Germ Warfare

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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 is the 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 see a 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."

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Robin Chotzinoff
Contact: Robin Chotzinoff

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