Germ Warfare

Holding the phone with Ask-A-Nurse.

I've been calling Ask-A-Nurse (at 303-777-NURS) almost since the moment the service was hooked up in 1987. These days the program is known as Centura Health Advisor, and registered nurses man the phones from 8 a.m. to 8 p.m. But in the early days, you could call in the middle of the night -- and that, after all, is when medical emergencies happen.

February 1987, 3 a.m.

I give my name and address to a NURS who advises me that, as a registered nurse, she cannot diagnose medical conditions but is permitted to give me some advice on how to treat my symptoms and whether or not to seek further medical help.

Me: "I'm just so tired. I feel as if cinder blocks are pressing into my limbs. I want to sleep all week."

Nurs: "Have you been busy?"

Me: "Yeah, well, my band's been gigging a lot of weeknights and I missed my deadline, and I probably shouldn't have drunk that third sea breeze, but I've just been so tired, you know."

Nurs (after ruling out several mysterious, life-threatening conditions): "Why don't you hang up and get some sleep?"

Me (hopefully): "You don't think I should see a specialist and get some medication?"

Nurs: "Nah. Hang up and go to bed."

Sometime in 1988My brother-in-law decides to show my five-year-old nephew the inside of a golf ball. The last time he cracked one open, it was full of about a million rubber bands, all packed in there like snakes. Unfortunately, nowadays they charge the balls not with mega-snakes, but with some kind of explosive. Ka-blam! Brother-in-law appears to be suffering from blindness! (Nephew entertained, as promised.)

Nurs: "Hang up. Dial 911."

1991

Me: "My toddler says her stomach hurts. She has a slight fever and is cranky. She won't go back to sleep. Is it appendicitis?"

Nurs: "Hold a minute while I look up those symptoms."

Thirty seconds into hold, the toddler throws up on the floor, then falls asleep.

Nurs: "Try to keep her comfortable. At some point, she'll probably throw up, and then she'll fall asleep."

Me: "Right."

1993

Me: "What if it was dark in the bathroom and I grabbed the wrong tube of ointment?"

Nurs: "What are you trying to tell me?"

Me: "I'm not saying who's responsible, but toothpaste got applied to a diaper rash instead of Desitin."

Nurs: "Warm bath. No bubbles."

1994

Me: "Let's just say a dog ate a Snickers bar. Would it kill him?"

Nurs: "I doubt it, but check with your vet in the morning."

1995

Me: "There are some very weird bumps all over my scalp."

Nurs (after asking very specific and possibly disgusting questions): "Hmm. This is an interesting one. I've never heard of this before. I'd advise you to see a dermatologist. This could be a symptom of a number of conditions."

Me (in a panic): "Like what?"

Nurs: "As RNs, we're not able to diagnose medical -- "

Me: "Yeah, yeah."

The Present Day

It is now well into 2000, I have failed to die from a scalp infection, and as a city, we are in the grip of what has to be the worst flu in recent history. It goes on and on. As soon as you get over the vicious sore throat, you're awash in green snot. Next comes the rattling chest cough. After that, it's freestyle -- a repeat of the green-snot cycle, or something unmentionable in the abdominal region, or one of your loved ones starts the disease afresh, sneezing on you plenty. Fevers are high and persistent. Nursing a small child through all of this brings on visions of the Old West -- where these epidemics could be lethal -- and a longing for patent medicine. (For you, if not the child.) Nursing a mate through all of this brings on visions of divorce court.

Doctors tell us that the flu returns every winter and that this year's version is just a little more tenacious than most. Clearly. Why else would they be selling Alka-Seltzer emergency cold-relief kits next to the cash register at the Farm Crest Milk Store/gas station?

On the Year 2000 Flu's behalf, I have called the Nurs line four times already, with no end in sight. The last call -- to find out how a cough syrup can both suppress a cough and cause "expectoration" at the same time -- I gave the Nurs my last name and listened to her read my address and date of birth off the screen. I pictured a green banner flashing at her: HYPOCHONDRIAC! FREQUENT CALLER! A PAIN! THIS IS THE SAME PERSON WHO PUT TOOTHPASTE ON HER DAUGHTER'S BOTTOM IN 1993!

Me: "Does your computer show how many times I've called in the past?"

Nurs: "Oh, ha ha ha."

I am momentarily distracted from my own symptoms by a flash of empathy for this Nurs and all the others like her. Are they sitting in cubicles in some bullpen, endlessly quashing the niggling concerns of endlessly (though minorly) infirm people such as me? How do they do it?

Four Days Later

I'm sitting with nurse supervisor Mary and her boss, Tom, in a room off the area that holds the Centura Health Advisor phone center. Just as I pictured, it is a large space divided into cubicles, with a Nurs inside each one. Judging from the flashing sign on the wall, the phone lines are jammed, and the average wait on hold is four minutes.

"We are getting a lot of calls on this flu," Mary opines. "People seem sicker than usual. A lot are just calling to see if it isthe flu."

"But as nurses, you can't diagnose a medical condition," I recite.

"Correct, but the flu is just, in general, more severe. And there are lots of new treatments people don't know about. They can try the new antiviral meds. But our usual advice," she admits, "is call your boss and go to bed."

Before coming to the call center, Mary worked in cardiac intensive care, which was "very challenging, and the pace was pretty fast," she remembers. "When I didn't need that anymore, I came here." Rising through the ranks from a regular call nurse -- most of whom have at least twenty years of prior nursing experience -- to become a supervisor, she relearned many of the basics she'd forgotten while working in her specialty. "The incubation period for chicken pox," she recalls. "I hadn't come across that in years. It was sort of like an ER situation expanded and broadened, and you had to have this unique skill of listening. When you don't have the ability to seea laceration, for instance, it all comes down to your interviewing skills."

In her five years at the phones, Mary dealt with hundreds of typical calls -- a mother with a sick child wonders what to do about vomiting -- as well as the "ones that send shivers down you," she says. "A middle-aged man who'd been shoveling snow and is having chest pain. I say, 'Honey, put down the shovel and call 911,' and he says, 'Oh, come on, it's not that serious.' Luckily, his wife is at home. She takes him to the hospital and I check back, and, yes, it's a heart attack."

The guy whose finger seemed suspiciously infected turned out to have Strep A, the flesh-eating virus. The pregnant woman with pre-term abdominal pain ended up undergoing an appendectomy that saved not just her life, but that of her unborn child. But usually, Mary says, it's routine home care. "Maybe because a nurse is approachable," she says. "We're more likely to recommend tea with lemon and honey."

Sensing a marketing opportunity, Tom adds, "We deliver peace of mind. We inspire loyalty."

Centura is an aggregate of ten Front Range hospitals, he explains, and the call center is not considered a "profit center." Which is good, because calls have come in from as far away as Russia and Korea, and no caller is ever turned down for geographic -- or economic -- reasons.

"Have you ever called the line yourself?" I ask.

"I called about a yellow-jacket sting just last summer," he says. "Do you know that a yellow jacket can get stuck inside a daiquiri straw? And when that happens, a person's lip can get stung."

"I called when my daughter got super glue on her fingers," Mary admits. "All it took was warm water, but I'd forgotten. There are situations like that. You gotta fix the problem, but it's...embarrassing. Anonymity is key. The person might have an STD. Or they've done something stupid. We can help them, but this is the hard part: You have to realize that they'll do what they'll do with the information. You can't make them get help. And there is always a little human interest on the side."

Mary deposits me in the cube of Nurs Marie, who's been with the call center since the day it opened. For reasons of patient confidentiality, I am not allowed to read what she types into her computer as she takes a call, but I can listen to her side of the conversation. Marie remembers the original program as a way to attract random patients to Porter Hospital and all of its adjunct physicians. But the service quickly took on a life of its own. "I loved it right away," she says, "because I'd been in nursing for twenty years and I was burned out, but I'd gotten into it to help people, and here I was doing that again."

At the moment, however, the human interest has become a bit much. "All morning long, we had this little old lady from Colorado Springs," Marie sighs. "It was hard for her to understand because she only spoke Spanish, but we got an interpreter, and it was still one of the sad calls. She had asthma, long-term, and she was coughing up blood. What she really needed was a doctor who would take an uninsured patient. She had run almost out of options. Finally we got a physician's office to talk to her, but she kept calling back. She got me. She got Ruby. She got the interpreter from the AT&T language line. Finding a new doctor for a Medicare patient is veryhard. I don't even like to think about it."

Luckily, a new call is coming in. Flu. And another one. Flu again.

"It's been intense this year," Marie says as she hangs up. "And you have to stay calm when they get upset, not get caught up in their anxiety. Instead of saying What? you say, Boy, that must have been frustrating."

Once in a great while, the tension ratchets up: The caller's a potential suicide, or a person who is sure a mistake's been made. He can't be having a heart attack -- he's too young.

"Have you ever heard of saving a life over a phone?" Marie asks. "Well, we try. We will call 911 to make sure the suicide called in. We'll call the police and say we'd like a followup. They don't always have time, but we like to hear from them."

Occasionally, she's able to follow the initial call to its conclusion. The guy with inexplicable abdominal pain later phoned to say it was cancer, but they'd found it early. The woman whose daughter had an allergic reaction to a bee sting called to say that, after a three-day hospital stay, her daughter was going to be fine. Most of the time, though, Marie hears nothing at all.

A row away from Marie, the Nurs at Station 18 -- "Does my name matter?" -- has a background in obstetrics, so today it's her job to call a list of fourteen women who've given birth and been home from the hospital for around 48 hours.

"We have several docs who contract with us to make these calls," she says. "I ask the basic health questions, but I'm also just calling to give them the idea that help is only a phone call away. It's not at all uncommon after you have a baby to be tearful, overwhelmed, depressed. Hey, when I had my first, I knew all about nursing critically ill babies, but I wasn't quite sure how to take care of the perfectly healthy baby I'd just brought home."

A few minutes later, Nurs 18 is deep in a discussion of that favorite postpartum oxymoron: Get plenty of sleep. Sometimes the new mother's asleep when she calls, and this makes her happy. When the new mother is awake, much of the talk centers around "what is normal," the Nurs says. "Women just want to know that. They're so worried about being good parents."

And the concern over what's normal, she adds, stretches far beyond childbirth. "I'm thinking of a newlywed husband who called me with some, uh, gynecological concerns. He called from his honeymoon in New York! I read to him out of Understanding Your Body and suggested he buy it for his wife. He did, and he called me back to say thanks."

"What do you think was going on there?" I ask.

"I don't know," Nurs 18 says, a little sharply, "and we're trained not to speculate. But it's hard not to wonder. Once I had a call from a woman whose husband was in alcohol treatment but for some reason was passed out in the truck on the front lawn. There may have been alcohol withdrawal, or just plain old alcohol."

"What did you tell her?"

"I told her that 911 is a real good option," Nurs 18 recalls.

But you don't hear that often here. Far more common, I realize as I prowl the aisles between the cubicles, is discourse about the eternal ailments: vomiting, diarrhea, fever, flu.

"The flu, oh, yes," agrees Nurs Karen, who is between calls. "I don't think we've even reached the plateau on this one yet. But a lot of it is simple. If a kid is sick to his stomach, you don't put milk in his cereal. People don't know that. Much is not simple. Chest pain -- a lot of denial goes along with that."

A conversation from the partition behind her floats over the wall. "Now try this," Nurs Ralph is saying. "Hold your baby as if it were a football..."

"Here's what I hear all the time," Nurs Karen continues. "'I did something silly, I did something stupid. I splashed something in my eye.'"

"You need to see your doctor," Nurs Ralph urges. "Do you have a doctor? Do you have a place to go? Good."

"Or nosebleeds. People think they should take them lying down," Nurs Karen says. "They shouldn't. They should stay upright."

"Take and make yourself a salt solution," Nurs Ralph suggests. "Boil you some water..."

"They feel stupid, but they call, which is good," Nurs Karen says. "They're too hard on themselves."

"And I want you to get in to see your doctor," comes the calm and steadying voice of Nurs Ralph. "Yes. Yes. I know. I can tell by your voice."

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