Andy Holden

Transcript

00:00:00
Rigelhaupt:
It is January 22, 2015. I’m in Fredricksburg, Virginia, at Mary Washington Hospital, doing an oral history interview with Andy Holden. And to begin, I’d like to ask you about how you began working at Mary Washington Hospital.

00:00:24
Holden:
I started in August of 1984. I had actually just gotten out of the Navy. My wife was from Dumfries Triangle. She didn’t come from a military family, so when we left and we went to Guam and saw the world that was a bit of a shock to her. I eventually had to decide to choose between the family and the Navy and the family won. We came back to Triangle, up there, for her family. Somebody retired in the medical equipment repair part of Mary Washington Hospital, which was my specialty in the Navy. That’s how I got a job down here and how I started.

00:01:00
Rigelhaupt:
Could you talk a little bit about the work you did in the Navy with medical equipment repair?

00:01:05
Holden:
I started as a Hospital Corpsman. You go to boot camp and you become a sailor first. Then their specialty was Hospital Corpsman, where I actually learned to treat patients, emergency care, and that kind of stuff. Then after a couple years, I was eligible and had good enough performance to go to their medical equipment specialty, which is actually an Army school. I went to Fitzsimmons Army Medical Center in Colorado and learned about basic medical equipment repair—little stuff, such as suction machines, defibrillators, sterilizers, and the backup equipment. In the Navy, after you do that for a few years, you then go back to school for X-ray and ultrasound. I didn’t stay in quite that long. When I came here, I had experience in the laboratory, which was exactly what the manager was looking for, taking care of sterile centrifuges, microscopes, and those kinds of things. That’s what I started with here: the laboratory and some other departments.

00:02:04
Rigelhaupt:
Had you always been interested in equipment repair? What attracted you to that specialty within the Navy?

00:02:09
Holden:
I’ve always been mechanical. When I was six years old I started taking my toys apart. It wasn’t until I was older I started to be able to put them back together. I grew up in southern Maryland where there really wasn’t a lot to do, except be a waterman. When I was in high school, I got into the rescue squad. I ran volunteer fire and rescue. When I graduated it was time to leave and I didn’t have many options. The only way to get out was really the Navy because there’s a Navy base over there. I found out that hospital corpsman and medical repair was a specialty group you could go towards. I wish it was a wonderfully long, thought out, planned decision, but sometimes what you stumble into and life sets the course that you take. And it turned out okay.

00:02:55
Rigelhaupt:
What year did you begin serving in the Navy?

00:02:58
Holden:
1977. [03:00] From ’77 to ’83, I was in the Navy. Then I started here in ’84.

00:03:05
Rigelhaupt:
What were some of the hospitals or medical facilities that you worked at when you were in the Navy?

00:03:10
Holden:
A lot of training facilities, but when I was working I worked in Quantico. I was stationed up there. It was working in what was then a hospital, years ago. Now it’s a clinic. There was a cannon on the front porch. I was one of the grunts that pulled that thing off and polished the cannon and the anchor that were there for about thirty years. I worked in Naval Hospital Quantico, ran an ambulance and was actually part of what was a new concept for the Navy called Navy Rescue. We didn’t have the ambulance parked at the hospital, but we were parked at the fire department and would run with the fire department. I think that happened for many, many years. I’m kind of out of touch with Quantico, but I don’t know how it’s run today. That was initially where I was again, a lot of EMS training and we did that for the Navy base. Then later, I got stationed at went to Fitzsimmons in Colorado as a student for medical repair. Then went to Guam Memorial Hospital—sorry, Naval Hospital Guam. I worked in the hospital out there. At one point, I was shipped off to Camp Lejeune to learn how to run with the Marines. When I went to Quantico, one of my duties during the summer was to work at Camp Upshire with the young lieutenants. I don’t know if they still do that or not, but they may very well. That was interesting. That was an interesting job and something very different. I can understand why the Marines are the way they are. There’s no such thing as a former Marine: they’re all retired. [laughter] Once a Marine, always a Marine.

00:04:52
Rigelhaupt:
What were some of the things you were doing with the young lieutenants, as you mentioned?

00:04:57
Holden:
Of course, first aid. A funny story that is totally unrelated to Mary Washington Hospital, but the lieutenants were always being trained on their compass work and their map work, and whatever. But they were never really taught common sense or situational awareness. As a hospital corpsman, I wasn’t issued a weapon. I was not allowed to carry a gun. I’d pick up a stick, climb a tree, and all the Marines would run underneath me. I’d go down and go, “Bang, bang, you’re all dead. Look up, guys.” The sergeants would have to take me aside and say, “Listen Doc, you’re embarrassing my lieutenants, you’ve got to stop that.” I trained on first aid type stuff and a lot of heat stroke. There were many college students. They put them through quite a physical camp—quite a physical workout during the summer. We had a few heat strokes and medical problems related to that. In the Navy, I was trained and able to do things like suturing and sew people up when I was on call and administer medications—the kind of things you’re not allowed to do outside. [06:00] I really appreciated that because I felt, as I got into work here in the hospital, my experience on the patient treatment side really tied me closely with the nurses and the clinicians. I felt much closer to what they do. I understood if their equipment didn’t work how much it impacted their day. I feel like it was a big benefit to me. It helped me really appreciate where they’re from, rather than so many folks, particularly computer people these days who just work on computers and don’t understand who is using them or what they’re using them for. They don’t think anything’s important with what they’re doing. A little diversity in career fields is a good thing.

00:06:41
Rigelhaupt:
Let’s go to your beginning to work at Mary Washington. So what do you remember about the interview with the manager?

00:06:52
Holden:
My first job in the real world was the Navy. They paid you X amount of dollars per year, per month. When I went to my interview, I had to do a little math ahead of time and I thought, “What do I want to ask for?” This was 1984 and I was asking for $7 an hour. I asked that and I told him that. He said, “Gee, I don’t know. I just don’t know.” I’m thinking, “Oh great, I blew it.” He says, “I don’t think I can go that low.” I’m thinking, “Oh boy, that was bright.” The scale was a few pennies higher than that, but that was how I started in the civilian world. So advice to anybody: know what the pay scale is before you ask how much money you want.

00:07:35
Rigelhaupt:
So it sounds like the interview was successful.

00:07:38
Holden:
It was. I knew the technical side and I could solve his equipment problems. I learned and I became part of the team. The job of medical equipment or bio-med, is what we call it. Sometimes they call it clinical engineering. The job is to not only maintain equipment, but to help the clinicians who aren’t equipment savvy understand how to use equipment, understand what the capabilities are, or understand what equipment is available to do the job that they need to do. There are a lot of regulatory inspections and making sure things are safe. There are some good points too. Some things that really give you a sense of well-being and that you’re helping people help others. The truth is, nobody ever knows about the bio-med equipment or a technician. They don’t know there are people out there, but they are pretty important to what happens within the function of a hospital. We used to call ourselves the grease that keeps the gears of the hospital running.

00:08:41
Rigelhaupt:
What do you remember about your first day of work here?

00:08:44
Holden:
I think I remember the ribbing from the other guys that were here before me. They, of course, had to try and make fun of me. Like now, I had no hair. [laughter] But, you know, just interaction and kind of hazing type thing. [09:00] We got over that eventually, I earned some respect, and they could count on me. So we got over that. There were only three technicians in the department. At the time when we were then at Fall Hill Avenue, it was a 240-bed hospital. Everybody knew everybody’s name. We had an unbelievably knowledgeable president. They didn’t call him a CEO back then. He knew everybody’s name and a couple of times a year he would come down to the cafeteria and cook breakfast for staff members. He remembered what you asked for from three to six months earlier. Unbelievable. Bill Jacobs is his name. He’s still around and every once in a while you see him. We recently did a twenty-year anniversary of moving over here and he came for that and he still remembered me. The hospital then was a very small and a very comfortable environment because everybody knew everybody. It wasn’t as busy as it is today. We didn’t have the documentation, the technology, or all of the processes. It was more face-to-face. I was a technician. I didn’t do administrative reports as a manager or supervisor. Back then there were only a few computers in the hospital and we had a word processing department. If there was a monthly report of all of the outstanding equipment we couldn’t find for inspection, they would have a long computer list and print it out on a pin-fed, you know, a dot matrix printer. He would literally cut it out with scissors and glue stick it together to make a new report and send that down to word processing. They would type it up, send it back for review, and he would sign it. It was a several day process for one document. Unlike today, we send out 300 emails or documents a day. It was a very different type of process—in some ways better, in some ways worse. That’s kind of what it was.

00:11:09
Rigelhaupt:
Do you remember what was the most exciting about the job when you first started?

00:11:14
Holden:
Knowing I’m helping people. Everybody in health care wants to help their fellow man and that’s why they’re in this industry. Whether it be the person that’s cleaning the floors in the room, the guy that’s fixing the equipment, the guy serving the meals, or the nurses on the floors actually doing the work: everybody has an ownership in what we do as an organization and taking care of each other. That’s why we have a good feeling when we leave at the end of the day. The work may be long, and it may be hard, and it may be busy, but we at least know we’re not making widgets or selling cars. We have a good feeling about what we do.

00:11:54
Rigelhaupt:
Do you remember any of the equipment that was new or different from what you had previously worked on in the Navy?

00:12:00
Holden:
Yes. This was a 240-bed hospital. We had one defibrillator in the hospital, which is the machine you see on TV; they thump the chest and that person wakes up. Now we’ve got about eight. But then, we had one in the hospital and the one that it replaced was what was then called an AC. Now they’re battery-operated and it’s DC, direct current. Then it was an AC, basically line voltage coming out of the wall. They stick it on your chest and hope that it helped. It was half the size of this table. The technology had moved on and they knew that DC defibrillators were better clinically. We had one pulse oxymitter. It is the little thing you see on TV: they put a clamp on your finger, it shines a light through, and registers your oxygen. They’re in every patient room and every bay now. We had one in the hospital in the OR. Our entire equipment list for the building was less than 1,000 devices. That’s a lot of blood pressure cuffs, stretchers, and bibs, and that kind of stuff. Now, it’s over 12,000 devices. The equipment has really changed.

00:13:14
Rigelhaupt:
What equipment do you remember being the most complicated, or the highest technology, when you started in 1984?

00:13:21
Holden:
I think probably the most technical and cutting edge equipment was in the laboratory. They had chemistry analyzers, what they called flame photometers that would burn a sample and then shine a light through the gas above it to see what light spectrums would go through. Depending on what was in the sample that was burned, different light frequencies would come. That was how they determined what was inside of a substance. That was very cutting edge, very mechanical, and very hard to keep tuned and working properly—and again, about half the size of this room [the interview took place in a conference room approximately twenty feet by twenty feet]. Whereas now, they have machines that can do the same function using safer technology and do fifty tests that would fit on your piece of paper. A lot of technology changes. Electronics that are high powered. We actually had vacuum tubes back then. We had ultrasound machines for therapy. If you got a booboo or a torn muscle, they’ll put this device and kind of warm it up on you and it sends ultrasound waves through, and it’s about the size of a soda. Back then, they were vacuum tube devices and they had big long spark caps in them. We had to go and calibrate them like spark plugs on a car used to be. They were huge devices. We had vacuum tubes in that and some other devices. But now a lot of that is solid state and doesn’t require as much maintenance as it used to. We find that because engineers can put twenty options into a machine when you really may only need one, they still put twenty in there. We have a lot of opportunities for teaching people how to use those other options and trying to keep all of those things working. [15:00]

00:15:09
Rigelhaupt:
What equipment was the hardest to keep working? What presented the challenges for you and your coworkers?

00:15:19
Holden:
In the late ‘80s, new technology came out called telemetry. We had little boxes that would be put in your pocket and they would run leads to your chest and it would register your heart rate. Rather than being tied to a machine in the bedside, it would allow you to get up and walk around. That technology was very dependent on good skin contact, on not being sweaty or a hairy chest. You needed to do good skin prep. They didn’t function very well once they’re dropped on the floor and they’d get dropped on the floor quite a bit. There were a lot of those types of repairs. Suction. Back in the old days, rather than house suction coming out of the wall, suction would be a machine where they would literally draw it into a canister and hopefully it didn’t go into the machine because it overfilled. Those kind of problems and those little things took a lot of man-hours to maintain. We started endoscopy probably in the late-‘80s to early-‘90s. It was probably late-‘80s where they could have these devices with cameras they could put inside of you to see how your stomach or other places looked. Maintaining that equipment was entirely new. There wasn’t as much emphasis on high-level disinfection as there is today. We now worry about so many things and they take a lot of steps to make sure things are completely clean. We didn’t know that as much back then. We knew about germs and sterile technique in the OR, but a lot of the equipment needed to support that was high maintenance and had a lot of mechanical valves. It took a lot of engineering time to keep them tuned.

00:17:10
Rigelhaupt:
It sounds like a few years after you started here, new equipment came onboard. As the hospital was considering buying new equipment, were you and your coworkers involved with meetings, decisions about what it would take to maintain it after it was purchased?

00:17:32
Holden:
Yes. Thankfully they do include the managers of the medical equipment branch in those decisions. Our manager was very tied into the ordering process, the discussion, and the evaluation process. Nowadays, the manager for bio-med actually falls under supply chain. They’re directly involved with the division that does the buying and heavily involved in evaluating new equipment systems, in the money approval process, and all that. [18:00] There’s a good connection between the people that maintain it, people who really understand the technology, and the purchasing of it.

00:18:08
Rigelhaupt:
Do you remember the first few years you were here, being in a meeting, where say a vendor came in with a new piece of equipment, is sharing it with the hospital, you know, trying to—I mean, not necessarily sell it for the sake of selling it, but it’s something you’re interested in purchasing, and looking at it, and trying to figure out how you would work on it?

00:18:26
Holden:
Yes. In the late-‘80s, the ICU had a computer that was again, about half the size of a Coke machine. It would analyze the waves, compare them against other known values, and kind of predict what the patient was going to do. That computer was programmed, each and every time the memory went out, by a paper tape. We literally would have a roll of paper on a wheel and you would hit the “Go” button to program it. It would throw a mountain, about 300 yards of tape out into a pile on the floor. That’s how we programmed the computer. Then we would have to wind it up very carefully, making sure not to tear it. We had to do that more times than not at three o’clock in the morning on a Sunday. New equipment came out that had memory inside of it, digital and electronic memory, hard drives, to where we wouldn’t have to mess with a paper tape anymore. That was a technology we really embraced because it easier to maintain and it was more stable. Computers in many ways are better because you can analyze more and any way you want it—when you want to change it, you just change the software. You could do a lot more and monitor more parameters for different clinical things as the study of medicine progressed. They started looking at different parts of the wave for different things and the computers would allow them to do that. That was an exciting technology that came on.

00:20:24
Rigelhaupt:
While you were at Fall Hill, you didn’t—not so much before you moved over here, but while you were there, new clinical lines started coming onboard. Do you remember anything? I think the NICU started to come on. Any memory?

00:20:44
Holden:
I remember interventional radiology was a new service. We had one machine and they had to figure out where to put it in the hospital. That was an entirely new concept. We built the cancer center, what was then out at Route 3. The idea of treating cancer with radiation, as well as chemotherapy, was new. [21:00] Endoscopy was a new service. I don’t remember the NICU then, but they were probably discussing it. Those were some of the newer ones that came on before we moved over here. And then we built a big NICU here at the time. A lot of new technologies were coming on. Some of the clinical programs have become what they now call centers of excellence. We have national recognition for our work in those areas.

00:21:34
Rigelhaupt:
One of the things you mentioned before was, it was very often three o’clock in the morning on Sunday. Could you describe the first few years you were here, how shifts worked? I think that bio-medical repair is 24/7, just like the rest of the hospital. How did your department work? How were shifts divided?

00:21:57
Holden:
We all worked day shift five days a week. We weren’t paid on-call. We were just to be available after hours. The way it would work is they would call the boss, and if the boss could get a hold of you, then you were the one elected to come in. They didn’t pay on-call pay or standby pay. It stayed that way until 1994—no, actually until ’97. We had a management change and they actually put our manager under contract with another company. That was the first thing they changed: they wanted somebody on-call to cover it so they didn’t get the phone calls. Twenty-four hours a day, seven days a week, you could get a hold of somebody by the telephone. And a number of folks did. [laughter]

00:22:51
Rigelhaupt:
Do you remember any memorable incidents of having to come in, in the middle of the night, a very critical piece of equipment that you would have been called in to help get working?

00:23:02
Holden:
We had to come in a lot for that computer with the paper tape. We had newer technology eventually. Usually cardiac monitoring type systems were the highest priority. If you have one IV pump go bad, you had twenty more in the room, then there’s no reason to call somebody in. Usually, it was the unique types of systems—sterilizers or the one-of-a-kind type things. EKG monitors—I came in a lot of times for those. Probably the one repair I remember above all over at the old hospital was the idea of cameras in the body was something new. They call them arthroscopies. They had a camera at the end of a stick and they would stick that inside of you with instruments in another hole, through what they call a trocar. They would work on you inside, particularly with appendectomies. [24:00] Those were the newer thing. They could take the appendix out without a huge hole in you. That was incredibly exciting. In fact, the first one we did was in the OR—the patient in the room with the camera, but we had wires running outside the OR to a conference room with a monitor setup. Anybody could watch and people from all over the building were standing there watching that TV monitor. We’d just never seen that before. Never seen the inside of the body. After a couple of years, it wasn’t as exciting and they didn’t run a monitor for everybody. One time, one of those cables failed and I got called in the middle of a procedure. I’m underneath the table and underneath the drape, holding wires together with my hands, and waiting for the doctor to finish his case. That was probably the one repair that sticks into my mind the most: you’ve got to do it, there’s no questions asked, and you do it today. Backup equipment, or different systems, they’d probably just roll that one out, and roll the new one in. But the concept of basically being under the sterile field and whether we would do it today or not, it would probably be a very different thing. That was one that stuck in my mind.

00:25:14
Rigelhaupt:
How long did that surgery last?

00:25:15
Holden:
About twenty minutes. My hands were so tired after that.

00:25:20
Rigelhaupt:
Well, it’s good that it wasn’t twelve hours.

00:25:22
Holden:
I’m glad it wasn’t. Probably would have been an open case had it been that long.

00:25:33
Rigelhaupt:
Let’s talk a little bit about, in the new hospital. And I’m wondering if you can think back to—do you think the first time you heard a rumor, or the water cooler talk that the organization was thinking about building a new hospital?

00:25:52
Holden:
We had been at a point back then when census was growing and growing and growing. We were full all the time and people were waiting in the emergency room. It had been a problem for several years—really, for several years. There was no other hospital, all the way down to—I’m not sure Henrico Doctor’s Hospital was here then. Potomac was there, but that wasn’t a big impact. So we had a lot of patients. They had to make the decision, was it time to grow again? About every twenty or thirty years, they had put an expansion on that building. It was about that time again, and they made the decision to build a new facility over here that would be larger. It was pretty amazing. The first time we really heard about it was when they came out with the architectural drawings to show the beautiful thing all done, and it just looks pretty. This was in the Star Trek days, so that was kind of the theme of it. The spaceship Enterprise is what we even called it. I was an associate still then, but I was fortunate enough to be put on the move committee for planning the move. [27:00] Now, this was literally three years before the doors opened and we moved in. We started planning about equipment, how we would get the patients moved over, how we would move the records and medicines, and all that stuff. At the same time, we brought on new technologies and new systems. We didn’t open new service lines that day, but we vastly expanded what we had and shortly thereafter expanded to new service lines. I was very pleased and excited to be on that group, and I think I’m the last one left in the organization that was on that group. Everybody else has retired or moved on. One of the interesting things is we wanted to give everybody in the organization a chance to see it before it was opening day. We wanted them to get some familiarity with it so they weren’t lost. We worked within our hospital, and we had a photographer then, and we made movies. We made movies on the Star Trek theme. We had the little blood glucose monitors that looked high-tech at the time as communicators and we added some sounds. The theme was, back then—you’ve seen the Energizer bunny rabbit, obviously. He was new, but we worked out with Energizer to get the actual costume. The Energizer bunny was an alien that appeared and we were chasing him all around the building. Our CEO at the time, Fred Rankin, was the captain of the ship, I was Mr. Spock with a hood over my head, and we chased this alien with some very poor visual effects that were transport in, transport out. My wife made costumes in the red for the security officer. You’re always worried about if you’re a red shirt, you’re going to get killed, right? But we didn’t kill anybody. We had gold officers and red security chiefs, and all of the posts. Star Trek was big back then, and I have to admit, I’m a Trekkie. That was the theme we used. We showed all of the different areas while they were still being constructed to our staff members. We made about three movies along that line. One of them, we managed to find, and we had displayed at our twentieth anniversary here last year in September. That was a fun project.

00:29:22
Rigelhaupt:
Well I want to learn more about the committee, but before getting there, I want to, you know, ask about the new hospital. You said that Fall Hill had had a number of additions?

00:29:34
Holden:
Yes.

00:29:35
Rigelhaupt:
And working with equipment in bio-medical, did you, looking back on it, have a pretty good understanding that the infrastructure was not in place at Fall Hill? That it would be very difficult to expand, either in terms of space, or wires, or energy, to really go to where the organization is going in terms of services offered? [30:00]

00:30:02
Holden:
I had no idea how much electronics was going to expand. We had the pleasure in the late ’80s of getting a 286 computer in the shop. We were able to do our work orders electronically. I really didn’t see how that was going to impact health care. I know that on the first floor with the ceilings, you couldn’t push a ceiling tile up because there were so many wires and pipes in there; there was really no room to expand it. By then, every department was crammed in. If we’re a 240-bed hospital and we’re full and we know we’re going to see more people. They were telling us then that people will be sicker in hospitals. This was shortly after DRGs came into place, diagnostic-related group. Before that, anything that the hospital and the doctors asked for, they got paid—great la-la land. DRGs came in and payments cut way in. It was pretty tight. Money was careful, but we knew that we were going to see more people. There was really no way to expand on the footprint. There was no open areas to go because we were landlocked by roads pretty much all the way around, unless they took out a few houses, which they didn’t own at the time. So I can understand why. They said they were going to buy ninety-six acres up here on the top of the hill, I think it was. It seemed unbelievable. In fact, for a number of years after we moved into the new building, half that property up there was still a big woods and piles of dirt. We didn’t have the rear entrance out to Cowan Boulevard; that was basically jungle at the time. We’ve grown with an ambulatory services center, the women’s center, the doctor’s offices, and all those buildings up on the hill. It’s become quite a campus. We really had no idea it would get that big and we had no idea the technology would play such a part. So crystal balls? I don’t know. If I could go back and change a few things, they had no idea how much equipment was going to expand in health care. We didn’t have computers on wheels and we didn’t do electronic charting and documentation. Today, we know that we need that. When we built Stafford, we put more storage for that kind of stuff to keep the hallways clear. That’s one of our biggest problems: all of the stuff in the hallway. In case of an emergency, we need to get it out of the hallway and it needs to be clear so you can get out in a hurry. Today, I’m a safety officer. I’m no longer fully with medical equipment repair. That’s our greatest opportunity and we know it. We have plans in place for how to address it during an emergency and we practice that. It could be better. Believe it or not, that building, which is only twenty years old, we could probably move to another one if we had an extra $200 million, and make it even better. But I don’t see that happening.

00:32:51
Rigelhaupt:
The move committee. Could you talk about who else was on that committee, and maybe if you don’t remember about the first few meetings? [33:00] It might be hard to remember the first one, but the first few?

00:33:05
Holden:
I was about the only associate-level person on it. I still remember my Navy days: where anybody that ranks above you is God and you don’t upset them. I was still scared to death. I remember at the time, the coordinator was a guy named Steve Ennis who has been in the Fredricksburg community all his life. He was very big in fire and rescue and he was in charge of security at the time. He took over the move committee. He was very good at organization and very good at planning. He managed that and kept us on-track. We had a guy named James Anderson, who was in charge of bio-med, medical equipment. A lot of details: he spent a lot of time on our 286 making sheets and spreadsheets, determining what we needed, and where it was going. We had nursing representation, then a woman named Sharon Fahey and later became Sharon Safferstone. She was the critical care director and later went to our care management here for many, many years. She just recently retired. Others would come and go. Those were kind of the core people, but there were other administrators. The problem in the first six months was getting their mind around we are going to move: “You’re going to take all these patients and move them? How are we going to do that? There are not enough ambulances in the city of Fredricksburg to do that and still maintain services. How are you going to have two emergency rooms running at one time?” It took us a long time to get around that. But thanks to Steve, we just ate that elephant one bite at a time. When move day finally came, it was absolutely flawless. I was left behind to pull equipment off the walls, get it patched up, and moved over for the things that we had decided we would reuse. I was actually there for two weeks after move day. I still remember about four or five o’clock in the afternoon. We had started early. About four or five o’clock in the afternoon, the overhead announcement came on and said, “The last patient is out. This building is no longer a hospital. Will the last person to leave please turn out the lights?” It was one of the things in my career that I’m most proud of. We’ve done a lot of good things, but I was most proud of that work and I felt like I had the most influence on. I’ve since moved to the leadership environment for a number of years and then I became safety officer. Now I’m safety and emergency manager and no longer responsible for medical equipment. I was involved with the design, the equipping, and the build out of Stafford Hospital. [36:00] That was an exciting project too, but somehow not as magical as moving patients from one place to another. We had everybody involved. The local counties—we had fifty-some ambulances from everywhere. It went very well.

00:36:23
Rigelhaupt:
Why don’t we get to move day. One of the things I’ve heard about in other interviews is what it would be like for clinicians and physicians who worked in the same space, and having an opportunity to think about where equipment would go. This was not trying to cram stuff into Fall Hill; this was a blank slate. What do you remember about those meetings, and talking about how to think about where equipment would go and how it would fit in with the patient care?

00:36:57
Holden:
I remember that we put a lot of thought and effort into it. Now the things that were bolted down stayed where we had intended them to go. Within days after move—or weeks after moving—the staff that worked in the spaces found more efficient places to put things than what we had designed. Human nature and that’s always the case, but there was a lot of thought put into what would be the best for flow. Today, we use something called lean, a performance improvement process. We actually think about the flow, the time involved, and put things that are used most often closest to where they’re used. We really didn’t have those kinds of processes back then. We worked along that line, but didn’t have a structured framework or tools to work with. They did real well. All in all, I think it went well, but a lot of human involvement. What the managers planned isn’t necessarily where the staff put it.

00:38:01
Rigelhaupt:
You were in charge of putting equipment in lots of different types of spaces. From, you know, patient rooms where people might not be as sick, to critical care, to ORs. What do you remember about the spaces that were most exciting to plan and think about where equipment, what was most challenging in terms of say an OR to a patient room?

00:38:24
Holden:
I think the most exciting was the ORs. We went from four to, I believe it was twelve; maybe it was less than that at the time. It was a whole lot more operating rooms and they were all larger. That was very exciting. We, of course, worked with the managers for whatever departments. The most challenging was in the areas such as a patient room, which are very, very similar, but in multiple departments. So you have fifteen or twenty different people with opinions on where you should put the needle box in their department and trying to get that standardized was quite a challenge. [39:00] It worked, eventually. A few things we had to move after we put them up, but it was a very good collaboration when it came to the shared decisions. Of course, the executives had the final say. They literally got involved in how many chairs you had, how many tables you had, and of course, how many X-ray machines you have. They were involved in all those decisions.

00:39:30
Rigelhaupt:
What do you remember about being involved with physicians and nurses?

00:39:35
Holden:
We had some physician involvement. Of course, they worked more so within their own divisions. Surgery division: those guys are pretty opinionated and always have been and they let it be known what they wanted. They would get together, and they would fight for their favorite toys. Some of which were very good for the clinical and sometimes we bought things that maybe we really didn’t need to buy because this doc really wanted it. I don’t think we do that as much today, but up until maybe even five years ago, if a doc that brought in a lot of patients said he really wanted a certain thing, he usually got it. We’re trying to become more realistic and more appropriate with our expenses these days. The physicians were always very well involved in making decisions, not so much where things went, but what services we would provide and what major equipment would support their services.

00:40:48
Rigelhaupt:
What do you remember about one of the first visits over to the new hospital? Probably when it was in the construction stage, while walls were up inside, but nothing’s really on the walls. It’s not clear if they’re going to be patient rooms. What was it like to walk around, and try to imagine where equipment would go?

00:41:05
Holden:
It was very confusing to figure out, first of all, what the department was. With just naked walls, you didn’t really know whether this was going to be a clinical unit, administrative unit, a patient unit, and you couldn’t tell the difference between a clean utility room and a closet. Even when they told me this was going to be echo, I really couldn’t put that together until it got to the point where some equipment started to mount. We bought a lot of new equipment. I can’t even tell you how many devices, but an unbelievable amount of new equipment, which was installed before patient move day. By the time it was just a few weeks away, you could really tell what the units were because we had equipment on the walls, stuff on the shelves, and it was just about ready for it to be put in operation. But the first few times over you couldn’t tell what was. [42:00] That’s why we did the videos, to try and get people familiar with it. Even then, people were lost for six months in the building—not just the patients, but the staff.

00:42:17
Rigelhaupt:
What equipment was the hardest to install, to get up and running in the new hospital?

00:42:24
Holden:
The hardest thing, I always felt, was the equipment that was relocated. It was up and operating the day it was turned off, and then you had to then install it over here while there were people working around you or patients being taken care of around you. Most of the big stuff like the X-ray machines was done by the vendors that owned the equipment or the vendors that sold and supported the equipment. Littler, portable machines were pretty much, you know, drop and go: move them, plug them in, and away you go. There was some wiring, plumbing, drains, that kind of stuff, but generally, the really challenging equipment was done. We moved sterilizers that we did keep. We didn’t move much engineering equipment. The boiler plant was all new and we didn’t move generators. Most of the big stuff that we did move were X-ray machines, some lab equipment, and those kinds of things, which are generally supported by their vendors. Because we had new technology, they knew what was going to be moved and how long it would be down. We planned for that. Things like a CVC analyzer in the lab, they had a new one that was sitting there and ready to run on opening day. They had already done all the controls and standardizations and it didn’t impact operations.

00:43:57
Rigelhaupt:
You mentioned generators. Was it clear to you, working in equipment, that there would need to be a larger supply of emergency power?

00:44:07
Holden:
Oh yeah. Bio-meds are electricians at heart and electronic technicians. We understand the concept of power. The fact that our footprint was growing by so much meant we went from one or two small generators to three large ones in what was then the new building. They were very excited about the fact that we would have reserve capacity. In the old building, we didn’t have that. You know, you had to be very careful what you plugged in when you were running on a generator. But we could run pretty much the whole building on it back then. That was before we started to add—doubling our OR sizes and we went from about a fourteen to a sixty-bed ED. We’ve grown, but we’ve added generator capacity now and we still have reserves.

00:44:58
Rigelhaupt:
What was the standard at the time for how long those generators would go? You know, they had to kick on? [45:00]

00:45:03
Holden:
I don’t think there was a standard. It was do it as long as you need to. Nowadays, I know a little bit more than I did and there are all kinds of testing. We have just expanded our fuel and we’ve easily got enough fuel to run everything we’ve got for ninety-six hours, which is the standard today. But back then, long before 9/11, there really was no standard. There was no emergency preparedness attitude in the country. I mean, we knew the lights would go out here in Fredericksburg. That was a problem every summer: the place would go out when all the air conditioners were on. We couldn’t afford that if you had somebody on a ventilator and we had emergency power from before I ever started. We’ve always had that in health care, from whenever we started using all this electricity.

00:45:52
Rigelhaupt:
Could you talk about, if you remember, those last few meetings of the move committee, before the move day? What were those like?

00:46:02
Holden:
It was, “Are we ready?” “I think so. I’m ready. Are you ready?” “I’m ready.” “Did we forget something?” “Did anybody see anything we forgot?” We had a pretty good confidence that we had covered everything, but we’ve never done this and never heard of it being done. We weren’t 100 percent sure we had thought of everything. There was some puckering going on, but it went okay. By the time we got down to the meeting two days before move—we moved on a Saturday or Sunday morning—it was, “Well, if we didn’t think of it by now, we’re not going to. So we’ll just fix it when we’re done.”

00:46:44
Rigelhaupt:
Could you talk about that last walk through you did, when the new hospital was basically ready to run, but there’s no patients there. What was it like to walk through a brand-new hospital that had no patients in it?

00:46:58
Holden:
It was a proud moment. I may not have put the things on the wall, but I was involved in almost every aspect of it, short of taking care of the patients. It was a very proud moment that we’ve done all this and it’s going to be so much better. Bigger and we’ll be able to do more because we’ll have technologies that we didn’t have before. It was a very exciting time and scary at the same time.

00:47:27
Rigelhaupt:
Could you walk me through the morning of the move? What you were working on, what you were ready to go on?

00:47:36
Holden:
The morning of the move, I was in an early meeting—not a meeting, but an early time frame. We were all here well ahead of the time we were going to throw the switch. They announced overhead, I think probably five minutes late, “Commence the move. The first patient is preparing.” [48:00] I was in the first unit that was planned to move, and as the patient started rolling out, I went into the room behind it and pulled the items that were supposed to be removed. They moved them a lot faster than I could keep up with them. I fell behind pretty quick, but it wasn’t a problem. It was a lot of the support equipment and other areas. Again, because we had so much new equipment, it wasn’t a big concern. It was a lot of excitement and a lot of emotion. Everybody was involved. It’s funny: one of the things I wanted to do was I wanted to be the first one to pay at the new building. The morning that we started, even before the first patient was rolled out, I actually went to the new building and went to patient accounts. I had had a lab test or something done, or maybe it was my wife. I went and paid a bill. I was the first person to pay a bill and had a receipt from the new address of Mary Washington Hospital. Nobody knows that and I don’t know where it’s at anymore, but it was something I wanted to do because I was quite proud of the new building.

00:49:05
Rigelhaupt:
So in the middle of all of the moving, you got to accounting?

00:49:07
Holden:
I got there early. They had to be open in both positions and they were there already. It’s just something I wanted to do because I was very involved in the whole process.

00:49:18
Rigelhaupt:
You should dig out that receipt.

00:49:21
Holden:
Yeah. I’ve got this little box of sentimental stuff. I bet it’s still in there.

00:49:22
Rigelhaupt:
That’s great. What do you remember about how it went, the day? It sounds like you said it went faster, real well?

00:49:33
Holden:
It went faster than we expected. We had planned for eight or ten hours and I think it was five to six before the last patient was out the door. It went much faster on this end. I didn’t get to be at the other end, but I heard about it and saw videos since then. Everybody had an assigned room. They went in the doors they were assigned to and rolled up and staff was ready. It was a mix and we pretty much had everybody on hand that day. People were staffing the new hospital and then as people left and they were pulled from here— they went over there to staff over there, too. It was well thought out, as far as that goes. It went very well and I have to really give Steve Ennis kudos for that. He was a pest when it came to it and he wouldn’t let people put it off—he’s famous for “What if.” “Well, what if this happens? What happens? And what if that happens? And what will you do then?” He’s known for that. He irritates a lot of people with that, but he was the best person that I know of in my career for the job. He did a good job with it and it went very well.

00:50:48
Rigelhaupt:
Actually, I want to go back, just for a minute, to ask you about when the new hospital was first announced. Do you recall any apprehension from the staff? [51:00] Do we really need this?

00:51:01
Holden:
Sure. You can pass out money and some people are negative about it. People don’t like change and it was more so back then. Change was a very slow moving animal. Nowadays, if something changes every single day, you don’t even hesitate. But back then change was very, very infrequent, and very slow. There were some people that were apprehensive. Obviously the people that were impacted by not enough space, facilities, and technology were excited and looking forward to it. But, you know, personalities: some people are negative about everything. Not many. Thank goodness.

00:51:45
Rigelhaupt:
Do you remember seeing any negative stories, or concerns in the local press, local media?

00:51:51
Holden:
No, I don’t remember that. I think the Fredricksburg area was excited that they would be getting a newer, better facility. There may have been and I just didn’t catch it. If it did, I didn’t want to see negative stuff. I didn’t notice it.

00:52:10
Rigelhaupt:
So you ended the move, it sounds like you were still up at 2300 Fall Hill.

00:52:14
Holden:
I was still in the old building.

00:52:15
Rigelhaupt:
What was it like to be in this place that you worked at for almost a decade, that six hours before had been a fully functioning hospital, and is now a building with hospital equipment?

00:52:29
Holden:
It was weird. I mean you could not quite echo down the hallway, but it was very, very quiet. You almost felt like there were ghosts looking over your shoulders, because there was nobody around. It looked like what you see on TV with the zombie movies in the old hospital, you know? All torn up and papers all over the floor. As the last person left, they weren’t too careful about where they threw things. It kind of looked like a bomb went off. Holes in the wall as equipment got pulled off the wall. It was a mess and it stayed that way for some time. They eventually had equipment resources people who came in and bought lots of equipment. I don’t remember how long it was, but it was some time before it was eventually rebuilt and turned into an office building, which we still use today for a number of our corporate divisions. It was an eerie day that day. I still remember. I’ll go over there today, twenty-some years later, and I’ll go into a department: I kind of close my eyes and I remember that today it’s a conference room, but this is where that department used to be. I remember there was an office right here and the guy sitting at the desk. I don’t know if his spirit’s still there or not, but I still remember the way it used to be. It messes with my mind that they had to change the floor numbers. [54:00] What was two is now three—ground first floor, second floor is one of the things that kind of always messes with me when I go over there.

00:54:07
Rigelhaupt:
Could you talk about what you did for the next couple of weeks? You said you were taking equipment out and still working at Fall Hill.

00:54:11
Holden:
It was a very, very busy time. My job was the old equipment and getting it over. Other people in the new building, their responsibility was to put it up, mount it, and get it operating again. My job was primarily everything in the old building and to take it down. That was it. I had pages and pages of equipment, of what it was and where it was supposed to go. I was very carefully taking it down, knowing that I might be the one to put it back up. It probably took a week to ten days for me to go through the building and get everything. Then I moved over to the new building, and we pulled them out of the same carts and put it up. It took longer. They had more people, but eventually I caught up with them. Even today, there are a few move stickers on equipment still around. In the main bathroom in the front of the hospital, there’s a sticker on the side. What we did is we had a sticker for everything that was moving: we put on it where it went in the new building. On that trashcan is the only sticker that I can find from equipment from the old building.

00:55:25
Rigelhaupt:
How big was the biomedical department, about the time of the move?

00:55:31
Holden:
At the time of the move, it was one, two, three, five technicians, and the manager.

00:55:40
Rigelhaupt:
So not that much bigger than when you started.

00:55:42
Holden:
No, no, not that much bigger. I guess about a year before I started it went from Mary Washington Hospital to MediCorp Health System. We started some outside expansion where we bought property up in Garrisonville, which we’ve since sold. We had doctors’ offices, we had a lab and X-ray, and the cancer center. We started off-campus expansions and that was kind of the whole thing behind MediCorp. We had to grow because we serviced all of that equipment. Pretty much everything owned by Mary Washington Healthcare, in terms of medical equipment, we take care of, or bio-med takes care of.

00:56:30
Rigelhaupt:
One of the things that happened, you know, pretty quickly at the new hospital was your expansion, in terms of cardiac surgery—

00:56:41
Holden:
Cardiac surgery. I remember it was about 1994, which would have been a year after we moved. We got a whole bunch of new infusion pumps and we started our surgical ICU and cardiac ICU, as I remember. We had it: it was cardiac ICU that became surgical because they started doing open hearts. [57:00] I don’t remember if Dr. Armitage was there first, but he lasted for a long, long time. That was pretty amazing. We had a whole new class of equipment: cardiac bypass machines, balloon pumps, and equipment that we had never seen before. Thank goodness they sent people off to school for proper, factory training to maintain some of that. Some of the equipment they kept under contract by the vendor because if you don’t get a chance to work on it enough, you can never become proficient. That’s the case even some today.

00:57:34
Rigelhaupt:
So thinking about say, some of the equipment in the cardiac surgery, do you remember a piece of equipment that it was most exciting to be learning how to repair, to work on? That, you know, caught your attention?

00:57:47
Holden:
For me, it was the interaortic balloon pump. I went to school on that. It was a machine that would put a catheter inside, from your artery all the way up into your aorta. It would sense your heartbeat. If your heart is very, very weak, what it would do is just a fraction of a second before your heart would contract, it would inflate this balloon; your heart would contract, the pressure would go higher than it can on a normal contraction because your heart is sick and it would force more blood to your brain. That’s how it worked. To understand the timing and all the valving, the calibration, and the mechanical stuff behind it was exciting. It’s pretty invasive and one of the more invasive things we do. Of course, we have lasers and things that go inside you and cameras and all kinds of stuff now. But that was one of the more invasive things that we started with, with cardiac surgery. I was never in the room when we did a cardiac surgery, but I have a pretty good idea what they did.

00:58:59
Rigelhaupt:
With something like cardiac surgery, the patients that are being treated here are sicker.

00:59:06
Holden:
Very sick.

00:59:07
Rigelhaupt:
And the level of care that can be provided at Mary Washington Hospital and sicker patients are treated here. How did that translate to equipment? I mean, were there things that came onboard because you had higher acuity patients? What do you remember about changes in your job that had to go along with, you know, a higher acuity patient population?

00:59:28
Holden:
What they call the standard of care increases. They require certain technologies that you didn’t have before. There was more technologies, more advanced electronic, more software in the cardiac unit and in the ICU area, as well as literally pumps. We’ve got a machine in the OR that that makes sterile ice. Basically it’s like a high-powered refrigerator in a little machine that freezes sterile water, so that you then have sterile ice that you can put inside the chest cavity. [01:00:00] You want to cool the heart so that it stops pumping when they’ve got somebody on bypass. Then they can work on it because it’d be pretty hard to work on and sew on a beating heart. That’s a technology that I never even imagined before. That was a new machine. We have something called cell savers, which are used if you bleed a lot. Some people’s religions forbid them from taking blood from anybody else. And of course it’s always better to get your own blood back. In the blood, there’s a lot of water and you can replace that with sterile water or plasma, but there are components in the blood like cells and platelets that you want to keep. This is a sterile centrifuge, in essence. Whatever they collect that comes out of the body, you can spin it and collect those cells and then give them back to the person that lost them. It allows people to live using their own blood products rather than going against their religion and getting blood from somebody else. All kinds of technologies related to the heart are different, really, than they are to working on legs or hips, or things like that.

01:01:22
Rigelhaupt:
Well, so it took a few years before biomedical, someone was on call 24/7. And, you know, with emergency cases to have equipment working?

01:01:31
Holden:
They start a couple years after there was the open-heart program. The OR decided that they wanted to have control over a bio-med that only took care of their equipment. And to be honest, they have more equipment than anyplace else in the hospital—the OR does. I don’t have an exact count, but it’s more numbers than other departments by a vast majority. They hired their own bio-med technician from us and they took one of our people and transferred him to the OR. The names have changed a couple of times, but they still have a person that does that. And it’s good because they’re familiar. They stay dressed out and they go in and out of the rooms. They help the nurses with equipment problems or training or help set up rooms. It’s been a good exposure. We back that one person up. We have a lot of interaction, a good working relationship, and we do work that they don’t do on their equipment. Later on—I’d say about 1997—we had a management change. The bio-med manager was replaced with a third-party contract. The first thing they did was put the bio-med under on-call, or actually standby is what they called it. Somebody would be committed to always being available.

01:03:00
Rigelhaupt:
Could you explain how the third-party contract worked with bio-med and, you know, what you and your co-workers thought about it?

01:03:05
Holden:
Obviously the co-workers—we were worried for our jobs. Later on, we figured out that all they did was replace the manager. The third-party comes in with their stack of policies and their promise to save money—they have purchase agreements and because of the larger volume and doing multiple hospitals with the purchase agreements they can save ten percent. It didn’t work for us because we were pretty efficient and we did not take care of the X-ray equipment. X-ray has always been, for political reasons I think, more than anything else, under service contract. They’re really, really close, I think, to bringing that back in under hospital management. But, for other reasons, up until now it had been done by a third-party vendor and that’s where the real profit is because a single tube for an X-ray machine can be over $100,000. If they buy ten of them a year, they might be able to save ten percent on them and that’s where they pass it along. As associates, we weren’t real excited because of a whole new boss, new process, we have two masters, and yet we’re still trying to take care of the hospital. Interestingly enough, the first manager came in and he lasted about four months and he left. The next manager lasted a year and he left. Next manager lasted a year and he left. Our leadership came to me and they said, “You’ve been here. We think you’re to the point you can do it, and we think we’d like you to try it.” So I took it over. I had to quit the hospital to go to work for a third-party department in order to manage the department I was already in. After a couple years, it was time for the contract to end. I told the chief operating officer, “The truth is, all you’re getting is me and a bill for their markup. They’re not saving you any money on parts and equipment. They’re not bringing in any great knowledge. I’m not getting any information from them that I didn’t have on my own already.” They decided to make a change. They brought me back in as a hospital associate, managing the same department, and they saved $250,000 over five years. It was the right thing to do. The department has been managed internally ever since. I stayed on as manager from 1999 up until just about 2013, when we had some people leave and I became safety officer. Then, in ’14, I became emergency manager, responsible for emergency management and safety. I just couldn’t do all of them and I had done a very good job of preparing for the future. [01:06:00] A warning to all you folks: don’t do too good of a job of preparing your replacement, you might not be needed someday. [laughter] But I’m happy for the organization because that person that I mentored and prepared for my position has done a great job ever since.

01:06:19
Rigelhaupt:
Who did you work with most closely when you became the manager of medical equipment?

01:06:25
Holden:
We have a regulatory body, the Joint Commission. There are a number of support services and they call them function teams, such as hazardous materials, utilities, life safety, and security—all the different areas of maintaining a building. I work closely with those function team leaders. I eventually moved into kind of being responsible for that section—I’ve been nagging them for information and keeping them straight for some time. We had a wonderful vice-president, who was actually with Sodexho and was a third-party contractor that managed our food service. Sodexho started as Marriott then it became Sodexo. This gentleman was long-term employee with what was then Marriott in the hotel industry. He came in because of the hospitality nature of what they do. He was in charge of all of support services, hospital departments, and he was a wonderful mentor, not only professionally, but also as an individual. He kind of set me straight and eventually grew me to a point where I am today. I’ve been successful for the organization. So I’m still here.

01:07:47
Rigelhaupt:
Who’s the person that you’re talking about?

01:07:48
Holden:
A guy named Sam Miller. He left a couple years ago to retire, but he will always be the one that I think had the greatest impact on my professional career.

01:08:03
Rigelhaupt:
When you started as the manager of the medical equipment department, what were some of the goals that you had? What were some of the directions you thought about or I’d like to see things go?

01:08:15
Holden:
Obviously my first goal and my greatest fear initially was accreditation with the Joint Commission. You know, we’ve got to keep the hospital doors open. That was a big focus. I was able to contribute to our accreditation, as only responsible for medical equipment. I was very involved with departments and what I enjoyed the most was I was able to do much more than I was as an individual technician responsible for just a few departments. As a manager, I was responsible for all of it. I was able to help and do more for the entire organization’s equipment than when I was as a technician. That was very exciting. But, I don’t know, what was the exact question? I think I kind of got off track.

01:08:57
Rigelhaupt:
What your goal, you know, what—

01:08:58
Holden:
The goal. [01:09:00] I wanted to grow. Back then, we had a little more time and there was a very big focus on professional growth and mentoring. We had some great programs and something called Leadership Belmont. We had some folks come in, and they would take us away from the organization and stay all day. It happened about every quarter and was a chance to learn about leadership and have different examples and projects. It was a great mentoring program. We still do some of that type of work today. That growing as an individual and professional was very exciting. We always have goals, professional goals and budget goals and associate satisfaction. Customer satisfaction. Any business has these wonderful things to work on every single day, every single year. They’re so important, but in many ways, they’re not what you do day-to-day. It’s a challenge to keep everything in the frying pan at one time.

01:10:09
Rigelhaupt:
How big was the department when you began serving as manager?

01:10:13
Holden:
Nine technicians. So we had nine technicians and a manager and an administrative assistant.

01:10:19
Rigelhaupt:
So, some growth pretty quickly after the new hospital?

01:10:23
Holden:
We had a lot of equipment, it was easy to hire more people back then, as we took on new services and as we expanded. We were able to say, you know, “If you give us another person, we can do this.” We did grow. Like I said, we went from 2,400 devices at one point up to over 12,000 when I handed the reigns to somebody else. We also shrank some. We were down to about seven technicians. As the balloon expanded, it shrank again, but we kept all those services, as we got more efficient.

01:11:05
Rigelhaupt:
You’re in management, mid-2000s. When do you remember first hearing about this idea of Stafford Hospital?

01:11:16
Holden:
[laughter] We were again at the point when the ER was always full, people were waiting to get to the patient rooms, and so it was a lot of customer problems then. We weren’t efficient and flowing anymore. They had a decision: they either had to close the top floor and expand two floors on the building, because the foundation is built for two more floors to go up, or build another hospital. We knew they were discussing it, but the board made the decision to build a new hospital up in Stafford. And then, shortly afterwards, Spotsylvania Regional Medical Center decided they were going to build a hospital. There was a lot of discussion about that. [01:12:00] We went to the college for a big meeting and members from both had talked about their plans and eventually they were both approved. Of course, you can’t just build one if you want one. It has got to be approved through the government and have a Certificate of Public Need, I think it’s called.

01:12:21
Rigelhaupt:
Do you remember any water cooler talk from you or your colleagues, just about what it would mean for Mary Washington Healthcare, or still MediCorp at the time, to go from one hospital to two?

01:12:37
Holden:
It was interesting, because the administrators, who aren’t here anymore, they made it quite clear that they wanted to do it right this time. [laughter] They wanted to fix everything that wasn’t perfect. We were going to build the unit the way it needed to be built and fix everything. There is always room for improvement. Like I said, even though we built this twenty years ago, we’ve torn up every department in the building and rebuilt it by now. More renovation plans—I know, it never stops in hospitals as things change. We were going to do this right and that was the discussion. We would have senior leader-led meetings when we talked about a department and their equipment. What do they need? What do they want? And what are they going to get within the budgets? We’re used to dealing with budgets: so we ask for eight when we know we need six, and they give you five. Those are games administrators play. They built it with expansion in mind. There was a plan on the books from the day it opened: today, if they need to expand another tower it would go out the front of the building, out the side where the parking lot is, to the left of that retention pond. There’s a plan and that’s where the next expansion would go. We didn’t know if that would be two years after it opened or twenty years after it opened. We don’t know. When they first started talking about the hospital, a lot of us responded, “Oh my goodness. I don’t want to go through this again.” A lot of people quit and a lot of people that would have been involved decided that they didn’t want to do it. We lost some good talent for that. Some of us that either were dedicated or not as smart stuck around and went through the whole process.

01:14:30
Rigelhaupt:
From the perspective of equipment, what did you learn from having built this hospital, and the new Mary Washington Hospital that you applied to ideas for Stafford as it was being drawn up?

01:14:48
Holden:
The first and the most prevalent idea was you need to build a storage room. Square footage is expensive, but you’re going to have equipment and you’re going to have things in the future you don’t have today. You have to have a place to put them. [01:15:00] You need open space. We got some of that. There’s actually a large shelf space on the second floor that is designed: if the OR has to expand, they can automatically move into it. It’s become the hospital junk room. The storage of the Christmas trees, and all my emergency preparedness supplies, and, you know, beds there for repair. Everybody uses it as a magic closet and we would lose that if they do expand someday. But that was the first thing I learned: you need room. Square footage is expensive and they don’t want you to have it, but you need it if you’re going to exist for a while. They were very good about all their technologies. They redesigned our interventional radiology with another whole room just for expansion. Rather than tearing out something that’s already built, there is a room that is shelled in for it, and the conduits are in the concrete. We built three floors, but we’ve never totally occupied three floors; they still have some room for expansion up there. We built a room for central telemetry monitoring. Back when we started, telemetry was done here on each individual floor. After Stafford Hospital started to be designed we eventually changed that model to one single room where everything comes back to and there is dedicated staff in a certain space that everybody can get a hold of. It’s safer, it’s more efficient, and it’s just the right thing to do. We built a room for that at Stafford, but by the time they opened it technology advanced to where we have them connected by fiber and to where this central telemetry can also monitor those patients, as well. That room may get used for something else.

01:17:08
Rigelhaupt:
Part of what you described is the hospitals were built bigger in terms of square footage because of equipment. What are some of the pieces of equipment that are taking up that space that is different in Stafford Hospital than it was even fifteen years before this one opened? The newer equipment that you really planned for at Stafford?

01:17:36
Holden:
Patient lifts and scales. When we built Mary Washington, there really weren’t computers on wheels and there weren’t rolling scales. The idea of a large person, that you would need a lift to lift them up, didn’t happen. We didn’t have obesity as much as we do today. [01:18:00] The equipment, scales, and all of the stuff that is in the hallways—things they use every day, like computers on wheels, medication carts, crash carts. We didn’t have much of that when we built Mary Washington Hospital. There is very little space for that kind of stuff. And beds, plain beds. It’s not unusual for a bed in a patient room to not be appropriated. If you get somebody that’s an older person who has bedsores, they need a special bed that inflates and takes the pressure off their pressure points. There are specialty beds that we have for certain people. You have to roll the bed out with the specialty bed and there’s got to be a place to put that bed. We don’t have that at Mary Washington. It’s a big challenge keep the hallways clear. They put them down and out of the way or in other spaces, but it could be more efficient. There’s only so much room under the roof. At Stafford, that was planned for, and they had alcoves and spaces just for it.

01:18:56
Rigelhaupt:
I’m curious if there’s a parallel with biomedical equipment. It’s certainly one of the things I’ve casually observed is, other equipment in homes, stoves and furnaces with computers. Mechanically they’ll keep working, but if the computer goes it stops working. Have you seen a parallel with medical equipment, that mechanically, the thing works, but there’s some little computer that is driving it, and that requires a different kind of attention than when you started your career?

01:19:33
Holden:
What I was always afraid of were the sterilizers. The enemy of electronics is heat and moisture and that’s all a sterilizer produces. They decided to put computers in sterilizers a number of years ago. I was always afraid that was going to be a problem, but they seem to build them pretty well. It wasn’t a problem and you could sterilize it. Now, there are computers in all of them and it’s not frequently a problem. No, the computer hardware and the electronics are more and more reliable all the time. The software, in many ways, is less reliable. You get a power glitch. I mean, you’ve all heard the joke: if you had to drive your cardiac monitors, stop, pull off the side of the road, roll down the windows, close the windows, and restart it in order to make it work—it would be a problem. With our computers, we do that every single day. We do have one advantage in that any medical equipment has to be approved through the FDA. There’s an extensive process. In many ways, it could take seven years. Believe it or not, the technology we have in medical equipment is at least seven years old. We don’t have the latest and greatest Pentium Five processors or Duo core processors, because it hasn’t had time to go through the approval process yet. [01:21:00] Medical equipment is generally more stable; they drop test it and they do all that. We don’t have as many problems, but we do sometimes get weird issues, a lot of recalls, and every single nut and bolt and screw that’s in any piece of medical equipment is registered with the FDA. They’ve shut down companies because they got a screw from Argentina that wasn’t previously tested. We’ve had problems with that. One company was actually locked down in the early ’90s when we were getting ready to move in. We had sixty-five new defibrillators ordered for the new building. They had them locked down because of something like that, a screw. We didn’t get them until like a week before we opened. The same company was locked down for a few years recently. We eventually got to the point where we had to shift technology and we had to go to another company because of those kind of problems. Computers are a part of frustration in everyone’s day, but in medical equipment they’re pretty durable. They do allow us to do things that you can’t do with just valves and switches.

01:22:16
Rigelhaupt:
Can you think of one piece of equipment that’s used in patient care that stands out in your mind as having most benefited from computer technology?

01:22:25
Holden:
I would think anesthesia machines. There’s something called an anesthetic agent monitor. Years ago, they used to just dial a flow meter and they would see about how much gas was going into the patient. They’d be, “Okay, that’s right. I’ve been doing that for twenty-five years, that’s the right amount.” But everybody absorbs gasses differently. So, some person may react differently to a medication than somebody else would. They wouldn’t know it until they were in bad shape. Computers allow gasses to be analyzed rapidly as they’re exhaled. When somebody takes a breath they can know exactly what’s coming in and what’s coming back and they know exactly what’s absorbed. They allow the processing of that information and the way it’s displayed to the caregiver faster, and in different modalities and different ways. Computers, I think, have helped quite a bit there, as well as in processing. Laboratory tests used to take machines half the size of the room or a Coke machine. Now you can have a machine—very, very small—that can do ten times what those old machines could do because they can take the same bit of information and process it differently and get different information out of it. As well as tracking: it used to be you could look at a blip on the screen, but once it moved over and it was off the screen you don’t know what happened. Now with trending, we can record what’s happened through an entire patient stay, even if they’re here for weeks. Docs can say, “We made that medication change a week ago. How has it affected their rhythm?” [01:24:00] They can go back and look at changes or look at their heart rate from weeks before, versus what it is today. All that memory plays a big part in health care.

01:24:17
Rigelhaupt:
If my notes are correct, in 2011, you became safety officer.

01:24:21
Holden:
I think it was ’12 to ’13, but I did.

01:24:25
Rigelhaupt:
Okay. So my notes are incorrect. Could you talk about becoming safety officer, and how you began to serve in that position?

01:24:34
Holden:
I had previously been co-chair of what was basically the safety committee. I was responsible for most of the administrative side of it. Somebody else was the heavy hitter that had to say, “No, that’s not the way it’s going to be. It’s got to be this way.” I took over that responsibility. It was, you know, a bit of a challenge because there is more responsibility now. Back in the old days, when I was a technician, I was responsible for what I laid hands on. As safety officer, I’m responsible for what 4,000 people lay their hands on and I don’t have control over everything directly. Eventually you get used to that. You have to be observant and you have to challenge people. If you see something that’s wrong, you say something. You encourage people to do just that. Situational awareness is very important: if you see a broken piece of furniture or a broken floor tile or broken medical equipment, don’t walk past it. Raise your hand, put a note on it, or make a phone call, and let’s get it fixed. It’s unsafe for you or your coworkers—also it’s broken and it can’t be used for our customers. It could be dirty and infectious. We want to get it clean and back in operation so it’s usable.

01:25:52
Rigelhaupt:
What were some of the primary things you worked on when you began serving as safety officer?

01:25:59
Holden:
Building some written plans. We have to have a lot of documentation for accreditation. Unfortunately, most of it just goes in a binder on the shelf and the only one that ever looks at it are the inspectors. That’s a huge waste of time. That’s one way that health care is still archaic. We haven’t progressed past a lot of that, but we’re a mix of old and new. I guess it will eventually. We will get it corrected and to where we don’t just have paperwork for the sake of paperwork, which is frustrating. I had to do a lot of that. I was also able to work with projects. We created a campaign called “Slick the Duck.” It was our safety mascot. We have a person who has a costume and we take that person and the costume out, and we pass out awards, we encourage people to be safe, and reward people for going periods of time without having injuries. We identify areas where there were problems and try and fix them. Then Slick comes out and helps us reward them. [01:27:00] They’re on the website, a lot of Slick the Duck pictures as we pass out awards. We try very hard to monitor. Every year it’s been a more increasing role on associate injuries: you can’t just assume that people are not going to get stuck with needles and you’ve got to stop that. We have safeties in place and we have everything you can think of, but sometimes it still happens. We’re trying to stop those kinds of things and changing the culture so it’s just not allowed. Not tolerated. Those are some of the things I’ve worked on.

01:27:38
Rigelhaupt:
In terms of your work in safety, did you also work with other physicians and medical staff in terms of, you know, questions of patient safety, hospital-acquired infections—things that I imagine, have a similar way of thinking about how to eliminate some of those issues?

01:27:59
Holden:
We used to be, years ago, in kind of a lot of silos. We’ve gotten good at everybody getting together. We still have different committees with primary focus names, like quality and patient safety. Safety council and there are other different groups, but we all get together, we share information, and we share ideas. We have a blameless culture. We try to say, “This has happened. This is how people got hurt and let’s all work together to figure out how to fix it.” It can’t be just one guy walking around responsible for everything. It’s everybody, people that are out there and see things every single day. There are 4,000, or now, you know, 2,500 people with eyes out there that can see things that I can’t. It’s everybody working together. The physicians are very much involved in that. We report physician injuries as well as patient injuries and staff injuries. They share that. They share it within departments or within surgical divisions. The docs get to see things like discharge rates and how their people are being discharged compared to other docs in similar specialties. They get to challenge each other and look for opportunities to always make it better. That’s really what it’s about: it’s always an environment of getting better.

01:29:28
Rigelhaupt:
It may be hard to pin down an exact year, but when do you remember the silos breaking down, as you described? That the culture became you exchanged information more freely?

01:29:45
Holden:
I don’t know that it happened at any one time. We’ve looked at that and we’ve tried to break it. [01:30:00] I honestly think, when Stafford Hospital came on and the administrator there, Cathy Yablonski, made a huge effort at identifying people with good attitudes before she opened her building. Every single person in Stafford Hospital, when it opened she vetted them and she interviewed them. She only allowed people with good attitudes and willingness to support what she coined an “always culture.” You can’t be good most of the time. You’re good all the time. You can’t be nice some of the time; it’s all the time. She drove that in. Stafford is a wonderful place if you’re a patient, if you’re a staff member, or if you’re a visitor. It’s a wonderful place. I’m personally excited that she just recently took over Mary Washington Hospital and she’s going to work to try and bring that culture here. When she started—in fact, this was been five years ago now—that that’s when things really started to change. Originally, it was Stafford is Stafford, not Mary Washington. There were directors and there were managers in both silos. That went away a couple of years ago, to where people have responsibility in both. Everybody’s exposed more to Stafford and Stafford folks are coming here. People are responsible for the same function and I think that’s been good for a lot of managers at Mary Washington. I think that’s good for our culture, and I see a lot of improvements like that, to where the silos are breaking down. People are less defensive about being caught making a mistake and more open to let’s figure out how to make it better. It’s been a huge improvement and I only see it getting better thanks to Cathy.

01:31:54
Rigelhaupt:
You know, looking at it, was there any sense of surprise that Stafford Hospital—this is probably not the right analogy, but almost—the smaller, younger sibling, was having an influence on the older, bigger hospital?

01:32:13
Holden:
I don’t know that people really recognize that. I know that anybody that has worked with Stafford— and I perhaps am more observant, only because I was a patient up there. I spent a week in their ICU before they knew who I was, back when I was here at Mary Washington and not at Stafford. I started out as a patient and got to see it from the patient’s eyes. Then later I became responsible for departments up there. There was a bit of head butting at first. Any place that’s bigger—we have greater, bigger services, advanced technologies, we’re a trauma center and they’re not. [01:33:00] In many ways Stafford Hospital is looked at as the younger sister hospital, but I think that’s gotten much better. I think some people were surprised, but it’s just gotten better in many, many ways and more accepted. It’s been a few years. We’ve had a lot of personnel change. People have started when the hospital was here, rather than we built it from scratch.

01:33:28
Rigelhaupt:
Could you talk about your change in job, going from safety officer to safety officer and emergency preparedness?

01:33:40
Holden:
When I went from safety officer and director of bio-med, I had a great person working under me in bio-med. I only had to do higher-level things. There was an opportunity. I was asked to take over emergency preparedness. This was during a period where, you know, there was a lot of scare about Obamacare. We didn’t know what we were going to do, but we knew that was what our worst care was going to become our best care—Medicare, Medicaid. There was a lot of concern about spending dollars. Two people went away: a person who was the emergency manager and a part-time person that did a lot of the warehouse work. I got that job on top of safety officer. It’s been quite a challenge, only because I want to be proactive and I want to focus on something. When I was a kid, I was probably ADD, even though we didn’t call it that back then. My father just called me lazy. It’s probably been one of my greatest skills: I’ve learned to have lists and calendars and prioritize. I try very hard not to miss things. I used to be very, very proactive with safety and medical equipment. I’ve been trying to build the new program, emergency preparedness, to that point. It’s incredibly complicated. How do you prepare for tornados that might happen? What do you prepare for? Ever since 9/11, there have been a lot of threats, and as you know from the news, there are new threats every day. We hear about every one of those and we ask ourselves, “Could it happen to us? And what do we need to do to prepare?” It’s a lot busier than I ever imagined trying to train people, trying to prepare. Ebola came along and we’re trying to prepare for that. Hospital evacuation was a challenge a few years ago. The opportunities come faster than I as an individual can address them to the level I would like to. But, I do hope that I get a chance to clean up my act, and get everything taken care of in time. [01:36:00] We’re good and I’m not the only one doing it. I’ve got a wonderful senior executive that really owns it and she’s fabulous. She knows everything that I’m doing. She’s involved in everything: emergency preparedness and enough safety that she needs. With me and probably eighteen other directors, she’s just as on top of it. I don’t know how she does it, except she gives a lot of weekends to this place. I’m fortunate that we have a team: we have physicians involved, managers, and we have a great relationships with Fredericksburg City, Eddie Allen, the fire chief, and with Mark Stone, the emergency manager at Stafford. Actually we’re reaching out: we’ve got a new emergency manager at Spotsylvania and I meet with him tomorrow morning for the first time. We have local resources. We have something called the Northern Virginia Hospital Alliance, which is a company that Mary Washington and Inova and all of the confederate hospitals in Northern Virginia got together to form back probably eight or ten years ago. That company has solicited government grants and resources for a lot of equipment, supplies, and emergency things that we could need in a disaster. That has been a wonderful relationship to help with all of this. They manage not just an individual hospital, but region-wide. We have a regional response and we drill regionally. We’re not in it alone. There’s a wonderful, vast outreach of networking involved if we did have an emergency. Mary Washington committed a lot of money, four or five years ago, and they built a huge command center. We have dedicated space with dedicated computers and radios, integrated video systems, and all this just in case we have a disaster. That’s a wonderful commitment. I’m proud of what we do, I’m proud to work here in this role, and I hope that it gets a little better every day with my work.

01:37:59
Rigelhaupt:
What were some of the—there were a couple of things you might point out in terms of emergency preparedness that now, you have a plan, you train, you train frequently, and well thought out, that earlier in your career, there might not have been anything?

01:38:20
Holden:
I mean if you’ve listened to the news, we’ve had a couple tornado scares in the last few years that we never had before. You never thought about tornados and you never thought about earthquakes until we had one two years ago. We’ve always worried about the truck of molten sulfur on an interstate or a train wreck of something we don’t know about. Those weather events are the things that we’re more than likely going to see. Those are the things that we never really considered before. We’ve focused on them and we’ve planned. We train our people as part of orientation and it’s part of drilling. [01:39:00] Every year, since around March, the state focuses on tornados. There’s a statewide tornado drill and we use that as an opportunity to reinforce training, both in-hospital and outside companies, as well. That’s one of those things that, you know, five years ago, nobody ever mentioned.

01:39:31
Rigelhaupt:
It sounds like there’s been a fair amount of coordination over the last few years with senior administrators, physicians, nurses, staff, and many departments around emergency preparedness. What do you think has led to some of the more open free flow of information and the coordination in that area?

01:39:55
Holden:
I think that probably the biggest impact is the Northern Virginia Hospital Alliance. Our executives had to decide to form the company with the other competitors. They have been actively involved on the board of directors for years. This year, my executive is chairman of the board of the NVHA, and I think involved on what’s called NVERS, the Northern Virginia Emergency Response System. It is all of Northern Virginia, Maryland, and D.C., and very involved with emergency preparedness. They have been involved, they are aware of grant funding that’s gotten together, and they have done things like, you remember when the cruise ship lost water and couldn’t flush toilets? Well, hospitals said, “Hey, that could happen to us.” So, all the hospitals within Northern Virginia, including Mary Washington and Stafford, through the NVHA, have drilled non-potable water wells. We have water—we have literally buckets and bucket brigades, buckets standing by. If we needed to we could flush toilets using that water. We hope to expand it, too. I mean, we have storage tanks and heater systems to keep them from freezing, but we hope to expand it to have risers that would pump the water up to the different floors so we could respond even faster. During Hurricane Isabelle we had a power outage here locally. I was without power for a week. We had generators, but we didn’t necessarily have fuel. We have written agreements and memorandums understanding that Quarles Petroleum will bring us fuel. I bet the college has got that same agreement with them. So how many people are counting on that same source? Working with NVHA, we’ve got agreements with people from other areas that are not on everybody’s list so we could get it. We recently expanded our fuel capacity. Instead of 10,000 gallons, we went to 40,000 gallons of diesel fuel so that we could keep the generators running longer. [01:42:00] With a regional effort and regional communication, we share problems, we share ideas, we discuss what’s happening in the world, and we try and learn from it. Active shooter is another concern. It’s never happened around here, but if it can happen in a little movie theater in Aurora, Colorado, it can happen here. We have worked with NVHA. We’ve got specialists actually from Israel. There was a hospital—I think it was John Hopkins in Baltimore—that had an active shooter a number of years ago. They formed a company, and we’ve invited them down, and we’ve done tabletop drills with them to talk about that in the hospital. We had an active shooter drill at Stafford Hospital, working with the sheriff’s department, where we were giving a class. The detective came in as a disgruntled husband, took a hostage, and went through the building, pretending to shoot an associate or two. Now, I’ve lived in Stafford County for twenty-eight years now, I didn’t know we had such a well-trained, well-equipped sheriff’s department. I kind of expected it to be the Dukes of Hazzard, you know? But it’s not that way at all. Stafford County sheriffs department is very well trained. We do learn. They have a brand new 800 megahertz radio system, which works everywhere in the county. They’re very proud. It didn’t work in the basement of Stafford Hospital because it’s underground. We do these drills and we learn things. We try and make things better, but many of those things didn’t happen ten years ago. We’re constantly growing, constantly improving. Even locally, we have gotten, I think, better every single day. We collaborate, something that never would have happened. Fredericksburg city has a van, an RV, that is set up as a mobile emergency command center. For the last two years, when we set up an event, like for the Marine Corps Marathon or the Christmas parade, I’m actually stationed in the command center. I’m at the scene with the vehicle. If something happens, we’ve got instant communication and instant liaison with the hospital. We can take care of people faster. That’s one of the big things about the NVHA: there’s a system where all of EMS knows if there’s an event and there are more than ten patients or any chemical hazardous material thing. They call NVHA and there’s a dedicated radio system to our hospitals, Inova, Prince Williams, Sentara—all of them, they all check in, and they update through a state-run web database. What is their capacity to take patients in the next thirty minutes? That information within ten minutes can go to the scene commander and they know where to send people for the fastest service. [01:45:00] That is an integration that we didn’t have and it’s just wonderful to have. Emergency preparedness is exciting. I hope I get to do it for a while longer because it’s enjoyable to have plans come together. It’s just a challenge when I’m one person and I’m not totally responsible for everything. I have to rely on the kindness and the relationships of others, but it’s exciting.

01:45:30
Rigelhaupt:
I want to go back to your working in medical equipment. And what would you most want the public to know about working in biomedical equipment and in a hospital that might not be common knowledge? And most want people to know about that job?

01:45:52
Holden:
I think everybody assumes that equipment is safe, and it is. It’s much better and more reliable today than it was ten years ago. I think the one thing I would want people to know is how frustrating it is to the medical equipment people when the lawyers get involved. Let’s say, a technology such as an infant care system. You get a new baby and you put them in a baby warmer, called an infant care system. When a new one comes out and the new one is $10,000 more than the old one. The lawyers are involved if they could be, and if something happens to the person in the old equipment, then they would find the hospital liable because they didn’t provide the most current equipment. Because of that we have to replace equipment when it’s still usable and current and good technology. That expense costs you money. That’s one of the reasons why health care is so expensive. Now, it’s not that we would want want to keep things on or round forever with Band-Aids and duct tape. But when there’s a technology like a light bulb—now we did have LEDs come out, but before that and for the last 100 years, technology doesn’t change much in lights. You have to replace them every five years because there is different ways to make a light bulb light or a heater heat. That is very expensive for health care and that is passed onto us as the consumers. I don’t have an answer, except that is lawyers for you. I think we all suffer from that challenge. It’s the same thing with our car insurance and the same thing with our home insurance.

01:47:40
Rigelhaupt:
Same question—what you would most want the public to know about being a safety officer in a hospital?

01:47:49
Holden:
Safety is everyone’s responsibility. It’s not just the department that maintains the medical equipment. It’s everybody’s responsibility. If you see something that looks wrong, raise your hand. [01:48:00] It could be, as you’re walking into a building that you don’t own, that you don’t work at, but if you walk by and there’s something on the floor that you could trip over, tell somebody. Don’t just step over it and wait for somebody else to call. It’s raising your hand and telling people that there’s a problem. People want to know, whether it be the Department of Transportation, a hospital, the courthouse, or even Wal-Mart. They don’t want you to get hurt. If you see something wrong, it probably is. Raise your hand and tell somebody.

01:48:34
Rigelhaupt:
Same question, what would you most want the public to know about the job of emergency preparedness in a hospital setting?

01:48:46
Holden:
Two things come to mind. One is for the home settings: take time to think about your family. Have a list and don’t rely on your cell phone for your contact numbers; write them down and put them on a piece of paper in your purse or in your wallet. If we lose electronics or if you lose your cell phone and you can’t get a hold of anybody, that’s the wrong time to plan. It would be great to have a couple cans of kidney beans, things you would give to the food drive, or some ramen noodles. Or have a couple gallons of water in the closet so that if we get snowed in, and you can’t get out, you have water to drink, you know? Have a couple cans of cheap dog food to feed the dog or cat food for the cat because you’ll endanger yourself. When you wouldn’t do it for you, you’ll go outside for your pet and you might get hurt. Plan ahead. You don’t have to have a “go bag” in your car ready to treat people if you’re not in that business, but it wouldn’t hurt to have a blanket in case you’re in wintertime and your car died alongside a road in four feet of snow. You might want to stay warm. Don’t plan for everything, but plan for some of the very basics: contact information, staying warm, or having water to drink. That would be my advice for homestead emergency preparedness. I think all hospitals try real hard, they work towards that, and they do things behind the scenes that you’ll never know when you walk into the hospital. You have no idea that we plan menus in case we’re ever stuck, we’re out of food, and we’re down to three days into the rotating menu. You have no need to know that, just like you don’t need to know about the fire protection systems. You just know that they’re there, that they work, and we work real hard to maintain them. They’re right. When it comes to preparedness, hospitals are very active in trying to make it better, trying to protect you as a visitor, or as a patient. Again, we’re not Israel, but someday the country is going to get there. If you see something that looks wrong, like somebody’s carrying a gun in the building—unless they look like they have badge raise your hand and tell somebody. [01:51:00] See somebody that looks suspicious, it never hurts to say something. I’ve had to challenge people before, but I just do it respectfully and politely and tell them why. I have got good reactions out of them. If you don’t have a good reaction, then tell somebody. Tell the security department and let them watch out for it. You’re not prepared to deal with people. You’re not. You’re not armed. Don’t try to stop an armed person. Use common sense and protect yourself and raise the alarm if you can.

01:51:39
Rigelhaupt:
The way I like to end these interviews is that the last question is actually two questions. And one, is there anything that I should have asked that I didn’t? And two, is there anything you would like to add?

01:51:54
Holden:
I don’t know. I think of this to be viewed primarily by students at the college. We’ve got a huge history. Mary Washington has been in Fredericksburg for roughly 110 years, maybe a little over that. Everything has changed: the locations have changed four or five times, the people have changed, and technology has changed. People who work in a hospital are here because they want to make life better. They want to make it better for ourselves and for you. It’s an exciting career. Nursing is incredible because it’s so diverse. As a nurse, you can be at the bedside and take care of people. We’ve got nurses that have been in nursery for babies for forty or forty-five years. Those are usually our nurses that are the longest term. I knew of a lady that was forty-five years in the nursery. You can do that. You can work with old people in geriatrics, you can work with medications, and you can be in management and manage nurses. It’s a very diverse field. Home health is another exciting area of nursing. It’s something to consider. It’s always changing. Today, there’s a lot of technology and a lot of stress, but that’s only in the hospital acute care setting. There are rehab hospitals, home health, and there are lots of different areas that can be exciting. Everybody’s got an interest in something. It’s very diverse. Unlike building cars: you might put on a left wheel for five years and a right wheel for five years. It’s got to change. Mary Washington Healthcare has been an exciting place to work. It’s close to home and I feel an ownership in the organization. I feel proud of what we’ve done. I hope we don’t continue to grow too much. [laughter] When the time comes and a better person comes along, I’ll pass on the reigns to somebody new. But until then, I hope to continue to be a big part of the history of what we do and help things advance along. [01:54:00] Thank you.

01:54:07
Rigelhaupt:
Thank you.

01:54:08
Holden:
It’s been fun.

01:54:09
Rigelhaupt:
Yes, it has.