Desert Adventure, Part 3: Orientation at the Indian Hospital

Starting my first shift at the Indian Hospital was an exercise in uncertainty. I did not know what to expect. Having worked for the better part of a decade at my previous hospital, I was pushing myself out of the comfort zone that inevitably forms with staying in one place for a long time. After encountering a bloated carcass and being nearly drowned, struck by lightning, and beaten to death by hailstones, I walked into the Emergency Department of the Indian Hospital with a vague sense of unease.

Seeing the layout of the department, it occurred to me that this five-year-old building followed a thirty-year-old "horseshoe" design. Most concerning was that the two "thrash" rooms were the farthest away from the charting area. They were cramped and did not allow for much movement around the beds. On the plus side, the rooms each had computers. I was also struck by how small the department was. This 11-bed department was a far cry from the gee-whiz state of the art 40-bed ER where I had previously worked.

I found the charge nurse, who greeted me warmly and instructed me to report to the ER Manager's office in the back of the department. I knocked on the door and was invited in, where I came to stand before a pudgy, bookish fellow who was busy studying some papers through narrow reading glasses. He said nothing for nearly a minute; he did not look at me, and he did not invite me to sit. When at last he put down the document, I saw that it was a flyer for an upcoming rodeo.

Finally, the manager peered at me over his reading glasses, but said nothing. I was becoming less impressed with the man with each passing moment. After another long interval, he handed me a manila folder, inch-thick with forms, and spoke.

"Here is your orientation packet. Return the completed forms to me by the end of your first week. You'll be working 0700-1930, seven days on, seven off, starting next Monday. Today and tomorrow you will be orienting to the unit and the hospital, then you have the weekend off."

Having finished speaking, he turned to his computer and began typing for a few seconds, stopped, then looked at me again over his reading glasses.

"Was there something you needed?"

"I was just unsure if we were done here," I replied. The manager blinked a couple of times, sighed, and returned to his computer.

"Please close the door behind you."

Well, this should be an interesting three months, I thought as I returned to the nurses' station. Seeing the charge RN again, I formally introduced myself. She stood up and offered a firm handshake and a warm, cordial smile. She was one of the very few Navajo RNs who worked at the hospital.

"I'm Lucille. Welcome."

"Thanks. I'm looking forward to learning new stuff," I said.

"Oh, I doubt you'll see much," replied a nurse who approached us. "Nothing ever happens here."

I studied my new colleague: she was pasty, sweaty, tired-appearing, morbidly obese, and smoked heavily, as evidenced by her hoarse voice and stale tobacco breath. Her voice also had a vague slur to it. Her name was Vera. She didn't smile for her badge photo, either.

"What kind of cases do you see most often?" I asked.

"Drunks, non-compliant diabetics, fights, and drug-related stuff," Vera replied with a dismissive wave of her hand. If you want to learn anything or see something exciting, you came to the wrong place, sweetheart." Having spoken her piece, Vera turned and propelled her ponderous bulk around the corner and out of sight.

I turned to Lucille, who simply shrugged and explained, "That's just Vera."

Lucille poured a cup of some dark, hot, acrid liquid presumed to be coffee, and offered it to me as she gestured for me to sit down with her at the desk. She picked up my folder with a grunt, dropped it on the desk to land with a heavy thud and sighed.

"That packet gets thicker by the week. But before you get started on that, we need to get you up to Security for your badge." She turned and called another nurse over. "Mary, this is William. He's a new travel nurse."

Mary smiled engagingly and offered her hand. Like Lucille, she was Navajo, and the only other native nurse in the department.

Lucille continued: "I'm going to take William to Security for his badge. Will you watch the unit for me?

"Sure," Mary replied.

As we walked through the hospital, Lucille pointed out the various departments and clinics. The main lobby was naturally-lit, and its walls were adorned with beautiful murals depicting Navajo culture. The place was cool and had a peaceful air.

"I heard that the hospital administration is being taken over by the Navajo Nation."

Lucille sighed and answered, "Yes, but it's opened up a whole set of problems for us."

"What kind of problems?"

"Well, for starters, did you notice all the moving vans in the IHS housing area?"

"Now that you mention it, yes. Are these people moving in?"

Lucille laughed. "No! They're all IHS staff leaving. If they stayed on, they'd be losing their GS pay scale and would be taking a big cut in income. So they decided to leave in a mass exodus, since all their assignments ended at the same time. We've lost about ninety percent of our staff, and now we're scrambling to find replacements."

"Didn't the administration see this coming before they took over?"

"I don't know," Lucille answered with another shrug. "Maybe they assumed that more IHS people would transfer over. That certainly proved not to be the case."

"What are you going to do?" I asked as we arrived at the Security office.

"Hire lots of travelers and hope we can find more permanent staff."

Security was crisp and efficient as they processed me and took my picture. In less than five minutes, I walked away with a shiny new badge. The picture looked better than I hoped. I'm not the most photogenic guy on earth, after all.

Lucille walked me over to Information Services, where I got my logon and password for the hospital's internal and email systems and the computer charting program. Upon our return to the ER, Lucille paired me with Mary, would would serve as my preceptor for the rest of the week. Mary sat me down at an open computer, had me log on and make sure my passwords were working, and said, "Just do your paperwork for now. We'll go through the department later."

My interlude with the paperwork turned out to be short-lived. Mary approached me and informed me that we had three ambulances coming in with assault victims. Alcohol was involved. On top of that, the waiting room was beginning to fill up with patients referred to ER by the clinic. Lucille was talking heatedly to the clinic RN:

"Why are you sending your patients to us... You're too busy? I'm looking at your census right now. You're not even half full! How can you be too busy if you are fully staffed and only half full!? Oh, the doctor told you to divert the patients. What's he doing right now... planning a rafting trip? PLANNING A RAFTING TRIP!? That figures. Oh well, nothing we can do about it, then. Yeah, I'm sorry too. Tell your jerkwad of a doctor that the ER sends our regards."

Lucille slammed the phone down the receiver and groaned. She looked at me and said, "Your orientation is over. How fast can you pick things up?"