Pediatric Complex Care Nurse, Monty Anderson

[00:01] Michelle: Monty Anderson's entire nursing career prepared him for where he was meant to be now a pediatric hospice and palliative care nurse. His time with psychiatric patients gave him valuable insight into the complex emotions of our fellow humans. His pediatric nursing experience taught him the developmental stages of children and family-centered care. As a charge nurse, he became competent in decision-making and prioritization and as a quality improvement nurse, he developed his research skills and honed his attention to detail. And now he's doing what he loves, using all of what nursing and life have taught him. In this interview, you'll hear Monty get emotional when he talks about the unimaginable, the death of a child, and you'll discover what you can do right now to get into this fulfilling nursing specialty. In the five-minute snippet, if I had a hammer, I'd hammer in the morning. Here is Monty Anderson. Well, welcome, Monty. Welcome to the show.
[01:31]  Monty: Thank you. Been looking forward to this.
[01:34] Michelle: Me, too. Our audience is really in for a treat for so many reasons, but you are so knowledgeable, you're so experienced in what you do, and you are just going to bring so much to the conversation. So my audience knows that I like to just jump right in. So tell me, many years ago how you got your start in nursing? How did you make that decision?
[02:05]  Monty: For as long as I can remember, from a very young age, I wanted to be a doctor. And as I was going through school, that is what I was focusing on. And I reached high school, started in Naval ROTC because I knew my family would probably have difficulty with trying to get into college and quickly realized in high school there are probably some areas that I was extremely weak in as far as medical school would be. Right at 16, when I could have graduated high school, and looking at the Navy, which is what I was in for, ROTC, the amount of time that I was going to have to pay back after school terrified me, thinking, oh, my God, I'm going to be 40 before I can do something that I want to do. And so I kind of did a total about turn and went into theater arts and I spent several years working with theater arts through Fresno State, through COS locally, and was looking at wanting to get married. And I was already working in a psychiatric facility as a mental health assistant. And so I started talking to some of the nurses that were there and they started asking me what I thought about nursing. And my only experience with nursing was really what they did, which was not medical inside the hospital, nursing, although every single one of them had another job. So I knew that the county Hospital in Tulare County was still open. I had heard horror stories about it, of how bad the care was there and how bad the situations were, and so I went and applied. And this is long before you had certified nursing assistance or order, anything like that. So I was hired on as an orderly, and my entire orientation consisted of a 20 minutes video of how to put a catheter in.
[03:51] Michelle: Oh, wow.
[03:52]  Monty: Because I, as a male nurse, male orderly, would put the catheters in, right?
[03:58] Michelle: Yeah.
[03:59]  Monty: And I spent a little bit over a year working at county hospitals, working as an orderly, and I loved it. And they gave fantastic care. Patients, no matter who they were, if they could pay, if they could not pay, everybody received fantastic care. And I loved it. So I knew then that's what I wanted to do. And so me being me did everything bassackwards and ended up getting married before going into nursing school. And I was lucky to get in my first time around, and I ended up graduating in 1980. It's funny, we had our graduation, and about four days later I started working at Valley Children's Hospital because I found out my second semester in pediatrics, I went home and told my wife, this is what I want to do. I had a little boy that I took care of for two weeks in a row that had bilateral broken legs from child abuse, and he could care less what had happened to him. He was just happy somebody was there playing with him. And that's the great thing about kids. And so I knew that's what I wanted to do.
[04:59] Michelle: I've talked to so many nurses like yourself that went into nursing after exploring other things. I think sometimes when people hear nurses talk or think, oh, you probably want to be a nurse from a small boy or a small girl, and it's like, no. It didn't enter my mind until this pivotal part in my life. So you started out in nursing and did you start right in pediatrics?
[05:30]  Monty: I did. Like I said, we graduated. I believe it was like a Thursday night. It was shortly before Christmas, and right after Christmas, I went to work at all the Children's Hospital through orientation.
[05:41] Michelle: Okay.
[05:42]  Monty: And so just I mean, right away.
[05:44] Michelle: Was it everything that you thought, or were there some surprises, like, oh, I didn't expect this, or anything took you by surprise?
[05:55]  Monty: Well, I came from the time before we had ratios and before those types of things, and so it was very much a sink or swim. So we had three weeks of in-classroom orientation, and then I was put on the floor. We're supposed to have two weeks on day shift, six weeks on night shift. I ended up on one week on day shift, two nights on night shift before I was let loose on my own because they were short staffed.
[06:19] Michelle: Sounds kind of like today's climate. Yeah.
[06:22]  Monty: Yeah, and it was just the way that it was. But I specifically remember one night going home and telling Vicky, my wife, that I have made a mistake. I am not going to be able to do this.
[06:34] Michelle: Yeah. I mean, it's so overwhelming. Pediatrics is such a specialty, and you need a long time, and even after you're out of orientation, you still need a long time to really feel kind of like, you know, competent.
[06:53]  Monty: About six months later, we all went out to breakfast one morning, and the LVN that I was paired with that night, that was just horrible. We got talking. I told that story of going home and telling my wife that I think I'd made a mistake. And she said I asked to never have to work with you again that night after that night. And she goes, I don't mind working with you now.
[07:13] Michelle: Oh, wow.
[07:14]  Monty: She goes, but it was a horrible night.
[07:16] Michelle: Yeah, we've all been there. I think one of the worst days I had in pediatrics was sadly, do you remember Take Your Daughter To Work day? We can't do that anymore because of COVID but, man, I took my daughter to work, and she was, I think, eight or nine, and she really hadn't expressed that she wanted to be a nurse, but she thought it would be cool to see what I do. And it was a day when we had one patient, and so that was like, oh, this is wonderful. We have this one patient we can just give all of our attention to. And so all the other two nurses were floated out, and then I started getting admissions, and they wouldn't give me my nurse back. We've been there, right?
[08:14]  Monty: Yeah.
[08:15] Michelle: And so I'm trying to start IV's, and I'm trying to oh, gosh, it was overwhelming, and it was a horrible day. And at the end of the day, Jessica said, I never want to be a nurse, sealed the deal for her. And I have to admit that I said yeah, I hear you. I don't think I want to be a nurse anymore either. It was really bad. So when you were at Valley Children's, were you in a general Peds ward or were you in a specialty, like an oncology ward or what did you do there?
[08:55]  Monty: At the time that I worked oncology was part of another floor. They had medical, they had surgical, they had the PICU and the NICU. The NICU, the new NICU, at least at the old hospital, had just been built, which they really pushed me to go into when I first went into the interview. And I just didn't feel like I had enough background able to do it. Come to find out, I had enough background to do what I was doing. I love schools. School taught me enough to not kill somebody, but I had to pass boards. But I did not know what I was up against. And so it was a medical ward that I was on. We had adult open hearts at the end of the hallway because they were trying to get their heart program going. So they were doing adult open hearts as well as pediatric open hearts. And so we would get floated to the surgical floor. We would get floated to the NICU. I never got floated to NICU there, but it was straight, just medical. And we had our surgical things that were there too, because we might have some neuro kids that hydrocephalus that had shuts put in so they would come back to us. And again, that was in a day to where we didn't have a pharmacy at night. We were the pharmacist. We had residents. So you were fulfilling all the medications for all the patients out of a locked drawer that we had of medications, yeah.
[10:24] Michelle: As well as doing patient care and everything else.
[10:26]  Monty: Exactly.
[10:27] Michelle: So how, how long before you came to Kaweah?
[10:31]  Monty: I went to Children's in 1980 and I came to Kaweah on February 22, 1982. Okay, so about two years.
[10:38] Michelle: And you came right to pediatrics?
[10:40]  Monty: I did. I saw that there was an opening and Children's was just going to twelve-hour shift and I was already driving and I had been Charge nurse up there, so I was already putting in extra time and so it was a good time to go ahead and move.
[10:54] Michelle: And what did you think of the Peds unit when you arrived at Kaweah?
[11:00]  Monty: I liked the size. I enjoyed that. I liked how close because I was used to that. Our rooms were all two bedrooms and things were close because the old hospital was very small. I actually enjoyed coming to Pediatrics. It was a little different as far as the medications that were being used because every facility has a group of medicines that they use, doesn't matter where you go. So I had to learn that. I didn't feel like I knew any more than anybody else did. I had experience with some things that others had just because I came from a Children's hospital. But the care is the same and it was a good group of people to be with. It was much more of a family atmosphere that I had than being at the larger hospital.
[11:53] Michelle: Yeah. So you started 1982 and then I arrived in 1986.
[12:01]  Monty: I was thinking of that the other day. I thought it was sooner than that.
[12:04] Michelle: No, I graduated in '85 December, and then I had six weeks in, six weeks on oncology for like a residency and then six weeks in ICU. And I've told this story before on here about it being the Reagan era and they called it the Fat Eighties. And there was a nursing glut and there were four positions at Kaweah and one of them was 4North Renal. I was like, no, one of them was oncology no, I think the other one was ortho no. And then Peds and I said, Peds, how hard can it be? Kids? I love kids. I'm one of eight kids. How hard could it be? Well, it kicked my ass. It was hard. So you and I worked nights for a long time and a couple of years together, and then I went to the day shift.
[13:16]  Monty: You were ruined forever then.
[13:19] Michelle: You're dead to me. Right. So you continued on in Peds, and then you got this really you did some stuff in the meantime. You were charged nurse on night shift, and then you came upon this really kind of niche job where you became the data person for Pediatrics/NICU, because our NICU was really rapidly growing and we had to start reporting data to CPQCC and everybody. Everybody, yes. And so you kind of went into that role. Talk a little bit about that. What did you do in that role?
[14:02]  Monty: It was a role that had just been opened up to just I think ER was one of the only places that had it at the time. And our director had brought me on and it was going to be education, quality assurance, and performance improvement, and then she kind of allowed me to let it blossom from there. So, yes, there was a lot of regulatory things that I had to be able to watch to report both to Federal as well as the State. A lot of research-based things that we would do would go to CCS, and to the organizations that worked with the NICU, like VON. Exactly. Same thing with OB. And so having to try to pull that data together to be able to submit. We noticed back in the early 2000s that our new doctors were seeing things here on a routine basis with newborns that they did not even see in residency. And we started having specialists as we would have different conference meetings over special cases that would say, like, you've had two of these in six weeks. I've seen one in my career, and I've been in this career for 30 years, so true.
[15:16] Michelle: Yeah.
[15:17]  Monty: And so we started working with CCS to start monitoring burst just to see do we here in the Valley seem to have a higher number of genetic problems, certain diseases, those types of things. Unfortunately, I left that position before I was ever able to see what the final outcome was. But we submitted data for probably about eight years to that. So with things like that but I was able to get involved with being able to set on the Child Abuse Prevention Council because I was able to have input in with that. I was able to get into education classes with families, with new dads, with new parents, those types of things. Got involved with breastfeeding at the hospital.
[15:59] Michelle: Yes.
[16:00]  Monty: And along with our manager out of the NICU at the time, who was just instrumental with being able to put things together at very little cost, trying to get our breastfeeding program up and going. It was a great position. The year I left, the year before, I had been looking at, I was missing patients. I was missing patients and missing families. And so I had thought about looking and moving on into something else at that time. And then of course, my wife died, so I decided no big changes or anything. And I knew the position was tentative every year as budgeting came up. So I saw riding on the wall as that was coming up, and sure enough, they eliminated mine and several of the other positions, and I thought that I was going to psych. I had worked in psych before. I enjoyed psych. Did not even know about our hospice program with pediatrics.
[16:54] Michelle: Psych: takes one to know one.
[16:56]  Monty: Yeah, very much so. Still does, I think. So that's how I kind of transitioned from there over into Hospice, into the Concurrent Care program.
[17:09] Michelle: Okay, so that was kind of one of my questions, and you kind of answered that like you were ready to do hands-on care again, to be with the kids, to be with the families. You're an amazing teacher and educator. I saw that in action all the time, and so I could see the pull towards that. But what in particular about hospice or complex care for kids kind of attracted you?
[17:42]  Monty: That's really our thing to know. When I went to Hospice, I did not know what Concurrent Care was, so I thought I was walking into straight Hospice. We were going to have children coming in that were dying, and we were going to be there for that process. There were years as a young nurse that going to the oncology floor, if we would get floated, I would have total anxiety over the idea of being with people that were actively dying, and made me extremely uncomfortable. And at some point, my wife and I started doing yearly counseling with Camp Sunshine Dreams through Valley Children's. And so that's for kids with cancer and their siblings to be able to go to. And there was something about that transition because every year you had some that didn't come back. And we had a whole ceremony up with Camp Sunshine, too, to help kind of commemorate that and keep their memories and their life going with the other people that were at camp. Something through, they just kind of clicked. And even though it was uncomfortable for me, I always seemed to be able to connect with the families and get through those children that we had command that were coming in, that were actively dying, or that we were going to be there for the process of them passing. So we had tried to get a butterfly room. We had tried to get a few things in pediatrics and just really could never get any traction to get it. So when this came up, it was like, yeah, I think I'd much rather do that than go to Psych.
[19:19] Michelle: Yeah. Wow. Well, let's talk about some of the differences between Hospice, Palliative care, Complex Care, kind of sort that out for us.
[19:32]  Monty: Hospice care traditionally is you have roughly about six months or less that you're expected to live. Things can change and you can live past that. So you're being brought on with no expectations of trying to pursue anything curative, no expectations of rehospitalization, you know, those types of situations. And so it is purely for you to have that process to die and to make sure that the family is prepared, to make sure that the patient is comfortable and that passing is with as little struggle as possible. And help the family to the best of your ability because everybody is different to work through that process of the fact that they're going to lose a loved one. In this case, the children, a child, is just an unbelievable thing. Palliative care is very much the same, but you are able to do some curative measures. So let's say that you get an infection or something along that line or you need some blood work drawn for looking at something like maybe a urinary tract infection, that you may be able to go ahead and do that. Concurrent Care allows for the idea that the children that are admitted in Concurrent Care, if they had no treatment for whatever their disease processes are, the expectation they would pass within six months if nothing was being done. In this case, you are able to readmit to the hospital, you are able to do curative things for infections while they're at home. So you may have a child that has a horrible seizure disorder, frequent respiratory infections, maybe skin issues, all of these types of things they can't eat and you can do two feedings. You can do things that are going to prolong their life without suffering.
[21:39] Michelle: Yes.
[21:40]  Monty: So we've had some children that we've had that have just these catastrophic multiple that's why we use the term complex care because you'll have children that will have three, four or five systems that are involved that you're having to try to manage all of them. If you do something for one, are you missing this one up that have been with us for quite a while?
[22:01] Michelle: Yeah. Well, that kind of leads us into the next question is what do some of your patients suffer from? Like what are some of their diagnoses?
[22:13]  Monty: Of course, we have those children that come in with cancers and for whatever reason in this area of brain tumors seems to be a really big thing. As far as our concurrent care kids have, we'll have a lot of children that have had brain injuries, a lot of genetic problems. And as you know, with genetic problems you're not dealing with just not dealing just with the respiratory, you're dealing with multi issues. You're dealing with horrible heart issues. So you're dealing with many different things. And then some of the treatments for them say you have a seizure child and perhaps they're on a keto diet to help control their seizures. Well, then that's a whole other thing that you have to deal with because if they also have respiratory issues, how are you going to treat them with steroids without messing up their keto and causing seizures worse? So how do you deal with those things? And so that's what we do on a daily basis is balancing. And fortunately, the majority of the parents, know their kids already. We'll have those few that come on to us brand new and so we do a lot of time teaching and so they're able to be part of the team and work with us to weigh, okay, so if we do this, this is going to happen. If we do that, this is going to happen and be able to make that decision with us as you went down to the decision try to do.
[23:34] Michelle: Yeah, well, we talk about this in NICU care all the time is the patient is not just your patient. The patient is the family. They come as a unit. You can't separate them. And so you're treating the patient, but you're treating, educating the family right along with it. So the family is hugely important to the success of the patient, I would assume.
[24:08]  Monty: Absolutely. When I teach nursing and talk to nurses that are going through pediatrics, the very first day, the first hour, we talk about before you can get to the child, you've got to get through the parent. If you're lucky, you'll have two parents. If you're extremely lucky, you're going to have a grandparent in there too. And you've got to get through them to get to that child. And that's actually very important because kids are somewhat distrustful. And so if they see that you're sitting down and you're talking with family, you become a more friendly person. And they see that as time goes if you can take the time just to sit down and it takes no longer to talk to the family, sit down and ask them what's going on than it does if you just walk in and do an assessment and bark everything out that you're going to bark, it takes no longer. But in the long run, it saves so much time to do that. So you've got to get through the family to get to the child.
[25:08] Michelle: That's what I call the defensive line.
[25:12]  Monty: Very much, though. Very much.
[25:16] Michelle: Well, talk about you have a new case. They've said, Monty, we have a new patient for you to see. So talk us through a little bit about opening a case. What is involved in that?
[25:30]  Monty: So we will receive a referral and it will either come from our medical director because he's also director of palliative care at Valley children's or we may get it from a private position but we will get a referral. And from there we'll go through and research what's been going on with them. What are the disease processes, what have they done for these things in the past? Is this brand new? Is this something that's been there for five or six years but it's just worsening now? It's amazing. Sometimes we'll come across children that have been there in the community for a long time and just floundering, the family, they don't know what to do, but they're just stuck with it and they're stuck with their primary care and nothing against their primary care because it's getting better. But they didn't know about us either.
[26:15] Michelle: Okay.
[26:16]  Monty: And so anyway, we'll get the referral from that. So from there we'll go through and research. And the sad thing is we have a waiting list. There are five of us. We have roughly about 80 children right now. So we have to prioritize. So hospice cases get priority and we bring those on. But we'll go through the referral and we'll call the family and talk to them and then from that point, we'll go out and make a visit because we need to see what are their expectations because sometimes they think what we're going to do is come out and provide the nursing care for them. So we have to be able to clarify that that's not what our role is but it gives us a little bit better idea of what's going on with them to see what we have to offer if it's going to be beneficial for them. And then we take it back to our group because we have meetings every two weeks and we talk about all of our patients in-depth and go through our planet cares with everybody and we'll go ahead and set up a hierarchy if we're going to bring them on. Example being we've had three admits this week. As of tomorrow, we'll have three admits this week. Bringing on that's like a busy week. Yeah, it's been a busy last three weeks have been busy because we've had several straight hospice children that we have brought on for end-of-life care.
[27:32] Michelle: Okay.
[27:32]  Monty: And we've had two that we've had to do what we refer to as continuous care. So when it gets down to the last several days, we typically got a nurse that's out there almost around the clock to be there with family. Some of the families want it, some don't. These families did. But then the process of us admitting once we get through that process or get to that point, there's paperwork. Like with everything you have consents to sign, and somebody's going to be here all the time and those types of things, and then we just go through and do a very in-depth assessment and do about 4 hours of paperwork and assessment charting.
[28:12] Michelle: Yeah, I was thinking of just taking.
[28:15]  Monty: Hours and putting time together and developing their plan of care and things. So by the rules, we have to see every patient at least every two weeks.
[28:26] Michelle: Okay?
[28:27]  Monty: We for the most part will schedule at least once a week with a new patient, depending on how complex they are and where they're at. We'll do the one week, but if need be, we'll see them two or three times a week. And we'll do that for several weeks just to kind of get everybody used to what's going on. And it gives us a chance to see what else they need. Because we have PT/OT we can have to go out to the house and work with them. We have clergy. We have fantastic social workers that know the ins and outs of the system and every single piece of help that you can find that exists.
[29:00] Michelle: Social workers are amazing, how they have every resource in their back pocket and they know exactly who to call for what situation.
[29:09]  Monty: And luckily, our social workers have really long backgrounds in dealing with social issues with families and children. Many of them have worked with CPS, they've worked with youth services. So they're very familiar with perfect family, especially for us in Tulare County.
[29:26] Michelle: Yeah.
[29:27]  Monty: And so we have a lot of things that we're able to offer. We have volunteers too, so we're able to see what things can we plug in to be able to help. One of the things that we have, and we can't do it for all medications, but for things that are specific to their diagnosis. Our pharmacy, our home infusion pharmacy, if we can bring their medicines on, then that's something that we can go through in order and then they can be delivered to them. So that takes one less thing off the band to deal with. So we're able to do that with them. Our PT/OT are fantastic, and they don't necessarily stay with the families forever, but they do a lot of teaching with them and get them to a point. And then most of the kids are plugged in with physical therapy to the hospital through the county or with somebody.
[30:14] Michelle: Yeah, well, you touched on a little bit ago when you were talking about the differences between Hospice and palliative care and such, and you talked a little bit about pain management. So talk a little bit more about that. Pain management for children. I would imagine it's different for children than it is for adults. I think the goals are probably still the same, but talk a little bit about that.
[30:44]  Monty: The medications are for the most part the same, and we start off with the least sedating that we possibly can. And kids are pretty phenomenal with what they can tolerate, but we started with the least sedating and then we have a lot of different mechanisms. We're able to do things with them. We can go straight oral medications if they're not able. To take oral. They might have an Ng tube. We could possibly do that. We have patches just like everybody else is able to use. We just had a case to where we were using inhaled morphine, so they were being nebulized, and that seemed to work really well for him. We will use Ativan. We will use things for sedation. A lot of the medications are the same. Dosing, of course, is going to be different, and each kid is a little bit different because there's some medications that you can give a child that just will make them climb the wall as opposed to what would happen with an adult. And so you titrate, you balance. How asleep do you want them? We will use Haldol. Haldol is wonderful when it comes to terminal agitation, which just visualize that word, you know, exactly the way that they're going to look with that. But it really does help get that under control.
[32:06] Michelle: Yeah.
[32:07]  Monty: But we have pretty good luck with just out-of-hand drips and with morphine. So that seems to work really well, at least for us. You're going to have those unusual cases such as bone pain and that type that are hard to control. And I had one case that we use Toradol. We would be on Toradol for a while, then off toward all. And it's amazing how well she did with the Toradol.
[32:33] Michelle: Yeah.
[32:34]  Monty: And she was awake well, which was a wonderful thing with her. But pain control is a big issue because it's very caused a lot of anxiety with family.
[32:44] Michelle: Yeah. I was imagining that you may encounter kind of pushback just from pure ignorance or people. There's a stigma, and I don't want my child to be on all these drugs.
[33:00]  Monty: When it gets to the point of it being terminal agitation. I don't want to call it a problem, but one of the things that you can see, pain is a very powerful stimulus. Okay. It can keep you agitated, keep you awake, keep you hyper-alert, do all those things. And if you get the pain under control and they're able to relax many times, they will let go. And they do pass. Has nothing to do with them being overdosed or anything. It has the fact that they are no longer in pain and they were able to relax and go through the natural process with it. The pushback that we'll see is that people are afraid that they're going to overdose every now and then, even still, every now and then. I don't want them addicted.
[33:44] Michelle: Yes.
[33:46]  Monty: We kind of sit here and granted,  that and I don't want to make light.
[33:50] Michelle: No, absolutely.
[33:50]  Monty: But the reality is and you find an appropriate way to discuss that, that's the least of our problems right now.
[33:58] Michelle: Yes, exactly. We hear that a lot. We heard that a lot in the NICU with babies that were suffering from neonatal abstinence syndrome.
[34:13]  Monty: Definitely.
[34:13] Michelle: When we had to start them on Methadone and we hear that, well, is he going to be addicted? And you want to say he's already addicted. He needs this because he's going through withdrawal. So lots and lots of education. Lots of education, and that's part of nursing. That's what we do.
[34:38]  Monty: And with us, we run 24/7. We have somebody that is on call every night, every weekend. Things get nuts. Our team is really a very tight-knit team, and so we have that. You phone a friend, so things get kind of crazy. You're able to call one of the nurses and usually, they're able to go ahead and fill in. If not, our management team is fantastic, but because we are available, then if they have questions, no matter what time of day, they're able to call with questions and we talk amongst ourselves. We have a daily kind of end of day to where we talk about what's going on. So that way we are able to go back and look at, okay, well, here's what was going on. I could read what they were doing and have a conversation with the family.
[35:24] Michelle: That continuity.
[35:26]  Monty: Most of us, if we're not seeing them every day, if there's issues going on, we're checking in with them by phone. And so that's where having a varied background coming into this is good because there's so much that you do by phone that you need to be able to have that experience to visualize what they're talking about, because you know the processes that the child is going through. So you can kind of anticipate. So then when you hear the family verbalizing it, you have a very clear idea because you've seen it before.
[35:55] Michelle: Yes, exactly. And if I remember correctly, you had some experience with call centers for pediatrics.
[36:04]  Monty: Yeah, I've had a lot of on-call.  I did Psych nursing and crisis psych nursing for about six years. Six years with that, with home health, I did on-call. And I also followed a lot of their pediatric kids starting back in 1986 up to about almost 2000. So I had a lot of experience with dealing with on-call type things. Did on-call with infusion centers through Children's and several other organizations, too. But yes, when medical was first thinking of going to the HMO style, one of the rules that was in there is that a family had to be able to have somebody that they could call with, ask a nurse, as we would call it. And so we were putting a lot together trying to see if we're to be part of that. And luckily there is a pediatrician out of the Midwest, Barton Schmidt, that had put together a book, and it was an algorithm of you asked this question, say it yes or no. You go to this question. So everything was fact-based, evidence-based, and then to know which way to go. And so we looked at trying to get that put in together and the county decided to go a different direction, yeah, but many offices use the same algorithm to this day it's still in print.
[37:23] Michelle: Yeah, and I remember we did talk about that for a while working in Peds. We got a lot of calls.
[37:34]  Monty: Absolutely.
[37:34] Michelle: A lot of ask-a-nurse calls from outside of the hospital and inside of the hospital. And it's a real skill. I'll edit that out. It's a real skill.
[37:57]  Monty: I had one time, my tongue got wrapped around my eye tooth. I can't see what I'm saying.
[38:03] Michelle: It's a skill.
[38:04]  Monty: Yeah.
[38:05] Michelle: It's a legitimate skill to be able to answer questions and maybe something that they're saying is alarming you and to not be alarmed.
[38:20]  Monty: You've got to be able to ask questions, too. You listen to what they're saying and if you have experience, you go back on your experience of what you think might be and you can ask clarifying questions that will run you down that path. And if at any point they say no, then you go to plan B and go with it. It's definitely a skill. And again, that's why I said I really encourage anybody that wants to go into something, home health or anything where there is going to be called, get a good varied background, get the experience. I'm not talking years and years and years.
[38:55] Michelle: Right.
[38:56]  Monty: Get the experience, get the exposure so you know what they're talking about over the phone.
[39:01] Michelle: Yeah, well, let's talk about, for a second, the importance of play for children, but in particular for sick children.
[39:15]  Monty: Kids are wonderful and under twelve, especially because they could have 104 fever. They feel horrible and they're laying there and you get their fever down. You get them feeling better. They want to get up and start playing. Plays a big part. And there's science behind being able to distract a child from whatever was going on with them. From their illness at that time or from their pain. Our brain is a wonderful part of our body. Just not to help us think and talk and do those types of things. But it knows that if it can get distracted that it will block the pain out, at least temporarily. It's just a matter of finding out what is the type of play that's going to work for them. And so play is a big part. Kids today. Tablet Phone TV is a big part for being able just to zone out for a while.
[40:12] Michelle: Yeah.
[40:16]  Monty: It's interesting going into the houses because I hear the same stories. Going to brush your teeth. So I hear him from you. Hear the same songs over and over and over. But it's working.
[40:28] Michelle: Yeah. Do you ever have parents that are like oh, he's getting too much screen time, I don't want him to get too much screen time and anything like that?
[40:42]  Monty: Every now and then most of the time they're pretty good as far as being able to sit down and do things with them. But you talked earlier about nursing burnout and taking care of ourselves. The parents are in this. Yeah, it is difficult for them because that is their life. And it varies with the families that we have. We have families that have both parents are home caring for the child. You've got some to where one is working and the other one is home caring for the child. And depending on the complexity of the type of care that they need, there is in-home supportive services and so they can get paid for being home. They have to qualify, they have to account for their hours, they have to update what care it is that they need. I mean, there's a big process for them doing this. And then there's some families that are able to, through some of the programs, have a nurse that is there for eight or 16 hours a day to be able to care for them. The family does not see money from that, but the nurses are paid for while both parents are working. So you have a big variety. But those that are home and they're there all the day, they're dealing with the phone calls, they're dealing with the appointments, they're dealing with the ins and outs of some of the medications, they're dealing with the feedings, the changing, the repositioning, the reporting of what they're seeing to whoever it is. It's like the old adage, we'll either break a marriage or we'll bring it together.
[42:19] Michelle: Yeah, and we've seen that in pediatrics. We've had kids that I remember in particular, near drowning, that had a very bad outcome neurologically. And they start blaming the parents, start blaming each other. And you were supposed to be watching the child and I was at the store. I don't know how a relationship could survive that. The blame and the guilt, that's really real. And we've seen that. I imagine it's just compounded when your child is dying and if two people are not on the same page, it's just going to create a lot of stress.
[43:12]  Monty: And it's difficult sometimes because if you have one parent that is providing the insurance, they have to work. And so just because of distance, just because of the inability, not wanting to just the inability, they can't be part of all these things. And if this is a child that ends up being admitted to the hospital or whatever, again, they're working and typically don't have much time to take off because they've already used time. So it really puts a burden on one over the other.
[43:44] Michelle: Right. And then the other one here is like, you weren't there, I've been here the whole time and yeah, it's really difficult.
[43:57]  Monty: Yeah. Pediatrics, honestly, pediatric nursing is about 50% medical and 50% psychosocial, and not negative psychosocial. Just the normal complexities of having a sick child, especially a chronically sick child that a human being would go through just dealing with that on a daily basis, and we're in the home. One of the few people that I think understands more than others of what's going on with them. And to be able just to sit there and do nothing but listen, you don't have to say anything. Just give them your time and just listen to them.
[44:36] Michelle: That's a real skill.
[44:39]  Monty: It is. I mean, you want to fix things, especially I'm a guy. I want to fix stuff.
[44:45] Michelle: Fixer? Yeah.
[44:46]  Monty: I work with a lot of moms, and I really try to get them to understand when they're getting upset with Dads. Okay, I need to explain something to you.
[44:55] Michelle: Men are from Mars and women are from Venus.
[44:59]  Monty: We see a problem, we identify the problem. We want to fix the problem. We want to move on.
[45:02] Michelle: Yeah. And we want to talk about the problem and yes. Well, I think you hit the nail on the head. You have to have that background where you're really a people person, and you understand people, and you have to know about the developmental stages that children are going through. You have to know about the norms before you can talk about the abnormals, and it's huge. One of the things that you deal with all the time in your profession is children dying. And so I want to talk for a moment about what does that mean for you as a nurse, as a person, to be with this child and the family at the end of their life?
[46:05]  Monty: Oh, there's so many things, I think, as nurses that we go through. I think the first is recognizing, especially if it's a new patient that's coming on, that they have never met us before, and they're pretty much just kind of handing over the most precious thing in the world to us. So it's a humbling thing when you walk into that and you realize it. So you recognize that first, and then you also have to recognize that the emotions that are going on yes, they're real to us, and we know what's coming. We know what to look for. We know those things the family doesn't. And so without just being blunt and noncompassionate, how do you keep them informed of those things? So you can kind of point out some families just want to know outright, what am I looking for? So easily. You can go down the list, but as they occur, you can point them out. But trying to make sure that you know that your emotions don't become part of their emotions, being very aware of, I can go to my car and I can cry, but I don't need to be doing that in there. That's not to say that you and the whole family will have a good Christmas place just because the moment happens to be right for it. We're human. They're human. We're all human, but that our emotions don't take over for theirs.
[47:47] Michelle: I think because we're human as nurses. And I know we've been in situations before where we've had children die in our presence and we have cried and the family has seen us cry. And I think that there's some I don't know if the word is appreciation on their part, but I think what we've heard from families is like when the nurses cried with us at the loss of our child, we really felt like they really cared.
[48:35]  Monty: Just for ourselves, for self-care. Again, our team, we watch out for each other very much, so we'll do joint visits with each other to go out on cases just so more than one of us are familiar with them, depending on what hours things are occurring, but also to give that support to whoever their primary nurse is that is there. There are times that if you ask the primary nurse, you're in the home and things are getting difficult. If you can slip away, you can go ahead and call one of the others, just kind of get boosted up a little bit and then we debrief. We debrief all the time with each other or the group of us. Again, like I said, we have a fantastic management team, so they've taken call for us so we can go out and just have a night where we can just go out and just kind of talk about things and just keep ourselves healthy. We make sure that we get our time away. We get our time off because you need to stay healthy so you can stay like the old adage of the oxygen mask comes down to put it on yourself first and that's what we have to do, but you have to be aware of it because many nurses don't do that. And then you get to the point where I don't want to say you don't feel but you're not aware of it anymore. You just kind of become numb and none of us want to be able to do that. And all of us have kids. All of us have kids and we have grandkids. So it's a very real thing to you when you're there and it's hard not to have emotions because of course, you are projecting. It's hard not to do that and look at it. By and far, the families are fantastic. We have very few nobody's ever held accountable with anger or anything because people are reacting the way they react. We will have some families that there's really no further contact because most of the time we will kind of follow up or we have our grief counselor will follow up and we keep track of birth dates and dates of death and things to go ahead and just reach out and see how the families are doing. And there's just no further contact. And that's fine. That's how they're processing, that's how they do there and they work through it. Others are so appreciative and they make contact with us all the time or we'll get messages from a family.
[51:12] Michelle: I would think that would be so special as a family to have the nurses that took care of your child to recognize we know that today is your son's birthday or the anniversary of his death, and we just want you to know we're thinking about you. I think that just would speak volumes about humanity, and it does.
[51:41]  Monty: And it's one of those uncomfortable things for us as nurses you think of, oh, my God, no. I don't want to remind them. I don't want to bring it up because you're afraid it's going to cause so much pain and I trust you. They're remembering all of those first as they go through that first year, especially. They're remembering that birthday. They're remembering the present that is not being unwrapped this Christmas, you know, they remember those things and have somebody else acknowledge that and acknowledge those feelings is big. And I've had families tell me that huge. I would think, yeah, I've got families from six years ago that I stay in contact with on those dates and still get positive, see them around town, make a beeline and give a hug.
[52:27] Michelle: Yeah, I would think that would stay with you for stay with you as a nurse and also with the family. Do you attend the funerals of children that have passed?
[52:40]  Monty: If at all possible? We do. We really tried to figure out and they're usually pretty good about letting us know with the funerals. There's just sometimes the time constraints or if you already had a vacation that was planned and you're going to be gone, but you can't sometimes if we've all had contact, we'll go. Sometimes if you just need moral support, one of us will go with another and do it. But yeah, we try.
[53:05] Michelle: What does that mean to you?
[53:12]  Monty: I'm not one for doing viewings, being present and being there with the family, and gives me a sense of closure and the family as well, I hope. Yeah, many have said so, but I hope that's one of those selfish times. I think at least for me personally, it's more of a personal thing as opposed to for the family. I want to do it out of respect, but it's still a personal thing for me.
[53:42] Michelle: What advice would you give to a nurse sitting right next to you who is not really big at going to funerals of patients that have passed away? Because it's hard.
[54:01]  Monty: It is hard. I think there's things that you can do. I try to do one or the other. I will try to go to if it's a church service, do a church service or go to the grave side. I find the grave side. There's no polite way of putting I find the graveside less emotionally taxing.
[54:23] Michelle: Yeah, that's good.
[54:25]  Monty: Then going to a funeral again, like I said, I don't do viewings for even family members. I don't do viewings, and that's just a personal thing for me. I've got in my head, but my memory is and I don't need to see something. I'm not against viewings. It's just not for me. So going to the grave side and to me, going to the grave side is a little more of a completion, and it's a personal thing sometimes not able to go to the grave site. You have 15 minutes to be able to kind of pop in and be able to be there at a funeral and go up and up the family or talk to the family, and you got to turn that switch off and go on and see another patient and go do something else.
[55:13] Michelle: Well, I remember you and Loretta and some of the more seasoned nurses talking about the importance of going to the funeral of a patient that we lost. And it was just really something that I hadn't been to many funerals at that time. I think I had just been to my grandfather's funeral at like, 21, 22, which is kind of, I guess, a good thing to say at that age of your life that you hadn't attended many funerals. But the thought of going to a child's funeral was just very foreign to me. And I just remember you guys talking about how important it is to have that closure and just looking at it from that perspective that I never looked at it from before, like I said.
[56:11]  Monty: And again, to me, having that closure, it's a personal closure for me. It's not a closure for the family. Tried to stay in the back. I try not to draw any attention. If I can, if I can go without my uniform, I do. But most of the time we're doing it during the day as we're working. But it is a closure for me.
[56:33] Michelle: Yeah.
[56:35]  Monty: And honestly, it's somewhat fascinating, especially living here and with the diversity of religions that we have, to see how different families, different cultures, and how they grieve and how they deal with death. It is absolutely fascinating. And to be part of it and be accepted into it, I think that's the biggest thing with this is the fact that we are so accepted into the families for these processes.
[57:03] Michelle: Yeah.
[57:04]  Monty: It's like when I was talking about the fact they're handing over their kid to us, they don't know me from Adam or if I know what I'm doing, but they still do it.
[57:10] Michelle: That's like trust. Blind trust.
[57:12]  Monty: It absolutely is trust. Just because I have an RN after my name, it seems to be an okay thing to do.
[57:19] Michelle: Yeah.
[57:21]  Monty: And you don't take that for granted.
[57:23] Michelle: No, absolutely not. Well, we've been talking about a lot of really heavy things here, and so we're going to make a little Pivot and talk about some things that are specific to nursing. And you touched on this a little bit, but maybe talk a little bit more about as a provider, you get close to these families, close to these children. How do you keep from experiencing kind of compassion fatigue or burnout? What do you do to help yourself besides drinking?
[58:02]  Monty: Drinking? Drinking is not a good thing.
[58:04] Michelle: No, it isn't.
[58:06]  Monty: Again, I think that you have to make sure that you're taking time to do the things that are important to you, that your life does not totally revolve around trying to care for this family. I think if you are doing that, you're taking on the idea that somehow or another, that you are more than what is needed with it. And that's not a good thing because it is going to catch up to you in the end. So take time out to do the things that you enjoy that don't have anything to do with what that part of your job is like. I would suggest going to work at a funeral home.
[58:49] Michelle: Maybe go to a concert instead.
[58:52]  Monty: Exactly that's. My music is a big thing for me is being able to get out, as you can tell. The other thing is we truly do rely on each other and talk to each other and get out of the group when we have to. We do have people that are available through work that help with compassion fatigue if you need that.
[59:21] Michelle: I love the debriefing experience too. That's so important.
[59:25]  Monty: Yeah, very much. And like I said, we'll do that amongst each other. And sometimes even our medical director will take part in it because there's some of these kids that he's known for quite a long time too. So he will become part of at least talk to us about becoming part of it. Again, just being aware. But you really have to be mindful. I think that's the one thing with this job is that you need to be mindful of what it is that you're doing, who you're doing it with, and what your limitations are. I said earlier, we say phone-a-friend all the time and we all do that. All of us have strengths in different areas. And so sometimes, especially if it's a child that you've been following for quite a while, you can kind of get blinders on and you're just not seeing something that you know something's there, but you're not quite sure what it is. So getting another pair of eyes to do it. Yeah, but talking to each other, we do that a lot in humor. Oh, my Lord. Humor. Humor is a big thing.
[01:00:27] Michelle: Humor is life. Right. But really know thyself. You just have to know yourself and what your strengths are, what your pitfalls are, and yeah, that'll serve you really well. As a nurse, do I need any specific certifications or training to do what you do?
[01:00:53]  Monty: No, I mean, there are certifications that you can acquire. There is a hospice nurse certification. There's actually a pediatric certification that can be obtained we've all gone through the trainings for it. I think any of us have taken the test to become we don't really feel like it's necessary, but we've gone through the trainings for it.
[01:01:16] Michelle: So, along those lines, as I was researching, talking to you, I found a lot of different professional nursing organizations, and I'll put these in the show notes. But Hospital and Palliative Nurses Association, Children's Hospice and Palliative Care Coalition, National Hospice and Palliative Care Organization, Pediatric Palliative Care Coalition, center for Pediatric Pain Research and the Institute of Pediatric Nursing.
[01:01:51]  Monty: I actually belong to one organization. It's the International Pain Society.
[01:01:56] Michelle: Okay.
[01:01:56]  Monty: And what I like about them is that it's people from around the world.
[01:02:00] Michelle: Oh, wow. Yeah.
[01:02:01]  Monty: So there are countries that are so far ahead of us on alternative pain controls in those types of things. We've got so much better here with use of THC, CBD, those types of oils and those types of things. That is amazing to see what occurs with the use of yeah.
[01:02:21] Michelle: You get to see all those different perspectives, and hopefully some of them will come our way.
[01:02:27]  Monty: They're slowly getting here, such as the IV Tylenol. That was something that was not in the United States for a number of years. It's now available so that you can get it. So that's a wonderful thing for those that can't take anything.
[01:02:41] Michelle: Yeah. Now, I think it would be nice to know what other countries are doing in that aspect. So what qualities do you think are helpful to have as a nurse caring for these complex children? Just like, I guess qualities, personality traits. What kind of person do I need to be to do this job?
[01:03:09]  Monty: Even though research shows that multitasking is not productive and is prone to errors, you definitely need to be able to multitask. You need to be able to develop a plan on the fly and to be able to stick to it and as it changes, change it on the fly. So you're constantly thinking, I've got plan A. Majority think of plan B and plan C, because just in case those do come across, you need to be detailed, oriented, because the amount of documentation that needs to be done just because of the regulatory agencies and not so much of them looking at your charting, but on the reports that have to be generated. So you've got to check a box because those reports have to go to them, which is what pays for everything and lets them know, oh, yes, you are doing quality care and that type of stuff. You need to be detailed-oriented to be able to do that. You need to be able to think two steps ahead if there is a problem that has come up, who can I reach out to and involvement in this? Because with our kids, you will have neurology, pulmonology, cardiology endocrinology, and Rheumatology that are all dealing with one child all the separate issues.
[01:04:35] Michelle: Okay.
[01:04:36]  Monty: And if I get lab work on two of those, hematology probably needs to know too, so we don't do something that's going to screw that up. So being able to keep track and keep good notes so you know who you're trying to get a hold of. You need to be willing to learn, because every day we have another syndrome that comes through that none of us have ever heard of before. And so you're sitting there with Google, starting with Google to see what it is, and then you're going from Google yeah. Then you're going from Google into Harriet Lane. Then from Harriet Lane, you're going into someplace else to find what's happening along those lines.
[01:05:15] Michelle: Do some of the parents provide education? Because I remember in Peds, we had a mom that would bring in a book, and she taught us so much. So is that kind of along those lines? Yeah.
[01:05:27]  Monty: I mean, every family is different, but most of them know their child, especially if the child is a little bit older. And they've had this most of their life. They know who the specialists are. They know the centers that deal with this. They know all of those people. And they also have networking because I've got one child that has a disease that the type of muscular dystrophy that he has, but there's like six others. Mom knows every single family.
[01:05:54] Michelle: Yeah. Wow. She's probably talked to them all.
[01:05:58]  Monty: Absolutely.
[01:05:59] Michelle: I learned a lot from them.
[01:06:00]  Monty: Absolutely has. So being able to get in on that. But they need to know that you're interested.
[01:06:04] Michelle: Yeah.
[01:06:06]  Monty: You need to ask them, what have you found out so they can feel comfortable with wanting to share with you.
[01:06:15] Michelle: Yeah. And you need to know your resources, I would imagine.[01:06:19]  Monty: Oh, absolutely.
[01:06:20] Michelle: Yeah.
[01:06:21]  Monty: Like I said, we are the library at the hospital.
[01:06:26] Michelle: The hospital librarians are amazing. She's just incredible. Yes, so true.
[01:06:31]  Monty: She saved my email, so I just have to shoot things to her to send to me.
[01:06:35] Michelle: Can I get this article? Can I get this study? Yeah, awesome.
[01:06:39]  Monty: But I tease all the time because I received probably 27 different summary articles or 27 different summaries on different things from pediatrics, ANA to whatever. And of those, all the subset summaries on a monthly basis. Then I tried to go through and just breeze through to say, okay, hey, this sounds interesting, and then dig further into it to see just trying to stay up on what's out there.
[01:07:09] Michelle: There's a lot. And I appreciate that you want to stay up on all the latest stuff.
[01:07:16]  Monty: That was one of the nice things from the previous job because of the amount of research and the different research studies with Boston and other areas that I was able to be involved with to be able to stay part of.
[01:07:28] Michelle: Well, you talked a little bit about PT/OT, but what other disciplines do you work with?
[01:07:34]  Monty: As far as within our group like that. We have our clergy, so they're able to go out to the homes. They're able to do blessings. They do blessings not only for the child, but they'll do it for the family members that are going on, because life goes on no matter if your child is sick or not. So you could have a grandparent that might be in the process of dying or they're afraid of going to die, so they can be there for those types of things, be there for blessings. They also typically have the speed dial number of all the different pastors to be able to get a particular pastor or priest that can be out and do that. Our social workers are phenomenal in what they're able to do. I've had one of our social workers basically go down a set in Social Security office without an appointment just to be seen to fight for something on one of our kids.
[01:08:28] Michelle: Do you have a dietitian?
[01:08:29]  Monty: We don't. We end up using the dietitians with the primary hospitals, but I've used our NICU and our pediatric dietitians at Kaweah when we were heading into formula problems with COVID and supply chain issues. We had so many problems with our formulas and tried to come up with alternatives for what the children are on. And so I've been successful to work with our dietitians at work and do over-the-phone interviews and consultations with our families so that we're able to get orders and be able to get things filled.
[01:09:09] Michelle: Do you work closely with pharmacists?
[01:09:11]  Monty: Absolutely. We have Home Infusion, which covers home health as well as us, and they're phenomenal to work with. Example, today, as I sent off a culture to them because we have somebody on medication that is resistant to, there's no oral alternatives that I could see, so I sent it off to them. So they went through and researched that, tried to come up. So, yeah, we work very closely.
[01:09:36] Michelle: That's great. All right, well, tell me, you're out in the field a lot and you're going to different homes, and you might have to make a decision kind of like in the moment. Do you have autonomy to do that? Do you have protocols or do you have to call the physician every time you need something? Talk about that.
[01:10:00] Monty: As time goes on. We will have our set of standard medications that they have. We may have added Benadryl, we may have added powder. Let's say we may have added a list of medications that we have that are on there as a PRN basis. And so we're able to fall back on those because we know what they're used for and they were used for the same exact thing. So we can advise on giving those contact the physician, say, here's what I did based on what we have, and if they want to change something, then we can go ahead and we can change it. Most of our kids, there are respiratory kids, they will have a sick plan, they will have a well plan. And so, you know, according to what the orders are, when they need to be switched over to the sick plan, which will increase medications, maybe add a medication, those types of things.
[01:10:56] Michelle: Yeah.
[01:10:57]  Monty: We do have autonomy within the nursing process of nonmedicine type things that you can do to help with situations that are coming up with them so that you can fall back on. We almost always will follow up to make sure that our nurse practitioner or physician is up to date with what's happening. And so we keep them in the loop with that, too. And like I said, every two weeks we go through every single one of our kids, and we go through in somewhat detail and talk about what's happening with them. And we're also able to find out what's happening at the hospitals with children. We're lucky because we're able to get into their charging system so we can see what they're doing and what they're thinking to keep track of. It not so much with CRMC yet. I'm working on it, but to be able to see it. But we do there's a lot of autonomy that we have.
[01:11:58] Michelle: It would seem like there wouldn't need to be.
[01:12:00]  Monty: Yeah, like I said, but we have a framework that we're able to work with, so we're not stepping outside our practices.
[01:12:06] Michelle: Sure.
[01:12:07]  Monty: Okay.
[01:12:07] Michelle: Well, that was one of my big questions. What's your schedule look like? What do you have to take call?
[01:12:17]  Monty: We do have to take call. Like I said, right now there are five of us that are covering. They're eight-hour days, so we have somebody that is covering from 05:00 at night until the next morning. Sometimes we'll split a night, depending on what's going on. If one of us happens to have something with one of the kids, with school, then somebody will cover that period of time. And then, of course, holidays and weekends, we have somebody that's on the full 24 hours, I typically like to get mine done and out of the way, so I'll take like a week at a time, which we're lucky. Our families are tucked in very well so we don't get blown up most of the time. I've only had a couple of those weeks that I've got my rear handed to me, how busy it is. We've all had those like that, but for the most part, we don't. It's very simple phone call, things that we can do.
[01:13:10] Michelle: Okay.
[01:13:11]  Monty: But we all take turns doing that, and we'll fill in for each other. Sometimes we'll take more so somebody has some time off, or we'll take less because we have some time off for different things.
[01:13:24] Michelle: Because to hear that you have 80 patients in your load and there's only five of you, that seems like it.
[01:13:34]  Monty: Could be spread I'm trying to think we were at 74, because, like I said, we'd lost several here in the last couple of weeks. And so I know that as of tomorrow, we will have admitted three. So it brings up to 77, 78. We have two more that are pending that are going to be admitted. Once they're discharged, we'll be back to 80. So five goes on to 80. But right now I think I have 17 on my own that I have. So we're all at 15, 16, and it depends. Some weeks. That's a wonderful number.
[01:14:10] Michelle: Yeah. Well, and the other thing is when we're talking about what qualities are helpful to have as a nurse, you were telling me how much you drive during the week, so you have to kind of like driving and being in the car by yourself. For a lot of people, you have a lot of autonomy. I suppose you could stop.
[01:14:36]  Monty: One of the reasons why I worked nights for so many years, if I wanted you in my department, I'd call you. Otherwise, get out. The way I felt about it.
[01:14:44] Michelle: Exactly.
[01:14:45]  Monty: I kind of feel with this the same way. One of the things I didn't bring up with everybody else, we have we have an interpreter. We have our very own interpreter that's able to travel with us or can do phone call things and can also translate for written things for us. And he is just phenomenal. Family love him.
[01:15:04] Michelle: Awesome. Yeah.
[01:15:05]  Monty: I mean, they trust him, I think, sometimes more than they trust us sometimes.
[01:15:09] Michelle: Yeah. He speaks their language. Right.
[01:15:12]  Monty: But I had to apologize to him the other day because I was driving from Terrabella to early March, and I had three separate calls going. I'm driving. I've got this text message, I've got a phone call, and I thought, I've got to pull over.
[01:15:24] Michelle: Yeah.
[01:15:25]  Monty: So to deal with that. So it was about 15 minutes late, and so that's why I said you've got to be able to multitask because you don't have a choice.
[01:15:31] Michelle: Right.
[01:15:32]  Monty: May not be the best way to do things, but you literally do not have a choice.
[01:15:38] Michelle: Yeah. Well, I think nurses are, we're the best at multitasking. And I did read that study, that literature on it's not really that good for you, but we resist. Yes. I can get so much done.
[01:15:57]  Monty: But again, you don't have a choice because things come at you and they come at you, and you can't look at somebody who's upset and say, Wait a minute. Take a number.
[01:16:06] Michelle: Yes.
[01:16:06]  Monty: And you come back calling number 70. How can I help you? But you can't do that.
[01:16:10] Michelle: Not really able to. Yeah.
[01:16:13]  Monty: Everybody needs to be able to be heard, so it's important.
[01:16:19] Michelle: I think so. Well, gosh, you have given us so much information and education and just experience. It's been amazing hearing. Obviously, we've known each other for a long time, and I've known what you did. And then when you went into this kind of niche, I really didn't have a full picture, but you have really painted a picture for me and I know for our listeners, too, what can I do right now if I'm a nurse and I say that's what I want to do, what can I do right now?
[01:17:02]  Monty: I would think that if it's something that you're wanting to do and you have the ability, say, here at Kaweah Delta, if a nurse would like to be able to see, they can ask you to do a ride along. There is nothing that I think exceeds the ability to get in and see what's happening, be able to see it firsthand, be able to hear it firsthand and be able to sense it firsthand. And so if you've got the opportunity to do something like that, take advantage of doing it. If it is something then that you feel like you can do, then I would say start getting your hands on anything that you can read. If where you're working, if death and dying as part of that, get in to see what can you do on that floor. If you're in the hospital, in that office, what are the things that you have available to you that you might be able to bring to that office to help expand that knowledge base for everybody else? Get yourself involved with it. The third thing, as I had talked about before, is get as much background as you possibly can for yourself. And it's a good thing for the patient because you have an experienced background to pull on, but it's also good for you, so you don't feel like you're just saying things off the top of your head. You've actually got an experience, you've got a fact, you've got something that you can pull from that, you know, is the truth as to be able to bring to the job to help that family. Because ultimately, that's what we're doing. We're trying to do something that is easing that situation, calming that family member or that child that we're wanting to do. We don't want to add to it by doing something that's not going to be effective.
[01:18:40] Michelle: Right. That's a really good point. And those are all really good, really good advice for the nurse that's like, I want to do this. This is going to be my jam. Thank you. Thank you so much for everything that you have brought tonight in the closet.
[01:19:03]  Monty: This is nice. I like the closet.
[01:19:06] Michelle: They've heard so much about my crazy closet, but it works, right? And so now, you know, at the end, I do the five-minute snippets. Okay? And this is just a chance for our audience to see the off-duty side of Monty Anderson. And so these are some fun questions that you know all the answers to, okay? You're at a concert by one of your favorite bands or musicians, and they invite you to come on stage to sing or play with them. Who are they and what are you singing?
[01:19:49]  Monty: Alive or dead?
[01:19:51] Michelle: Either one.
[01:19:53]  Monty: It would be Pete Seeger and it would be singing if I had a Hammer.
[01:19:59] Michelle: Love that song.
[01:20:02]  Monty: Yeah.
[01:20:04] Michelle: Okay. If I weren't a nurse_____
[01:20:09]  Monty: I would be working in theater.
[01:20:11] Michelle: Theater, okay.
[01:20:12]  Monty: Yeah. That's what I did before.
[01:20:13] Michelle: Now what nurses do all day.
[01:20:16]  Monty: No, I dealt with lighting, building sets, and that's what I love doing.
[01:20:20] Michelle: Okay. Yes. What always cheers you up when you think about it?
[01:20:27]  Monty: Kids laughing.
[01:20:29] Michelle: It's just the sound of happiness.
[01:20:32]  Monty: Yeah, it cheers me up. Absolutely.
[01:20:36] Michelle: Are you a cat or a dog person?
[01:20:38]  Monty: Dog.
[01:20:39] Michelle: Okay.
[01:20:39]  Monty: Cats tolerate me.
[01:20:42] Michelle: I wish I could do cats. They seem pretty cool, but I'm allergic, so I can't. When was the time that you acted nonchalant but you weren't in a code or something like that?
[01:20:59]  Monty: Every single one of them. I'd say work-related in the emergency situation. Non-work related diet. Believe it or not, I had a homeless man in my car a couple of years ago. My car ran out of gas and one of my coworkers came and picked me up and we had to go do a visit. And I came back, the battery had gone dead, the window was down, we were putting gas in. I go over and I go to open the door and this head turns around from the driver's seat and stares at me. I let out several expletives, so I wasn't real nonchalant. Then put through the door open, I can get out and get out. Then I was nonchalant.
[01:21:44] Michelle: Then you were nonchalant.
[01:21:45]  Monty: Oh, my God.
[01:21:47] Michelle: Yeah. That would be crazy. What mythical creature do you wish actually existed?
[01:21:57]  Monty: Fairies.
[01:21:59] Michelle: Don't they exist already? I thought they did.
[01:22:02]  Monty: Well, I haven't seen one.
[01:22:03] Michelle: Okay, we need to have a fairy sighting.
[01:22:08]  Monty: Yeah, I mean, I almost had a unicorn, but Fairy, I would love for there to be a fairy.
[01:22:13] Michelle: I love it. Finish this sentence. My grandkids are:
[01:22:16]  Monty: the joy of my life.
[01:22:22] Michelle: Amen. The best room in your house and why?
[01:22:28]  Monty: The bathroom and it's obvious. It's multitasking.
[01:22:33] Michelle: Oh, my gosh. Yeah. Wow. Okay, I'm losing all I cannot speak. What app can you not believe someone hasn't made yet?
[01:22:51]  Monty: I'm trying to think of all the ones that I have right now, which is too many.
[01:22:57] Michelle: An app that you just can't believe someone has not made this app yet.
[01:23:05]  Monty: Honestly, that'll come to me at two in the morning.
[01:23:09] Michelle: Yeah, these are hard. They're thought-provoking.
[01:23:14]  Monty: I mean, I have an app for everything.
[01:23:17] Michelle: World peace?
[01:23:23]  Monty: On an app? Punch a button. Yeah, see, I was thinking more pragmatically. You know what? Possibly just because I'm healthcare? Nearest emergency room.
[01:23:39] Michelle: Okay.
[01:23:39]  Monty: Nearest AED.
[01:23:41] Michelle: Oh, that would be awesome.
[01:23:44]  Monty: If AED's had a tracker in them.
[01:23:46] Michelle: I think Google Maps you can go, but you can't find an AED. I don't think on Google Maps that would be awesome. You got to do it.
[01:23:55]  Monty: See, I think cars you have cars that come with vacuums. Now, I think a car needs to have a built-in AED. That all you have to charge. All you have to do is take it out, and you've got it. But it comes as just, like, a spare tire.
[01:24:07] Michelle: and you just use it on yourself if you need to.
[01:24:09]  Monty: You could use bond if you need to and put it on yourself.
[01:24:12] Michelle: Oh, my gosh. I love it. Okay, our time is up. That was fun. See, you knew all the answers.
[01:24:22]  Monty: Apps. Like I said, I've got an app for everything on my phone right now.
[01:24:26] Michelle: Right. No. Well, this has really been fun. I want to thank you for being here. It was kind of hard to get together just because of your crazy schedule. It certainly wasn't because of mine, because I'm retired now, so I have all this time, and I'm like, why can no one make an appointment? Well, because they're all working, Michelle. That's why.
[01:24:52]  Monty: I've got grandkids, babysitting. And I'm watching grandkids, and we've got concerts that we're going to.
[01:24:58] Michelle: Life. You got life. Well, I'm so glad that we got together. Thank you so much.
[01:25:04]  Monty: Well, I really appreciate you asking me. I never think about myself doing things like this. I just do what I do.
[01:25:11] Michelle: Well, I knew it would be hard because I've known you for a long time, and you're not one to toot your own horn, so you indulge me. And you actually did a pretty darn good job. Yeah. Thank you. You have a good night.
[01:25:28]  Monty: Thank you. Bye.