Going With the Flo

By: Jennifer Rawley

This past week, many of us have been impacted directly or indirectly by Hurricane Florence. In many professions, including healthcare, this means we must devote extra time and effort to preparation. I work at a specialty hospital in Durham, NC, where forecasts showed we were expected to get substantial rain and winds. Thankfully, the storm is slowly passing by and we seem to have fared well. Grateful as I am, it’s hard not to feel a bit guilty for our luck.  Reports continue to pour in about the immense tragedy that is still unfolding to our south and east. Nonetheless, the preparations and planning that took place, along with the emergency operations implementations, required great effort and teamwork.

In years past, I lived in Florida and have been thru several hurricanes and accompanying emergency operations. I have also managed thru a handful of extreme weather situations since taking my current position, so events like this week are not new for me. However, this is the first time ever that I felt any trepidation and believed there was a real potential for major impact. The eventual path and downgrading has been favorable, but the plans put in motion were the same on the front end.

I first started paying attention to the reports on Friday, September 7th. I didn’t get too excited right away; like I said, it wasn’t my first rodeo. Some of the storms I recall bracing for, helping with disaster relief after, getting hit with, or thanking the heavens I didn’t, include – Floyd, Katrina, Erin, Opal, Bertha, Fran, Irene, Charley, Matthew and Maria. As the details and path of Florence worsened over the weekend, I began mentally preparing. Starting on Monday, the first of several planning calls and meetings began and I left work with my head spinning. I thought about how many times in the past I had been complacent in these situations. As a non-management staff member, I often felt obligated to serve on the “A team” because I wanted to be seen as dependable and helpful. Usually, nothing major resulted weather-wise in our location, and it felt like a let-down of sorts. I was left questioning leadership judgement calls or feeling frustrated that I was required to stay for too long. It’s especially easy to become apathetic when similar scenarios play-out over and over. I’m not proud for feeling this way, but I have to own up to it and recognize others may feel the same.

I knew I couldn’t let my team fall into this type of thinking- I had to do something different. As reports of shortages of food, water, and gas in the area became first-hand experiences, a twinge of anxiety set in. I realized that at best, outcomes of human behavior and panic could make this week a challenge. You can’t put into words what it is like to pass by a dozen gas stations in a major city in this country and not be able to buy gas at any of them until you are faced with it. It doesn’t even seem real, especially when the storm is 5+ days away and you are nowhere near the coast. I started to worry what I would do if people ran out of gas and couldn’t get back and forth to work. Most of us do not live in Durham, we commute in from neighboring cities. (For the record, all our gas and food was replenished by Wednesday and has not been an issue since that I am aware of.) I was up late Monday thinking of how I might get the team engaged. I came up with something – it was super cheesy, but fun, and I hoped it would work.

I grabbed a dry-erase map out of my four-year-old son’s room on my way to the hospital on Tuesday. I printed off a low-quality replica of the Indominus Rex from Jurassic World and cut it out. I taped it to the map and used dry-erase markers to indicate the path towards the NC coast. Down one side I wrote in topics for our emergency operations kickoff meeting- food, supplies, communication, sleeping, etc. Down the other, I created two columns for the A and B teams respectively. The A team stays for the duration of the event and leaves once it is safe. In severe cases, it can be for days on end. The B team stays home during the event, and comes in to relieve A team once it’s safe to do so. Everyone in acute healthcare knows you have to be on a team, it just goes with the job. In my past experience, most people don’t want A team, probably because I’ve worked thru so many hurricanes that end up being uneventful to my hospitals. As such, I was expecting the same from my team.

Under the columns, I dubbed A team the “Stormtroopers” and B team the “Cleanup Crew”. I thought up silly unique code-names for each member of my leadership team and created individual tags to tape on the map. To maintain ultimate suspense, I hid them behind a piece of paper. I also loosely scripted a monologue for the meeting. At the start of leadership meetings, I am usually very nonchalant and conversational. This time was different. The team was silent at first as I rolled out the map and posted it on a corkboard. Everyone laughed when they saw the dinosaur in the middle of the Atlantic with a hurricane symbol across its midsection. With great effort to keep a straight face, and as much dramatic effect as I could muster, I started on my script:

“This is phase one real world, we need to bring everyone in. Operation Flo-Rex is now live. As you can all see from this technologically advanced diagram, the Indominus Flo-Rex is making her way towards us; determined to wreak havoc and leave destruction in her path. As of our most recent reports, she will make landfall around 2am Friday morning near Morehead City and we will likely experience strong winds by Thursday morning. This is a slowdown from yesterday, so she must have had a nap, but could pick up speed again. Our mission is to establish plans to operate this hospital safely regardless of what is to come…”

…”Everyone will now be divided into one of two teams, you are either a stormtrooper or on the cleanup crew. Choose- but choose wisely, as there are pros and cons associated with each. Stormtroopers- here is your showcase: A fantastic adventure awaits you should you choose to bid on team A. For one, you get to be off, or work a short shift, on Wednesday. Then you get to come back to the hospital on Thursday and stay here, potentially for days on end, there’s just no telling. Fortunately, we have lots of goodies to keep you happy; such as the most eclectic selection of edible indulgences ever seen in this office before.  I personally hand picked each item out of shipping containers and boxes this morning at Target, with a few hundred other people…..” and I continued on making it sound enticing, with sarcastic details about hanging out with work friends and sleeping on air mattresses.

“Cleanup crew, here is your showcase: A super boring stretch of days awaits you as you get to work like normal this week, but extra hard, to prepare the hospital and set the stormtroopers up for success. As soon as emergency ops are fully deployed, you get to go home. Hopefully, you loaded up on all the yummy food and drinks like we did here, to get you thru the coming days. Charge your phones before leaving, because you just might lose all your electricity, water, wifi, and other fine things. It will be boring, and in your boredom you can think of your fellow team members having hurricane fun together at work with fully functional generators and running water….” and I went on to ensure it sounded like the lesser fun of the two ‘showcases’.

“Everyone has code names for this operation. If you do not like your code name, or find that you don’t identify with it, you may request a new one.”  More laughter, so I kept going.

I pointed to the two columns and asked who wanted to go first. They had giggled thru my script, but got quiet again. I pointed to my CNO since I knew he would be Team A no matter what, but also because he was supposed to be on vacation starting Saturday. I reached under the paper and pulled out a name and taped it under the first column, “Tango”. Everyone burst out in laughter and he shook his head and said, “touche”, because it’s an inside joke. Hands went up as we ran thru the names and stormtroopers were- Tango, Blue-Pill, Mobilizer, Aggelicious, Chaos-Muffin and Terminator. Cleanup Crew included Socialite, Special-K, Roach, Dar the Great, Puff-Daddy, Terminator and Chaos Muffin. All the names were either self-proclaimed or based on personalities or jobs. Blue-Pill is my pharmacy director whose last name is Blue. Puff-daddy is my respiratory manager- as in “take 2 puffs…” on an inhaler, etc. One of our interim leaders, who travels from Pennsylvania each week didn’t get assigned a team, but she got the name ‘Bug-Out.” Her rental for weeks now has been a cherry-red VW beetle convertible, and she is leaving, so I thought it made sense. I’m not at liberty to explain Tango, and I think Terminator origins would blow my cover, but you get the idea.

All in all- task accomplished in record time. No whining, no excuses, everyone on a team and happy to do it in under ten minutes- total success. After this, we pushed on to the serious conversations around the topics of staffing, shelter, food, drugs, supplies, dialysis, communication, providers, fuel, and others. Over the next four days we planned and executed a textbook emergency operations plan, with laughter and fun, but always with safety as our top priority.

It’s now Saturday, September 15th around 9pm. I am at home, as are most members of my leadership team. We are very lucky- but Flo-Rex continues to downpour on many areas close to us. We have had rain and wind, but for the most part nothing terrible. The A team stuck it out, and just when I asked if a hurricane could possibly move any slower, it dropped from 5 to 3 and then a 2 mph crawl! We were getting very tired, our endurance was up, and not much was happening beyond any other thunderstorm we might experience in a non-tropical fashion. In the end, I consulted with my colleagues at some other area hospitals and based on their input, the weather reports, and the fact that the hospital was running quite smoothly, I made the decision to send the A team home.

I hope they don’t think I made them stay too long, or not long enough. I hope they know I had everyone’s safety in mind- theirs, the other staff, the patients and everyone’s families. I hope that next time- and I know there will be a next time- they rise to the occasion to do what they do best- take care of our patients and each other.

I cannot express enough how proud I am of my team and the effort they have put forth with positive attitudes. I’m also very grateful to be part of a wonderful organization that allows me to be the type of leader my team needs and that supports me every step of the way.

I’m home now, safe and dry, while many of my fellow colleagues are still serving time on their A teams because their B teams can’t get in safely yet. My eight year old daughter, Addysen, is patiently waiting for me to finish typing this. She painted an oil canvas earlier today she titled “The Calm Before the Storm.” She used another painting she found as inspiration because it reminded her of some scenes from the news this week of a calm beach with just a single person on it. Admiring her piece, I realized when we don’t have control over situations, like a storm, we can still stay calm and go with the flo. Even in the areas hardest hit, hospitals are taking care of patients thanks to staff remaining calm and being prepared. It’s what we do, it’s what we will always do.

God bless all those who have or will be impacted by this disaster, our thoughts and prayers are with you.

Originally published on 9/16/2018 on LinkedIN see it here
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After my initial post on LinkedIN things took a sudden turn. Monday September 17th we awoke to a tornado warning in Durham county and within an hour a second one. Thankfully we were all fine here but it was an unexpected jolt. At the risk of sounding cliche, the hurricane week was a breeze compared to the week after, but that’s life.  Thanks to everyone who pulled together to take care of patients and each other during this time.
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