Career Geography, Part 3

Once I made it to DC, I entered a world that was part old school boy’s club government and part cutting-edge government.  It was an interesting time.  My boss told me he wanted me to get married, buy a house and start a family, so I wouldn’t be tempted to leave.  He really did want me for the long haul. It made me feel secure, but I also made a joke about not realizing I was supposed to get married already and I apologized for the delay and promised to “get right on that”.  I was used to being in the closet and had no problem simply pretending that I was either too fat or too ugly to find a girlfriend.  It’s what you do, when you are of a particular persuasion.

My first task was to train my co-worker Neal in all things Prosthetics.  We spent the first month or so, in side-by-side cubicles (waiting for our offices to be remodeled) while I regaled him with my abundant knowledge.  Not really.  We did become fast friends, bonding over fried foods and Star Wars. At one point I sarcastically referred to him as ‘Junior’, since he was eight years younger than me.  He responded by calling me ‘Scooter’, for reasons known only to him.  I laughed, but when he introduced me to his girlfriend, Jenn, as Scooter, it became my official east coast nickname.  In DC, as well as Central TX and Central PA, I was (and still am) called Scooter.  So much so, that at their wedding in Savannah, GA in 2011, Jenn’s mother (the incomparable Toni Montgomery Grupp) heard someone call me by my name and asked me, “Who’s Dustin?”

I was suddenly thrust into a position where I was making presentations to large groups of people across the country as well as working directly with people who had been in the VA longer than I had been alive.  The speeches caused me no concern; however, I struggled with the one-on-one interactions with people who didn’t think I had “paid (my) dues”.  A talent for self-deprecating humor, while not necessarily great for my confidence level, gave me an edge over my fellow youth with these Baby Boomer, especially when it was coupled with my middle-aged body shape. 

During this time, I was diagnosed with sarcoidosis, the lung condition that had led to my mother’s death in 2000.  In my initial shock, I never questioned my doctor’s prescription of 60 mg of Prednisone (a steroid) per day.  It caused my physical state to crumble at an astonishing rate.  I began to gain weight almost daily.  The weight gain exacerbated my already painful arthritis.  I had flashes of heat (like I was experiencing menopause) and of anger.  My best friend, Christopher, was my roommate and de facto nurse, having changed his mind about a career as a chef in France, opting to move to DC instead of returning to Mississippi.  I also became diabetic but as my doctor had tested me before the steroids (and I was not diabetic), he didn’t treat it as he assured me it wasn’t diabetes causing my symptoms.  When I finally visited the emergency room after a particularly brutal day, they tested my blood sugar and it was 600.  To give you a frame of reference, Patti LaBelle went into a coma when her blood sugar was 500. 

I quickly switched doctors and he began to slowly wean me off the steroids, but he told me I needed to move somewhere with better air quality; less pollution.  He repeatedly told me, “DC is a tidal basin, swirling with pollution, Dustin, you’ve got to move.”  I mean, what do you do with this information?  I couldn’t just tell my boss, “Thanks for the life-changing opportunity.  Remember when you said you didn’t want us to be tempted to leave?  Well, I’ve got this doctor’s note…” 

But, you do what you have to do and when I explained to Mr. Downs the situation, he was very supportive and told me there was an available position in VISN 1, in New England.  VISNs, you remember from the last post, are like regions.  VISN 1 comprised eight medical centers in six New England states; the main office being housed on the campus of the Bedford, Massachusetts VA, about 25 miles north of Boston.  So, I traveled to Bedford, interviewed and was selected for the position of VISN Prosthetics Manager.  In between the five hour-long interviews required for the position, over the course of one day, I chatted (and bonded) with Marion Felix-Jenkins, who would become a very close friend.  Several people told me I should live in Nashua, New Hampshire, because they had no state tax and no sales tax. 

Nashua is called the “Gateway to NH” because it literally sits on the border, at Exit 1.  It is so close to Massachusetts that the southern-most section of the parking lot of Nashua’s Pheasant Lane Mall is actually in Massachusetts.  My commute would be about 15 miles each way, which took about 20 minutes, if you left early enough.  Much, much better than DC traffic to be sure, but as it was January in New England, there was snow; lots and lots of snow.  So much snow that a little over a month after we arrived, Valentine’s Day weekend, there was a blizzard. 

No one seemed to be bothered by what I considered to be very heavy snowfall.  I guess it was the trauma from the Lake Effect Snow in Cleveland, but when my car was almost covered by noon, I said, “I’m from Mississippi and this snow is crazy and I’m going home!”  The commute that normally took 20-30 minutes, took 3 hours that day, including the 10 minutes or so it took to loosen my fingers from the death-grip I had on the steering wheel as I was determined to avoid the ditch like so many others I saw. 

One of the things I have learned in my career is that if you want to find out how to improve things, ask the people who are doing the work.  So, I made a quick tour of the eight facilities, meeting my new staff and asking what they needed from me, what plans they had to improve their metrics (I had researched their data and knew there were significant challenges) and where they saw themselves in the next five years.  I listened and learned and let them try their ideas.  Most weren’t successful.  I had some ideas myself and introduced them at a joint meeting.  Not everyone liked my ideas, so I made them a deal.  I would give them one month to make improvements in their metrics using their ideas and if there wasn’t any improvement, they would agree to try my ideas for one month.

When only on facility showed any improvements, we implemented my ideas which I based on the reviews I had made at all facilities within my first month.  I put together a program that focused on standardizing work processes, redesigning their compliance systems and focusing on face-to-face training for the staff) and had immediate improvements.  We went from one of the worst performing VISNs to one of the best in a span of three months.  We even had one facility (Togus, Maine) that was selected as Prosthetics Service of the Year for the entire VA nationwide. 

These results caught the attention of my VISN’s leadership who selected my program as a Best Practice.  They submitted my ideas and results to Central Office and I made a presentation to a whole lot of important people via teleconference, including the Deputy Under Secretary for Health for Operations and Management, who named me a Best of the Best Practices for VA.  I then made another presentation to even more important people in DC.  While I was succeeding in my career, my health was continuing to spiral.  I was trying to manage my diabetes, but my weight had ballooned to 400 pounds and I developed neuropathy.  I also developed sleep apnea.  I was physically exhausted many days and would nod off each time I stopped at a red light when I was driving.  This was not going to end well.

Fortunately, a taping of 60 Minutes in the offices of the guys who accidentally invented the Segway, would change my life in unforeseen ways.