Registered Nurse First Assist, Bill Patty

[00:00] Michelle: If you like wild rides, you will love listening to my guest this week, registered nurse, first assist, and my little brother, Bill. Patty. With 38 years of operating room experience, from a surgical tech to a circulating nurse and culminating as an RNFA, he paints a very clear picture of what the job entails. And as Bill says, church mice need not apply. We talked about the schooling and experience you need for this advanced practice degree, the certifications, professional organizations, and the roles of all the or players. I learned that the job is highly technical and physically demanding, but also extremely rewarding. And for Bill, the joy of his life. We had a candid discussion about his medical retirement from the OR and how the loss of his nurse identity catapulted him into the darkness of suicidal ideation and fueled his alcoholism. His answer to my question, what do people misunderstand about you made me rethink my judgment towards addicts in the five-minute snippet. Customer service. What's that? Well, good afternoon, Bill. Welcome to the podcast.
[01:38] Bill: Good afternoon to you, too. Thanks for having me.
[01:42] Michelle: Well, it's a pleasure. I mean, because you're my brother, and I like talking to you. And a couple of months ago, I put out the call to action that I needed an or nurse. Got a few nibbles, but nothing ever panned out. And then a couple of weeks ago, you kind of read me the riot act, and you said, hey, why didn't you ask me to be on? And I was like, you know what? I was kind of looking for a circulator nurse.
[02:17] Bill: Right.
[02:18] Michelle: And you're a very specialized OR nurse, so you're an RN First Assist. But that's why I didn't ask you. It was nothing personal about you, so I'm glad that you kind of took me to task about that.
[02:34] Bill:  All right. I still am an operating room nurse as well. All three roles in the operating room.
[02:43] Michelle: Yeah, and we'll talk about that because I do want to know if you have to know about the different roles in the OR, so we'll get into that. But first, I want you to just start by talking a little bit about your backstory. Like, what did you do before nursing, and how did you get into nursing?
[03:03] Bill: Okay, well, it kind of started in my junior year in high school. Yeah. My high school counselor had met with me, and he said, you've got enough units or credits to graduate, basically now. So if you don't want to go to your senior year in high school, then you don't have to, and you meet all the requirements. So he told me, if you would like to make some more progress with your education and going to college and things like that, all you have to do is take this one little test. It's called the California High School Proficiency Examination. So I took that, I aced it, and then it's equivalent to a high school diploma. So everything was good. And so what would have been my senior year in high school became my first year in the surgical technology program at a trade vocational college in Visalia. So at the time, I was, like, way ahead of my class because my class was supposed to be 1984. Well, I graduated from the surgical technologist program in 1984, so actually started as a surgical technologist in the OR when I was still 17, if you can believe that, from my parents and the state to allow me to work as one. So I did that. Everything was fine, and then I thought it was a very interesting career. And anyways, I did that for ten years, and I moved around quite a bit and went from different cities here and there, Visalia, Hanford, Fresno, and Santa Rosa. Then I joined a traveling surgical tech program and became a traveler down the Bay Area. So I got to work in a lot of hospitals in San Francisco and Oakland and Daly City, and that was very cool. I loved all that. So after about ten years of that, I thought to myself, I'm kind of doing the role of a lot of other RN's here, but I'm only getting about half of the pay. I felt like I was being cheated. And then at that time, the culture in the or was a very hostile environment. The nurses hated techs. The techs hated the nurses. The nurses called us uneducated monkeys. They said any monkey can do your job. Treated us horribly, and they were like, I'm an RN. You're working under my license. You're just a piece of was kind of, it got to be that. So I figured, you know, if you can't beat them, join them. So that's when I thought, you better go to school and become a registered nurse. So I did the prerequisites and all that up in Humboldt county, went to school up in Humboldt County, became an RN, and then that was in 1995, and then I went right into the OR because I was already a surgical tech within the OR. That was just the natural course of progression. They tried to get me to do a year out on Medsurg. And I fought, fought and fought. Say no, that's not my cup of tea. I went out there, I lasted about three days and the director of Med/Surg called the director of nurses and said, we can't handle him. You got to take him back, put him somewhere, but we can't handle him. So anyways, I kind of did that on purpose and I knew that if I manipulated my way enough I could get my way back into the OR. So the director of nurses met with me and she said, I hear it's not working out for you in Med/Surg, so I'd like just put you in the OR and teach you how to be an OR nurse. So I did that, learned that and then I did that for only one year. So I wasn't that great at it, but I could get through most cases on my own with very little or no help. So I went about that and then I was at about the year mark of being an OR nurse and our current OR director walked up to me and she had a big handful of keys on this big key ring and she said, she slapped it in my hand and says, congratulations, you're now the new director of surgery. They just fired me. I said, oh, wow, I'm sorry to hear about that. So I said, I don't know anything about being in management in the OR any other job for that matter. So she said, oh, you'll figure it out. You're smart. So I went down to the director of said, you know, I have no way of knowing what to do. I've never done any of this. She said, I'll work with you, Bill. You're going to be fine. It'll work fine. So it did. And I got to gain the trust of my staff and the physicians and management and I actually liked it for about eight years. And then after about the eight year mark, I started to hate it, started to just really despise going to work in the morning. I did another four years. So I did twelve years total. And the stress after about eight years got to be so bad that alcohol kind of served as a medication for that stress. So I found myself drinking more and more after I got off work and it was the only thing that would give me any relief from all that stress. And so I kind of self-medicated for many years after that, knew I had a problem with it, but was in denial and wasn't quite willing or ready to deal with it. I know a lot of other nurses have gone through that. After twelve years, I decided that I really wanted to do something else. I wanted to get back in the operating room and take care of patients the way I always did before. And that's the part of nursing that I loved. I was thinking about it, but I really wasn't ready to hold the trigger on it right then. So the next week, the director of surgery called me into her office, and I was a manager of surgery at the time, and so she was a step above me. She told me that my position had been eliminated and that we had another OR manager, too. Her position was eliminated as well. So the hospital came in and did a sweep. They call it like a sweep. Every couple of years, the staffing gets a little too inflated and directors and managers get too hire happy. We get kind of heavy on staff, and staff is your number one expense. So they told me, you're going to be laid off. You don't have a job here anywhere, but we're going to give you six months of full pay and full benefits as a severance package. So I thought this came from God. This was a gift from God. Now I can pull the trigger on doing the advanced practice program and become an RNFA, an RN First Assistant. So it just worked out so beautifully that it really couldn't worked out any other way. I signed up for a first assisting program. At the time, there was only six programs in the country, and the one I picked was in Taos, New Mexico. And the only reason I picked it because the instructor was the first person to open an RNFA program within the United States. And she did that in 1985.
[11:30] Michelle: Wow.
[11:31] Bill: Figured she's really top of her game, and she was. And I went down to Taos and I did the program for a year and everything was fine. I graduated from that. I became an RN, First Assistant in surgery, and I had a few good surgeon mentors that had always encouraged me in the previous years to become an assistant because they already knew what I could do as a scrub tech and as a scrub nurse. So they just figured this would just be the perfect fit for you. So they kept encouraging me all along, you should go to a first assisting program. You'd be awesome at it. So I got the hospital to sponsor me and they gave me a stipend to go on top of my bereavement or not, whatever income, because job there, they helped me out a little bit and they said, if you complete this program, we'll hire you on as an RNFA. I said, wow, that's awesome. They said, well, we love you, Bill. You've been great. I'm sorry, but we had to lay off 35 middle managers in one day, and you were one of them. We had to cut the fat. I said, I understand it's a business. It's a hospital. People don't think about that. But hospitals are businesses, and they need to make a profit to keep the lights on. Everybody thinks that health care is. You're there to take care of the patients, and that's all. You're there. You know, that's part of it, but it definitely isn't all of it. I'm sure you understand that, Michelle.
[13:22] Michelle: Well, yeah, I do. There's a lot of chatter right now about hospitals putting profits over patients.
[13:32] Bill: Exactly.
[13:33] Michelle: Yeah. So I totally get that it's a business. But I think we need to remember our roots and why we're here.
[13:41] Bill: I've worked at a lot of catholic healthcare systems, and when I was director of surgery in Eureka, and I was called down to go to the headquarters down in Orange County, and here you've got this catholic organization that owns all these hospitals nationwide called St. Joseph Health System and things like that, and Providence Health System, and there's a lot of different ones. But I went down there as a director of surgery, and I was in these board meetings and they were negotiating contracts with certain companies, like big companies like Johnson and Johnson, Stryker, Bard, I mean, Medline, Cardinal, that kind of boardroom. And the vice presidents of the hospital system were screaming at these vendors, using curse words and saying, if you don't f and give me this deal, we're going to drop your whole company into the sea and you'll never see us again. You'll never get a dime out of us again. And I thought, man, this is supposed to be like a Catholic Christian organization. Well, it wasn't. Those boardrooms were vicious. Each other constantly screaming at the top of their lungs, we've got 14 hospitals. We can make or break your company. You give us the price we want for all the supplies, or you can go to he l hockey sticks. And it was like that. And I thought, man, this is supposed to be a Christian organization. And they're just being so cutthroat and mean and vicious that it's like, man, this doesn't add up. But then I started to realize that this is a business like any other. It has to make a profit to keep things going. Even though they call themselves a nonprofit, they still have to make a profit to keep the lights on. I got off on a tangent there.
[15:51] Michelle: Okay, so now you're an RN First Assist. Where did you go to work for your first job?
[16:01] Bill: It was at St. Joseph Hospital in Eureka, California. The first year I was put with my sponsor, surgeon, which was a wonderful general surgeon named Thomas Rids. I think he's still practicing up there. So he was going to take me under his wing and so I was going to basically do an apprentice with them. So for a year, I mainly worked with him. I did work with all the other surgeons, which technically were also my sponsors. But I learned the most from Dr. Ridds, who took me under his wing and basically taught me how to be an assistant surgeon because that's what the RN First Assistant is. A lot of people don't understand that is that we work under a waiver from the state of California to function as the assistant surgeon. So by law, I can do everything the surgeon can do. I can make incisions into the body. I can dissect tissue, I can cauterize blood vessels. I can tie off blood vessels and veins and arteries and all kinds of stuff. I mean, I'm right there with the surgeon. So he has his eyes on me the whole time. I can drill into bone. I could put plates and screws in the bone. I can put pins, k wires and things in the bones. And I can basically do everything the surgeon does, aside from a few very tricky things like cannulating a cystic duct or something like that. In gallbladder surgery, something like that I wouldn't do. But in ob-gyn surgery, I was doing a lot of tubal things, fallopian tubal surgeries and ovarian surgeries, ovarian cysts and things like that, where I was doing a lot of weird cannulation things where I'm putting a catheter basically down into a tube and that kind of stuff. And I'm on the opposite side of the surgeon, opposite side of the table.
[18:11] Michelle: So I think there is a big misconception about the role of the RNFA.
[18:16] Bill: Yeah, absolutely. Some people think, oh, they're just glorified scrub techs or glorified circulators that have learned how to scrub in the OR. It's not that we do the surgery with the surgeon as a team, myself and him or her. We do it together as a team. And probably one of the biggest roles of the RNFA, the first assistant, is we need to kind of lay down a clear path for the surgeon so that they can perform the surgery. That means we need to get all the other stuff out of the way and we do that with a procedure called retraction. We have all these retractors that we use so that I can retract all this tissue away from the surgical site where he needs to work or she needs to work, and I'd lay down basically a roadmap for them that they can follow. I can lay this whole thing out so they've got a clear path and they don't have to worry about things getting in their way. We do a lot of other things as well, like cauterization and dissecting tissues and drilling and screwing and all that kind of stuff, but that's really the main gist of it for what I did. I did a lot of orthopedic surgery. I think that was the most popular specialty that I worked in, although I worked in all other specialties as well, neuro and general and ent and eyes and podiatry and cardiac stuff. I worked in open heart for a few years.
[20:07] Michelle: How long did you have to work under a surgeon until you kind of went on your own?
[20:17] Bill: Well, I worked for about a year under my primary sponsor, a surgeon. I kind of was working independently all along. But officially, after, like, a year of working with him, I was kind of let go and like, okay, you know what to do. You know how to suture. You know how to tie sutures, you know, basically all the ins and outs of the business here, of assisting. So you're basically on your own from here on out. And I said, okay. Well, it's, you know, it was a learning curve at that point. It took another year or two to get my sea legs about me, where I felt really comfortable doing most procedures in the OR. And after that, it was like second nature. And I loved it. I absolutely loved that job.
[21:07] Michelle: If I'm a circulating nurse in the OR and I'm thinking about becoming an RNFA, how much OR experience do you think I need before I go on for that advanced practice degree?
[21:23] Michelle: Well, the certification program under, there's a company called, well, it's CNOR, but it's a company called Competency and Credentials Institute out of, I believe, Boulder, Colorado. If I'm not correct on that, you can grab it. I think it's Boulder. But anyways, they're the ones that administer the CNOR examination and the FA examination. Anyways, I became a CNOR. They said that in order to be an RNFA, you have to be a CNOR first. What they want is four years of OR experience, at least two years as a circulating room nurse and two years in the scrub nurse role, whether that be in the surgical tech realm orthe LVN realm or the RN realm, it doesn't matter. Two years and two years circulating. Within the circulating room role, the only thing you can be is an RN. They will not take LVN's anywhere in the country. They will not take surgical techs. You have to be an RN, but within the scrub role that we call it scrub, whatever you want to call it, scrub tech, scrub nurse. You can be a surgical tech, an LVN, or an RN, any of those roles. And what they would like you to be to qualify to become an RNFA is two years scrubbing, two years circulating, and the CNOR designation, and then you can attend an RNFA program. And so I had already had ten years of a tech, so I had that covered. And then I had already had a year of circulating, and then I needed another year, so I waited another year and circulated for another year. Anyways, I did that. Then I got fired or laid off, whatever you want to call it. But I got the full severance pay and I was very grateful for that. And so I didn't have to worry about an income for six months. I didn't have to worry about health benefits for six months. And I went to school in Taos and I became an RNFA.
[23:51] Michelle: Okay, so you touched on a little bit about certification. So there's a certified nurse operating room and then professional organizations for OR nurses, RNFAs. That's the Association of Perioperative Registered Nurses, or AORN.
[24:16] Michelle: Yes. Okay. And there's also what I call the CCI, which is the Competency and Credentialing Institute. And they're the ones that kind of, they write the examinations for CNOR. They write the examinations for certified registered nurse first assistant. So they kind of handle both of those. I also belong to an association of surgical technologists, which is also, I believe, out of Boulder, Colorado. Some reason Boulder has all these or things going. I don't understand it, but whatever I was. What do they call CST? Certified surgical tech for ten years. That CCI program kind of handles the certifications. The AORN is basically a governing body that represents all the operating room nurses and RNFas. Not the techs, but RNs and RNFAs. They represent us in states all over the country. They represent us in the legislature. They help to pass laws that allow us to do different skill sets and things in the operating room. They handle issues that are nationwide within the operating room, such as wrong site surgeries, things like that, reducing the number of that still to this day, there's about 3000 wrong-site surgeries that are performed every year in the United States and say, well, how can that happen? Well, a few years back, the World Health Organization got involved and said, this is going on worldwide. We need to do something about this. And so they came up, they said, you know what pilots have? They have something called a checklist. And so they go through this checklist basically for everything they do. And you can talk to Jennifer about that. She's a trained pilot. So they know pilots have this checklist. Why don't they have a checklist in the operating room? So they kind of developed this checklist, and all the OR's in the world had to pick it up. And then we had to do what was called a time-out. We had to do it kind of like three times where everybody stops what they're doing and they pay attention to the one who's delivering the time out verbally. So it doesn't matter what's going on. Everybody must remain totally silent. Time out in pre-op, where we get the patient, we don't identify them. We let them identify themselves. Because some patients are so confused. You can say, Mr. Wilson. They'll say, yeah, what? Well, their name's Mr. Patterson. We kind of ask questions where I need to figure out what they're telling me is correct with my paperwork. So I perform the time out as an or nurse in pre-op, and I get that information. I make sure that I have the birth date, the medical record number, and the name, and all those three things are correct before we move forward. And then I look at the consent for surgery. What are we doing? And so I'll ask the patient, do you know what we're doing with you today or to you today? Oh, yeah. You're doing a total knee replacement. Well, which knee are we operating on? Oh, you're operating on my right knee. And sometimes I've looked at the consent and said, huh, the consent says left knee, but the patient says right knee. So we've got a discrepancy there. So I called surgeon. I look in the H&P,  history and physical, and I also noticed that the surgeon has. Hmm, everything's left in the H&P. The consents for a left total knee. The surgery schedule says left total knee. And see, these are how those accidents happen. These are how those wrong-side surgeries happen.
[28:42] Michelle: Exactly.
[28:43] Bill: We're not perfect. We're human beings. We're fallible, and we make mistakes. We're human beings.
[28:50] Michelle: Yeah. And even with all the fail-safes that we've enacted, it still happens.
[28:59] Bill: Exactly. And so you're supposed to do that and pre-op, right when you hit the or the operating room, when you open that door and pull the patient's gurney or bed into the OR, you say, time out, and everybody stops. You say, this is Mr. Sorensen, and we'll be performing a what doctor? And the doctor will say a right total knee replacement and say, is everyone in agreement with this? With the consent says, right total knee. The schedule, the HP, is everybody in agreement with this? Does anyone have any concerns about what we're doing in here? No, we're all clear on that. Okay, we can proceed. And then we proceed. And we get the patient under anesthesia or under a regional anesthetic and conscious sedation, that kind of stuff. And right before the surgeon, we drape, we prep, we drape the patient out. Right before the surgeon cuts, makes an incision, we stop again and we say, time out. Second time out, third time out, whatever it is, and we say, time out again. Everybody stop what you're doing. And then we say, ok, we're doing a right total knee on Mr. Sorensen. Does anyone have any questions or concerns about that? No, there's no questions or concerns. Let's proceed. All right. I think a lot of hospitals do that, and I think there's still a lot of hospitals that cheat on that and don't really do it to the standards that the World Health Organization wanted in the first place. And that's why they said there's still 3000 wrong site surgeries performed in this country every year. I was involved in probably ten of them in my career when we didn't have those time-outs. And so the surgical tech had no idea really. We knew we were doing a total knee, but we didn't know what side. We knew we were doing a total hip replacement. We didn't know what side, and no one told us. So it's like, okay, well, there was a lot of things like that that happened. I was involved in probably about six inguinal hernia surgeries where we did the incorrect side in the recovery room. We found out from the patient, like, did you do it? Because my right side really hurts bad. My left side doesn't feel bad at all. What happened? They're like, oh, my God, we hit the wrong side.
[31:48] Michelle: Yeah. And I don't mean to laugh at that.
[31:53] Bill: It's a kind of evil kind of laugh.
[32:01] Michelle: Well, you're affecting patients lives forever. And it's not only the OR, of course where we do timeouts, being a longtime NICU nurse, before we put in umbilical lines, before we did any procedures on a baby, we always did a timeout, too. So super important, and thank you for going through the whole process of that. I want to get into a little bit of the meat of what you do on a daily basis. So first of all, we talked about some of the different roles in the operating room. So circulating nurse or a scrub nurse, a surgical tech is in there. But do you think as an RNFA that it's important to know the roles of everyone that is in the operating room?
[32:52] Bill: Oh, absolutely. It's essential. You need to know the person who's scrubbing the case, whether, like I said, it was a tech or an LVN or an RN, you need to know what they're doing. They're responsible for all of the instrumentation and all of the supplies that we'll be using intraoperatively. So if you look over there and you see like, well, we're doing an open reduction, internal fixation of a hip, and you look over there at the scrub nurse's table and you see that they don't have the right equipment or instrumentation, and then you say, like, hey, do you have these trays? And they're like, no. And they're like, well, you're going to need them. We need to get that stuff now. They have that before we even came into the OR. There's that. You need to know what the OR nurse does. The circulating room nurse is basically responsible for the entire OR. Ultimately, it's the surgeon. But if you ask the surgeon, they'll tell you that the circulating room nurse is 100% responsible for what happens there. There are eyes and ears. They're the unsterile person in the OR. Everyone else is sterile except the circulating room nurse and the anesthesiologist. So they're the ones that have to check in the patients, bring them back to the OR, help get them positioned on the or table, whatever position that we're putting them in, which we have lots of positions, depending on the surgery that we're going to do. And then they're responsible for all the legal documentation. So they are responsible for all the times, like the time we entered the OR, the time we started the surgery, the time we stopped, the time the patient left the OR, and all of the legal documentation, such as what's the names of all the players in the room and what's their title? Those have to be documented. And we have computer programs that kind of walk you through all of that. So it's not that difficult. So it's not done on paper anymore, like when I started in the old days. And I'm sure you remember that stuff, Michelle.
[35:19] Michelle: Oh, heck, yeah.
[35:21] Bill: It was all done on paper. So when they made that huge movement, like, well, we need to go to an electronic medical record situation, then that's when it's kind of started. Well, we went to the EMR, but we found out that we still needed the paper on top of it, so we kind of still had both. But the circulating room nurse is responsible that they're responsible for getting the patient on the OR table safely in position. Safely and prepping. Safely and prepping appropriately and correctly. Because prepping is a science all of its own. They teach programs on prepping patients in surgery. There's a certain way that we have to do that for every single surgery that we do. And they're all different from each other. So it's not just a matter of throwing betadine on something and spreading it around. It's a lot more complicated than that. And then they're responsible for all the timeouts and then delivering any kind of sterile supplies or instrumentation that we need during the surgery, like additional sutures that may be needed, additional hardware for orthopedics that may be needed, that kind of thing. And helping the anesthesiologist with the induction of anesthesia. If they're going to have a general anesthesia, or if they're going to have a spinal or an epidural or just a regional nerve block, they're the ones helping the anesthesiologist perform all.
[37:02] Michelle: So they have a really important job.
[37:04] Bill: It is. And the RNFA, basically what we do, we go out preoperatively, we meet with the patient, we establish some kind of a relationship. We go over all the things that are basically in the timeout, make sure that everybody's on the same page, and we kind of give them a little bit of encouragement and this is not going to be so bad. So I know you're nervous. If you weren't nervous, I'd be worried about you.
[37:37] Michelle: I guess there's a preconception that people that work at the OR, they chose the or because they don't like to work with patients that are awake and talking to them and stuff like that. But like what you just said, you have to really establish a rapport with the patient, develop a relationship and gain that trust and calm their fears. And so there's a bit of emotional intelligence involved in that.
[38:12] Bill: I hold their hand and I say preoperatively, I said, would you like to say a prayer?
[38:18] Michelle: That's really nice.
[38:20] Bill: Well, most people say, sure, and we'll hold hands and say a prayer for a successful surgery and God give everyone the skills.
[38:32] Michelle: To operate on the right side. Right.
[38:35] Bill: And has a successful operation in the en. So you only have a very limited time to meet with the know. I have about five minutes, I would say, tops, to establish some kind of relationship or report. Hi, I'm Bill Patty. I'm a registered nurse for assistant. I'm going to be assisting Dr. So and so with your surgery. I've done hundreds and hundreds or thousands of these in 38 years, and you're in good hands. We got a great team in there. You're going to be fine. I mean, just reassure them. Don't give them a false sense of reality, like, nothing's going to happen to you. Everything's going to be fine. Because sometimes everything isn't fine and sometimes there are troubles and there are complications within the surgery that we weren't expecting, but they happen. So I don't want to give people, like, a false sense of reality. Want to reassure them that, I know you're nervous, but we're a very trained, skilled team and we all work together very closely and we do hundreds of these surgeries every year together, the team. So you're in good hands, that kind of thing. And it calms their nerves down quite a bit. And then I offer a prayer and then we also have pastures and things like that around there that can also come and help out with prayer before surgery. And everything seems to work out very well. And like I said, there is a lot of that. Or people don't really want to work on the floors because they don't want to talk to people and they don't want to hear someone's Story 1000 times while they're in the hospital for three weeks. And my niece, oh, I have a video of her, blah, blah, blah. It's just kind of like all that redundant kind of stuff that you get on Med Surge. It's like it gets to be a little much.
[40:43] Michelle: Well, I can tell you didn't like being a med surge nurse for three days.
[40:48] Bill: Exactly.
[40:49] Michelle: Don't hide it.
[40:51] Bill: It wasn't that I didn't like people, but it's just like I couldn't listen to these stories so much because in nursing school I had to. I figured after nursing school I don't really have to. And there's some people, it takes a very special person to be a med surge nurse and listen to all that stuff. You were in the neonatal intensive care unit, so your patients weren't talking that much.
[41:20] Michelle: That's right.
[41:22] Bill: So you have to look at a lot of different signs, like this baby isn't looking right. I see retractions and they're not too good and things like that.
[41:34] Michelle: Yeah. You got to use all those other senses, right?
[41:37] Bill: Yeah, because they're not going to talk to you. It's like having a pet. You don't know what they're feeling. It could be hurting really bad.
[41:44] Michelle: Well, they do talk to us. It's nonverbal, though, of course. And we have to learn what the cues are for sure.
[41:54] Bill: Absolutely.
[41:55] Michelle: Yeah. Well, let's talk about personalities in the OR. So there's some big personalities in the OR. Surgeons are kind of known for their egos. Right. But how do you manage that in the OR? How do you manage those different personalities?
[42:14] Bill: Well, the OR is definitely not for the meek and mild or timid or shy. Surgeons can sense fear a mile away just by looking at you. So if you're going to project that kind of image to them, you are prey, and you could be preyed upon and they could eat you alive. And I've been in many operations where that's happened, happened to me, it's happened to my colleagues, that kind of thing. Now, when I started out in the early 80s, it was a very hostile environment. I would call it a very abusive environment. The surgeons could get away with whatever the hell they wanted to, and the administration didn't do anything about it. And when we complain, administration told us, well, they're paying the bills here, they're keeping the lights on, and they're paying your paycheck, so shut up and get back to work. Well, over the years, and it was very abusive. I mean, I remember searching and screaming at you f and ahole. You don't know what the f you're doing. I don't know why you're doing this. You should have worked at McDonald's, that kind of stuff. Just very demeaning and demoralizing and constantly putting you down and doing the same things to my colleagues. And sometimes I got out of surgeries and I felt like I was about 3ft tall, because for the previous 4 hours, that's how I was treated. And it's no way to treat people that are trying to help you and help the patient. Well, over the years, it's gotten way better. And this last hospital I worked at with Adventist health, they wouldn't tolerate any of that at all. And I love that about Adventist health. So we really didn't have that. We had some of it from one particular surgeon. And everyone knew that surgeon and that surgeon had been disciplined a lot and suspended a lot over the years, and we all knew, but that surgeon was only allowed to go so far. So I would say for the rest, 99.9% of the other surgeons I worked with, they were all angels. They knew that we were there to help them. They knew that we had a tough job, a stressful job, and they treated us like human beings. They treated us with utmost respect and kindness. And I love that about working for Adventist health. And I never got that from any other hospital I worked at. I never got it from the catholic hospitals that I worked at, and I worked at several of those. And they let people walk all over you as well. So it's still a dynamic where it's not for meek and mild. So if you're a little kind of church mouse kind of person, you're not going to do well in the operating room, you're just not. Because there are times where within, I would say, 90% of all the cases go off without a hitch. We do our thing, everything goes the way we thought it was going to go. About 10% of the time, things aren't going well, and we're leaning to a catastrophic situation here, so things can get very tense. One second, everything could be totally fine. We're all talking about football and who won the game and why did they win and why did the other team lose? And I went skiing with my kids this weekend and it was awesome. And then the next second can be like, oh, my God, we're bleeding out, we're hemorrhaging. We got, get the vascular tray, get a vascular surgeon in here now. So things can change very rapidly, and then that's when surgeons, they have the ultimate responsibility, so they just start screaming things like, I need this, I need that. Don't f around with me. And come on, let's get your ass off. Let's go. Let's, let's go, go. They get very frustrated, and that's when they have an outbreak, and we understand that and they understand it too. And then once things get settled down, they apologize and say, I'm sorry, I shouldn't have screamed at you guys. It's just everything was going wrong because they have to look at successful operations and they're being rated by the hospital and they're being looked at. So their infection rate, their success rate, if they have to readmit the patient within 30 days, all those statistics are all mounting up against the surgeon. So I understand that they're under the gun to not have these situations happen. So personalities can be, you can get personalities within the OR crew besides the surgeon, the anesthesiologist can be kind of a bear sometimes to work with and assist them. They've got a very stressful role as well. And sometimes the patient can go into Afib or VTAC or VFiB just all of a sudden, and then you're running for a crash cart, and now you're doing ACLS kind of stuff. So it can change very rapidly. But like I said, for the most part, everything goes off without a hitch and there's no problems and everybody gets along very well, and I'm really happy about that. This last hospital I worked at was really good.
[48:23] Michelle: Yeah, well, I'm happy as well to see that things have changed in terms of the physicians and I guess institutions tolerating abuse.
[48:36] Bill: Surgeons were taught when they were in residency, they were taught by their attending surgeons that, hey, you are the king of the OR. You're the master of your domain. You're in charge of everything here, and you have to take charge. And if you have to scream and yell at people, then that's what you have to do. That's just the name of the game. And so they were taught, like, I have to be mean to get anything that I want. And we had one surgeon here that would do that. And the way that you said, well, how do we deal with that kind of stuff? A lot of times the way that I dealt with an angry, abusive surgeon is just to say nothing at all. They hated the silence, and they knew that something was wrong because I just wouldn't respond to it.
[49:36] Michelle: One of the reasons why we've come so far, I think, is that institutions started saying, we're not going to tolerate this behavior. And here's a perfect example. Years and years ago, being a NICU nurse, we attended all the c-sections, and I attended a c-section, and the surgeon had told the family that the baby was going to be a certain weight. And when the baby was born and on the table, of course, we hadn't weighed the baby yet. But the surgeon was asking how much the baby weighed, and I said, well, we haven't weighed the baby yet. We're going to do that next door in a few minutes. And she said, well, how much do you think the baby weighs? And I said, oh, this baby probably weighs about seven pounds. And she said, no, the baby weighs nine and a half pounds. And I was like, no, there's no way. The baby is nine and a half pounds. Well, when I left the or with the baby in my arms, she turned around and threw scissors at my back.
[50:51] Bill: Oh, my God.
[50:52] Michelle: And zero was done. To this surgeon, they say, oh, write up a Midas report, which I did, of course, and nothing was done. And I'm glad that those days are, if they're not completely gone, they're much improved, because institutions are saying, you're a professional. You're expected to behave in a professional manner. This is called workplace violence, and we're not going to accept this anymore. So I'm glad about that.
[51:30] Bill: Yeah. You also asked, how do we manage that kind of behavior. Since we're kind of taught, like, it's not appropriate to fight that thing out in surgery when it happens. So be quiet, shut your mouth, and you can address it outside of surgery when the patient's gone to recovery room and things like that. So I would be very quiet. I wouldn't say anything when they were or whatever or anyone else. And that made them feel uncomfortable that we didn't respond, but that was what we've always been taught. So when we left the operating room, and I would leave and I would talk to the surgeon face to face and say, you know what? I'm not a dog, and please don't treat me like that ever again. And if you continue this behavior, I'm going to bring it up the chain of command, and I might even file an abuse report with the board of physicians in California or something like, know. And that would scare the hell out of, you know, I was just know, I'm a human being. I make mistakes. I'm sorry. I did the best I could, but I don't deserve to be treated like garbage, so please don't talk to me like that again. And most of the time, they'd say, I'm sorry, Bill. I was just kind of stressed out at the time. I didn't mean it. And I'd say, well, okay, but it's not okay. It's not okay. It's harassment. And there's laws against that in the OR. And after, like I said, after being in the OR for 38 years, the OR harassment thing started to change. They started to make laws against it, and nurses and tech started suing surgeons for harassing them on the job. It became what you said, like a hostile work environment. That's an OR. That it's very demeaning and demoralizing, and you don't deserve. Nobody deserves that. We're doing the best we can do with what we have. Sometimes we don't have all of the necessary things that we need to do our jobs. And if you look at you, I'm sure you've heard about Press Ganey and things like they have questions like that on there. Do you feel like you have everything you need to do your job correctly or appropriately or whatever? I'd say no, because there are some things that we needed that we just couldn't get and so we had to borrow, beg and rob and steal from other operating rooms, which wasn't okay, then they wouldn't have what they needed. So it was things like that. It was like this whole battle between satisfying administration, satisfying the surgeons, satisfying the OR staff. And that was a dichotomy that I could not wrap my arms around it when I was in management in the OR for twelve years. And that's what led to the burnout of being twelve years. I couldn't do it. I couldn't be the middleman between making the hospital happy, the doctors happy and the staff happy and stay within my budget. I only had so much money to spend and then you've got doctors coming in there every day. I need this new supply. How much is that? Oh, it's $8,000. Well I'm sorry, we're budget that within the capital budget for the following year. We can't buy that right now, doc, I'm sorry. And then they were very pissed off, very upset and they would put it out on the staff and things like that. So it just wasn't a good deal. But anyway, in terms of handling the abuse or anything like that, the best way to do it is don't say anything and then meet up with the surgeon after the case and just tell them, listen man, I'm a human being, I don't deserve to be treated like that. Please don't ever talk to me like that way again.
[55:45] Michelle Yeah. So just one on one?
[55:47] Bill: Yeah, one on one. That's the best way to do it because if you take that to the director of surgery, they'll say, well did you talk to the doctor about that? Well, no, I was kind of intimidated and afraid to do that. Well you should talk to them about it first and then if it doesn't get solved, then come to me. So I understood from being previous director of surgery you have countless people coming into your office with all kinds of problems but no solutions. So I came up with a rule when I was a director, I said, if you bring me a problem, you have to bring me two solutions, possible solutions, or else I'm not even going to listen to you. And the staff understood that and they came with that kind know demand was met. So they came up with solutions and we looked at them and said, well, yeah, that'll work or that won't work, or we can try this or try that or whatever. So that was a good question, Michelle.
[56:46] Michelle: Well, thank you. Let's talk about the physicality of the job of the RNFA. So just take me through a little bit about how physical am I going to be in the OR.
[56:59] Bill: It's very physical. If you're not physically fit, you're not going to make it because there's a lot of medical equipment, surgical equipment that you have to move from the storage room or other operating rooms, like anesthesia machines, giant carts of supplies that weigh hundreds of pounds, heavy trays, instrument tray that will weigh 75 pounds that you have to lift up, put down on another table and be able to open up. You have to be able to lift patients that are over 300, might be 400 pounds or even more. You have to be able to roll them over and position them on the OR table. So there's a lot of heavy lifting. There's a lot of heavy pushing and pulling. Standing on your feet. Could be 1 hour, it could be 15 hours without a bathroom break or anything. You just hold your bladder or whatever and keep going. There's no way that you can just say, well, doc, I'm sorry, I got to pee. Give me a few minutes, I'll be right back. There are certain cases where we do that, but it's usually only when the surgeon is doing it as well. The surgeon will say, okay, time for a potty break. Let's divvy. Who's going first? Because there always has to be somebody left with the patient same time.
[58:37] Michelle: So if the surgeon has a big bladder, then you're just out of.
[58:43] Bill: Yeah, I mean, if they have a big bladder and they say, hey, I need a break to go to the restroom real quick. So, Bill, watch the patient while gone. If there's any bleeding or whatever, stop it, that kind of stuff. Okay, doc, no problem. Maintain the sterility at all times. One of the most important things in surgery, as you know, being a neonatal nurse, intensive care nurse, I mean, if you administer one bacteria into that baby while you're putting a pick line in her central line or whatever you have to do, you know, that could be life and death. They get septicemia and die. So the sterility part is key. It's 99.9% of really pretty important. After a while, it'll be like if you're in there for. The longest case that I did was 28 hours without a potty break or a drink of orange juice or a sandwich or anything. And that was hard. And I got to the point where it was a holiday weekend, and this was up in Eureka, and I did 44 hours straight there at the hospital with never going home. And we tried to call people in to relieve us for a little bit. And guess what? No one answered their phone.
[01:00:13] Michelle:  Amazing, the holiday weekend. Surprising.
[01:00:17] Bill: Yeah. They were like, I'm not coming in. I'm at the lake, or, you know, you ain't going to get me. And I had the same mentality, too, when I wasn't working on holidays. I'm off for three days, Jack. You ain't going to find me anywhere. But I got to the point it became dangerous. And I had been scrubbed for 28 hours without a break. Not even able to sit down.
[01:00:43] Michelle: That's dangerous.
[01:00:46] Bill: Yeah, I collapsed on my mayo stand, which is the tray that has all the instruments on it and things that we need. My head fell on that, contaminated the whole mayo stand and all the instruments. And I just passed out. And I was still standing up, but I was asleep. The surgeon just said, let him sleep. It was an Indian surgeon. He said, let him sleep. And he knew what was going on. He said, I'll get my own stuff, and I'll go to the back table and get more stuff. Don't worry about it. So it became that dangerous and I never wanted that again.
[01:01:22] Michelle: Well, that's crazy. Well, what about the pay for an RNFA?
[01:01:28] Bill: Well, it goes up considerably from an or nurse. I know that. So I was making probably, I don't know, pretty decent money as an or nurse here at Adventist hospital. And then when I became an RNFA, it went up probably over. Probably $22 an hour over an or nurse, or a nurse's on-call pay was like $6 an hour, and mine was $12 an hour to be on standby. So the pay went up quite dramatically. And that was done from basically northern California and central California statewide. Kind of index thing on wages. So the hospital Kaweah Delta, where you worked for 45 years or whatever.
[01:02:26] Michelle: Just 40 years, come on.
[01:02:26] Bill: Yeah. How many years?
[01:02:28] Michelle: 40.
[01:02:29] Bill: Okay, 40 years. And anyways, they have to periodically look at wages, and they'll look at Fresno, they'll look at Hanford, they'll look at. They. They kind of look at the ones that are close enough to Visalia. Well, Hanford's not paying what we're paying, but Fresno's paying a lot more, so that's kind of how it all came about. But, yeah, the pay was quite way better than just the standard or nurse. I was very happy about that.
[01:03:04] Michelle: Yeah, well, it should be, considering you're an advanced practice nurse.
[01:03:10] Bill: Yes, it was very rewarding, I would say. I didn't really struggle for money. I didn't wish for anything. I had everything I wanted, and I had plenty of money in the bank, so if I needed something, I didn't charge it. I just bought what I needed.
[01:03:28] Michelle: That's a nice place to be.
[01:03:31] Bill: Oh, yeah. Very comfortable.
[01:03:33] Michelle: Okay, well, let's say that I'm a nurse and I'm thinking about becoming an RNFA, so convince me of why I'm going to love it, why I should do it.
[01:03:48] Bill: Well, yeah, why you should do it is if you're already an operating room nurse, or if you're not, I would suggest getting into an operating room. There's no program that teaches you how to be an OR nurse. It's pretty much all on-the-job training. So it's not like I can go to this program or go to the school, and they'll teach me how to do that. They're really not available. So you're kind of trained on the job by another nurse that you're shadowing for. It could be six months, it could be a year that you're shadowing the nurse. When I got here to Sonora, I was hired as an RNFA, and then all of a sudden after I was hired, there was like seven or nurses that quit within like a month. It was devastating to our operating room staff, and it wasn't because they didn't like the place. It was like people were moving away, be with family and all these things like that. So it became a situation where the or director met with me and said, I know I hired you as an RNFA, but I actually need you as an or nurse. I said, hey, back up here. I've only been an or nurse for like, maybe one to two years, and that was 15 years ago. And she said, don't worry about it. I'll put you with my very finest OR nurse. They'll train you up, matter a couple of months. You'll be working all the or by yourself. So I would try to suggest to that person who has an interest in first assisting, first get into the OR. You can get into the scrub nurse role, and that will teach you probably 80% of what you need to know about first assisting. Anyways. I would do that first. And then what was the other question?
[01:05:51] Michelle: Why would you love it? What do you think a nurse would really love about it?
[01:06:00] Bill: It's hard to describe, but it's so incredibly awesome. I couldn't even believe it because you kind of become the assistant surgeon and at the end of the surgery, the surgeon gives you a high five or handshake and say, Bill, you are incredible in this operation. I couldn't have done it without you. The amount of praise and respect that you get is worth all of that and then some. I really didn't find that within any other role. You did have surgeons, when they would leave, say, all right, crew, good job today. Everybody did awesome. Thank you. So, you know, that wasn't the norm, but as an RNFA, I got so much satisfaction out of the surgeon just saying, like, my God, dude, you were right on the money the whole way through. I mean, I really couldn't have done the surgery without you, Bill. And then to be there the next day and I'm in the lounge in the or having coffee at 630 in the morning and have the surgeon walk in. And we had five RNFA's at the time, so I was just one out of five. The surgeon would walk in, hey, Bill, are we working together today? I go, yeah, actually we are, Doc. And he's, we're going to kick ass today, Bill. I'm like, yeah, I'm planning on it, Doc. So there was that kind of thing. The recognition that you would get as an RNFA was just, I mean, it was just beyond the scope of any other role that I had played in the just, I felt like I became one of them and I was just so close to being a surgeon. That was just amazing. So I think the recognition that I got was what just drove me to love that job. And I woke up, my shift was from 630 to two or whatever or 230. I got there at six every morning. I woke up at 430 every morning and I was jazzed. This is a person that most people, they hate their jobs. I mean, there's a lot of people that hate their jobs and they wake up every morning and go, oh, no, I got to go back to that effing place all day. God, I can't stand that place. But I got to do it because I got to pay my rent or whatever. But I got up at 430 and I was just stoked. I was jazzed up. I'd be like pounding coffee or I had three cups of coffee before I got to work by 06:00 and I'd watch the news and I'd be so stoked, like, who am I going to be working with today? What am I going to be doing? It was just an amazing feeling. So anybody that asks, what were you doing as an RNFA? Why did you want to do it and why should I want to do it? Well, you want to do it for the recognition and the praise, because that really goes a long way in your life. It really does. Just to have that kind of notoriety and have everybody else in the or hear that, because here I am. We're getting to the end of the surgery. I was suturing all this stuff, suturing muscle and fascia and ligaments and all kinds of things, and subcutaneous tissue and subcuticular skin and skin and all that, and have the surgeon just say, Bill, I'm just amazed. You just did an incredible job here today, and not having him say to any of the other staff, that same thing was just kind of like, I felt kind of good about it and bad about it at the same time. I'm like, well, we couldn't have done it without this whole crew, so let's give the crew a round of applause, too. And a lot of times. Oh, yeah, I forgot about you guys. Well, don't forget about doc. They made this whole thing happen, too. So that's what I would say to anybody, why would you do it? Or what would be a good reason to go into this? Because, oh, man, there's just so much joy and praise, and it was awesome. I loved it.
[01:10:29] Michelle: Well, it does feel good to get that kind of respect from your colleagues whom you respect, and for a lot of us, that keeps us going for a long time.
[01:10:46] Bill: Yeah. I don't know how much recognition and praise that you got in the NICU, maybe from other doctors and pediatricians that came in, said, hey, Michelle, you've done an incredible job taking care of this little baby that weighs three know or something. Like, I don't know how that works in NICU.
[01:11:06] Michelle: The same. Exactly like what you and of like you were touching on. It's a team effort, right? And you were good to point that out. Like, hey, I wasn't the only one here. There's a whole team, and it's the same for in the NICU. Of course, I would get personal recognition from my colleagues, but then we would also get recognition, for our efforts as a great team that worked really well together. So that feels good. Well, I think that's good advice.
[01:11:42] Bill: The other part of that, not to toot my own horn, but I will. It became a situation at the hospital where the doctors were requesting me over the other four artifacts that I worked with there. So it made me feel good and bad at the same time, but I couldn't help it. And I had some of them come to me like, what are you doing that we're not doing? I'm like, dude, I just do what I was trained to do and what I feel like the best way to get through the surgery, and that's what I do. It was kind of like a big boost of my ego, and at the same time, I felt bad for my other colleagues who weren't getting requests like that.
[01:12:29] Michelle: Well, Bill, we're getting ready to kind of wrap things up a little bit, but there's one more thing that I wanted to touch on. I just wanted to ask you if you felt free to talk about it. So you are medically retired from the RNFA job, and just tell me how that's been, what it's been like, what you miss about it. Just talk about that.
[01:12:55] Bill: Well, I was doing an extensive hand-arm surgery with a very notarized hand-arm surgeon up here, and it was a long surgery, about 4 hours. And I was suturing up, like the forearm. I had probably like a 12-14 inch incision to suture up, coming from the bone up to all the layers of tissues until you get to the skin. I found my right arm was feeling very strange. I mean, it just felt weird. It felt like it was going numb. And I'm right-handed, so that's where I do my suturing with. I have the needle holder in my right hand, and I have a pickup, little forcep  in my left hand so I can pick up the tissue and then I can put the needle through and I can pull the needle through with the needle holder. I got about halfway through the incision, and the surgeon was looking at me and he knew something was wrong. And he said, what's wrong with your right arm? And I said, doc, I don't know. I said, all of a sudden it's going numb and I can't feel much anymore. And I said, I'm sorry, but you're going to have to finish this because I can't. So he finished it, and he did an assessment on my arm and my hand after the surgery, and he said, yeah, you've had something happen to it. I'm not sure what it is, but we're going to have to find out. So he sent me to a neurologist and they said basically you had a stroke within what was called the brachial plexus, which is a bunch of nerves that come off the cervical spine into the shoulder area and the nerves innervate the arm and the hand. But what happened was my arm kind of went paralyzed and my hand went paralyzed and they still currently are. I'm getting therapy on it, but it's not working that well. So it helps a little bit, but not what you'd expect. So I knew at that point I went off on disability through state disability insurance and I was still getting paid. Okay, but what's happened in the last couple of years with that is everything that I talked about previously about all the recognition and all that left me. I kind of went from 100 miles an hour to 0 miles an hour overnight. And that's been the hardest thing for me ever. This is a job that I love so much. I mean, I just coveted this thing so much. I was so happy at 430 in the morning to jump out of bed and look forward to the day. It was just unbelievable happiness. I just couldn't describe it, and couldn't wait to get to work, and a lot of people can't get to that point. So I was just devastated. And I have been for the last couple of years that I haven't been working. It was just, I thought, well, this is kind of a forced medical retirement. I can't go back to the OR as a first assistant. I can't even be an OR nurse, nor can I be a scrub nurse or a scrub tech ever again. I can't do it one-handed. So it became very depressing for me and I talked to my doctors about it. And so I've been on an antidepressant for the last couple of years. That helps a lot. But it still doesn't take all that sting away of not having that Espri decore that I was getting every day of the week. So it's been a huge toll, and I don't like to whine and complain about it a lot because it's not going to help. But yeah, it was a huge loss for me. I felt like I lost a huge part of who I was because a lot of people say, don't ever let your job define who you are as a person. But I have to say I made that mistake early on and the operating room became my home since I was 17 years old. I never did anything different, and I'm 58 today, so I retired at 56. I had 38 years in the OR and I have to look back and say, you know what? That job really did define who you are. And I think my older brother, who had passed away early on in life, had the same kind of thing where the job defined who he was as a person. And so it's like, well, you're an RNFA. Well, that's who you are. That defines you as a person, and you should never let that happen. But it happened to me. And so I felt devastating depression. I felt suicidal. I was calling suicide hotlines, and talking to people. I was getting mental health people to come over to my house. I had my director of surgery take my gun away that I had in the house, and he said, I need your gun. I don't want it in your house. I said, well, I understand. And I had fantasies about shooting myself in the head with that gun. And thank God he took it away. He still has it to this day because, I don't know, I still have depression. It's not nearly as bad as what it was, but it's been bad. And then I am also battling addiction, and I know a lot of nurses out there are, too. And I've been an alcoholic for at least 20 years. I struggle with that addiction as well. And I've kind of done everything, run the gamut with that. And I've been to over 1000 AA meetings, and I've had a sponsor for 20 years. I've actually had two sponsors in 20 years, but it still doesn't make the desire to drink go away. So AA says progress, not perfection, but I do the best that I can. I'm not perfect. And I'm still here. God willing, and by the grace of God, I'm still here today. I'm so happy to do this interview because I wanted people to understand what it's like in the operating room. And it's a glorious place to be. I wouldn't want to be anywhere else, really, in life. I grew up there and I had my shit kicked out of me for many years, but it doesn't happen anymore. So I'm happy about that. And I'm happy for the final days of my tenure in the or as a registered nurse, and first assistant. That was probably one of the best things that ever happened to me.
[01:20:24] Michelle: Well, I'll tell you, I'm happy that you're here, Bill and I'm happy to know that you're getting the help that you need. Of course, I knew that you had been down. I knew that you've been battling addiction. But until somebody tells you how bad it is, you never really know. And I think that you're definitely not alone in being a nurse and having your identity tied up in your job. And I hope that as a profession, I hope we're becoming more well rounded and we're encouraging the new nurses and the new generation of nurses to not. We're warning them against getting their ego and their identity tied up in being a nurse. And like you said, it's a wonderful profession. I've loved every minute of it. And obviously it has its challenges. And a lot of what you were saying, it resonated with me in terms of losing that when I retired. You lose that social connection. And you lose the banter that you have with your colleagues on a daily basis. The recognition for me, the patients. I did a lot of education with the patients, and so I missed that. And so I think there's a new wave coming, that we're going to protect the new generation of nurses from kind of going what we went through.
[01:22:17] Bill: And I believe that we're human beings. And you know how you've been friends with somebody for many years and then all of a sudden they say, well, I'm moving to New Hampshire. And then it's like, well, we'll stay in touch, and then nobody does. And it's kind of like. That's kind of like the end of the relationship.
[01:22:39] Michelle: Yeah, it can happen. It has happened. People say, well, life gets in the way and stuff like that, and that's definitely true, but it takes effort and you have to stay in contact. And sometimes it's easy to say nobody's reaching out to me. Well, it works both ways. If you feel like you need social interaction, then it's on you. You have to reach out and ask for it and facilitate it, even though it's really difficult.
[01:23:19] Bill: It is. And actually, the last two years I've done that, the staff I worked with were just unbelievably awesome. And for a little while, they came by the house we visited. They called on the phone, and then all of a sudden the phone call stopped happening and the visit stopped happening. And I was like, calling them, like, hey, man, why don't you drop by on Thursday afternoon? Okay? And then they didn't show up. And so it's kind of like going from, like I said, 100 to 0 mile an hour overnight. All that recognition, all that praise, it just disappeared. And so you're like, sitting here, which I'm laying here in a hospital bed because I'm basically coming off a really bad illness. But anyway, it's kind of like, well, the surgeons aren't calling me. They're not dropping by anymore. The staff's not dropping by. They're not calling me, you know? And people like, you know, go on with their own. It's like, that's not a priority to call Bill or stop by his house. I've got other things I got to do. So I understand that because I've done that to other people myself. Always be there for you, man. I'll always stay in touch. And then I never did. And that's happened with me and my own family. It's like, we should have been more communicative with our own brothers and sisters, but we weren't. And there was no really reason for not. It wasn't because we hated each other or had a beef with one another. It was just kind of like we kind of left home altogether at the same time. And then it was like, I don't know if we were too close together, growing up in the house with eight kids, or we just wanted break from each other. I don't know.
[01:25:17] Michelle: I'm voting for the break.
[01:25:21] Bill: I can't really put my arm around, like, what is the real reason? Maybe it was because we grew up together as eight kids together, and everybody was too crammed into two bathrooms, and all we. When we got out on our own, we were, huh? We can take a deep breath, right? And so I think you did that. I did that. Chris Joe did that. Robbie and Martin. Did he? Jenny and Yvette,  not so much. But I think it's a weird phenomenon. I think we were too close living together until we were 18 or 19 and we moved out. So whatever that means, I don't know.
[01:26:08] Michelle: Well, that's a whole nother episode, right?
[01:26:12] Bill: I'm really happy to participate in your program, and I think you've got a wonderful podcast. I've heard really good things about it. I actually went on the Internet, and I found a lot of stuff about you and your podcast. I was spying on you.
[01:26:31] Michelle: Wow. Okay. Well, thank you for those words, Bill. It means a lot to me.
[01:26:38] Bill: I was stalking you on the Internet yesterday, I found out a lot of good stuff.
[01:26:47] Michelle: Well, listen, for those that are listening, that want to reach out to you with questions or anything, where can we find you?
[01:26:57] Bill: You can find me in my email: Liampatty@gmail.com. You can find me on Facebook at Bill Patty, basically. And then picture me, a bald guy with maybe a operating room cap on and a goatee, a picture on my profile, and then you can find me on Instagram under @Druidrn.
[01:27:28] Michelle: Okay. And I will put all those links in the show notes for anybody that wants to find you that way.
[01:27:34] Bill: That's good that our great-great-great-grandfather was a Druid in Ireland. I don't know if that's true or not. But studying a lot about the Druids, and I thought they were awesome. You know, they were people based on spirituality and not, you know, they kind of worship the sun, moon, stars, earth, wind, fire, you know, all that kind of stuff. But they didn't worship God, and they did great until St. Patrick came along and slaughtered millions of them in Europe to bring Christianity to Europe instead of this spirituality thing that Druids held. So it's interesting. That's why I don't celebrate St. Patrick's Day.
[01:28:23] Michelle: Okay, well, thank you for sharing those resources. And like I said, I'll put them in the show notes.
[01:28:30] Bill: Okay, perfect.
[01:28:31] Michelle: You know, at the end, we do the five-minute snippet.
[01:28:35] Bill: Yeah, that's fine.
[01:28:36] Michelle: Okay, so it's five minutes of just fun. Are you ready to play?
[01:28:42] Bill: Sure.
[01:28:47] Michelle: Okay. Would you rather never eat watermelon again or be forced to eat watermelon every meal?
[01:28:57] Bill: I'd rather be forced to eat watermelon ever again.
[01:29:02] Michelle: So you never want to eat it ever again?
[01:29:05] Bill: No.
[01:29:05] Michelle: Could do without watermelon.
[01:29:07] Bill: Absolutely.
[01:29:09] Michelle: Okay. Do you have a life motto, and if so, what is it?
[01:29:15] Bill: Live free or die.
[01:29:17] Michelle: Would you rather get a paper cut every time you turn a page or bite your tongue every time you eat?
[01:29:26] Bill: Oh, I think I'd want to get a paper cut every time in the page.
[01:29:31] Michelle: Because how often do you turn pages? Right?
[01:29:34] Bill: Not very often.
[01:29:36] Michelle: But you eat every day, so you'd be biting your tongue every time.
[01:29:40] Bill: Hurts a lot when you bite your tongue, at least it hurts me a lot.
[01:29:43] Michelle: Totally. What do people misunderstand about you the most?
[01:29:50] Bill: Oh, boy, that's a good question. I think being judged for my history of alcoholism, I think that's put a big damper on how people perceive me and whatever. And I'm not that kind of person that's hurting others or that kind of thing. I'm only hurting myself. I mean, I am hurting people that also care for me and they want me to live and be happy and all that kind of stuff. But, yeah, I think that's the main stigma, that's why. I feel that why people don't understand me completely the way I should be understood.
[01:30:31] Michelle: Well, I think that anyone who really knows you deeply knows that you're a very compassionate human person.
[01:30:39] Bill: That's why I got emotional in the first part of this interview because I felt like crying sometimes.
[01:30:44] Michelle: Yeah. Okay. Would you rather oversleep every day for a week or not get any sleep at all for four days?
[01:30:57] Bill: I guess I'd rather oversleep.
[01:31:01] Michelle: Yeah. Not getting any sleep is bad for you. Okay. If you could go back and give yourself your 18-year-old self, one piece of advice. What would it be? 18 years old.
[01:31:17] Bill: Don't drink. Don't drink, don't drink. I think we're looking back on my life. Everything negatively or bad or awful or horrible has happened to me has all been surrounding around my use of alcohol. I never got into any drugs at all. Never any street drugs. Marijuana, heroin, coke, whatever. Only alcohol. But that's what I would say to my 18 year old self. Just don't drink, man. Just don't drink, period.
[01:31:49] Michelle: Great advice from somebody who knows what they're talking about. Would you rather get trapped in the middle of a food fight or a water balloon fight?
[01:32:02] Bill: Oh, probably a water balloon fight seems more fun. Yeah. As long as I can throw water balloons at other people that are throwing them at me.
[01:32:13] Michelle: There you go. Would you rather live in a treehouse or a cave?
[01:32:19] Bill: Oh, a treehouse.
[01:32:21] Michelle: Yeah. I agree 100%. Yeah, there's something about a treehouse. Would you rather have a photographic memory or an iq of 200?
[01:32:35] Bill: Probably a photographic memory.
[01:32:37] Michelle: What would you do with a photographic memory?
[01:32:40] Bill: I don't know. I would use it to refer to things that I needed in the future. That kind of thing where you can say, well, instead of taking a screenshot of this or writing it or whatever, I know I'm going to need it in the future. So if I had a photographic memory, and I believe that I do have a photographic memory, about 80%. I do have a photographic memory. I can look at something, I can remember it for what it was. I could remember the numbers, the letters, all that kind of stuff. Yeah, photographic memory would be better for me.
[01:33:18] Michelle: Well, that must be a familial trait, because I've had a photographic memory for a long time. I can read something and I can go back and know that it was on the left side of the page about halfway down.
[01:33:33] Bill: Yeah, I love that. Well, I didn't know that about you, too.
[01:33:36] Michelle: Hey, well, we are siblings.
[01:33:39] Bill: Maybe a familial thing.
[01:33:40] Michelle: Yeah. What's your biggest pet peeve?
[01:33:45] Bill: Oh, God. People that don't do their jobs and that. People that don't respond to you when you've responded to them and all the follow up phone calls that you've always left. I mean, that really burns. Know, it's kind of a trade up here where I live in Sonora, California, that people have told me like, hey, we don't operate the same speed as other cities. Very slow up here. And then you have to call back again. You have to call back again and keep calling and calling. So that really is my pet peeve up here. I don't know if it happens anywhere else, but boy, it sure does here. These people just don't care. They don't really do their jobs.
[01:34:36] Michelle: Dude, customer service is dead, haven't you heard?
[01:34:40] Bill: Yeah, that's true.
[01:34:43] Michelle: It is true.
[01:34:45] Bill: I was trying to get a hospital bed. It took me 15 calls to get it. And then after that they called me every three days and said, your beds here. I said, well, I'm still in the hospital, so I'll call you when I get home. Please don't call me again. Three days later I get a call. Your hospital beds in. Well, I know I'm still in the hospital. I have to call you when I get home. They kept calling me over and over and over, so I think it was taking up too much room in their shop or whatever. I don't care, whatever.
[01:35:18] Michelle: Well, I'll tell you what, you really gave us quite a ride today, and I appreciate it. I've loved hearing your stories. A lot of them I knew about, some of them I didn't know about. And I think for any nurses that are listening, you've certainly given them a picture into the job of an RNFA. And thank you for that, Bill. I really appreciate it.
[01:35:46] Bill: No, I was a joy to do. I mean, I've never done anything like this ever in my life. So it was absolutely incredible to do share what I have, what I've learned, and what I haven't learned. It's been an awesome little assignment that you gave me. So I want to fill out the little profile so that people can find me online. Yeah, you're always willing to reach me in any of those things that I said before here.
[01:36:16] Michelle: Yeah, I'll put those in the show notes. And yeah, you definitely get your bio in there. That way they can go to the website and see your bio and contact you and all that good stuff. So thanks, Bill. It's been really fun.
[01:36:32] Bill: Yeah, thank you so much. Have a good day.
[01:36:35] Michelle: You too.
[01:36:36] Bill: Okay, bye.