Susan Fontenot

Transcript

00:00:06
Rigelhaupt:
It is November 12, 2014. We are in Fredericksburg, Virginia on the campus of Mary Washington Hospital doing an oral history interview of Susan Fontenot. The first interviewer and the first voice you will hear, male voice, is Andrew Perrow and I will pick up some of the interviewing later in the interview. My name is Jess Rigelhaupt. So Andrew, go ahead and begin.

00:00:30
Perrow:
So could you tell me where you went for your nursing degree?

00:00:33
Fontenot:
Germanna Community College.

00:00:36
Perrow:
Okay, and could you briefly describe the education you received there?

00:00:40
Fontenot:
I graduated from Courtland High School and that summer immediately started classes at Germanna to get the preliminary classes out of the way. With it being a two-year program, I really wanted to concentrate on just nursing classes. It actually took me almost three years to do a two-year degree because I did all the classes I could up front. And then I was lucky because some of them I didn’t have to do because I had just graduated from high school—they took my chemistry. It was two years: first year basic, second year very intense, and then I graduated in 1990.

00:01:40
Perrow:
So what was attractive about Mary Washington and Snowden? What made you want to work here?

00:01:44
Fontenot:
I started at Mary Washington Hospital when the hospital was on Fall Hill Avenue. I came here because there was no thought of going anywhere else. I didn’t even think about working anywhere else. There are a lot of family connections: my grandmother worked at the hospital, my mother worked at the hospital, and I actually started working for the hospital earlier as a nursing assistant. CNAs now get certification, but because the nursing director at the time knew me and my mother and my grandmother I was just able to become an NA. She didn’t make me get my certificate because I was in nursing school. I started out as an NA and I didn’t even fill out an application when I became an RN—it was just kind of like, “You’re going to work here, right? Yeah, I’m going to work here.” It just went from there. [03:00] Back in the day you’d become a RNA until you passed your boards and then you went to an RN. So I went from an NA to a RNA to a RN.

00:03:10
Perrow:
Did you have any initial reservations about going into nursing or did you always know this is something you wanted to do?

00:03:15
Fontenot:
I didn’t really think about it until more of my senior year because then it’s, “Oh. I got to figure out what I’m going to do.” It was always something medical. I broke my leg when I was in the fifth grade and so I was going to be a bone doctor and stuff like that. By nature I take care of people and I’m a people person. It’s just my nature: if I’m in a crowd and somebody needs assistance or I can see somebody needs something to drink—it’s just my sixth sense to know to do that. I have a lot of compassion. It just made sense to be a nurse and there’s a school right down from where I lived that I could get my degree.

00:04:09
Perrow:
Great, great. Now I’ve heard that nurses who go into the field just for a job, they don’t stay long. Is this true?

00:04:17
Fontenot:
No. The way I was raised, I’m an old nurse. It’s a life commitment. You have to want to be a nurse. You can’t just be a nurse. At least that’s the way I was raised. Back in my time, you have to be able to do it, you have to have the compassion, the work ethic, and the dedication.

00:04:45
Perrow:
Okay. So what would you say then are the most important traits that any nurse should have?

00:04:49
Fontenot:
There are two sides to that. To be an efficient nurse, you have to have excellent organizational skills. You have to have that—I call them street smarts. You can be really book smart, but to work in an acute care facility you have to have street smarts. I have lots of street smarts. I think as far as your work performance, there’s some tick boxes you need for that. As far as the care of your patients, I’m a toucher. You have to have a lot of compassion, a lot of patience, and you just have to be a giver. You can’t be a taker. It does get frustrating—I mean you do have moments where you’re not as compassionate as you should be. You certainly don’t let that show, but it’s a hard job. [06.00]

00:06:01
Perrow:
Alright, well so now I’m going to move on to your specific job working here. Could you describe to me what your first shift was like and what you were feeling at that time?

00:06:07
Fontenot:
Here at Snowden?

00:06:08
Perrow:
Yeah, yeah.

00:06:09
Fontenot:
When I worked at the original hospital on Fall Hill Avenue, it was called 1-East. And 1-East was the sister floor to ground southwest, which was our basement psychiatric facility. I would float there and then ground southwest nurses would float up to 1-East. The original 1-East was kind of a hodge-podge of things. A lot of times it would be nicknamed like “1-Beast” because it was just a really hard, hard floor. We got all of the alcohol and drug with detox and withdrawal patients. We would get a lot of indigent, homeless, or mentally ill, but they weren’t to a level where they could go to ground southwest because they needed more medical attention. When we moved to this hospital on Sam Perry, 1-East changed to a different name, but I always stayed with the same floor type. It was about twenty years of working that and then it was time for a change. I have always been a very big advocate for the mentally ill because if you had cancer, you’d get chemotherapy. If you had diabetes, you’d take insulin and if you broke your leg you’d get a cast. It’s hard for the mentally ill because you can’t see where their disease process is. I’ve always been very intrigued about that and how the mind can splinter and all the co-morbidity things that they have to deal with. A lot of times you aren’t just mentally ill, but you also have other medical issues. I thought that I would come over here and see what it was all about. I actually kind of came unannounced, walked in, and said, “I’d like to see what this place was all about.” Everybody here was just wonderful and they’re like, “Come on back!” Being a nurse already with Mary Washington, there wasn’t any kind of confidentiality thing or anything like that. I was not getting paid, but I just shadowed a nurse for a couple hours. I was like, “Okay. Where do I sign up?” I transferred over and I’ve been here since.

00:08:51
Perrow:
Great. So what tools would you use to cope with stress or feelings of being overwhelmed while working here?

00:08:57
Fontenot:
I am very lucky because I have a wonderful gift of being able to turn things off. [09:00] I mean, truly turn things off. I am able to not think about things patient related at home. You hear horrible, horrific, unimaginable stories of abuse that people, our patients, have received and it’s gut wrenching. At the time you’re right there with it, but when I get in my car and go home I don’t think about it anymore. I don’t think about it anymore. I’m lucky with that. Then being in management now and nursing leadership, it’s a twenty-four seven with staff—and you know, little text messaging it gets you every time. I’ve gotten better at it. I am a doer and I like to do and I like to make people happy. I’m a people pleaser and I am learning some boundaries: I don’t have to take a text message at 1:00 a.m.

00:10:19
Perrow:
Okay, before coming into this interview we had done some preliminary research on nursing and a big topic that we had focused on was becoming “burnt out.” Is that so in your experience?

00:10:33
Fontenot:
Absolutely. Absolutely. But the thing with that, is you have to be smart enough to realize it. I was lucky. I went from working three twelve-hour shifts, to working two twelve-hour shifts, to working one twelve-hour shift, to one eight-hour shift, and then I got to the point where I was only working four hours here and there because I didn’t have it. I didn’t have anything in me to give and I knew that I didn’t have it anymore. That’s when I walked over here to Snowden and now I work full time again.

00:11:14
Perrow:
Oh wow. Okay. So moving specifically to your relationships with patients; do you have any one patient in your history that you’ll just know you’ll never forget?

00:11:21
Fontenot:
Oh my goodness, yes. Several. Vivid. Face. Name.

00:11:26
Perrow:
And these are memories that you feel will carry—will be with you for the rest of your life?

00:11:32
Fontenot:
Oh yeah. Oh yeah. Because their situations and their stories were just so intense.

00:11:40
Perrow:
I see, okay. So now moving away from specific patients how would you deal with emotional family members of patients and in your interactions how would you deal with them?

00:11:52
Fontenot:
That’s hard. I must say, when I started I was a twelve-hour night nurse. [12:00] Night nurses don’t deal with a lot of families and doctors and such. But over the years, working all the different shifts and, of course now in full time and being in management, you listen to a lot of families who aren’t happy. You just have to look at it for what it is. Whatever anger—it’s just a reflection of feelings that they have inside. Maybe they feel guilty about something and they’re overly defensive. I always listen and look, but then I think in my head and do little stories, “Okay. So he feels guilty because he didn’t come to see grandma and now grandma’s dying. He’s going to put on a big show, you know?” I just try and rationalize behavior because so much behavior, when you clear out a lot of the bluster, is simple things: it’s simple emotions that give a lot of behavior, whether it be anger or guilt. You just try and say the right things at the right time. A lot of times it’s just letting them vent and letting them talk. It might take a while, but you just listen and then you sometimes have to just validate their feelings. Sometimes, it’s “I understand you feel that way.” Sometimes it’s just that validation that they need, because they’re scared.

00:13:36
Perrow:
Sure, sure. So what would you say that your biggest accomplishment thus far in the nursing field has been?

00:13:42
Fontenot:
I don’t have per se like a huge accomplishment that has gotten any kind of awards. But I’ve worked for this facility for twenty-five plus years and I’ve never had a “needs improvement.” Everybody that has worked with me I feel would say positive things. I’m easy to work with and I’m fun to work with. I guess it’s just that my name still has a positive image with it. I like to brag that I’ve worked here for this long. I guess that’s probably the biggest achievement and that I can say my grandmother worked here and my mom worked here. My mom actually was born at Mary Washington hospital, the original one on Sophia Street. I just like to be able to give and I like to be able to give some history talking about Mary Washington. [15:00] You almost get a little protective in that it has always been in my life and I can’t imagine not having it.

00:15:16
Perrow:
Sure, okay. So how would you describe the nursing community here at Mary Washington and Snowden? Strong support system would you say?

00:15:25
Fontenot:
Oh yeah. Yes. Oh yeah. You mean as far as the nursing leadership supporting other nurses or just all nurses in general?

00:15:34
Perrow:
All nurses in general, the entire nursing community working together.

00:15:40
Fontenot:
You know from working over there for so long and now working here, I’m constantly calling, text messaging, or emailing people over there to assist me with things and vice-versa. Even though, you know, the floors have gotten to be their own entity. In the original hospital on Fall Hill, we didn’t have a pneumatic tube system: you had to hand carry your urine specimen to the lab. So you’d be in the lab and I’d see you and I’d be like, “Hey how are you?” With the pneumatic tube system and the hospital getting bigger, you lost that face-to-face. Everyone kind of shelved into themselves because they didn’t need to leave the floor. But with saying that, there’s still such closeness with sharing ideas. If you need assistance or if you need something and you don’t know how to contact somebody then you know who to contact to find out who to contact. I’m a master of that because I know somebody somewhere that’s going to help me. Even though it’s a huge health care system now there is still a closeness and its nice seeing faces that you have seen for a long time and that are still here too. You feel like you’re in this own kind of club of people that have been here for a long time.

00:17:22
Perrow:
So since you have had extensive history here, have you had any regrets that you would say have shaped your identity as a career nurse?

00:17:30
Fontenot:
No. No. The only time once maybe was my brother had a friend who had a business of—you know the show Intervention?

00:17:50
Perrow:
Yeah, yeah.

00:17:51
Well he had a business of doing that and so I was approached about flying out to interventions and being the medical nurse support, which would have been totally awesome. [18:00] However, I have a husband and children and that just wasn’t in the forecast for me.

00:18:06
Perrow:
Okay. So I guess kind of going off the Intervention aspect. How would you say that nurses are perceived in popular culture and would you say those images portrayed? Are they accurate, inaccurate?

00:18:22
Fontenot:
I’ve been a nurse for so long that there have been different images. I’ve always been very proud to say that I’m an RN. I think it’s an awesome thing because I can work in a hospital, I can work on a cruise ship, or I can work for a CEO of a Fortune 500 company. You can do just about anything by being a nurse, which is pretty awesome. Do we get paid enough? Well, that’s a whole other story. I don’t really know because I’ve never really asked, but I’ve always been proud to say that I am an RN. And with having a daughter that’s in college, I was very careful not to push any of that on her. But that’s what she wants to do regardless. I think it’s just because of, you know, watching me, seeing me, and the way it has worked so well with me. She has my gut and so she’ll be a good nurse.

00:19:50
Perrow:
In your history as a nurse, have you ever had a request either from a patient, family member, or other medical staff that you did not agree with? And if so, how did you approach that?

00:20:03
Fontenot:
That’s a big question. Anything unethical, there wouldn’t even be a thought. There wouldn’t even be a tempted second to even think of doing anything unethical. I am a huge advocate for my patient. When I am taking care of that patient, they are mine and I get very protective. That’s something else that people probably don’t know: nurses get very protective and very territorial of their patients because it’s a reflection of you. If you’re patient is doing well, then you’re doing good. Your patient’s room is going to be clean, your patient is going to be clean, and your room is going to be neat because that is a reflection of the kind of nurse you are. If I feel that my patient is not getting what they need, I will ring a phone, knock on a door, or have no problem jumping through hoops to get what my patient needs. [21:00] If I feel that there’s any abuse or a family situation that isn’t healthy, then there are steps we can take. If I feel like another provider or another entity isn’t doing what they need to do, then there are steps to take for that. So did that answer?

00:21:39
Perrow:
Yeah, absolutely. So you said that your family—that you have an extensive family history in nursing. Other than your mother and grandmother did you have any mentors within the nursing community that you would say helped you?

00:21:54
Fontenot:
Just the whole hospital in itself? We’re talking the ‘70s and early ‘80s. My mom and my grandma worked at the hospital together. Every night—living in a small house—my mom would call my grandma or my grandma would call my mom and they talked about the hospital. They talked about their day, who said what, what’s going on, and so I went to sleep every night hearing about Mary Washington Hospital. Then every Christmas my mom would have to work and I would go with her in the morning. Back then it was okay for a ten year old to sit at a front desk greeting customers, patients, and doctors and it was a tradition for me to do that. I’ve known all the supervisors and all the leadership people from the very beginning. Martha Brooks is probably the nurse that stands out in my mind the best because she was my first manager as an RN. She’s just in class by herself. She’s so gifted with telling you to “go to hell” that you want to say, “When can I go there?” She had this way of making you want to be a better nurse and she had a way of telling you that you weren’t really doing too good and you would do anything to do better. Then the other nurse that probably sticks in my mind is Mary Beth—back then she was Mary Beth Odell, and I believe now Mary Beth Freckmyer. She was my first preceptor at the old hospital and she now is a nurse practitioner specializing in geriatrics. [24:00]. She had a big, big, big soft spot for the geriatric population. I remember one of my first things that I did when I was precepting to be a nurse was soaking patients’ feet in water and cleaning their toenails. I didn’t even think that was something that would gross somebody else out because it was needed. I had seen her do it so of course this is something that I’m going to do. I can guarantee you nowadays, that’s probably not something the nurses are getting oriented about.

00:24:41
Perrow:
So kind of moving into the practice of nurses. Are there any programs here or were there any programs in your education that would prepare any nurse, or you specifically, for the death of a patient? And if so what was that experience like?

00:25:00
Fontenot:
I remember seeing my first patient who died. I do. I think with the whole morbid, grotesque body fluids that you deal with and the sights that you see; death is a next step in that. It certainly didn’t bother me and that’s certainly not a reflection that I’m cold hearted or what have you, but it didn’t bother me. I’ve never really been around anybody who had a hard time with that. I can’t say that there was any kind of class or any kind of course. If you were having a hard time with the process, I’m sure there was some kind of counseling that you could get for that. I mean, you know all the sick jokes you hear about nurses who can truly do post-mortem care and eat a sandwich at the same time? It’s true. Yes, you can talk about really gross things and it just doesn’t bother you.

00:26:15
Perrow:
So you become, I don’t want to say desensitized, but—

00:26:19
Fontenot:
Yes, you do in a sense. You do in a sense. Christmas dinner and I’m talking about a homeless guy that had maggots in his wound. The wound was really clean though because the maggots ate all the dead flesh. And I say, “What’s wrong?” And everyone’s like “Oh my gosh!” I also learned early on that my smell is a big trigger for me. I breathe through my mouth. I never breathe through my nose. When I walk onto a floor, I instinctively breathe through my mouth.

00:26:55
Perrow:
And doing that helps you deal with—

00:26:58
Fontenot:
I can’t smell anything! Now there have been smells where you could taste them. [27:00] That’s when you put a little toothpaste under your nose and put a mask on. But that’s one of the things I taught myself to do because I knew smell was a big trigger for me. If you start gagging, it’s embarrassing—and then once you start, it’s just a mess. I breathe through my mouth.

00:27:19
Perrow:
Okay. So I guess moving away from that, would you be able to describe the relationship between the nurses here and the doctors? Positive, would you say?

00:27:28
Fontenot:
It has come so far. When I first started working at Mary Washington Hospital we didn’t have doctors at night. There were no doctors in the building, except in the ED. If we had a code blue, we would run it until either a doctor came in or the ED doctor would come over. Sometimes we had a doctor who would do rounds at night because he was infamous for not wanting to talk with patients’ families. Probably about seventy-five percent of the time he would be in the building if we were having a code and he would respond. He was a cardiologist so it worked out well. But we didn’t have doctors in the building. We didn’t even have a pharmacist in the pharmacy at night. If I got a new admission from the ED onto my floor, I would then call the supervisor—well page the supervisor because there were only beepers. The supervisor would call me and I’d say “I got a new admission.” And she goes “Okay. Give me a minute.” She would go into the pharmacy. Sometimes if I needed a couple things, she would have a flashlight and she’d come in, and she would be like, “Okay, what you need?” I’m like, “Grab me a couple Tylenol. Get me a Rocephin vial and that should do it.” She would bring that down to me and go on about her business.

00:29:04
Perrow:
Great. You were talking about this doctor that would only come around at night. Were there any other major differences between day shifts and night shifts that you can remember, or that you experienced?

00:29:13
Fontenot:
No pun intended, but it’s night and day. [laughing] It’s a whole different vibe for daytime versus nighttime. Now there are doctors 24/7 at the main hospital. We started with hospitalists, which was a new thing to our organization. I don’t know when. It was probably when we moved into the new hospital in 1993 and I worked nights. I think a couple of years later we got our first three hospitalists: that was Dr. Ken, Dr. Newberg who’s still here, and Dr. King. [30:00] Those were the three that started it up and it really worked well. Now we have mostly hospitalists that hold the care of the patient and then if they need a specialist they’re consulted. That is wonderful to have because you always have a doctor in the hospital.

00:30:34
Perrow:
Okay great. So kind of moving onto different nurses-roles that nurses have played within the hospital. Have you noticed a shift in the perception of male nurses in the past or a change in the perception of male nurses within the past decade or so?

00:30:47
Fontenot:
It’s funny you said that, because we were just talking about that this morning. When I first started in nursing school there was one male and it has slowly become a norm. You do see more male nurses in a specialty role versus bedside. I have worked with phenomenal male bedside nurses, but you do occasionally run into the little old lady that doesn’t want a man examining her, putting in a Foley, or changing a dressing. That’s a give and take—I’ll do this and he would do this for me. But you’ll see more males in the ICUs, the EDs, the cardiac cath labs, and all that.

00:31:51
Perrow:
Okay. Kind of on the same page here, has there ever been an experience in your nursing career where there has been a language barrier and that may have impeded your work as a nurse or has that never been an issue for you?

00:32:00
Fontenot:
Of course it has.

00:32:05
Perrow:
And how would you deal with that?

00:32:06
Fontenot:
We have interpreters. We have interpreters that are available 24/7. They have to be interpreters. You can’t use the housekeeper that speaks Spanish. You have to have an interpreter that has been cleared by the hospital. If there’s no one available that speaks that language, we have phone communication. That’s basically a phone, but I talk to you through that line and I don’t talk to the interpreter. That’s 100 percent available all the time.

00:32:49
Perrow:
Great, okay. So I don’t know if this is standard practice or not but I’ll ask specifically to you. Have you kept up any relationships with patients who have since sought treatment and recovered?

00:32:59
Fontenot:
No.

00:33:00
Perrow:
And is that standard practice for all nursing?

00:33:03
Fontenot:
Yes. For where I am now, yes. You’ll still get the patients and you’ll sense something. Then you’re like, “Oh no.” You look down. And they’re like, “Hey! You remember me? You took care of me at Snowden!” And you’re like, “Uh-huh. It’s good to see you.” You never approach them, but you certainly are respectful when they approach you.

00:33:31
Perrow:
I see. So do you have any advice that you would give, off the top of your head, that you would give current nursing students who are looking to go into mental health as a nursing profession?

00:33:41
Fontenot:
If I hadn’t mentioned before I’m a little old school. I’m an old nurse. I am firm believer in when you graduate from nursing school you need two years on a med-surg floor and don’t you dare not do that. They used to make us do that and they don’t now. I think it’s so important to be a well-rounded nurse, to have head-to-toe assessment skills, to do basic nursing procedures, and to be able to quickly assess a patient for a stroke, a heart attack, or an abnormally bloated stomach. I think it’s so important to know. It’s kind of like, “You just got to do your duty, new nurse? You need to do two years in the trenches and then go to a specialty.” That’s my advice. My advice also is when you’re in nursing school you must get a job in a hospital or nursing home or rehab facility—any place you can witness bedside care because it will let you know whether you want to do this. Because it can be, “I’m going to be a nurse and I’m going to work this and I’m going to make this and find a cute doctor.” No, that’s not going to happen. You’re going to get vomited on. You’re going to get spit on, you’re going to get bit, you’re going to get kicked, and you’re going to get body fluids on you that you don’t want on you. By putting in your two years, I think that really shows you what it is all about. Also doing that while you’re in school because if it’s not something you want to do, you can be like, “Oh no. That’s not for me.” Unfortunately, nowadays there’s such a high demand for nurses, you can go right out of school and go right into the NICU or go right into a specialty. I’m not saying that that’s bad, but it’s just not the way I was raised.

00:35:48
Perrow:
Could you see yourself happier in any other area in the medical field or is nursing where you’d stay for the rest of your life?

00:35:57
Fontenot:
I’d love to uproot this place and put it in like, Key West. [laughing] [36:00]

00:36:06
Perrow:
[laughing] As far as professionally though, you would—

00:36:08
Fontenot:
No, I’m cool. I’m cool. I’m good where I am and I’m good at what I do.

00:36:21
Rigelhaupt:
So I want to jump back in time. What’s your first memory at Mary Washington Hospital?

00:36:26
Fontenot:
Wow, really?

00:36:32
Rigelhaupt:
Not really. I mean your earliest memories.

00:36:36
Fontenot:
It would be going in to see my grandma. My grandmother started working here in ’62 and then my mom didn’t start working here until, I think, the mid or the early ‘80s. We would come in and visit my grandma. It was in the early ‘70s and you could just come in and visit her. She worked in the admissions office and she had the black and white typewriter. Everything was paper. I remember walking back in the different cubicles, coming to her and then the switchboard. We would go pick up my grandma and visit her and then we’d go see a friend of hers that my mom knew at the switchboard, which was literally the pullout, plug-in switchboard. They all smoked down there so it was really smoky. You could smoke in the hospital back then. In fact, when I first started patients smoked. It wasn’t anything; it wasn’t anything at all.

00:37:43
Rigelhaupt:
So having memories that go back to-a ways, do you have memories of even the Fall Hill building changing, expanding? I mean there was an expansion in ’79 and how the hospital changed on Fall Hill?

00:38:00
Fontenot:
Sure. Because I volunteered as a candy striper and actually my picture is in the hallway across the street, in the long hallway from the information desk connecting it to the Tompkins-Martin building. There’s a picture of me and I believe Dr. Tarrow was cutting the cake when they did the expansion of the mother/baby ward. I think that was in ’81 or ’82. Of course. Of course. The Amy Guest wing and all of that. Ironically, when we opened a new wing here at Snowden, we named it 1-East in honor of that original floor at the Fall Hill hospital.

00:38:48
Rigelhaupt:
What did some of the expansion at Fall Hill represent? Maybe not as a teenager you recognized that it meant the hospital could provide different medical care, but looking back at it was it establishing a pattern of growth for the organization? [39:00]

00:39:04
Fontenot:
Absolutely. Absolutely. Even at a young age and with being here my whole life, I didn’t appreciate the growth. I couldn’t do things I had done before, like riding my bike down Route 3. My grandma and my mom would get busier and they would talk. I grew up with the growth of the health care and changes. There are always these changes in a health care organization. You either change or become extinct, so that’s what it’s about.

00:39:56
Rigelhaupt:
Could you describe, if you can remember the first time you walked in as an RN and that first shift where, I don’t know if it literally said RN then, but if—

00:40:13
Fontenot:
Oh yeah. I don’t know if it did or not. I actually think that I have my badge from when I first started because you had to put it in and you punched in a number so the badge was different. I do have my husband’s because he was an orderly here when I was in nursing school and so that’s how we met. That’s another connection. I forgot what your question was.

00:40:51
Rigelhaupt:
Describing your first shift as an RN.

00:40:54
Fontenot:
Oh yes, yes, yes. First of all everything was handwritten. I started out doing twelve-hour nights so you come in and you get report and you would have eight or nine patients, which is a lot. But their level of disease process is nothing like it is now. The patients in the ICU back then would have been dead and the patients that I took care of would have been in a higher acuity floor. It’s a degree. Everything was hand written and all the medications were handwritten by the unit secretary. You would sit down with the book and go through it. They had the Kardex with the pencil and you would erase it. It was still basically what we’re doing now: you’d go through their name, any kind of medical history, what brought them in, what we’re doing for them, and if they had labs. [42:00] Then you’d have your sheet and take your notes and I remember I’d always get a bedside table. It was pretty much a desk on wheels and I’d start in my first room. In 1-East when you approached the unit, the right side were semi-private rooms and there were two patients to a room. Then on the left side were all the private rooms. We would put people who needed isolation back then, which is different now than anything. I remember taking care of my first HIV patient and of course we had him in a private room. All of our detoxers would have their private rooms. Whichever side I was on I would start with my beside table and I’d have my coffee, my papers, and anything I could possibly need that I saw on my report. I’d go in and I’d assess and say hi, introduce myself, document the bedside chart in the room, and then just go on down. By the time you were done it was time to come back and start medications, 10:00 p.m. medications. Boy those are different: we would use the same IV. You would piggyback in an IV antibiotic right in and it would be done—the needle just sticking there. If the patient was a little restless, maybe put a piece of tape over it. Then you would come back and you would see, sometimes, it was long and the blood was back in the tube. It was no big deal. You would just unhook the IV and sometimes we would tape what—well what I was taught to do was you would tape the cap of the needle cap onto the tubing. You would just take it out, hook it, then recap it right there, and it would be one thing taped. You’re recapping needles, which is just horrific, an unimaginable practice. In fact, now you couldn’t even do that because we’re needle free for IVs. There are needles when we have to give IM injections and stuff like, but there are no needles with any kind of IV system now. It’s all needleless. There weren’t gloves—I mean there were gloves, but you had to go look for them. There weren’t gloves in every room. If you really knew you were going to have to do something that you really needed gloves, you would go get gloves. But if you just needed to quickly take care of something, you washed your hands. In fact, I would wash my hands until they would bleed because of that. You’d reuse things, such as glucometers. [45:00] We’d use the same device to stick the same device. Of course we’d change out the needle, but it’s still the same device I’d use on you and you and you. I would take out the little sharp point—never mind that there was probably, maybe blood that had fallen because it wasn’t anything! I would use the same tool and I would take it and do it. Then giving blood: the only time you could give blood on an IV pump system would be in the ICU or something major. You could only give it by gravity. Now you can only give it by pump. You would not give it by gravity now because they have found that blood should only hang for so long. Whereas before it could go in for four to six hours. Now they’re finding you can’t. Even just pumps, IV pumps. We would have IV pumps if it was something special, but we would just have dial-a-flows. We’d hang a bag of fluid and hook it in. We would have this little thing that would be 100 or 125, and we would just dial this plastic knob. So yeah, real different. Getting an admission at night was very rare. If you got an admission it was such a big deal, such a big deal. And then if you got two—oh heavens—you were calling the nursing supervisor saying, “I already got one. You’re going to send me another one? What is this?” Whereas now you can get eight admissions in one night and not blink an eye. We used to mix all our own medication bags. We would mix up all our own antibiotics. If an IV bag had to have potassium put in it, we mixed it ourselves. To tell a new nurse that now it’s like, “What? That’s crazy! Why would they ever let you do that?” It’s because we know more things now. And I mean leather restraints—oh yeah. In looking back, it’s horrible and you can’t wrap your mind around it. But like I said at the time, it’s all we knew and it’s all we had. We certainly weren’t being malicious on purpose. It just shows you where we’ve come. [48:00] It’s just we were doing the best we could at the time. It was almost like a triage. You just had to get through this little crisis. I have stories. Floating on up to the oncology floor and a man was near death and he wanted to have a cold beer every night. Cafeteria would send him a cold Miller Lite every night because it was the compassionate thing to do. “That man can have a beer. He’s dying.” One of the biggest things I miss with working with my addicts and my substance abusers or even the mentally ill that are very unstable is not being able to bribe them with a cigarette. It’s such a basic thing to them. I would get through the shift so much easier with bribery—a wonderful thing. I mean, it’s a beautiful thing. I’d be like, “Look. I need you to do this. And then at ten o’clock I’m going to come and I’m going to bring you down to the end of the hall. You’re going to have a cup of coffee and a cigarette.” “Okay, okay!” I’d love to be able to, even today say, “I want you to stay calm. I don’t want you to yell or get aggressive. I want you to take your medicine and at one o’clock I’m going to take you outside and you’re going to smoke a cigarette.” It’d be nice, but that’s not ever going to happen. I’ve seen it work as well as other things and it would be nice to be able to do that. [51:00]

00:51:01
Rigelhaupt:
Was 1-East considered a medical-surgical floor?

00:51:04
Fontenot:
It was a medical floor. It was a general medical floor. Now we have acute floors, progressive units, and ICUs. We were the hodge-podge, melting pot, dump floor and you would get every kind of patient you can imagine. It was an awesome way to get a grasp on everything, but we specialized in medically clearing the mentally ill. If someone tried suicide and they took enough medicine that they had to be intubated. Then if they weren’t quite ready to go to Ground-South they would transfer from the ICU to us. Maybe for just a day of watching them and making sure everything was copasetic, and then they’d go down to Ground-Southwest. You would develop relationships with patients because they were your indigent or homeless. Back then there weren’t a lot. I remember hearing about the first homeless people that they found under the bridge. That was neighborhood news. Back then you knew everybody and they would come back to us all the time because, unfortunately, we couldn’t give them long term treatment. We would just patch them up as best we could, get them healthy, and then go back out. And then they would do it all over again. It was horrible because it put such a strain on your body. What would happen is they would use whatever money source they had and then they would continue to drink. Then if they couldn’t afford any more alcohol, the police would see this person on the sidewalk acting really bizarre. Well, they were going through alcohol withdrawal, which will kill you. They would come in and we would get them all clean and sober and they would go back out. It was a lot of repeat, a lot of repeat.

00:53:49
Rigelhaupt:
What do you remember about the first conversations, maybe water cooler style talk about the potential for a new hospital?

00:53:58
Fontenot:
Oh, wow! [54.00] I am trying to think. Martha was our nurse manager and they prepared us a lot with the building. They would give timed tours. I remember they put a Christmas tree up on the top of the building one Christmas. Was it September of ’93? Okay, September of ’93 we moved in so it was that previous December that they put a big Christmas tree up top. I also remember naming the streets. You know how Sam Perry? You don’t know Sam Perry? They had a contest of naming the streets and Sam Perry was a wonderful, wonderful man who volunteered thousands of hours to the hospital, mostly in the ED. Sam Perry Boulevard. That’s cool. Then all the secondary, the side streets and stuff. That’s how that happened.

00:55:29
Rigelhaupt:
Was there input from you or your colleagues in nursing as far as what you wanted to see in what would be the new 1-East at the new hospital?

00:55:41
Fontenot:
The 1-East here?

00:55:44
Rigelhaupt:
I mean was Snowden built simultaneously in the sense were you going have a similar patient population at the new hospital? Were there things you had said, “Could you do this?” Or—

00:56:00
Fontenot:
To be honest in ’91 or ’92 that wasn’t the flavor. I remember some thought of how we think it should be and they would give us tours and show us. But it wasn’t a lot of bedside nursing input. However, when Stafford was built it was all nurse driven. It was all nurse driven. I myself sat in a lot of the meetings with, “What do you want in the room? What do you want the room to look like? What do you feel you need?” From back, way back then to now, it is very, very, very nurse driven. Because hey, we kind of run the show. [laughing] [57:00] A happy nurse is a happy patient and a happy patient gives us good ratings. It’s pretty basic. Are there things that need to change? Yes. Is there any organization that everything is perfect and doesn’t need changes? I would flip hamburgers at a diner before I worked as a nurse anywhere else.

00:57:37
Rigelhaupt:
What do you remember about your last tour, or the last time you were in the new hospital when there were no patients?

00:57:46
Fontenot:
It was so big! Are you kidding me? Think of Fall Hill Hospital. Now it’s changed so much. And you guys aren’t from around here—so very different. It’s hard to wrap your mind around it. It was itty-bitty and like I said we’d have to walk to get everything. If we needed a certain supply, you’d walk down to get the supply. If you needed a medication picked up or something special then you went to the pharmacy or you went to the lab. You knew where everything was. The floor, the original floor I worked on Fall Hill, was just one little hallway. It was a long hallway and it had two rooms in the back and then it was another hallway and then the nursing unit. Walking over to the new, big hospital we all joked, “We’re going to have to wear roller skates. Oh my gosh. How are we going to do this?” Because it’s huge! All the rooms were private, which is like, “Really? Wow!” Somebody was smart and was thinking forward. Can you imagine now having semi-private rooms with all the isolation and such? You’d walk in and it was this funky shape and we had carts. I wanted my little side nursing table: “I was fine. Why you gotta go messin’ with anything?” It was hard at first. Change is hard. Then we went on a whole computer. Are you kidding me? Computer? [laughing] We didn’t have that. I do remember our secretary learning a new system. I think it was called Sunquest and lab reports would come out. [01:00:00] I started in the lab when I was in high school and I was a lab tech. I would be at the desk and I worked hematology. So the lab lady that was running the test would then hand me the written results. At seventeen years old, okay? Then I’d take that, find the patients name, handwrite the results, and then the floor would call and say, “Hey can you give me the test results of Mr. So-and-So?” And I’d be like, “Oh yeah, sure. Here.” Who am I? [laughing] Even back then we moved from that to where they were put into a computer. I think it was called Sunquest. Then over here the training was intense. It was scary. A lot of nurses didn’t do well with the change. A lot of the older nurses decided not to come over. It was just the next step. It was the next step. I remember moving that morning. It went really well. In fact, it went better than they thought it was going to be. We had bags. We had like school bags that we would put their chart into, their Kardex stuff. You would have the chart and then you would have the nurses’ stuff. You would have a notebook and you would put all your patient’s material into your own notebook. We’d put the chart, their Kardex information and then their medications in a bag. I remember just using a Sharpie, marking the name, and putting it right on the bed. We had extra crew on, extra CNAs, because we gave everybody their bath.

01:02:20
Rigelhaupt:
Were you working the morning ambulances drove people across the street?

01:02:28
Fontenot:
I came in the night that we moved and so I had to get all the patients ready and organized and ready to go. Then I left before our patients moved because we were the last to move. Then I came in the next night and worked there. I was very apprehensive. I showed up like an hour early and made sure I could find everything.

01:02:52
Rigelhaupt:
Tell me about the first night you were working in this new hospital.

01:03:00
Fontenot:
I remember it being very quiet because we, of course, had no census. They tried to get rid of everybody they could for safety reasons. They had a lot of people available to help you. I do remember that. I can’t remember anything that was catastrophic. It was okay. It was okay. It became just like anything, a habit. Now I can’t imagine not doing it the way that we had been doing it.

01:03:51
Rigelhaupt:
What did the new hospital represent?

01:03:54
Fontenot:
A lot of change. We started taking care of sicker patients. We had technology and new medications and were keeping people alive a lot longer than they would have been. Taking care of really sick patients that would have normally been, back in the day in the ICU. It was hard, it was really hard being a floor nurse in an acute medical floor. It was non-stop. The little funny things that you read—it’s true. You wouldn’t go to the bathroom or eat. It was constant. It was constant because the pace of everything sped up and newer things, faster things.

01:05:16
Rigelhaupt:
What are some of the clinical practices you have observed as being an important part of the growth and expansion of the organization? Cardiac surgery being one of them?

01:05:29
Fontenot:
I mean, hello. There’s a helicopter that’s landing on the roof. Any other time at Fall Hill Hospital it would have to land in JM [James Monroe] High School’s field hockey field. The ED alone—our ED back on Fall Hall was so itty-bitty. I actually volunteered in that ED my senior year of high school. [01:06:00] It’s way different than starting out Fall Hill. Then my skill level went so high working over there towards the end. Working night shift you have to have a really high level of skill because there’s no IV therapy. I could put an IV in a dead person because you had to: if the IV came out, it has got to go back in. We had chest tubes back in the day, but these chest tubes now are such advanced things. IV pumps look like spaceships and I started with them just on gravity. A lot more bedside procedures are being done with specialists and just everything that is available here now. Before you would have to go to Richmond or up in Northern Virginia and now everything is right here. There wasn’t home health. It’s just really different.

01:07:33
Rigelhaupt:
Part of the history of acute care hospitals is just that: that it’s acute care. And yet as you described, the patient population that you were working with, chronic conditions that aren’t surgical or acute care cases. Why do you think the hospital organization invested—I mean I know it has to treat everyone, it’s a community hospital—but it sounds like there was significant amount of support for—

01:08:10
Fontenot:
Because you said it: they’re a part of our community. It doesn’t matter who they are or what they have. We don’t turn anybody anyway. We do not turn anybody away. They’ll stay until we can discharge plan safely. It gets a little tiresome at times when, “Joe’s back in!” But you take care of them because that’s what you’re supposed to do.

01:08:43
Rigelhaupt:
Are there ways you can think that the organization, the hospital or health care system made a concerted effort to support the treatment of chronic conditions of mental health? [01:09.00] Is it necessarily what it’s advertised in the sense that it’s cardiac, it’s those life saving—

01:09:15
Fontenot:
The “big money?”

01:09:16
Rigelhaupt:
I will let you use that term but I mean in the sense that—

01:09:18
Fontenot:
The surgical floors make money because people are coming in to get elective surgery and they have insurance. It was known because it’s common sense, but we were never treated differently and we were never frowned upon or treated any differently. There wasn’t any of that. Now, there’s a whole lot more because of the thought process—what was it? I guess maybe fifteen years ago was the big home health push: “Let’s keep them out of the hospital.” That was a new thought process: “You’re healthy, but you need IV antibiotics? Well, you’re going to go home and I’m going to come do them for you. There’s no need for you to stay in the hospital.” Who would have thought that? That’s a good idea. So we were able to clear out the patients that needed that. Or you would go home with a PICC line [peripherally inserted central catheter]. We didn’t have PICC lines at the old hospital. That was brand new. PICC lines can stay in a hole a lot longer than regular peripheral IVs and that was the huge step in sending people home with PICCs and IV antibiotics. That helped. There are Coumadin clinics and there is the breast cancer navigational pathway. There’s the CHF, congestive heart failure, and there is everything that anybody can imagine for a chronic disease. There’s a support group for it and it will be advertised on the website here at our campus. Diabetes—oh my gosh. That’s amazing how that has come around. There also has been a lot more look into the comorbidity. You have diabetes and you have high blood pressure and you have kidney failure. It’s looking at it all together. With psychiatric patients now and we’re also looking more at their comorbidity. We’re a psych facility. We do not do IVs. [01:12.00] We do not have oxygen in the building. We don’t have a code cart. We’re behavioral health. One day, are we going to have that? Yeah, we will. I don’t know when, but now if our patients become medically unstable we have to send them across the street. That’s a lot of effort and I’m sure a lot of finances and resources. I’m sure eventually we’ll have a medical psych floor because that’s the future. You can look ahead and know that’s something we’re going to need because we see the pattern of people having to go to the main hospital to get medical treatment. Then they’ll come back and they’ll transfer back. Even though we are a separate building, we are a floor of the hospital. Snowden was independent and then Mary Washington Healthcare bought us a while ago when it wasn’t doing well and now we’re doing really good.

01:13:08
Rigelhaupt:
Thinking back on some of the history of Mary Washington’s involvement with mental health, how would you describe its commitment to providing those services in its history?

01:13:22
Fontenot:
It’s a lot more out in the community. Now, we work very close with the Rappahannock Area Community Service Board. We work with Micah House. We work with different community services. We have to because so many of the times we rely on them to help us safely plan a good discharge for someone. We get some many homeless, whether they came in homeless or their situation made them homeless. It’s hard. It’s hard to find where to, with good conscience, discharge these patients. In fact, this morning I called to make sure the cold weather shelter was open because it’s something we need to know. If we’re discharging somebody and we don’t have any place to send them, then we at least need to hook them up with the people at the cold weather shelter. We deal with a lot of long term. We’re an acute care, meaning that I always try and say, we’re an emergency room for the mentally ill. You come here when you’re having a crisis. We’re going to get you as stable as fast as we can and get you back out there. But when we get you back out there, we’re going to connect you with outside services. We’re not going to just discharge you: we’re going to make sure you have a psychiatrist and we are going to make sure you have appointments. [01:15.00] It’s never just a discharge. With the mentally ill, there’s not a cure. Well, PTSD can be cured but that’s another story. There’s no cure for it. It’s management. It’s about managing your mental health and the importance of nutrition, sleep, and medication. Medication. I’ve probably passed ten billion pills in my lifetime. I am all about medication. I have seen it do wonderful, brilliant, amazing things. You have somebody come in that has not been compliant with their medications and they are either Jesus Christ or the Devil, whichever way they go. Or they are literally tearing open their flesh to get the bugs. Or they are pulling their teeth out because somebody has put transmitters in them. They are literally on top of the table screaming. Or the fixed delusions and they’re so paranoid that someone’s going to kill them. Can you imagine thinking that someone is going to kill you all the time? Or hearing voices? And you hear them but nobody else does? An auditory hallucination is a lot more common than visual hallucinations. It’s really rare that you see someone that has visual hallucinations. They come in this crisis because either their families have called for help and the police come and get them or they are found out on the streets by the police. We’re real familiar with the police officers in the area too because we get so many patients. They come in and then sometimes two days, with two days of medication they are right as rain. Right as rain. And it’s like, “Can’t you see how important your medicine is?” They get all healthy, they leave, and they feel so good: “I feel great!” And they slowly stop taking their medicine. The best thing we can do is to constantly educate and teach them lifestyle skills to keep them out of here. I work with the community a lot more now than I did up there just because it’s different. [01:18.00]

01:18:02
Rigelhaupt:
Is there a history as well in medical cases or even in your experience on what was a medical floor of the organization really trying to work with community services? Thinking about chronic conditions and support, the treatment of that outside an acute care setting?

01:18:28
Fontenot:
The thought behind having hospitalists all stemmed from the fact that doctors didn’t have time to see patients in their office and then come see their patients here. The thought behind that was, “We had hospitalists so that the doctors are in their offices to take care of their patients that aren’t in the hospital.” As a whole, Mary Washington is so broad and we do have so many outlets. I don’t think you can say anything in the community without having Mary Washington be a part of it because it’s the heart of the city and the county. Like you said it does employ so many people, but it’s where you go. I’m sure there is case management at the main hospital and they are talking to all the different entities for placement, whether it be rehab or a nursing home or setting up in-home care for their patients that are going to their own home. Here of course it’s a little different, but I truly can’t think of anything that isn’t a part. Like the YMCA—the original YMCA and then the new one. Dr. Massad was a surgeon here. So many people don’t know that, but he was one of our original surgeons and that’s why the building is called that. I always like to tell people things, like I told y’all about Sam Perry, because it’s neat. I really am proud of the fact that the hospital is so huge now. It’s a big deal, but it still has some of that old town vibe. I like to see that. [01:21.00] Marianna Bedway is our VP and I worked with Marianna years ago at the old Fall Hill Hospital. She was my nursing supervisor. She worked the three to eleven shift and she was the nursing supervisor. I worked with her in many different capacities, but she’s Marianna to me. In fact, I’m asking her to write a letter of recommendation for my daughter to get into the VCU School of Nursing. I had no problem doing that because I knew she would. I like to be able to still see that because so many things have changed and it’s so big. It’s nice to see some of the things that still happen.

01:22:04
Rigelhaupt:
What are some of the things about Mary Washington Healthcare you would most want the public to know that might not be common knowledge?

01:22:13
Fontenot:
How much stuff goes on behind the scenes. Things that nurses—I can only speak for nurses because that’s what I am, but how much we do that people don’t know. For example, I had a man that came in for whatever reason and he was travelling. He had his dog in his car. He didn’t know where his car was and he didn’t know where his dog was. I was immediately like, “Oh my gosh. We have got to figure this out.” He was my patient and I knew this needed to be solved for him to even try and start getting healthy. If you’re mentally stressed, your body is going to shut down. The involvement of trying to find this animal—but I didn’t even think about not doing it because that’s what I needed to do. I called the police officer that brought him in, which I found through paper work. Then getting a hold of that police officer through the dispatcher saying, “It’s not an emergency. I just need to talk to him.” Then getting the information from him, getting the tow truck, and then finding where his car is. Then calling the car place and saying, “Was there a dog in there?” Then it was finding the animal warden or whoever picked it up and then what animal shelter or SPCA, and whether it was Fredericksburg or Stafford. It was a process, but it was so worth going in and telling him I knew where his dog was, his dog was safe, and that they would hold the animal until he could get out. [01:24.00] Things like that, just tons of little things that are little, but take extra steps and make such a difference to patients. You can’t just give patients medicine or surgery: you have to give them everything. Like I said, I’m a toucher. But I’m very aware, especially working here with touch because of past traumas. I’ve seen just what touching can do. You can’t just pass pills. You have to bring in—you know, back then it wasn’t MP3s or iPods or anything. Bringing in a little—I don’t even know what they’re called, I don’t know if boom box is politically correct—bringing in music because they liked a certain song. For our adolescents that are here on Christmas, Santa comes and the nurses are the ones going out there and buying their gifts. It’s unthinkable to have somebody in a psychiatric facility on Christmas morning—and it doesn’t matter what your religious beliefs are—and not having something. We do it of course for our adult patients, too. But the community and the newspaper, they don’t know that. If somebody needs clothes, we’re going to get them clothes. We have funding to provide medication. If I find dollar stores that have reading glasses for a dollar, I’m buying as many as I can. Do you know how hard it is to get somebody to do a therapy group with paper when they can’t read it? We have a glasses box. We supply shampoo, but we don’t supply conditioner. If you have really long hair and you’re a woman, you want conditioner. That’s going to make or break your morning: if you can get in the shower and wash your hair and then use conditioner. It seems simple, but it’s a big deal. You go to the dollar store and get a couple bottles of conditioner and then you just singly dose it out for the whole infection prevention thing, but you dose out some conditioner. It’s those little things and we do a lot of that here because our patients are different. They get up every morning, they make their bed, they get dressed in their own clothes, and it’s an open milieu. [01:27:00] It’s a lot more of lifestyle, ADLs coming up to get their medicines and coming up to get their food, whereas at the main hospital it’s delivered to the door and they’re in the bed and it’s got side rails. If we can do anything here to make their day a little bit easier, no matter how small, it’s done. It’s done. You wouldn’t think not to do that.

01:27:44
Rigelhaupt:
So my last question is actually two questions. One, is there anything that I should have asked and I didn’t? And two is there anything you’d like to add?

01:27:55
Fontenot:
I guess the level of doctors is pretty amazing. We had and still do have awesome doctors. I mean, Dr. Bernstein is the man. He is just amazing. We always call him “Dr. House.” We have these doctors but now the level of the doctors that we have. Endocrinologist. We didn’t have an endocrinologist before. We had your basic pulmonologist and cardiologist. I think that it’s really cool. The trauma doctors too and all of that. The whole cardiothoracic, which I’ve never had an interest in, too technical. I think that’s pretty amazing, having that smartness here and that ability here. Some have come and gone, which is the nature of the beast. I think just the incredible medical care that we have here and I think that it’s awesome that we don’t turn away anybody because we’re here for the community. That sounds cliché, but it’s true, trust me. I have witnessed it. They’re not going to not take somebody in. It’s just really different nowadays, not bad. It has just changed so much. [01:30:00] I get a real tickle out of telling people crazy things that used to be and they’re like, “No way!” And I’m like, “Yeah! We did that!” [laughing] Not because we were trying to be bad, but that’s just what we did at that time. I also think it’s really cool how we’ve come, especially with the mentally ill, how far we’ve come and what great work we do here. The reputation we have in the state of Virginia and even outside of Virginia—we have had people come out of state to come to our facility here at Snowden because of the reputation that we have. We have inpatient, of course, and we have partial programs and we have one of the few adolescent partial programs. Adolescence is hard, but our partial program is incredible. Our whole IOP, which is our whole substance abuse: we do a lot of cool things here. And that’s real different from Ground-Southwest when it was in the basement and you walked through a door and it locked and you walked in another door. You want to talk about smoke? Whew, a lot of smoking going on in the basement in the psych hospital. Very small and dingy. It has changed and of course now we’re in the middle of renovating so we’re getting a whole new facelift here. That’s exciting. We should be done by January and that’s going to be awesome.

01:31:54
Rigelhaupt:
That’s a great place to end. Thank you.

01:31:58
Fontenot:
You’re welcome.