygen but then took it away if she got even a little bit better.
He went on to tell me how the same thing happened when they approved a wheelchair. “Poo just laughed when the truck came to take the chair back, ‘there go my legs!’ she said.” Leif’s small hand folded into a fist and he pounded it on the railing, “Fuckin’ Welfare system! “
The next day I spent at momma’s bedside. I noticed how her feet were so cold and always seemed to be sticking out from under the flannel hospital sheet so I bought her a pair of fuzzy pink socks and carefully put them on. The nurse said I should talk to her, that she could hear me, and so I did. I told her about the beautiful tree just outside the window that still had its leaves. I told her about how blue the sky was and how nice the fall air felt and how she didn’t need to worry about Leif because I would help him. I kept talking until another nurse came in, one I hadn’t seen before, and she hung a plastic bag of something that looked like pureed chicken on the pole above momma’s head. The nurse called it ‘nutrition’ and I know momma needed it but it made me sad. Like she’d turned a corner and was taking the exit marked, leaving forever, instead of the one that said, slowly coming back.
Sometimes I just sat in the chair beside her bed without talking and I’d glance up at the clock that hung high on the wall as it ticked away the minutes in military time. I tried not to think of why a clock like that hung behind every bed in the ICU, but I knew it was to mark the time of death.
When Leif arrived I was relieved and happy to have company. We talked about the past and he told me how he’d managed to find out where momma’s own mother was living. They’d gone to visit her and stood talking in the driveway. “She didn’t invite you in?” I asked.
“She said her husband was sick and sleeping. Poo didn’t even say a word, she just stood there with a little smile on her face.”
“I never even met my own grandmother.”
“She had on a gold ankle bracelet.”
Leif grew quiet and his eyes seemed to focus on something far away. I stood to stretch my legs and Leif did the same.
We went to the cafeteria for a dinner of broiled fish and rice. I watched Leif’s face break into a big smile, revealing crooked, tobacco stained teeth. I put my fork down and asked to be let in on what he was thinking. “Poo was mad that she didn’t have a clan affiliation, so I declared her a member of the badger clan and she seemed to like that a lot.” I laughed thinking of the badger and its relentless tenaciousness and agreed it fit momma perfectly.
The next morning I awoke suddenly after hearing a knocking at the window. I sat up wide -awake and looked to where the sound had come from. The curtains were closed and I could tell it was still dark outside. The dogs weren’t disturbed and my husband, Richard was still sound asleep. The clock on the nightstand read 4:19 and I new momma had passed away at that exact time. It was her knockin’ at the window to say goodbye. I called the hospital and although momma was still alive, her conditioned had worsened and she was retaining fluid. I walked to the window, pulled the curtains back and pressed my forehead against the cold glass. I rapped with my knuckles four times. Yes, the sound was just what I’d heard, one, two, three, four, I am O.K., I am so sorry, one, two, three, four, please let me go…
The sight of momma in her hospital bed frightened me, and I could tell by the soft outline of her flesh under the white sheet that her body, so full of fluid, had nearly doubled in size. The Lasix wasn’t working and they’d have to try something else. The fuzzy pink slippers I’d placed on her feet were gone but I understood why as I watched the nurses checking the pulse at her ankles every half hour or so. I sat silently at momma’s bedside that day, too sad and overwhelmed to say a word. The hospital staff filed in on a regular basis to check the machine settings, adjust this button or that, replacing IV bags or putting drops of liquid in her eyes to keep them moist. “She has very pretty blue eyes.” A nurse commented, wiping the excess liquid that spilled onto momma’s cheeks like tears.

Copyright 2017 caceresbg

Short Story: The Upside

The Upside


I’ve been waiting for you. Patiently waiting among the sepia pages and crisp black and white edges. I don’t mind when you leave, not really. I needed a break and have enjoyed the naps, solitude and quiet and falling asleep at 8:30 and waking up at 7:30 and the ice cream and rum and cokes—but not the weight. I’ve packed on 10 pounds and quit yoga. I damned near caved in during your last visit. When the valerian root tea stopped working and I couldn’t sleep—at all. I went to see a doctor and told him. Yes I did! I told him all about you and how much I loved you and how you were there when I needed the extra energy or the words. Yes –the words. I cried a little when I told him how you helped with my poetry—our poetry. He smiled and I saw how handsome he was. He was impressed that I’d never been fired from a job because of you. I didn’t tell him that although I’ve never been fired—I have had nine different jobs at the same company in the past 15 years and it was you that gave me the confidence to make a move when I needed to. You taught me how to shine and charm my way through interviews.

When you left I spent long hours alone. I read six books and became invisible at work, grinding through each day and checking the clock every ten minutes or so. Like I said, I needed a break and I’m not sad when you leave, not really.

But a few days ago I began to sense you. I knew you were nearby! I got all riled up about some small injustice done to one of my coworkers and then last night I laughed with my husband—really laughed –hard and loud, and it felt so good. And this morning I wake up at 2. Bam! You’re back and I’m so excited. Fuck the long dark days of November.

I cut my own hair a few days ago. I did! I just couldn’t spend the money and it needed to be done. I bent over and brushed all my hair down, gathered it and cut off two inches with a pair of pinking shears. I read somewhere a long time ago that Jennifer Aniston used to cut her own hair that way. Well I’m sure it was before she was very famous and it was my idea to use pinking shears. It’s not bad but shorter in the front than I intended and the look is feathered. Oh God—circa 1975. Whatever—hair grows—end of story, no big deal.

You and I are going to have a blast this winter. I’ve missed my creative cohort and I need you to stay with me at least until the first of the year. There’s some shit going on at work and it hit the fan last week. I know, I know—your timing couldn’t be better! I need you to help guide me through the river of corporate bullshit. Without you it just rises, and rises, pulsing warm and smelly against my throat so that I can hardly breathe. It’ll be ok. I always think to myself….they’ll either fire me or promote me—ha!

I have a good analogy for how different I am with you. It came to me a few days ago just after Halloween. You see we had these glow sticks hanging on our front door and I brought them in the next day and laid them on the kitchen table. A few were still glowing very brightly and I thought—that’s me. I’m a fucking glow stick. When you’re not here I’m still me. I look the same and have all the same physical and emotional components. But something wonderfully amazing happens when you are near and something inside breaks and floods my brain with an amazing light. Neurotransmitters go wild and I’m super charged. My intellectual capacity expands, my wit and charm emanate and attract. I am a powerhouse! Even my heart grows bigger—just like the Grinch’s heart in Dr. Seuss’s story—I can actually feel it enlarging. Pounding harder and growing bigger. A cardiac erection! And when this happens I think I have it all figured out—the solution to homelessness and unemployment and the answer to why some mothers don’t love their children. I want to open a shelter that provides food and warmth and art therapy! I wan to teach the illiterate how to read! I want to help the broken souls love again.

It’s so quiet now. The clock reads 2:45 but it’s actually 1:45 AM because of Daylights Saving and I am up and alone by the fireplace just writing away and drinking a cup of tea. I put away the coffee just like I always do when you show up. I don’t mind really. The last couple times I drank it I felt sick to my stomach and I think my blood pressure rose a little too high. This’ll be a good break from all that caffeine that usually course through my veins. Don’t need it now anyway! Did I ever tell you I actually drink a full pot of coffee every morning when you leave?   I know, I know but caffeine is a drug and I guess I’ve built up a bit of a —tolerance.

I wish I understood you better. I’ve read everything you asked me to read but it all still seems so magical and mysterious. The upside to you is you—I mean me.   We are here for each other and always will be.