Career Geography, Part 4 (Almost Done, I Swear)

One of the things I’ve been most proud of working for the VA (Department of Veterans Affairs) is that our veterans have access to the most cutting-edge technology in the world.  There are many partnerships with research entities like DARPA and Rory Cooper and his cadre of geniuses at Brown University.  Oftentimes when the most advanced technology is released to the public, Prosthetics in the VA is the only customer as Medicare and private insurance companies are slow to respond.  If it’s approved by the FDA, the VA will provide it for veterans. A perfect example is the iBot, the wheelchair that climbs stairs. 

DEKA is a research and development founded by Dean Kamen, who invented the Segway, while trying to create the technology for this wheelchair that would raise the user to eye-level as well as help them maneuver up a flight of stairs.  It became available on the market in 2005 at a cost of $25,000.  The VA was the main customer as Medicare only covered 20% of the cost.  I refer to DEKA as a brain hive in New Hampshire.  The people working there are so smart you can hear a faint buzzing sound whenever you are in their midst.  You may know them as the people who created the gleaming silver skeleton of the bad guy in Terminator 2.

I know all this as I visited their main office when they were demonstrating their latest artificial arm technology.  My boss in DC, Fred Downs, is an arm amputee.  Even though there had been many developments in technology for artificial limbs, it was mostly with legs as arm amputees (especially from the Vietnam era) were less frequent, as most of the time a battlefield explosion that would take someone’s arm would also kill them.  As the body armor technology advanced, more and more arm amputees survived their injuries and the technology needed to catch up to that of legs.

DEKA was doing phenomenal things and had created an artificial arm that could be raised above shoulder level, a task previously unachievable.  It could also allow the user to grasp a bottle or can (without crushing it) and bring it to their lips to drink, another task we take for granted that was previously unavailable to the target audience. As Mr. Downs is a very well-known gentleman-about-DC, serving as the National Director of Prosthetics for the VA for more than 20 years and having written several novels and appeared both before Congress and in many movies and TV shows, Mr. Kamen asked him to demonstrate their latest achievement on an episode of 60 Minutes to be filmed at their offices less than 30 minutes from my office at the VA.  How could I not attend?

During my time in New England, a new Deputy had been hired in the Prosthetics office where I used to work; Dr. Billie Jane Randolph.  She had been one of the important people who had seen my presentation about success we had been experiencing in our region.  She asked if I would meet them in New Hampshire, so we could talk about possibly creating a program based on my work.  We converged on the DEKA offices and were immediately told by the 60 Minutes producer that as we had not been cleared to appear on camera, we had to ensure that we avoided being filmed.  After 15 minutes of dodging a very busy cameraman, we decided to withdraw to the employee kitchen to eat and get to know each other. 

Just like Jackie, I was immediately enthralled as BJ and I clicked.  She was from the boonies of Kentucky but had risen through the ranks of the Army and serving as George W Bush’s physical therapist in the White House.  Armed with a PhD in Education, she was a force of nature, so when she asked me to come to DC to create an education-based review and audit program I was unable to say no.    So, in February 2009, I temporarily returned to my old job for what was to be a 90-day detail. 

Once there, I jumped in with both feet, creating an auditing tool, selecting and training team members from across the agency and planning weekly visits to all 153 VA hospitals over the course of three years.  We had ranked each facility’s Prosthetic Service based on our national metrics and started with the lower performers as they needed the most assistance.  Unlike other federal audits, ours was education based, meaning if we found a deficiency, we would immediately halt the audit and have a training session with all staff, followed by a meeting with the leadership to show them how we had found the deficiencies and how to proactively address them in the future. 

As the end of the 90 days neared, I was asked to extend another 30 days to lead the first two audits as a demonstration of how they should be accomplished; Tuscaloosa, Alabama and Pittsburgh, Pennsylvania were selected, and the training commenced.  Over the next two years, my detail was extended in 30-day increments while our teams conducted audits at facilities, ranging from Alaska to Puerto Rico, Hawaii to Maryland and many states in between.  The plan was to complete an audit at every location, but after we had completed our 53^rd trip, we were asked to take a step back, review our findings and develop a national conference, sharing what we had learned, both areas of consistent concern as well as Best Practices.  We used this conference in Boston to highlight some of the best performing sites we had found, including San Diego and Fresno, California as well as Boise, Idaho. 

One of the locations I had personally audited was Palo Alto, California, one of the largest and most complex VAs in the country.  It was one of five Polytrauma Level One sites, which was the first stop in the VA for any veteran discharged with a significant injury such as spinal cord injuries, amputations, traumatic brain injuries and visual impairments.  The five were in disparate parts of the country to ensure proper triaging before being sent to their home facility.  Due to this designation and the integral piece Prosthetics plays in returning veterans to as close to normal function as is possible in their homes, these facilities (Richmond, Virginia; Tampa, Florida; Minneapolis, Minnesota; San Antonio, Texas; and Palo Alto) should have a stellar Prosthetic Service.                While there is no such thing as a perfect program, there were significant issues in Palo Alto and after my report was shared with facility leadership, I promised I would find them the right leader to take them to the level where they should be.  I tried to find the person with the right mix of subject matter expertise and leadership skills.  I reached out to those I felt would be successful, but most were unwilling to move for family or career reasons.  I couldn’t fault them for that.  I realized I knew of only one person who was both the perfect fit and a gypsy at heart; me.  I asked me if I was interested and, lo and behold, I was.  

             
               In June 2011, I packed up my life and drove across our great land, almost literally from sea to shining sea with my best friend Christopher and a 2006 Dodge Charger crammed to capacity with clothes, books and other belongings I didn’t trust the movers to deliver unscathed.

If you had told me, even six months before, that I would be living in California at any point in my future, I would have thought you were crazy, yet here I was.  Welcome to Silicon Valley, home to 15-year-old millionaire tech nerds, weirdly aggressive hippies, astonishingly over-priced tract homes and the trust fund babies of Stanford, the only university I know of with Louis Vuitton and Tiffany’s retail stores on its campus.  How would I fit in? 

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.