He Won't Bite

The Joint Commission on Accreditation of Healthcare Organizations has arrived at my facility for their triennial visit.  Happily, for the first time in my 20-year career, I don’t have any programs under my leadership that are part of this inspection/review.  

I spent 14 years of my career in Prosthetic and Sensory Aids, which is a department somewhat like a pharmacy but for home medical equipment, like artificial limbs, hospital beds, wheelchairs and computers.  We also provide services such as home oxygen, which requires periodic visits to veterans’ homes to ensure that they were receiving the proper equipment, it was working as it should and the customer service from the contract provider.

When I moved to New England in 2007, it was to take over the management of Prosthetics at the eight VA medical centers in the six most northeastern states.  In 2008, we hired a new manager (Rick) at the VA in Manchester, New Hampshire.  As he was new to Prosthetics, I would meet with him each week to train him on the different aspects of his service.  As I am a hands-on trainer, my method would consist of having him observe me, having me observe him and then fine-tuning everything before signing off on the training.  My oversight is full-service, y'all.

As any mailman, UPS driver or Mormon missionary will tell you, the biggest danger in unknown homes is the dog, not the potentially crazy homeowner.  Through trial and error over several years, I learned that dogs can be dangerous and their owners, delusional.  My advice was always to ask the homeowner to put their animal (dog, cat, emu) in a closed room prior to entering their home for the very quick and efficient visit.  The plan was never to be in the home more than 10 minutes.

On the first training trip for Rick, we arrived at one of those charming cottages scattered throughout picaresque New England.  We rang the doorbell and unleashed the unholy barks of what could only be described as either a pack of wolves or one angry mutt with a karaoke microphone.  He/She/It was loud, people.  L.O.U.D. 

When the elderly veteran’s wife appeared, she opened the wooden door but left the screen door shut to my great pleasure.  I introduced Rick and myself and told her why we were there and then asked, ever so politely, if she could put her dog(s) in another room while we made our very quick equipment check.  She responded, “Oh, he won’t bite.”

I smiled and said, “I’m sure he won’t, but we would feel safer if you would.”

She smiled a blank smile and said, “Oh, he won’t bite.” 

I smiled, again, and said, “If you could put him in another room, that would be appreciated.”

From behind her, her husband said, “Just put him in the other room!”

“Thank you,” I said to the disembodied voice in the background.  I placed my hand on the screen door handle to keep her from opening it up, just in case Cujo (my name for him) wanted to say hello.

Still smiling, she repeated, “He won’t bite.”

By this time Cujo had made it to the door and was jumping against the screen door, barking furiously.  I backed away from the door, Rick having already, wisely or cowardly, walked to the safety of the car.  I kept my hand on the screen door handle and said, louder (which I’m sure didn’t help to keep Cujo calm), “Can you please put your dog away, ma’am?”

Again, she said, “Oh, he won’t bite.” 

I decided to abort our attempted visit and turned to run to the car.  Well, I don’t think what I attempted was actually running, but let’s just say it was.  As my hand left the screen door handle, Cujo made his move and hurled himself out the door and immediately ran toward me.  Rick jumped into the car, while I turned to defend myself.  Cujo leapt up and bit me on the stomach, through my coat, sweater and undershirt.  I screamed, “Call off your dog!”

She replied, “Oh, he won’t bite.”

“Lady, he is literally biting me right now,” I yelled while bashing Cujo on the face and snout and ears and whatever else I could make contact with to get him off me and keep him from ruining my sweater.  As someone who, at the time, wore a majestic size 5X, it was increasingly difficult to find cute clothes in that gargantuan size.  I needed to keep what I had.  I was yelling and beating Cujo with all the strength I could muster, which admittedly was not enough.  He either enjoyed trying maim me or got his teeth caught in the lovely wool of my Ralph Lauren cable-knit sweater in Cranberry, but he was not letting go.

I screamed again, “Get him off me!”

She repeated, “Oh, he won’t bite.”

I finally landed the right combination of yelling, hitting, running in a circle and praying and Cujo released me and fled down the street like a prison escapee. 

I stared at Rick, then the lady, turned to watch Cujo as he disappeared in to the distance and could not form words that were proper, government-sanctioned or even remotely Evangelistic or Jesus-approved, so I just sort of waved at the house and got into the car.

As I shut the door, I heard her ask, “Did you get what you needed?”

“Yeah…Sure…Aaaah,” I mumbled giving her a thumbs-up, knowing deep in my heart of hearts I wanted to share a decidedly different digit.

I turned to Rick as I started the car and said, “Just so you know.  That isn’t the worst home visit experience I’ve had, although it’s in the top five.  At least this one didn’t break the skin.  I should write Ralph Lauren and let him know his sweaters can stand up to dog attacks.  Maybe I’ll be in a commercial.”

                Rick retired not long after.

                I haven’t missed Prosthetics for even 10 minutes, y’all.  True story.

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.