Chest Pain Radiating to the Shoulders & Neck - A False Alarm (part 2)

Presbyterian Intercommunity Hospital-Whittier

The first part of this post is here: http://aboutlifeandrunning.blogspot.com/2015/02/chest-pain-radiating-to-shoulders-neck.html

It took barely half an hour to arrive in Presbyterian Intercommunity Hospital – Whittier (PIH), and I calculated that if the ambulance travelled at 60 MPH, then the distance must have been approximately 30 miles. In the ambulance with me were two paramedics and a registered nurse. According to one of the EMT's, normally an RN is not included but since I was considered critical transport, the RN was a requirement for this particular ambulance company. When I was unloaded at PIH, it took a while to find the unit I was being sent to due to the huge size of the hospital. All we knew was that I was going to room 3001 which meant it was on the third floor. But the third floor of which building was the question since the hospital had two buildings. Eventually we found it and I was offloaded from the gurney to the hospital bed. Lucky for the ambulance staff, they didn’t have to lift me and even if they had to, it would have been too easy for them since I’m only about 120 pounds soaking wet.

Hospital Care Kit

My private room and bathroom was spotless and a care kit sat on the bedside table. The usual items in an admission care kit like a basin, pitcher, tumbler, toothbrush, toothpaste, body wash/shampoo, lotion, mouthwash, and a full size box (!) of Kleenex  were already at my tray table when I arrived at the hospital. What was an unexpected surprise were a few additional personal touches to enhance a patient's comfort like an eye mask, ear plugs, and lip balm. Nice job PIH! The only thing I had trouble finding was the remote control for the TV and the wall lights. The next time the CNA came, she showed it to me - it was stowed in a receptacle under the bed. The visitor’s bench on one side of the room also happened to be a pull out bed in case a relative or friend wanted to sleep over.

My hospital bed

The nurse came and introduced himself (Rafael), hooked me up to a Holter monitor, checked my heart and lungs, did a stroke assessment, then asked me about my medical history. He said a hospitalist (doctor) was coming to see me shortly. Rafael come back later to swab my nose for an MRSA (methicillin resistant staphylococcus aureus) test. He said they had to do it whenever a patient was transferred from another hospital. He reported later that the test was negative. Meanwhile, I fired up my computer and connected to the hospital wi-fi hotspot. I hope I did the sequence correctly: call 911, stabilize in the ER, get admitted to the hospital, then post to Facebook, instead of the last one being done first. Well, I couldn’t connect to the wi-fi in the ER so…

The hospitalist came, listened to my heart and lungs, asked questions, did another stroke assessment, then went to the nurse’s station to write his orders but first I asked him if the nurse could give me a snack or if I was supposed to be NPO for the anticipated tests in the morning. Thankfully the CNA came back with a turkey sandwich and milk. It was my first meal since noontime the previous day and it was already 3:30 a.m. While I was eating, my brother apparently read my post on Facebook and tried contacting me via Skype video chat, but I had turned my computer off while the doctor was talking with me. When I turned it back on, I saw the missed call but before I could call back I had to update Skype first. When we finally connected, my brother Larry and his better half Ninette said they had just gotten back from out of town when they saw my post. We chatted briefly and updated them on my condition, then I tried to get some sleep by about 4:15 a.m. Alas, my body reverted to night shift mode and only slept for about an hour. The nurse came to ask me if I wanted the alternating pressure device attached to my legs to prevent stasis and blood clots. I declined and told him it wasn’t necessary since I expected myself to be moving around anyway.

The phlebotomist came next and I asked her about the blood test and since it included blood sugar and cholesterol levels, I informed her that I had eaten only two hours prior. She said she was going to note on the computer that it was a non-fasting result. Soon shift change came and I met the day shift nurse, Emily. To my surprise, Rafael, the night nurse gave report about me in my presence. I have never experienced that before. I told Emily that I was an uncooperative patient because I refused to wear the alternating pressure device.

So this is how Monday morning went: breakfast was served and as I was about to start eating the orderly or transport aide from the radiology department came by to pick me up for my head MRI. He was nice enough to give me a few minutes to eat. I was supposed to be on a cardiac diet (low fat, low cholesterol, low sodium) so it was surprising to see eggs and sausages on my plate. I haven’t eaten those things in years!

Then I was transported downstairs on a wheelchair down long hallways until we reached the MRI room. They were finishing up with another patient, then it was my turn. They checked me for metal objects so they put aside my partial denture and I let them know that I had a metal plate on my left ankle which has been there since 1972 when I broke it in a motorcycle accident. The technician said it was okay. I was pre-warned of the noise of the machine and given earplugs and an ear cover. Pretty soon, the machine started thumping and I started to get anxious. My pulse rate went up and I tried to slow my breathing down. Then suddenly I realized, it wasn’t so much that my heart was beating so fast and hard but it was the thumping of the MRI machine, so I just concentrated on relaxing. Pretty soon 14 minutes in the claustrophobia causing machine was over, and I was wheeled back to my room. It took so much concentration to keep me from jumping out of the machine in the first couple of minutes.

When I got back to my room, I asked Emily if I could walk up and down the hallway for at least half an hour so I don’t miss my daily workout and so that what is reflected on the Holter monitor would mimic what I would normally do at home. She okayed it but told me that if I started having chest pain or dizziness, to alert the closest nurse. With that, I started my walk. I encountered a therapy dog on my first lap and let it smell the back of my hand, then I continued my walk. Alas, it only lasted for 6 minutes. Did I have chest pain or dizziness? Well, no. I saw someone enter my room with a machine so I followed her. The cute girl told me I was going to have a Lexiscan. I asked, who is Lexi and why is she going to scan me? Two other technicians showed up while I was being hooked up to an EKG machine and something which I found out later was the Lexiscan was injected in my vein. While the 3 techs monitored me, my attending physician showed up and I gave him a fist bump instead of shaking his hand because it's better for infection control. He asked me a few questions and told me that my MRI was normal. There was no sign of a stroke that the other hospital may or may not have seen on the CT scan. That was another good news in addition to my normal troponin levels. I was to be taken downstairs again later for a stress test which did not involve a treadmill. The Lexiscan nuclear dye would take care of detecting any abnormalities in my heart and circulation. If you want to learn more about Lexiscan like I did, just look it up on the internet. Shortly after, another phlebotomist came to draw blood for CK-MB test.

I went back out to the hallway still wearing a hospital gown, reset my stopwatch to zero and started my walk again. This time there would be no more interruptions other than dodging nurses, doctors, housekeepers, and visitors in the hallway. Fortunately I wasn’t accused of indecent exposure since I wasn’t wearing anything underneath the gown. I should have asked for a diaper to provide more coverage rather than go commando. I completed 35 minutes and decided that was enough. A nurse's aide came to my room to bring me gray hospital socks so I can wear them instead of the red ones which came in my care kit. She said red socks were for patients who were at risk for falling and after seeing me power walking in the hallways, she didn’t think I was one. I jokingly told her I could fall for her so the red socks would be justified. She said I better not. When I saw her again a few minutes later, I changed the tone of my voice and told her – I could fall for her (as in love). Jokingly, of course J

COW-Computer On Wheels

While walking up and down the hallways of the telemetry unit, I noticed there was a COW (computer on wheels) in every room running e-MD, an electronic medical records system. I’m used to the Cerner and Epic systems. Aside from e-MD, the staff used Vocera to communicate with each other, it was attached to their lapel or scrubs near the neck area then they would mention the name of another staffmember and the system automatically connects to the other person and they can talk to each other. I won’t be surprised if the Vocera is also connected to the patient’s call light.

Lunch-Barbecued chicken breast, mixed veggies, mashed potatoes, oatmeal raisin cookie

Lunch came soon and I checked with Emily if it was ok to eat. She said yes and that the only thing I can’t have is caffeine because it affects the Lexiscan test. Trying my best at being a model patient, I even took my tray back to the dietary department cart out in the hallway and let my nurse know that I ate 100%. While I waited to be picked up for the test after lunch, a social worker stopped by to ask me if I had an advance medical directive. I said I didn’t but had a POLST (physician’s orders for life sustaining treatment) in my doctor’s office. She said that if I was interested in filling out an advance directive she could bring the forms for me, help me with it and have it notarized for free in the hospital. So I asked her to bring me one. Since she was a social worker, I also asked if they assisted patients with transportation if nobody was able to pick me up to take me home. She said they did and I requested the service. She came back with the blank advance directive which I proceeded to fill out. By the way, an advance directive is a legal paper filled out by a patient on what his wishes are if he becomes incapacitated and cannot make medical decisions for himself. The patient also assigns another person to make sure that his wishes are carried out.

Then an echocardiogram technician showed up and she did the ultrasound test while I lay on my left side. A few minutes after she left, I was finally wheeled along even longer hallways to the nuclear medicine department. The myoview/lexiscan test was done while I was lying supine first, then in the prone position. I was sent back to my room to await the results and if everything was clear, I was to be discharged.

I saw the social worker again and asked if the notary public was still available to witness my now completed advance directive. Unfortunately he was gone for the day so my advance directive is still unofficial until witnessed by a notary or two other uninterested parties.

Emily came back to see me at about 4 p.m. and told me my myoview/lexiscan stress test was negative for abnormalities and she would be preparing my discharge papers as well as arranging for transportation. I tidied up my hospital room before getting discharged and took home the care kit because when I asked the CNA if they wanted to return items I didn’t use to the supply room, she said they were going to automatically throw them away.

At 5 p.m. came and unhooked my Holter monitor, removed my IV access, then walked me downstairs to the lobby where the taxi driver was already waiting for me. I thought it was a hospital van that was taking me home and was surprised it was a taxi. I jokingly asked Emily if they used Uber to transport patients. I thanked her for taking care of me and bid her goodbye. Then I boarded the taxi, chatted with David, the driver as he entered the 710 freeway towards Long Beach. Because it was President’s Day, traffic was light and we arrived at my home in about 25 minutes. Thus ended my latest bout with chest pain false alarm.

It was reassuring to know that after all the necessary tests have been done, the chest pain, burning sensation in the neck and shoulders, and dizziness had nothing to do with my heart and brain.

However the cause of all the pains I've been experiencing remains a mystery as it is still happening two weeks after my trip to the ER and one day of hospitalization.  It could be that my body is suddenly reacting differently to exercise now and the soreness is not what I used to experience.

Random notes and observations: Just realized that I had this problem on National Heart Month.

If anything happened to me while I was by myself at home, I might not be found until weeks, months, or even years later, which has happened to other people and became news items.

With two IV sites and four blood draws, my arms look like a heroin addicts’.

As much as possible, I try to minimize my impact towards the world and my relatives and friends because as much as I dislike inconvenience, I do not want to inconvenience anyone either.

This is about the 4th time I've had a false alarm in the last 15 years or so but I've never really told anybody about it, not even my immediate family. Of course there was no Facebook when the first two happened.

I was surprised that neither the ER nurse nor the Telemetry nurse asked me if I was out of the country recently as required by the ebola screening process. Maybe because I didn't have a fever.

I think the reason why I couldn’t be accommodated in any hospitals near my home was because while I was at the emergency room, there was a drive by shooting in Long Beach where 5 people were shot and in another incident, a man in a wheelchair run over by a car.

When I was having those frequent pains, it made me more grateful when I was able to wake up in the morning still alive.

Part 1 of this post can be found here: http://aboutlifeandrunning.blogspot.com/2015/02/chest-pain-radiating-to-shoulders-neck.html

Chest Pain Radiating to the Shoulders & Neck - A False Alarm (part 1)

In the past month or so, I had been experiencing some tightness in my chest, burning sensation in my shoulder and neck muscles, along with dizziness which I can describe as similar to turbulence while flying in an airplane. I’ve always rode it out rationalizing that it was just muscular pain and my inner ear problem which happens from time to time but always suddenly disappears for months at a time. I couldn’t account for the burning sensation though. I finally made a doctor’s appointment and told him about my symptoms. Blood was drawn and the doctor’s office was going to get a preauthorization for a treadmill stress test. My lab tests turned out to be normal except for a slightly elevated creatine kinase (CK), and bilirubin. When I asked the doctor about this, he said those numbers were nothing to be concerned about. In the meantime, they were still waiting for the insurance company to respond to the preauthorization request.

On Sunday morning, February 15^th, I felt the symptoms worsen in the morning, then thinking I might be hypoglycemic, I ate 3 pieces of toast and lay down on the couch for a few minutes, which seemed to help, before I started my workout. Because of the way I felt, I only did a low intensity workout on the recumbent stationary bike and kept it to my minimum of 30 minutes. I had lunch afterwards then watched a video. At about 2 p.m., I started feeling the symptoms again and it worried me. Perhaps it was time to call 911 before anything worst happened. I picked up my phone (Majicjack) and there was no dial tone, so I disconnected the USB cord then reattached it. I dialed 911 and was transferred to the paramedics line. After a few rings, I got cut off! I dialed again and this time the paramedic dispatcher answered and verified my address and was told the paramedics were on the way.

Initially, 3 medics came, then at least 7 more showed up. I said, darn, how many units rolled? One of them said “The city of Long Beach considers you a very important person”, which made me chuckle. They said they were going to take me to a hospital. On the way out of my apartment on the second floor, the paramedics asked me if I was able to walk down the stairs towards the gurney. I said yes. I was already attached to an EKG machine with the wires on my chest. The paramedic holding the EKG machine led the way and I said to him, "this must be how a dog feels on a leash". He laughed and said, "oh, still cracking jokes huh?"

As I was being loaded into the fire department ambulance, the medic mentioned that I was going to be taken to Pacific Hospital of Long Beach (now College Medical Center). I asked if I can be taken to Memorial Hospital of Long Beach instead or Community Hospital of Long Beach where I work. He said that the only emergency department that was would be able to take me is PHLB because the others were busy. So off to PHLB we went, the same hospital that laid me off a year and a half ago, with an ER that I did not exactly trust based on my observations when I used to work there. The medic gave me three sprays of nitroglycerin 5 minutes apart and had me chew and swallow 2 baby aspirins. Time of arrival in PHLB: 3:15 p.m.

The thing with chest pain is that you get seen by the nurse or doctor right away, or so you would think, but since I was still conscious, did not appear to be in distress, with a heart that was still beating, I wasn’t seen as quickly as I had been in my previous hospital visits. I was transferred from the paramedic gurney to another gurney right next to the holding room where the psych patients were waiting to be medically cleared before being transferred to the psych unit. I was hooked up to an EKG/blood pressure/pulse oximeter machine which emitted beeps every few minutes signaling something amiss with my heart. Either that or the machine was not detecting accurately. Blood was drawn, a chest x-ray was done, then a CT scan of the head. I had sent a text message to my cousin Maryann informing her that I listed her as my emergency contact. Shortly, she and her husband Mike showed up at the emergency department and I updated them on what was going on. They were surprised to observe what appeared to be homeless people in the waiting room and the behaviors of the psych patients a few feet away from my bed. Believe me, I experience that every day I’m at work because that’s the population we mostly treat.

Before Mike and Maryann showed up, I heard a policeman mention a 5150 to any designated LPS facility and asked one of the nurses what LPS meant. The nurse didn't know, so being the show off that I am, I proceeded to explain that LPS stood for the Lanterman-Petris-Short Act which basically says that no one can be involuntarily committed to a psych hospital indefinitely unlike before. For more detail, you can read about it here: http://en.wikipedia.org/wiki/Lanterman%E2%80%93Petris%E2%80%93Short_Act . 

In the meantime, the admissions staff was trying to get authorization from the insurance company to admit me for observation or transfer me to another hospital within their network which have prearranged contracts with the insurance company. That took hours probably because it was a Sunday and the following day was a federal holiday (President’s Day). I was offered morphine for the chest pain which I declined because I felt it was too strong a medication for me, so I was given a couple of baby aspirin. I was told that my troponin level was normal but the CT scan showed a possible mini stroke very recently, however it was inconclusive.

When the insurance company finally gave authorization to transfer me, I thought I would be sent to Memorial Hospital which was only about a mile away and because it was part of their network. Instead I was being sent to Presbyterian Intercommunity Hospital, and I was thinking the one in Downey, but then I was mistaken again and was told it was the one in Whittier which was much farther away from home. Maryann and Mike stayed until 10:30 and when I learned of my transfer, I sent them a text message update. Thank you so much Mike and Maryann for staying with me for a few hours. The ambulance arrived at midnight and shortly after, I was being whisked from Long Beach to Whittier. I learned later why none of the other Long Beach hospitals couldn’t take me.

To be continued in Part 2, as this entry is quite long already.

Ruminations While Being Unemployed

As our final paycheck day approaches at a rather glacier-like pace, what has occurred in the past three weeks of mostly sitting around?

Is it a good idea to go to employers' place of business when you can fill out applications online at home? Most employers direct you to their computers to fill them out anyway. There are some positions that are not posted online though, and employees usually hear about them first or are posted in human resources offices.

Herein is the power and convenience of the internet - questions like: do I qualify for unemployment insurance, how much will I expect to receive?, is it taxable income?, how many weeks can I collect?, etc. These may be questions that you might forget to ask the human resources department when they issue your last paycheck. These things pop up in my mind at random times of the day.

After a call from a coworker asking about severance pay, I told him I don't remember seeing it in the personnel handbook which was last revised in 2009. So after his call, I dug out the Human Resources handbook from my filing cabinet and I was surprised that there was a section about severance pay, although it wasn't fully explained but rather just referred to an obscure line mentioning a policy and procedure number. So off to the portal I go (and I'm glad this is still accessible). The search function didn't reveal anything but with further exploration, I found the policy and procedure manual with the aforementioned obscure number. Basically what it says is that the company does indeed a policy for severance pay but it's up to them to decide whether to pay it or not. The policy doesn't even have a calculator which shows how many weeks of severance pay to be given based on how many years of service to the company.

Here's an idea: since it's been chaotic at our former workplace and if we really want to help our former PHLB co-workers, we can sign up with the registry College Hospital uses and tell them we are available to work at College Medical Center. Provided of course we are not in their do-not-return list.

My excuse used to be I didn't have time to go places because I was working a lot. Now that I have the time to go places, my excuse is that I don't have the money to do so.

Time to compile my duties and responsibilities as a Behavioral Health Worker by copying and pasting from my blog and adding it to my resume.

Also time to consolidate bank accounts to lower the monthly balance requirements so I can avoid monthly maintenance fees. That's because I'm losing direct deposit of paychecks which the bank requires in waiving the monthly maintenance fee. Better still if I move my account to a credit union since their balance requirements are much lower.

Should I sign up for the Affordable Care Act, a.k.a. Obamacare so I can have health insurance next year? I've blogged about this earlier this year: An Obamacare Loophole For Early Retirees?

And lastly, should I pay off my mortgage with whatever savings I have left to decrease my monthly overhead drastically? How many months will the leftovers last? I won't know till I receive my final paycheck. Unemployment is so darn inconvenient! Let's just call it forced retirement without money to spend.

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Questions and Concerns at College Medical Center (formerly Pacific Hospital of Long Beach)

The old Pacific Hospital had a similar sailboat logo. That ship has sailed.

          Oh boy, it looks like transitioning from Pacific Hospital of Long Beach to College Medical Center is going to take some major adjustments (I'm trying not to say that it's going to be a mess). The electronic medical records system has to be reprogrammed to the needs and procedures of College Hospital and even the paper forms may have to be replaced. Hopefully the learning curve won't be too great once the new system is in place. For those who have resisted in learning the former system or were not using them enough, they may have a more difficult time to learn the new one.

          Based on how many people they haven't rehired, one can assume (mistakenly or correctly) that either College Hospital is going to bring in their own staff, hire replacements, or reduce the number of floor staff from the numbers that Pacific Hospital used. That would mainly affect the Behavioral Health Workers who monitor the patients closely on the units and possibly the Licenced Vocational Nurses or Licensed Psychiatric Technicians who pass out the medications. The Registered Nurses shouldn't be affected since there is a legal requirement for them to be assigned only a certain number of patients (patient ratio).

Having not even been interviewed much less rehired, I will only have to be there for about 3 weeks to see all these changes. Already some of my soon to be former coworkers mentioned that I'm going to be missed because I was the only one assembling charts for new admissions. They never took the time to learn my streamlined system. But it's not rocket science and easy for them to pick up.

          When PHLB transitioned from strictly paper charts to the electronic medical record system, I had the foresight to retain the old paper charts in case of computer down times. Those papers were the only backup system the hospital had which were already preassembled, although separate sheets still existed in cabinets. I also have about 200 chart packs already made which goes with the EMR system, which would have tided over the unit I work in for about 6 weeks before the retained staff would have to make their own. Of course all of those old and new charts would be useless if College Hospital opts for their own forms. They will have to sort out which papers are needed and which are not so they can work together with the EMR without duplication.

          Communicating and taking care of psychiatric patients are ongoing learning processes because no two patients are alike and even a patient behaving a certain way during one hospital stay may not behave the same way next time. Paperwork remains more or less the same and this happens to be my specialty. I'm sure that the retained staff and the rest who will be newly hired will adjust to the new system sooner or later but they will have to take more initiative in doing so. I just take pride in thinking that I learn them sooner than most and find the most efficient way of applying them during the course of my work. Will they really miss me? Perhaps only for a couple of weeks, they they'll adjust and it will be business as usual. Thanks for thinking of me that way though. If only the staff recruiter knew...

p.s. My other posts regarding this matter:
Questions and Concerns at Pacific Hospital - Part 1

Questions and Concerns at Pacific Hospital - Part 2

Questions and Concerns at Pacific Hospital - Part 3

Questions and Concerns at Pacific Hospital - Part 4

Questions and Concerns at Pacific Hospital - Part 5

My Looming Unemployment

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My Looming Unemployment

Classic rock - 

Styx - Blue Collar Man (Long Nights)

          It looks more and more like I'm not keeping my job past October 29th. On Monday, October 7th, the sale of Pacific Hospital of Long Beach to College Health Enterprises will be finalized and I will be considered a straggler of Healthsmart Pacific, the former owner, because I never got the interview I was hoping for. Most employees have gotten their interviews and offered jobs by the new owner who will rename the hospital College Medical Center. A bunch of "oldtimers" like me were not even considered. As I brace myself emotionally and financially for unemployment, I wonder what it was in my application that excluded me for consideration. The only criteria that comes to mind or what it appears like anyway, based on myself and others who were not hired are these: over age 50, 10 years or more with the company, and earning such and such amount. Our applications seems to have been set aside without further consideration. One of those is illegal (age discrimination) but of course they won't tell you that they used it as a basis for exclusion.

          So where do I go from here? There will be the usual job search of course, but what strategies should I come up with so I can meet my living expenses if I become unemployed for the long term? My main concerns are my mortgage (I don't want to be homeless), health and dental insurance, homeowner's association dues, utilities like heating gas, electricity, and internet, food (of course), gasoline, and on an annual basis - car insurance, real estate taxes, and income taxes.

          Cash out of my vacation time which is about 400 hours, will help of course and that will sustain me for a few months. Applying for unemployment insurance after October 29th and hopefully receiving a few dollars a week for 26 weeks, will be another help, provided I don't get myself fired before then, otherwise I won't qualify for this compensation. Here is the link to for filing a claim: http://www.edd.ca.gov/unemployment/filing_a_claim.htm . I also have some savings. It is a matter of calculating how long I can make all of these last before I go broke. As all if not most of us know, I cannot touch my taxed deferred retirement plans without being penalized until I turn 59 and 1/2. That is still 3 and 1/2 years away. Then when I turn 62, I can start collecting minimum Social Security (provided it's not bankrupt then).

          In the meantime, is it a good idea to try contacting the recruiter to find out what it was in my application that excluded me for being considered, and perhaps also ask how I can improve it to make it more attractive to employers?

          Wracking my brain due to all of the above made for a restless sleep so I just got up early and wrote this. If only I had enough money, early retirement would be nice, but then again, if I get bored at home sometimes during my days off, what more if didn't have a job to go to anymore? Well, at least I got my free flu shot from work a few days ago.

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Questions and Concerns at Pacific Hospital - Part 5

from 

Pacific Hospital

to 

College Hospital

 and back to

 Pacific Hospital

The owner of Pacific Hospital has called off the sale of the facility to College Health Enterprises. What does this mean? Heck if I know. Already twice in the past month, a memo was sent to the doctors practicing in PHLB that the sale was delayed. In the meantime, checking the collegehospitals.com website, you would see that they have added the Pacific Hospital address as one of their 3 facilities with a link where you can download an application form, although the rest of it says the website is under construction. Strange that they did that while the sale was pending. To add to this confusion, College Hospital has started taking applications, conducting interviews, and even hiring people for what was supposed to be College Hospital of Long Beach or College Medical Center (this is the name they used on the website). This process was conducted by a College Hospital interviewer independent of Pacific Hospital's human resources department. There was even a Q & A meeting with the College Hospital and Molina Medical administrators last week.

This surprising turn of events happened on Thursday - September 26th. Prior to receiving the email from the owner of Pacific Hospital, I emailed human resources about my concern of not yet being interviewed despite being one of the first ones to file an application. It was later that evening that I learned that human resources was not involved in this process and that College Hospital had their own criteria. Not being called in for an interview yet by this time did not bode well for me and several others. Now that the sale has been called off, I wonder what will happen to the applications and especially those who have been rehired and already signed their acceptance to work for College Hospital. Were all those efforts for naught? They must have been elated, then deflated. In my case on the other hand, first I felt some embarrassment for not even making it to the interview process, then as time went on, I started feeling insulted. Why? Because some of the people who had their interviews and others who were rehired, I felt that even though they deserved to be in that position, I worked twice as hard as they have in the 10 years I have been with the company and haven't slacked off from the day I started. Unfortunately, hard work doesn't show well on application forms or résumés.  I may have to learn how to use better B.S. words to make my applications look more attractive.

Here is my speculation. The owner probably noticed in the past month that even though the behavioral health and medical units were no longer being managed by outside companies while the sale of the hospital was being worked on, they continued to thrive, and thus saved a lot of money being paid to those companies. If Pacific Hospital can become leaner like this, their earnings would be greater and that translates to more money for the current owner. But that's just my imagination running wild.

What will happen next is anybody's guess. The employees remain in limbo. I will have to treat this like a doctor advising a patient with an enlarged prostate: watchful waiting.

Update: 9/27/13 3:00 p.m. - We have just been notified that the WARN Notice (http://en.wikipedia.org/wiki/Worker_Adjustment_and_Retraining_Notification_Act) that was issued to us more than a month ago is still in effect, which means we could still get laid off after October 29, 2013.

Scuttlebutt in the main campus is that the owner asked for more money from the buyers.

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Questions and Concerns at Pacific Hospital - Part 4

                COLLEGE HOSPITAL OF LONG BEACH

               The change in ownership of Pacific Hospital of Long Beach from Healthsmart Pacific to College Health Enterprises was delayed for a week but the employees were able to start reapplying for their jobs two weeks before that. It appears that the new official name is now College Hospital of Long Beach. With the change in ownership, the psychiatric unit which was being managed by the Memorial Counseling Associates has had a sudden drop in the number of inpatients because the doctors from that group have lost their admitting privileges. See, MCA has their own intake department and doctors group which funnel patients coming from Pacific Hospital's emergency department and other area hospitals towards the 3 psych units Pacific (in this case, College) Hospital has. College Health Enterprises have their own intake department called Access Services and their own admitting doctors. With the loss of MCA, the psych units have lost a lot of patients due to discharges and needs to reestablish a new patient base before the census goes up again. In hospital parlance, census is the number of patients who are being treated on the unit.

                 The consequence of having a low census is that the staff have to take turns getting cancelled from work due to staffing ratios. The hospital only needs a certain number of staff to cover a certain number of patients. Hospital workers know about this and I may be overexplaining myself for the sake of making it clear for non-healthcare workers. On the first official day of College Hospital running the show, it just so happened that it was my turn to get cancelled, which hasn't happened in approximately 2 years. Thus, I got a call from the nursing supervisor at about 5:30 p.m. on Monday notifying me so, because the census in the unit I work in, which has a capacity of 36, had dropped to 18. Ergo, not only are we in danger or being laid off, but while waiting for word if we are going to be rehired or not, we are already losing income because of the low census. Our first hope is that census rebuilding won't take too long by reassigning the psych patients who show up in the emergency department to the College Hospital doctors. The second hope of course is to be rehired.

                There should not be a similar problem with medical patients though, since there won't be a change in the admitting privileges of the doctors. The only change they are having is that Molina Healthcare will be managing the medical units. But I could be wrong since I'm not privy to that kind of information. Meanwhile last week, a representative from the labor union which College Hospital Cerritos employees belong to, contacted me via email after reading my blog, asking questions which I didn't know the answers to.

This wasn't meant to be a series of posts but it had become so as things have evolved. Here are the links to my previous posts regarding this matter: 

Questions and Concerns at Pacific Hospital - Part 1

Questions and Concerns at Pacific Hospital - Part 2

Questions and Concerns at Pacific Hospital - Part 3

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Questions and Concerns at Pacific Hospital - Part 3

         In my previous blog regarding this subject, I mentioned that I wish I had the facts (Questions and Concerns at Pacific Hospital - Part 2). Well we received some information on Thursday, August 29th about what was going to happen to the hospital and our jobs. It was finally confirmed that Pacific Hospital of Long Beach was sold to College Health Enterprises who owns College Hospital. They will be in partnership with Molina Healthcare who will be managing the medical units while College Health will be doing the same with the psych units. I believe Pacific Hospital had a similar arrangement with Molina a few years back. As far as our jobs are concerned, all employees will be terminated and the expected layoff date is October 29th. We will be asked to reapply with College Health Enterprises effective September 9th when they take over. As required by law, we were given a notice informing us of the Worker Adjustment and Retraining Notification (WARN) Act, which we had to sign. A memo from the current owner of Pacific Hospital mentioned that employees rehired by College/Molina will continue benefits and retain any accrued PTO (vacation time). At least the part about the PTO is a relief. In case of a layoff, there is no mention of severance pay.
          With all that information, more questions and concerns arise but basically similar to what I wrote in Part 2. There is no guarantee of being rehired but at least it gives as a couple of months of leeway to find another job. Believe me, I've already started looking but what I've seen so far as being offered in area hospitals are per diem (no benefits) positions. Questions include - will the shifts go back to 8 hours or continue with 12 hours; if rehired and basically starting from scratch, will the pay scale be lower; since Memorial Counseling Associates will no longer be managing the psych unit, will there be a change in doctors; will it be better to gamble and resign so I can cash in my PTO then reapply with the new company, or wait to be laid off? Being laid off, though not good, is better than resigning because at least you can collect unemployment insurance, which is not much, but better than nothing. If rehired by the new company though, at least medical and dental insurance benefits will continue even if there is a decrease in pay. What about our 401k retirement plan? Will it roll over to College Hospital's investment company, or will it be up to us to keep it in the same place or transfer it to our own investment company? In an ideal world, if some of us get laid off, it would have been nice to get some severance pay in addition to the PTO being cashed out. Or if rehired, it would be good if they just pay off the Pacific Hospital PTO and start from zero with whatever vacation benefits that College Health has. I can dream, can't I?

Disclosure: I worked at College Hospital Cerritos twice - once in 1981(when their area code was still 213) which was my first ever psychiatric hospital job, a few months after moving to the United States, and the second time in the mid-90's. I have also experienced a couple of lay offs. The first with Los Altos Hospital and the second with Lakewood Regional Medical Center, both which gave employees several weeks worth of severance pay. And finally, Barry Weiss, who is the owner of College Health Enterprises is the brother of my colonoscopy doctor - Steven Weiss.

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Questions and Concerns at Pacific Hospital - Part 2

          After writing about my questions and concerns a few months ago (Questions and Concerns at Pacific Hospital) following the FBI and IRS raid at my place of work, it has been quiet until recently. The employees have always known that the hospital was looking for a buyer as well as a new management company for the psychiatric units, and it may be possible that the buyer might manage those psych units as well.
          Unverified rumors have been abounding in recent days about Pacific Hospital already being sold and that an announcement will be made in early September. As to who the buyer is, rumor has it (pardon me Adele), it is College Hospital, who owns College Hospital in Cerritos and Costa Mesa. That company has done several tours of Pacific Hospital in recent months so they definitely showed an interest. Some employees have mentioned (again unverified) that when Pacific Hospital hands over the operation to College Hospital, the employees will be asked to sign some papers ending their (our) employment with Pacific and start anew with College, essentially from scratch. The speculation includes forfeiting our accrued vacation time or PTO and a possible decrease in hourly salary, plus elimination of shift differential for the night shift. With a little search on the internet regarding California Labor Law, unused vacation time will have to be paid by the employer upon termination of employment, so it's illegal to forfeit it. Doesn't a change of ownership constitute a termination? Getting paid my vacation time is a great concern for me because I have a lot of hours accrued which I had intended to use for emergencies. This is the section of the Labor Law which covers vacation time: http://www.dir.ca.gov/dlse/faq_vacation.htm which specifically states:

Q.	What happens to my earned and accrued but unused vacation if I am discharged or quit my job?
	A.	Under California law, unless otherwise stipulated by a collective bargaining agreement, whenever the employment relationship ends, for any reason whatsoever, and the employee has not used all of his or her earned and accrued vacation, the employer must pay the employee at his or her final rate of pay for all of his or her earned and accrued and unused vacation days. Labor Code Section 227.3. Because paid vacation benefits are considered wages, such pay must be included in the employee's final paycheck.

          There are a couple of scenarios that have run through my mind. One is to wait for the announcement and just go with the flow and be rehired by the new company with the possible loss of vacation time (if their lawyers found some kind of loophole). The other is to resign as soon as possible so the accrued vacation time can be cashed out before the new company takes over, then after a few weeks, reapply for the same job for lower pay. Of course being rehired is not a sure thing, so that's another concern. Like I mentioned before, there are not too many jobs available in the psychiatric hospital business nowadays. If I quit and cash out my vacation time, I may be able to get by on it for 2 to 3 months, but also have to sign up for COBRA insurance so I continue to be covered by medical insurance, that is, until Obamacare takes over in 2014 (in case I get unemployed for the long term). For now, it's all up in the air because the employees have been kept in the dark and have been left with rumors and speculation. Meanwhile, time is running out. I wish I had the facts.
A couple of days after I posted this entry, the facts were revealed to the employees: Questions and Concerns at Pacific Hospital - Part 3

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The Days After The Assault

The days that followed the assault, I had to report to the Memorial Occupational Medical Clinic at Long Beach Community Hospital for a follow up check with the doctor. The doc did neurological checks on me (which the ER never did, by the way. Neuro checks are a must for any head injury!). Some of these checks are the same as what a cop would give you to test for drunk driving. I passed the tests but was still having headaches and occassional dizziness, so the doctor ordered me to be assigned to modified duty. When I submitted those orders to the Human Resources Department, I was told that the hospital didn't offer modified duty. However, in cases like this, they sent employees to a company called Healthpointe in the city of La Mirada, to attend safety classes while recuperating. I would be paid my regular hourly wages other than the night shift differential. A coworker was sent to these classes months ago and told me then what it was like. So the day after seeing the doctor, I reported to Healthpointe. The first person I saw looked familiar and he happened to be a housekeeper from the same hospital I work in. In fact I met him months ago when he helped us deal with a flood on the night shift. At least Juan would be able to show me around and tell me what to expect for the duration of our daily 8 hour stay at Healthpointe.

At exactly 8 a.m., we reported to the classroom which had a few rows of tables with computer terminals on them. The first thing we did was go to the physical therapy gym for stretching exercises, but you could do pretty much whatever you want to do for 15 minutes, be it lifting weights, using the stationary bike or treadmill, or walking outside. After that, it was back to the classroom for what would be a whole day of watching videos with lengthy pauses in between. Lunch was from noon to 1p.m. then it was back to the videos until 4:45. Then it was back to the gym for 15 minutes, then time to go home. This happened on Wednesday where one of the nurses at the front desk had to do double duty of doing her regular job and showing us the videos (the poor woman). The next couple of days were better because the lady who conducted the class was more structured. In between videos, we were given reading material, then had written quizzes on them. As much as I don't like taking tests, at least it made the time go quicker.

Before I went to class last Friday, I had to go back to the doctor at the Occupational Clinic for a reevaluation. A nurse practitioner saw me instead and gave me another neuro check. Everything was okay except for the huge migraine headache I experienced the day before (my first one ever!), and a bunch of milder ones since the day I was punched. The nurse said that was to be expected and that the headaches would diminish over time. She did give me another 3 days of modified duty and another follow up appointment for this coming Wednesday (10/17/12). If I'm feeling better then, they may return me to full duty.

In the meantime, while I've been attending these safety classes, with my sleeplessness at night, I've learned to act like a cat. You may infer what you wish with that one.

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An Assault With No Visible Triggers

I've been working in Psych Units since 1981 and as psychiatric workers (nurses and mental health workers) we are trained how to manage assaultive behaviors (MAB). We are taught to watch for signs of an impending assault so it can be nipped in the bud, so to speak, before an assault happens, and the cycle that follows. When we see a patient starting to get agitated, we could intervene verbally and/or with medications to calm him/her down so that a full blown assault doesn't happen. Basically these are the steps to an assault: Baseline behavior where a patient is acting normally, a trigger which gets a patient agitated, the assault itself if the patient perceives that his/her needs are not met and attacks somebody, the recovery phase when the agitation declines, then back to baseline when the patient is acting normally again.

So what can you do when the usual signs of an assault cycle do not exist like it happened to me? There did not appear to be any triggers when the patient jumped off the bed twice nor when he tried to punch the respiratory therapist. Certainly none when he punched me at least three times on the head and face, since I was only helping him go to the bathroom. Whatever triggers all appeared to be hidden in the patient's mind. How does one defend from that especially when the patient exhibits baseline behavior right before and immediately after the assault? It was like turning a light on and off.

The doctor could have ordered a tranquilizer after the patient already tried to strike the respiratory therapist, but was concerned that it may impair his breathing if he fell asleep. But that was why I was assigned to watch him 1 to 1, so in case he had breathing problems, I could intervene by at least repositioning him or calling the nurse for assistance.

With the patient's history of assault, I believe he should have at least received a sedative. That may have prevented the attack on me and at the same time, I could have observed him all night to make sure he didn't go on respiratory arrest. Instead, I had to go to the emergency room at 4:15 a.m. to be checked out while leaving the patient alone with his breathing problems. I ended up not leaving the emergency room until close to 8 a.m.

So what happened to the patient after I left him? I don't know and I really don't care. What I care about is my own health because without it, I can't take care of the same kinds of patients who may or may not try to hurt me.

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Assaulted By A Patient On The Medical Floor

October 9, 2012. 03:50 a.m.

Twenty four hours ago, I became a victim of an assault at work. A patient I was watching on the medical floor punched me on the back of my head and face while I was assisting him in going to the bathroom. But first let me backtrack to the events that led to this assault. I reported for work in South Campus and saw that one of the mental health workers had to float to 1 South. I checked the log book  to see whose turn it was to do it and it was me. I drove to the main building and when I arrived in 1 South I was assigned to watch an elderly Filipino man who the staff reported created no problems during that day, although he had acted out the day before, becoming violent because he wanted to leave the hospital. After getting a snack and receiving his medications, he went to bed and I thought it was going to be a long but easy night for me. At about 10:30 p.m. a nurse discovered another patient having a seizure in his room and the Rapid Response Team was summoned to check him. This patient was just transferred earlier in the day from South Campus for assaulting another patient. He had a previous history of having an adverse reaction to medications causing him to become unconscious. In fact a few days before, he was in ICU because of that. The family also reported that this has happened while the patient was not in the hospital.

 After being evaluated by the doctor, the patient was ordered transferred to the medical floor (2 North). He had apnea and had to be hooked up to the Bi-pap machine. A staffmember was needed to watch him for breathing problems and in case he throws up while hooked up to the machine. Having no other options, the nursing supervisor pulled me from my duties of watching the elderly man and sent me to 2 North to watch what turned out to be a crazier version of Mike Tyson. At first there was no problem because the patient was very sedated from the medications he got earlier in the evening. He was even taken to the radiology department to have a CT scan of the head done, and a chest X-ray in his room to make sure he didn’t breathe anything solid in his lungs while he was having a seizure earlier. Well, after all those tests were done, the patient suddenly woke up and jumped over the siderails of his bed to the ground. He was convinced by the staff to return to bed. As the respiratory therapist was trying to hook him up to the Bi-pap machine, he kept taking the mask off. He was given a regular oxygen mask instead. Then out of the blue, he got up and tried to punch the respiratory therapist. A code gray was called requesting assistance to control an assaultive patient. It was the beginning of a long and difficult night for me.

Due to the recent reactions the patient had to medications, the doctor didn’t want to order anything to sedate the patient for fear that he would go into respiratory distress (I’m assuming). Just a second after the patient tried to punch the respiratory therapist, he looked calm as if nothing happened. He jumped off the bed a second time. A second code gray was called. Again, just as soon as the patient was agitated, he was quiet again. This was a dangerous sign because he was unpredictable and could strike at any time without provocation. Still, a sedative was not ordered. The rest of the staff went about their business after that and I was left alone with the patient. He was also hooked up to an IV and he kept punching numbers on the keypad of the IV machine. When I asked him what he was doing, he glared at me and told me to leave him alone. I checked with the nurse to see if what the patient was doing would affect the operation of the IV machine and he said it did not, so I let the patient do whatever he thought he was doing. He even got angry at a nurse when she told him to put his oxygen mask back on.

The patient fell asleep for about an hour or so, but woke up suddenly at 3:50 a.m. wanting to use the bathroom. I lowered his siderails, unplugged the IV machine, then as I was ready to escort him to the bathroom, I felt a very hard punch land in the back of my head. I felt another one near the same area, then on my left cheek. I yelled for help as I was falling to the floor and a bunch of staff showed up at the door. Then just like a couple of hours earlier, the patient appeared calm right after he assaulted me. He even gave me a urine specimen that the nurse asked me to obtain from him earlier. He was finally placed on soft restraints which I wasn’t sure was going to hold him because he appeared to be too strong for them.

In the meantime, I had other concerns. My head was throbbing and I was dizzy from the punches. I felt a bump where the first punch connected in the back of my head and had some pain on my left cheek. I told the nursing supervisor that I needed to go to the employee injury clinic as soon as possible because I was afraid that I had a concussion. He asked me if it can wait until 7 a.m. because he didn’t have enough staff to cover the patient, and I said it couldn’t. He went to get the paperwork. When he came back, he asked me to fill them out while he contacted the clinic. He planned to have the hospital van take me there because I couldn’t drive myself due to the dizziness. I learned much later that the clinic was supposed to have a shuttle to pick people up but it wasn’t available and not only that, there was no doctor available at the clinic. The nursing supervisor managed to get authorization from the administrator on call to have me treated at our own emergency room. I was escorted there at about 4:15 a.m. and more paperwork had to be completed. Soon, I was evaluated by nurse Jack whom I knew from being floated to the ER once in a while. He obtained an order for a head, neck, and face CT scan. Funny to think about it now, but other than getting my vital signs, neuro checks were not even done on me, nor a doctor see me until was discharged several hours later.

So I was assigned a bed and while waiting to be taken for the CT scan, I just sat there and read a magazine. Pretty soon, I got a text message from Michelle, one of the nurses I work with at South Campus, asking how I was doing. Our charge nurse Jim was checking for possible admissions from the ER and saw my name as a patient there. They haven’t heard about what happened to me. I texted Michelle back saying I was waiting for the CT scan because a patient punched me on the head a few times.

After waiting for more than an hour, the radiology technician showed up and escorted me to the CT room where she took the three ordered tests for the head, neck, and face. She was the same technician who did the CT scan hours earlier, of the patient who assaulted me. After the scan I was back in my ER bed to await the results. My headache and dizziness were still present but felt lesser. Michelle asked me if I needed a ride home and I said I would let her know. Feeling less dizzy an hour later, I told her that I may be able to drive myself home and thanked her for her offer.

Change of shift came at 7 a.m. and I was still in the ER waiting for the CT scan results. This was the worst time to ask a nurse for it as hospital workers would agree, so I just waited until night shift to day shift report was done. I checked with Olga to ask her if radiology is going to call in the results or if they had to check the computer if it was already in. She said they just got the results and the doctor was reading it. Then Jim, my charge nurse and Paulette, the psychiatric emergency team nurse (she was working the ER that morning) showed up to check on me. I told them what happened and that I was just waiting to be cleared by the doctor. A few minutes later, a doctor came to ask me a few questions while I asked him a few as well about my condition and CT results. He said I might have suffered a mild concussion since I didn’t lose consciousness , I was not disoriented, I answered his questions without hesitation, and didn’t have nausea and vomiting. Those were all signs of a concussion by the way. He offered me Toradol for the headache, but I declined fearing it would impair me from driving. He said it wouldn’t but I said no anyway, saying I would just take a Motrin when I get home. After that, with Paulette facilitating the paperwork, I was discharged from the ER. I’m glad she didn’t put me on a 5150 – 72 hour hold J.

My long night wasn’t over yet because I still had to report to the nursing supervisor to find out what to do next with this workmen’s compensation issue. He gave me an authorization for treatment at the employee injury clinic and I was finally able to clock out from work close to 8 a.m. I called the clinic asking them if there was a time limit after the injury for me to show up and the lady said no. I’m planning on going there today for a follow up and see if I can be cleared to return to work tonight barring any complications the rest of the day.

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