One of the unique aspects of nursing is that you are likely to work side by side with someone who has been practicing vastly longer than you have. Nursing is not a profession where long years of experience automatically translate into management. Many nurses do not want management because it takes them away from the bedside. Instead, they are compensated with other perks of seniority such as first dibs on shifts and holidays, the option of choosing whether or not to interact with problem families, and the license to practicing nursing the way they learned it, no matter how long ago that was.
Now I love working with nurses who have been around forever. They have done everything and they have seen everything and for the most part they are happy to share everything they know with you, so long as you come with an appropriate attitude. This doesn't mean you grovel, but it does mean that your bachelors degree does not trump their diploma and 20 years on the floor. While it is said that nurses eat their young, this had not been my experience…or maybe working 15 years in the software industry with ex-military folks who didn't care about my hurt feelings was good preparation for nursing.
Case in point, my new manager, Kyle. About a month into my first job, I was transferred from the acute care unit to the ventilator unit. I don't know how much input Kyle had into this decision, but it was the Director of Nursing's will that I replace the nurse who was transferring to another facility. I could see immediately that everyone loved April, the nurse who was leaving. Meanwhile Kyle had not acknowledged my presence even after a week of orienting to the unit. I wasn't sure this was going to work out so well. Even after April left, Kyle barely spoke to me. He would talk to the respiratory manager and the lead nursing assistant when he wanted to know what was going on. I said nothing. I was determined not to fail what was clearly some test of my metal.
While the day shift is undoubtedly the lighter of the shifts, I think it is the hardest shift to transition into. If anything weird is going to happen with a patient, it happens between 12am and 7am. There are simply less people in the building to help you if something bad happens, your access to doctors is diminished, you can't get STAT anything. Most 911 calls happen on the 11pm to 7am shift. When you come on for the day shift, you have to catch all the events of the last shift and help finish some of the work. Things like IV dressing changes, catheter changes, certain blood tests get left for the last minute. In order to move the process along, I follow the nurse coming off shift to give her a hand and get report.
On this day, I was following Maggie, a forty year nursing veteran. Maggie is tall and wiry with a whisky voice from too many cigarettes and a tanned hide from too many afternoons on the golf course. She started working the night shift after her husband died. There was something I admired about the candor of her grief. It was raw, but not maudlin. "The wee hours are when I miss him most," she would explain. "By the time I get out of here, it's morning and I have the day ahead of me." She had certainly figured out a way of making the best out of a bad situation.
"Come help me change this catheter on Mrs. Gillian," she said, waving me into the room. "She's just so big, I can't possibly move her on my own." Another thing about Maggie is that she is blunt in a way that we're not anymore. What used to be an "alcoholic" is now a "history of ETOH abuse" and what used to be "an overweight patient that requires two staff to move" is now a "bariatric" patient. There is no mean-ness in Maggie, she's plain-spoken. But it's jarring to hear the forbidden words made flesh. Call it what you will, at five feet and 250lbs, Mrs. Gillian was a big woman.
So I followed Maggie into Mrs. Gillian's room. It's still dark outside and the fluorescent light is on over the sink. This combined with the flickering of the TV makes me feel like we are working clandestinely. Mrs. Gillian, who is conscious, but unable to communicate except by grimacing, sweating profusely and breathing against her ventilator is expressing her displeasure. Her breathing on the ventilator makes a noise similar to a donkey's bray. It is dissonant, patternless, and echoes in my head on nights when I can't sleep. It sounds like pain to me.
"Did she push this thing out?" I ask, starting to feel a little dizzy. Her breathing was so uncomfortable and she was using so many muscles to breath against the ventilator, she expelled the catheter. The golfball sized balloon that would normally keep the catheter in place was still in tact, laying at the foot of the bed. "Oh yes," Maggie responded while pulling a new catheter out of its wrapping. "She does it all the time. I don't know why we keep putting new ones in. She's got to be in agony. But then she has these bed sores, so I guess we keep doing it until the doc says otherwise." Maggie continued unwrapping the catheter. She checked the balloon by inflating it just a little and then she lubed the tip. She cleaned Mrs. Gillian's perineal area with the cleaning swabs that come in every catheter kit. Then I rolled Mrs. Gillian to her side so that Maggie could approach from behind, something they don't teach you in nursing school. It's not the "official way" of inserting a catheter, but it's how you do a big patient on an air mattress when the target area is obscured by folds of skin and legs that are clenched shut.
Just when I think I cannot hold Mrs. Gillian steady anymore, Maggie is done. I roll Mrs. Gillian onto her back and straighten out her bed clothes. Something was wrong. Maggie hadn't been wearing gloves. I know I saw her wash her hands but the pack of sterile gloves was laying on the mattress with the rest of the used kit. No way, I thought, she couldn't have. But she didn't. Maggie was washing her hands again as I cleaned up the rest of the kit. "Thanks for your help," she said as she walked out of the room.
I washed my hands and went out to the nurses station, which was abuzz with the morning's activities. In the background a respiratory therapist was opening a bag of chips. "I brought food!" she announced. Maggie sailed over to the bag. "Thank you so much. I'm starving," she said. She reached into the bag, pulled out a handful of chips and walked away. "No chips for me," I thought to myself.
Just then, Kyle picked up the bag of chips,"Who brought these in?" Kyle asked, enthusiastic about free junk food so early in the morning. He grabbed a paper towel and was about to pour some out when I said "I wouldn't eat those if I were you." Kyle looked at me as though I was the junk food police. "Why not?" he retorted. "A certain someone inserted a catheter bareback this morning then had their hands in that bag you've got there," I stated matter of fact-ly and then turned back to Amy, the desk nurse. "Bareback?" Ken asked? "Yeah," I said, without looking up from Amy, "no gloves." A muffled squeal escaped from Amy, "Ooooh, she did that for you too?"
Kyle held the bag of chips by his fingertips and dropped them into the trash. As he breezed by me on his way to morning meeting, he said, "Bareback…I like that."
Kyle stopped ignoring me after that.
**Names are changed.
Wednesday, February 10, 2010
Tuesday, February 2, 2010
Before You Go
When I do nursey stuff, I work in a ventilator unit. I say "when" because I used to do it full time. Now I do it part time and every time I work, I remember why I can't work there full time. When the house is full, I am responsible for up to 13 patients. On any given day, half of those patients are in a persistent, vegetative state, one fourth are "awake" and one fourth have an actual hope of going home. Of those folks who are "not awake" some are DNR/DNH (do not recussitate/do not hospitalize) and those who are not, should be. DNR means that if I find you unresponsive, I will not initiate any life saving measures such as CPR and I will not send you to the hospital. Do not hospitalize means that if you have something wrong with you like lethally abnormal electrolytes, we will try to manage the situation in-house, but we won't send you to the hospital. It is one of the steps the road to hospice or comfort care.
This weekend, I cared for a woman who was actively trying to die. It is a privilege to care for people in this state. Sometimes you're the last touch they feel, the last voice they hear. If you are the last bridge between this world and the next, you always hope you made the "here" better for them. This woman was in agonizing pain when the morphine wore off. It hurt when I wiped her mouth or repositioned her hand. So my job for the day was to make sure the morphine didn't wear off.
By now, we all know that hearing is one of the last senses to leave when someone is dying. In my practice, I recommend the patient be surrounded by family talking about the positive things that are happening. If the TV is the patient's only company, I make sure it's tuned to music. What a patient should not be hearing is "I don't want to send my mom to the hospital for a blood transfusion, I already told that stupid doctor that!" What we have here is an ambivalent son. He doesn't want his mom to suffer, but he doesn't want to let her go.
At this point, I suggest we step into the nursing office. I explain that the Responsible Party (the person who has legal authority to make health care decisions on a patient's behalf) canceled the "Do Not Hospitalize" order on Thursday and with blood work as abnormal as this patient has, I have to follow the orders of the on-call doc unless the on-call speaks to the Responsible Party directly.
(It should be noted the the on-call doc has NEVER seen this patient and practices medicine in such a manner as to keep the patient safe and not get sued. I leave it as an exercise to the reader to decide the order in which these occur.)
At this point, the son is actively trying not to wring my neck. He is frustrated because he knows he argued his step-dad into canceling the DNH order earlier in the week. Step-dad knows the score and understands that his beloved is not going to recover and is suffering. Son is not ready to let go of his mother. Who is? I tell the son that I will not send his mom to the hospital if he will help me get the step-dad in touch with the on-call. It's the only way. Son gets on the cell phone - it goes to voice mail. Step-dad is on his way home, somewhere between Philadelphia and the Poconos.
Finally we are able to get the step-dad connected with the on-call and a new DNH order is obtained. End of shift, I go home.
But I'm still thinking about work. What happened here is mostly avoidable. Mom is probably in this situation because she did not have a living will. Without the living will, this family had to go to court to decide that the spouse and not the son would would make decisions on behalf of this lady. This case is not isolated. Many of my patients are not married to their companions. But without any document indicating who should make decisions or who should execute the decisions you have already made, you will be kept "alive" until your heart gives out (not a good death), some other party will choose for you, or your companion will have to go to court to "prove" that you are a family.
You don't have to be married and you don't need a lawyer. For a few dollars, organizations like Five Wishes provide living wills in simple language. All you have to to is fill it out, get it notarized, then give it to your doctor or make sure your companion has it. The red tape in a nursing home is ten-fold. Your family has enough to worry about with you in a coma. Before you go, do them a favor and execute a living will.
This weekend, I cared for a woman who was actively trying to die. It is a privilege to care for people in this state. Sometimes you're the last touch they feel, the last voice they hear. If you are the last bridge between this world and the next, you always hope you made the "here" better for them. This woman was in agonizing pain when the morphine wore off. It hurt when I wiped her mouth or repositioned her hand. So my job for the day was to make sure the morphine didn't wear off.
By now, we all know that hearing is one of the last senses to leave when someone is dying. In my practice, I recommend the patient be surrounded by family talking about the positive things that are happening. If the TV is the patient's only company, I make sure it's tuned to music. What a patient should not be hearing is "I don't want to send my mom to the hospital for a blood transfusion, I already told that stupid doctor that!" What we have here is an ambivalent son. He doesn't want his mom to suffer, but he doesn't want to let her go.
At this point, I suggest we step into the nursing office. I explain that the Responsible Party (the person who has legal authority to make health care decisions on a patient's behalf) canceled the "Do Not Hospitalize" order on Thursday and with blood work as abnormal as this patient has, I have to follow the orders of the on-call doc unless the on-call speaks to the Responsible Party directly.
(It should be noted the the on-call doc has NEVER seen this patient and practices medicine in such a manner as to keep the patient safe and not get sued. I leave it as an exercise to the reader to decide the order in which these occur.)
At this point, the son is actively trying not to wring my neck. He is frustrated because he knows he argued his step-dad into canceling the DNH order earlier in the week. Step-dad knows the score and understands that his beloved is not going to recover and is suffering. Son is not ready to let go of his mother. Who is? I tell the son that I will not send his mom to the hospital if he will help me get the step-dad in touch with the on-call. It's the only way. Son gets on the cell phone - it goes to voice mail. Step-dad is on his way home, somewhere between Philadelphia and the Poconos.
Finally we are able to get the step-dad connected with the on-call and a new DNH order is obtained. End of shift, I go home.
But I'm still thinking about work. What happened here is mostly avoidable. Mom is probably in this situation because she did not have a living will. Without the living will, this family had to go to court to decide that the spouse and not the son would would make decisions on behalf of this lady. This case is not isolated. Many of my patients are not married to their companions. But without any document indicating who should make decisions or who should execute the decisions you have already made, you will be kept "alive" until your heart gives out (not a good death), some other party will choose for you, or your companion will have to go to court to "prove" that you are a family.
You don't have to be married and you don't need a lawyer. For a few dollars, organizations like Five Wishes provide living wills in simple language. All you have to to is fill it out, get it notarized, then give it to your doctor or make sure your companion has it. The red tape in a nursing home is ten-fold. Your family has enough to worry about with you in a coma. Before you go, do them a favor and execute a living will.
Friday, January 29, 2010
Gabriella 1992-2010
Ballet, Piddle-Kitten, Boo-boo Girl, Gabriella-Just-So. She had a lot of nick names, but she was first and foremost, Gabriella. Her origins were dodgy. One day in January 1993, I received a call at work from HeWhoShallNotBeNamed*. There were these two kittens that someone found outside and there were people who were willing to take one cat or the other, but not two together, and he thought they really should stay together, can he bring them home?
I "reasoned" to myself: we already have three cats. One more isn't much work and really two more is just a little more work than one..."OK, bring them both."
When I came home there were two kittens in a cardboard box. Gabriella was a brown and black tabby with the cutest white paws that looked like she was wearing slippers. She looked up at me with her big green eyes and started meowing. "She's talkative," I said. Some how "talky" became "gabby" but that didn't sound dignified. So "gabby" became "Gabriella" and it instantly seemed like the perfect name.
Friendliest of the bunch, she would jump up on visitors and paw at them until they gave her the attention she craved. She loved teaser toys and chased them long into her senior years. She overcame diabetes and accepted blood tests and insulin shots with grace and dignity. When I was in nursing school, she loved to sit right next to me on the couch as I studied or wrote up care plans. She loved to be brushed and groomed. Just the site of the comb and she would come running and purring and nuzzle you until you brushed her.
She and Bijoux were engaged in a love affair. Many times I came home to find them curled up together on the couch or the bed. The sound of the door would wake them out of their sleepy rapture and they would through a guilty glance at me before one or both of them would jump off the bed...the spell broken.
Late last year, we started noticing that Gabriella was walking into us or not getting out of our way like she used to. She also wasn't responding to her teaser toys. I brought her to her vet who immediately suspected retinopathy related to high blood pressure. We took her to the specialty vet, who confirmed the original diagnosis. We started her on a course of blood pressure medication and her sight was restored within a few weeks.
Early this month, she started vomiting and having diarrhea and wouldn't eat. We went back to the vet and what I suspected was confirmed, lymphoma. We started her on prednisone, prilosec, and metronidazole to help control the diarrhea. We also started her on fluids. Her appetite was restored after a few days. She went back to eating her old food if it was watered down into a slurry. She did very well for a couple of weeks until this past weekend, when she stopped eating and stared throwing up blood tinted vomit. I made an appointment with her vet on Tuesday morning. On Monday night, she still would not eat. Out of desperation, I offered her ice cream. She ate it. I gave her milk, she lapped up two cap fulls and then would not eat any more. She walked back to the bedroom and crawled under the bed.
On Tuesday, I woke up at 4am to the sound of Gabriella breathing. She was under my side of the bed. I went to the floor and checked her. I knew what was happening. I put my hand on her to let her know I was there. She left us at 6am.
She was a companion of mine for almost 18 years, traveling from wherever she came from in New York to New Jersey to Pennsylvania. I can still remember the first time I saw her sitting up straight and tall, with her white paws in perfect alignment with her chin and I thought "well doesn't she look prim and proper and just so?"
She was precious and we miss her.
*A former companion.
Thursday, January 28, 2010
Pearls of Wisdom*
Grab a cuppa and make yourself comfortable for this one, we're going to be here a while. So we are back in the saddle again looking for a house. Among the many things that nobody tells you when you are home shopping is that you probably won't get the first house you bid on, something hinky will happen with at least one of your deals, your realtor may go MIA for a week with no explanation, and there will be wackos. If none of these things have happened to you, then you must live in some alternative universe from which I don't know. I share the following with you as not just a warning, but as a counter experience to those flowery house shopping shows on the home porn channel where at the end of every show, someone is joyfully moving into their very own home.
Take a picture of this: We met Gene at an open house. We were not interested in the house but we got along with Gene. He was low pressure, affable and most importantly, Mr. DS related to him. We exchanged contact information and within a day, we were receiving matches out of the MLS. Within a week, we had our "first date" to see if we could work together. During that first showing, I expected that he would present us with a contract. He did not. Instead, he showed us our Consumer Rights and when I inquired about a contract, he stated that he didn't require one until we wanted to bid on a house. Seemed fair enough, we didn't really see any harm. If he was willing to show us houses, we would certainly give him the contract if he showed us one we wanted to buy. And he did. After a couple of weeks of looking we settled on a cape with fabulous plaster walls, hardwood floors, original built-ins, and a separate office space over a two car garage. Needless to say, the deal went hinky. The seller got greedy and we backed away from the deal. Gene tried to save the deal, but he understood that we felt the seller wasn't dealing in good faith. We were deflated, disappointed and emotionally drained. Since it was so close to Christmas, we all decided to take a holiday break, rethink our options and resume after the new year.
In the first week of January, I emailed Gene and explained that since there was so little to choose from in the area where we had been searching, we decided to look in another, adjacent county and would he be willing to continue to work with us in that area? His response was that there certainly was more inventory to choose from, provide him a starting point and he would get back to us. I did so. A day passed. Three days passed. A week and still no word from Gene. This was not like him, he was usually very prompt in getting back to us. Maybe he had decided he didn't want to work with us after all. I recalled him telling me that if I were to stop returning calls and emails, he would take the hint.
I raised the possibility to Mr. DS that Gene had abandoned us and maybe we should talk to another realtor. "What about the woman who sold your condo?" I asked. "Is she still in business?" Mr. DS mused. "Yes she is," I said. "I Googled her and she has a web site and everything. Do you have any issues with getting in touch with her?"
Pearl responded quickly. She remembered Mr. DS and was pleased that we thought to contact her. We spoke via conference call to make arrangements to meet the following Sunday morning. As soon as I got off the phone with her, Gene called. He apologized profusely for not being in touch, but he had a military family on housing leave and he had been totally involved with them. I told him I understood, but I was disappointed that he didn't let me know what was going on. I thought he had dropped us. After all we had no contract with him and there were no mutual obligations. But I did let him know that we were talking to other realtors. Then he admitted that he would continue to work with us if that was what we wanted, he honestly felt more comfortable showing homes on his "side of the river". That was fair. The parting was friendly. In the mean time, I relayed our story to different friends and some were kind enough to recommend their agents. I thought this time it might be useful to talk to a couple of people before settling down to one.
On a rainy Sunday morning, we met Pearl at at real estate office which she claimed she never really used, but was a mutually convenient meeting place. She was assertive, with a good handshake and eye contact, but there was something about her energy that made me nervous. We exchanged pleasantries and then she asked us to tell her a little more about what we were looking for. While we were talking, she never stopped playing with her hair, fiddling with her hands or fidgeting in her seat. Her first response was, "there's not a lot of activity in that area, is there anywhere else you're interested in?" I sat back a little. I knew people who lived in that area and by their report, there were many properties available at all price ranges. We explained why we were looking in that area…that our previous deal had fallen through and that the new area had many of the same qualities as the old area, but seemed to have more inventory.
After more conversation, she explained the way she worked. She told us that Gene was wrong for not insisting we sign a contract with him, that it was unethical to wait until we wanted to make an offer on the house before entering into a contract, that she always has a contract with her clients; she said that she was an excellent negotiator and that she could absolutely get the best price for us. Then she asked us if we had any questions and I asked her how comfortable she was showing us homes in the area we discussed. She responded, "I can sell anywhere. With the internet, anything I don't know about a place, I can look up." And then she proceeded to show me her iPhone and how it had an app for the MLS and that she was always available via text and Twitter. And while I don't disagree that the internet has opened up a world of information to us mere mortals trying to buy a house, I wondered how you could find equivalent neighborhoods on the internet…and I'm not just talking price, it's about the feel of a place, how well the homes are kept, if the people who live there like to park on the street, even though they have driveways and garages, if the road is very busy at rush hour because it's a popular cut through for people trying to avoid busy main roads. Those are qualitative aspects that only a person who knows an area can help you with. She handed us her contract and suggested that we look it over, think about more questions and get back to her. She was always happy to answer questions.
Look it over we did. What she did not explain was that she handed us an exclusive contract. She never explained the difference between the exclusive and non-exclusive contract - never even brought up the existence of a non-exclusive contract. She also never offered to set us up on her MLS, which I have noted is a courtesy that many realtors do even after the most casual of contact. She offered us her web site, which was a front end to the MLS. We could search by price and by county, but we could not narrow by city or school district which is invaluable since you can search many towns within a region. And when you got results back, if you looked at the Details View of a house on page 5 and clicked "Return to Search Results", the page took you back to the beginning of the search results and now I had to remember what page I was on. Mr. DS noted this too. Plus the "details" had no real information, such as tax records. "Ok" I thought to myself, "annoying, but not a deal breaker." I emailed more questions: how do I get more information if I see a property I like, are you available to show homes on weekends when we are both available, would distance be a problem, do you feel comfortable handing short sales? I asked this specifically, not because we are terribly interested in short sales, but because Gene steered us away from short sales. Now I know that is a loaded term, but when I asked about short sale properties Gene would specifically say that he didn't think we should look at them and simply didn't make those appointments. So that was "steering" in the real estate sense of the word and I know it's not supposed to be done, and I was willing to forgive Gene for that because he made up for it in with his other qualities. I also asked Pearl if she would be comfortable with a 3 month contract instead of a 6 month contract. There was something about her that made me uneasy. It might have been her general twitchiness, it might have been her disregard for our concern about her lack of knowledge about the area, something about her didn't feel right to me even though I had no doubt that she would be formidable in a negotiation.
Pearl did call us back about my email and answered my questions. But what really put me off were the following: When I raised concerns that we might need the expertise of a local realtor, her response was that a local realtor had a vested interest in keeping the price of a property high, because they probably lived in the area and wanted to see the property values remain high. That didn't ring true to me. Doesn't she have a vested interest in keeping a price high since she gets a cut of the sale price? Then she chided Mr. DS for not calling her first, "I'm really surprised that you didn't call me when you started looking for a house. Why didn't you contact me first?" Where did that come from? Why would you put a prospective client on the defensive? We didn't plot to exclude her, we were calling her now, didn't that count? I ended the call by saying, "Full disclosure, we are interviewing another realtor so once I talk to that person, I will let you know what we decide." In the mean time, I was thinking that we really needed to talk to another realtor.
I contacted Bonnie, a realtor recommended by friends who had just bought a house and spoke with her on the phone for about 40 minutes. She had a totally different vibe. She was hearing what I told her, she was professional, she asked if I was aware of and understood the differences between the different kinds of buyer-broker contracts. I asked about what her expectations were from us and about what kinds of transactions she was comfortable handling. She did not talk about the other realtor and what he may or may not have done wrong. She talked about what she was able to do for her clients in relation to what I had told her. Her next question was to ask if she could set me up in her MLS and start sending us leads on properties. "What?" I thought to myself, "without a contract?". I felt a little more at ease with Bonnie. She promptly started sending listings and we decided to spend a day checking out some of the neighborhoods. After spending the entire Saturday in the car, Mr. DS and I broached the realtor situation. Given the fact that we really did not know the areas where we were looking and that there was so much inventory, I felt that we really should be working with someone local. Mr. DS agreed. Now I had to tell Pearl we would not be working with her.
Monday morning, bright and early, there was an email from Pearl asking if we had spoken to "the other person" and come to a decision. I crafted a carefully worded response that we appreciated her time but we would felt more comfortable going with a local realtor because of our lack of familiarity with the area. If things changed for us, we would certainly keep her in mind. Maybe that was what pissed her off, because within an hour, I received what could only be described as a screed. She opened by telling us "thanks but no thanks". She was actually going to suggest that we should go with the other realtor because we were taking so long (4 days) to decide. First Pearl of Wisdom: just go with whoever waves a contract in your face. After all, it's not as if you're going to be spending a lot of time with this person or sharing sensitive information with them.
After reviewing our situation, she "would not consider working with (us) in the future" because we had not demonstrated "loyalty" to the other realtor and had "refused to sign a contract with him". Second Pearl of Wisdom: if after combing the same 10 mile radius for weeks you don't find a home, you're disloyal if you decide to change locations but still contact your first realtor and give them the option to work with you in the new area. You are also disloyal if the first realtor doesn't ask for a contract and you agree to that. For the record, when we did make an offer on a house, Gene had a signed, exclusive contract. For the record, you're also disloyal if your realtor goes MIA for over a week and you would still consider working with him.
Her displeasure with us mounted: We clearly did not know what we wanted because we changed locations and we asked about short sales. Third Pearl of Wisdom: No matter how little inventory there is in an area and no matter how much sense it may make for you to look in another location, you shouldn't do that because then it looks like "you don't know what you want". Also don't ask about short sales, even if the realtor sends them to you from the MLS. Because first, that's considered "jumping from one thing to another" and second, "they are not realistic for your price range". Never mind that they are included in the search that the realtor set up for you.
Her final complaint against us was that we did not "understand the value that a realtor provides". Fourth Pearl of Wisdom: If the value a realtor provides includes discouraging a client from looking in a particular location, putting a client on the defensive, not providing full disclosure about all the kinds of arrangements that are available between buyers and brokers, and providing a buggy piece of software with which to perform crippled searches of the MLS, then no, I guess I don't understand the value she provides.
What is wrong with people? Lots of folks have not hired me and while I may have felt or even known they were making a mistake, in business, relationships matter. You can't just vent your spleen at someone when they don't behave the way you want. For one thing, it's rude. But for another, you never know where your next job is coming from. Despite the casual nature with which he conducts his business, I could in good conscience recommend Gene as an expert in his region and an excellent resource in general. On the other hand, I think Pearl needs help. She's very angry about something and it's not just about me not hiring her. The final Pearl of Wisdom is: follow your gut and dodge a bullet.
*Gene, Pearl and Bonnie are all aliases.
Take a picture of this: We met Gene at an open house. We were not interested in the house but we got along with Gene. He was low pressure, affable and most importantly, Mr. DS related to him. We exchanged contact information and within a day, we were receiving matches out of the MLS. Within a week, we had our "first date" to see if we could work together. During that first showing, I expected that he would present us with a contract. He did not. Instead, he showed us our Consumer Rights and when I inquired about a contract, he stated that he didn't require one until we wanted to bid on a house. Seemed fair enough, we didn't really see any harm. If he was willing to show us houses, we would certainly give him the contract if he showed us one we wanted to buy. And he did. After a couple of weeks of looking we settled on a cape with fabulous plaster walls, hardwood floors, original built-ins, and a separate office space over a two car garage. Needless to say, the deal went hinky. The seller got greedy and we backed away from the deal. Gene tried to save the deal, but he understood that we felt the seller wasn't dealing in good faith. We were deflated, disappointed and emotionally drained. Since it was so close to Christmas, we all decided to take a holiday break, rethink our options and resume after the new year.
In the first week of January, I emailed Gene and explained that since there was so little to choose from in the area where we had been searching, we decided to look in another, adjacent county and would he be willing to continue to work with us in that area? His response was that there certainly was more inventory to choose from, provide him a starting point and he would get back to us. I did so. A day passed. Three days passed. A week and still no word from Gene. This was not like him, he was usually very prompt in getting back to us. Maybe he had decided he didn't want to work with us after all. I recalled him telling me that if I were to stop returning calls and emails, he would take the hint.
I raised the possibility to Mr. DS that Gene had abandoned us and maybe we should talk to another realtor. "What about the woman who sold your condo?" I asked. "Is she still in business?" Mr. DS mused. "Yes she is," I said. "I Googled her and she has a web site and everything. Do you have any issues with getting in touch with her?"
Pearl responded quickly. She remembered Mr. DS and was pleased that we thought to contact her. We spoke via conference call to make arrangements to meet the following Sunday morning. As soon as I got off the phone with her, Gene called. He apologized profusely for not being in touch, but he had a military family on housing leave and he had been totally involved with them. I told him I understood, but I was disappointed that he didn't let me know what was going on. I thought he had dropped us. After all we had no contract with him and there were no mutual obligations. But I did let him know that we were talking to other realtors. Then he admitted that he would continue to work with us if that was what we wanted, he honestly felt more comfortable showing homes on his "side of the river". That was fair. The parting was friendly. In the mean time, I relayed our story to different friends and some were kind enough to recommend their agents. I thought this time it might be useful to talk to a couple of people before settling down to one.
On a rainy Sunday morning, we met Pearl at at real estate office which she claimed she never really used, but was a mutually convenient meeting place. She was assertive, with a good handshake and eye contact, but there was something about her energy that made me nervous. We exchanged pleasantries and then she asked us to tell her a little more about what we were looking for. While we were talking, she never stopped playing with her hair, fiddling with her hands or fidgeting in her seat. Her first response was, "there's not a lot of activity in that area, is there anywhere else you're interested in?" I sat back a little. I knew people who lived in that area and by their report, there were many properties available at all price ranges. We explained why we were looking in that area…that our previous deal had fallen through and that the new area had many of the same qualities as the old area, but seemed to have more inventory.
After more conversation, she explained the way she worked. She told us that Gene was wrong for not insisting we sign a contract with him, that it was unethical to wait until we wanted to make an offer on the house before entering into a contract, that she always has a contract with her clients; she said that she was an excellent negotiator and that she could absolutely get the best price for us. Then she asked us if we had any questions and I asked her how comfortable she was showing us homes in the area we discussed. She responded, "I can sell anywhere. With the internet, anything I don't know about a place, I can look up." And then she proceeded to show me her iPhone and how it had an app for the MLS and that she was always available via text and Twitter. And while I don't disagree that the internet has opened up a world of information to us mere mortals trying to buy a house, I wondered how you could find equivalent neighborhoods on the internet…and I'm not just talking price, it's about the feel of a place, how well the homes are kept, if the people who live there like to park on the street, even though they have driveways and garages, if the road is very busy at rush hour because it's a popular cut through for people trying to avoid busy main roads. Those are qualitative aspects that only a person who knows an area can help you with. She handed us her contract and suggested that we look it over, think about more questions and get back to her. She was always happy to answer questions.
Look it over we did. What she did not explain was that she handed us an exclusive contract. She never explained the difference between the exclusive and non-exclusive contract - never even brought up the existence of a non-exclusive contract. She also never offered to set us up on her MLS, which I have noted is a courtesy that many realtors do even after the most casual of contact. She offered us her web site, which was a front end to the MLS. We could search by price and by county, but we could not narrow by city or school district which is invaluable since you can search many towns within a region. And when you got results back, if you looked at the Details View of a house on page 5 and clicked "Return to Search Results", the page took you back to the beginning of the search results and now I had to remember what page I was on. Mr. DS noted this too. Plus the "details" had no real information, such as tax records. "Ok" I thought to myself, "annoying, but not a deal breaker." I emailed more questions: how do I get more information if I see a property I like, are you available to show homes on weekends when we are both available, would distance be a problem, do you feel comfortable handing short sales? I asked this specifically, not because we are terribly interested in short sales, but because Gene steered us away from short sales. Now I know that is a loaded term, but when I asked about short sale properties Gene would specifically say that he didn't think we should look at them and simply didn't make those appointments. So that was "steering" in the real estate sense of the word and I know it's not supposed to be done, and I was willing to forgive Gene for that because he made up for it in with his other qualities. I also asked Pearl if she would be comfortable with a 3 month contract instead of a 6 month contract. There was something about her that made me uneasy. It might have been her general twitchiness, it might have been her disregard for our concern about her lack of knowledge about the area, something about her didn't feel right to me even though I had no doubt that she would be formidable in a negotiation.
Pearl did call us back about my email and answered my questions. But what really put me off were the following: When I raised concerns that we might need the expertise of a local realtor, her response was that a local realtor had a vested interest in keeping the price of a property high, because they probably lived in the area and wanted to see the property values remain high. That didn't ring true to me. Doesn't she have a vested interest in keeping a price high since she gets a cut of the sale price? Then she chided Mr. DS for not calling her first, "I'm really surprised that you didn't call me when you started looking for a house. Why didn't you contact me first?" Where did that come from? Why would you put a prospective client on the defensive? We didn't plot to exclude her, we were calling her now, didn't that count? I ended the call by saying, "Full disclosure, we are interviewing another realtor so once I talk to that person, I will let you know what we decide." In the mean time, I was thinking that we really needed to talk to another realtor.
I contacted Bonnie, a realtor recommended by friends who had just bought a house and spoke with her on the phone for about 40 minutes. She had a totally different vibe. She was hearing what I told her, she was professional, she asked if I was aware of and understood the differences between the different kinds of buyer-broker contracts. I asked about what her expectations were from us and about what kinds of transactions she was comfortable handling. She did not talk about the other realtor and what he may or may not have done wrong. She talked about what she was able to do for her clients in relation to what I had told her. Her next question was to ask if she could set me up in her MLS and start sending us leads on properties. "What?" I thought to myself, "without a contract?". I felt a little more at ease with Bonnie. She promptly started sending listings and we decided to spend a day checking out some of the neighborhoods. After spending the entire Saturday in the car, Mr. DS and I broached the realtor situation. Given the fact that we really did not know the areas where we were looking and that there was so much inventory, I felt that we really should be working with someone local. Mr. DS agreed. Now I had to tell Pearl we would not be working with her.
Monday morning, bright and early, there was an email from Pearl asking if we had spoken to "the other person" and come to a decision. I crafted a carefully worded response that we appreciated her time but we would felt more comfortable going with a local realtor because of our lack of familiarity with the area. If things changed for us, we would certainly keep her in mind. Maybe that was what pissed her off, because within an hour, I received what could only be described as a screed. She opened by telling us "thanks but no thanks". She was actually going to suggest that we should go with the other realtor because we were taking so long (4 days) to decide. First Pearl of Wisdom: just go with whoever waves a contract in your face. After all, it's not as if you're going to be spending a lot of time with this person or sharing sensitive information with them.
After reviewing our situation, she "would not consider working with (us) in the future" because we had not demonstrated "loyalty" to the other realtor and had "refused to sign a contract with him". Second Pearl of Wisdom: if after combing the same 10 mile radius for weeks you don't find a home, you're disloyal if you decide to change locations but still contact your first realtor and give them the option to work with you in the new area. You are also disloyal if the first realtor doesn't ask for a contract and you agree to that. For the record, when we did make an offer on a house, Gene had a signed, exclusive contract. For the record, you're also disloyal if your realtor goes MIA for over a week and you would still consider working with him.
Her displeasure with us mounted: We clearly did not know what we wanted because we changed locations and we asked about short sales. Third Pearl of Wisdom: No matter how little inventory there is in an area and no matter how much sense it may make for you to look in another location, you shouldn't do that because then it looks like "you don't know what you want". Also don't ask about short sales, even if the realtor sends them to you from the MLS. Because first, that's considered "jumping from one thing to another" and second, "they are not realistic for your price range". Never mind that they are included in the search that the realtor set up for you.
Her final complaint against us was that we did not "understand the value that a realtor provides". Fourth Pearl of Wisdom: If the value a realtor provides includes discouraging a client from looking in a particular location, putting a client on the defensive, not providing full disclosure about all the kinds of arrangements that are available between buyers and brokers, and providing a buggy piece of software with which to perform crippled searches of the MLS, then no, I guess I don't understand the value she provides.
What is wrong with people? Lots of folks have not hired me and while I may have felt or even known they were making a mistake, in business, relationships matter. You can't just vent your spleen at someone when they don't behave the way you want. For one thing, it's rude. But for another, you never know where your next job is coming from. Despite the casual nature with which he conducts his business, I could in good conscience recommend Gene as an expert in his region and an excellent resource in general. On the other hand, I think Pearl needs help. She's very angry about something and it's not just about me not hiring her. The final Pearl of Wisdom is: follow your gut and dodge a bullet.
*Gene, Pearl and Bonnie are all aliases.
Friday, January 15, 2010
My Heart Does Not Leap for Joy
At some point during nursing school, I actually noticed my heart and it wasn't after the scant exercise I was able to steal from my schedule. I'd be sitting in class and feel a "thud", as though my heart was jumping up into my throat. It never happened more than once at at time, but it might happen several times within an hour, so much so that I would notice it. But there was no pain and it never happened during strenuous activity, so I didn't give it a second thought.
Then it started happening after a glass of wine or two. Drinking alcohol has always disturbed my sleep, but I noticed that when I woke up after drinking and falling asleep, the heart-thud thing was there, more intense and uncomfortable to the point where I could not fall back to sleep.
At work, I noticed it would happen in conjunction with other symptoms I would loosely call panic. And that was very uncomfortable. I have heard people describe cardiac symptoms in conjunction with panic attacks, but I never felt panic until I started working as a nurse. These episodes were minor, really. I felt confused, light headed, unable to "process" what was being said to me, felt like I was going to fall over. Yes... lovely and safe. I would excuse myself for 15 minutes until I could talk myself down. But the heart-thud thing was still there.
I finally got sick of it after Thanksgiving when the symptoms were really interfering with my ability to enjoy the spirits of the season. I finally went to the doctor and sheepishly described my symptoms. Very matter-of-factly she said "Let's draw some blood and do a Holter monitor study."
Holter monitors were something I had seen on patients. Members of my own family have had studies done. I was hoping it was just reflux. But apparently, I have reached an age when any cardiac symptoms result in action.
A Holter monitor is a small, portable device that measures the electrical activity of your heart in order to determine if you're having abnormal heart rhythms. Electrodes are attached to your skin, the electrodes are attached to a recorder that is no bigger than an 80's vintage beeper. You wear the recording device for 24 hours, going about your day, but writing down your activities. So if you climb three flights of steps to do laundry, you write it down. You also write down the time you feel your symptoms and what activity you were performing when you felt them. I diligently recorded my activities and symptoms and turned in the device on the following day.
About a week later, my doctor called with the results. "I think you are fine, but you did have some abnormal rhythms, which is normal for healthy people but I really think it would be best to have a cardiologist review the results and evaluate you." Huh. "So you're saying I'm fine, but I should see a specialist?" I reiterated. "Yes. I'll make a referral for you," she said.
One New Years Eve later and I am sitting in the office of a cardiologist. I'm not a person who runs to a doctor with a hangnail. I've got enough medical background to handle most garden variety illnesses. But here I am, sitting in a cardiologist's office. A few minutes later, I am in an exam room with a nurse getting my history, taking my (very low) blood pressure and running an EKG on me. Nothing abnormal during the EKG. Woo hoo.
Finally the doc comes in and introduces himself. He gets more of my history, does a thorough physical exam rivaling what we learned in nursing school (and have yet to see again). Then he proceeds to sit down with my reading and shows me where my PVCs are. PVCs are premature ventricular contractions. It just means that the electrical impulses of the heart are initiated from a part of the heart other than from where they are "supposed" to be initiated. It's normal when it doesn't happen more than once at a time. He ruled out a thyroid or any electrolyte imbalance as a cause due to my blood work. He suggested it could be "hormonal", as women of a "certain" age often report palpitations. He suggested limiting alcohol, avoiding any decongestants and continuing to exercise, as a conditioned heart is a healthy heart.
What I came away with is that I am "of that certain age" where I can't count on my body to just do what it does without asking me to take notice. In my case, it doesn't want alcohol, it doesn't want paralyzing stress and it needs exercise. Message received.
Thursday, December 10, 2009
Is Your House in Order?
I never expected finding a house to be a simple task, full stop. But I was unprepared for the deluge of paper that follows applying for a mortgage, deciphering the crypto-speak on the seller's disclosures, the frustration toward the seller who decides that "today is just not a good day" to look at their house that has been on the market for over a year, the sheer disappointment when you actually arrive at the house that looked so promising in the pictures only to discover that there is something really weird or unacceptable.
Let's talk about the weird or unacceptable. I decided to come to this process with an open mind. Initially, I thought I only wanted one style of house...but then I realized that style of house is usually only found in city neighborhoods and city neighborhoods mean that I am too close to my neighbor. Living in apartments for as long as I have has developed in me a strong and certain desire for a buffer zone. I have compromised on the acreage in the country...but that's as far as it goes. So the lesson here is that pretty much any style will do. I won't not consider a house because it's not a craftsman style bungalow.
But just because I am open minded doesn't mean that I will consider any four walls. If I drive up to a house that is, say brick face, and there is a big patch of vinyl siding in the middle of that brick, that's weird. That patch of vinyl in the middle of the brick is jarring to the eye. It's like when I notice a stain on someone's shirt. I can't not see it; I wonder if the person realizes it's there; I wonder if they are ignoring it or if they don't care. Then I wonder if they don't care, why don't they care?
So there is this patch of vinyl on the front of the house, note to self: something I have to fix. The inside of the house looks well cared for. The family room has been redone rather nicely, they clearly sprang for many expensive options in here like the stone fireplace and the flag stone apron around the fireplace. Then there is the custom built media cabinet that is really lovely and has a closet behind it so you can keep the wires from the equipment stowed and organized. That was well done. And there is the cedar bead-board on the ceiling to deaden noise, it looks terrific and it is a nice touch. But what about that patch of vinyl out front?
We move on to the sun room. Hinky thing number 2. What is up with these walls? They are some kind of composite material used in bathrooms for the insides of showers. The walls move when I press them. Crap this is no good. What's this behind the couch, dirt? From when water leaks in, dries up and leaves sand behind? No, no, no, this won't do. And what's that you say? There is a basement? Some owner of this house hollowed out the crawl space and put a second kitchen near the sump pump? No, a thousand times, no! I am holding the line against weird and unacceptable.
And then there is the cesspool of childhood issues that were never resolved percolating just beneath the surface of your public-facing persona. I always knew that I would be wary of a house with a wet basement. Many an argument ignited between my parents because of our soaking wet basement. And then there was the shame surrounding the fact that I lived in a house with a soaking wet basement. Somehow, my parents were not like the other parents who had managed to avoid buying a house with a soaking wet basement. They always claimed that the seller never told them about it. Things that were stored in the basement always had a funny smell (now identified as mildew) and even though my mother valiantly tried to make that room livable, there would always be a flood. Sometimes it was minor dampness that would soak up through the carpet. Other times, like the time when I graduated from college, the sump pump failed and 2 inches of water soaked the entire basement. Somewhere there is a video my mother took of my father sweeping the water back into the sump pump basin with a big squeegee. When he realized he was being taped, he lost his composure and hissed at her, "Why do you want to record this misery?" Yes, why record it? That basement is as much a part of me as my size 10 feet.
That memory follows me to every house I visit. If it's not a damp basement, it's an errant patch of vinyl or a shabby second kitchen hewn out of a crawl space next to a sump pump. If a house is a reflection on its owner, then what do I want a house to say about me? Order on the outside reflects order on the inside? No inadequacies to see here, move along. The people who live in this house have no issues with alienation or personality disorders, are not grappling with professional failures, they don't live with persistent irrational fears that hamper their personal and professional development. The people who live in this house have their act together, they get along with their family, their pets are continent, and their basement is dry.
Let's talk about the weird or unacceptable. I decided to come to this process with an open mind. Initially, I thought I only wanted one style of house...but then I realized that style of house is usually only found in city neighborhoods and city neighborhoods mean that I am too close to my neighbor. Living in apartments for as long as I have has developed in me a strong and certain desire for a buffer zone. I have compromised on the acreage in the country...but that's as far as it goes. So the lesson here is that pretty much any style will do. I won't not consider a house because it's not a craftsman style bungalow.
But just because I am open minded doesn't mean that I will consider any four walls. If I drive up to a house that is, say brick face, and there is a big patch of vinyl siding in the middle of that brick, that's weird. That patch of vinyl in the middle of the brick is jarring to the eye. It's like when I notice a stain on someone's shirt. I can't not see it; I wonder if the person realizes it's there; I wonder if they are ignoring it or if they don't care. Then I wonder if they don't care, why don't they care?
So there is this patch of vinyl on the front of the house, note to self: something I have to fix. The inside of the house looks well cared for. The family room has been redone rather nicely, they clearly sprang for many expensive options in here like the stone fireplace and the flag stone apron around the fireplace. Then there is the custom built media cabinet that is really lovely and has a closet behind it so you can keep the wires from the equipment stowed and organized. That was well done. And there is the cedar bead-board on the ceiling to deaden noise, it looks terrific and it is a nice touch. But what about that patch of vinyl out front?
We move on to the sun room. Hinky thing number 2. What is up with these walls? They are some kind of composite material used in bathrooms for the insides of showers. The walls move when I press them. Crap this is no good. What's this behind the couch, dirt? From when water leaks in, dries up and leaves sand behind? No, no, no, this won't do. And what's that you say? There is a basement? Some owner of this house hollowed out the crawl space and put a second kitchen near the sump pump? No, a thousand times, no! I am holding the line against weird and unacceptable.
And then there is the cesspool of childhood issues that were never resolved percolating just beneath the surface of your public-facing persona. I always knew that I would be wary of a house with a wet basement. Many an argument ignited between my parents because of our soaking wet basement. And then there was the shame surrounding the fact that I lived in a house with a soaking wet basement. Somehow, my parents were not like the other parents who had managed to avoid buying a house with a soaking wet basement. They always claimed that the seller never told them about it. Things that were stored in the basement always had a funny smell (now identified as mildew) and even though my mother valiantly tried to make that room livable, there would always be a flood. Sometimes it was minor dampness that would soak up through the carpet. Other times, like the time when I graduated from college, the sump pump failed and 2 inches of water soaked the entire basement. Somewhere there is a video my mother took of my father sweeping the water back into the sump pump basin with a big squeegee. When he realized he was being taped, he lost his composure and hissed at her, "Why do you want to record this misery?" Yes, why record it? That basement is as much a part of me as my size 10 feet.
That memory follows me to every house I visit. If it's not a damp basement, it's an errant patch of vinyl or a shabby second kitchen hewn out of a crawl space next to a sump pump. If a house is a reflection on its owner, then what do I want a house to say about me? Order on the outside reflects order on the inside? No inadequacies to see here, move along. The people who live in this house have no issues with alienation or personality disorders, are not grappling with professional failures, they don't live with persistent irrational fears that hamper their personal and professional development. The people who live in this house have their act together, they get along with their family, their pets are continent, and their basement is dry.
Monday, November 30, 2009
Home is...
The Sunday finally came where, with a great, deep breath, we walked into an open house and introduced ourselves as Mr and Mrs Degenerate Scholar, prospective home buyers. Instantly, all our fears and hopes were made flesh. There were questions to answer, forms to fill out, expectations to manage, realities to accept and move on from.
That first Sunday wasn't our first time looking. We had spent a weekend or two doing drive-bys or more like drive-byes. At the risk of sounding like a snob, most things we looked at did not meet expectations. We were not looking at anything fancy, but we both have definite ideas about what we don't want. On that first Sunday, we met a Realtor we felt comfortable with. He knew alot about the places where we mentioned looking at, he discouraged us from some of our high tax follies and he seemed to connect well with Mr. DS, which is no mean feat.
After e-mailing back and forth a couple of times, we agreed to our first "date" to look at a house. I had scoped out a cape in a rural area built in 1963. We arrived early and drove around the area for a few moments. The good news was that I could see Mr. DS was won over by. I sensed he was hesitant about distance from civilization but in reality, we were not far from amenities and I could see he liked the surroundings.
After walking around the property for a few minutes, we entered the house. The Realtor joked that it smelled like grandma. To me it smelled just like my mom's friend T's old house. Not unpleasant, but like old cigarettes and memories. Frankly the charm ended there. The owner had purchased the house in 1990 and it was evident she had not put dime one into modernizing the place. The kitchen was a relic from the 60's, the bathrooms were small and the fixtures had never been modernized. While I am not of the school that you should change and throw away that which is in perfect working order, opening a window, clearing cobwebs and painting go a long way when you are trying to sell a house in a buyers' market. Mr. DS was of the opinion that the fireplace mantle had not been finished and between him and the Realtor, they declared that the lamp wire connecting much of the electrical system was definitely not code. I was imagining what the inspector would say about the septic system. If the electrical was original, what of the septic?
Deep sigh...not the place. It could have been with just a little work from the owner. But between the price she was asking and the updates we would have to make just to bring the place to the sub-par standard we live with now...it would be alot of money and time and contractors. There's a house for us somewhere...
That first Sunday wasn't our first time looking. We had spent a weekend or two doing drive-bys or more like drive-byes. At the risk of sounding like a snob, most things we looked at did not meet expectations. We were not looking at anything fancy, but we both have definite ideas about what we don't want. On that first Sunday, we met a Realtor we felt comfortable with. He knew alot about the places where we mentioned looking at, he discouraged us from some of our high tax follies and he seemed to connect well with Mr. DS, which is no mean feat.
After e-mailing back and forth a couple of times, we agreed to our first "date" to look at a house. I had scoped out a cape in a rural area built in 1963. We arrived early and drove around the area for a few moments. The good news was that I could see Mr. DS was won over by. I sensed he was hesitant about distance from civilization but in reality, we were not far from amenities and I could see he liked the surroundings.
After walking around the property for a few minutes, we entered the house. The Realtor joked that it smelled like grandma. To me it smelled just like my mom's friend T's old house. Not unpleasant, but like old cigarettes and memories. Frankly the charm ended there. The owner had purchased the house in 1990 and it was evident she had not put dime one into modernizing the place. The kitchen was a relic from the 60's, the bathrooms were small and the fixtures had never been modernized. While I am not of the school that you should change and throw away that which is in perfect working order, opening a window, clearing cobwebs and painting go a long way when you are trying to sell a house in a buyers' market. Mr. DS was of the opinion that the fireplace mantle had not been finished and between him and the Realtor, they declared that the lamp wire connecting much of the electrical system was definitely not code. I was imagining what the inspector would say about the septic system. If the electrical was original, what of the septic?
Deep sigh...not the place. It could have been with just a little work from the owner. But between the price she was asking and the updates we would have to make just to bring the place to the sub-par standard we live with now...it would be alot of money and time and contractors. There's a house for us somewhere...
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