Transcript of interview with Helen Smith by Emily Powers, March 4, 2008

I$H Ad way An Interview with Helen Smith An Oral History Conducted by Emily Powers Heart to Heart Oral History Project Oral History Research Center at UNLV University Libraries University of Nevada Las Vegas ©Heart to Heart Oral History Project University of Nevada Las Vegas, 2009 Produced by: The Oral History Research Center at UNLV - University Libraries Directory: Claytee D. White Editor: Gloria Homol Transcriber: Kristin Hicks Interviewers: Emily Powers, Lisa Gioria-Acres, Claytee D. White ii These recorded interviews and transcripts have been made possible through the generosity of Dr. Harold Boyer and the Boyer Foundation. The Oral History Research Center enabled students and staff to work together with community members to generate this selection of first-person narratives. Participants in the Heart to Heart Oral History Project thank the university for the support given that allowed an idea of researching early health care in Las Vegas the opportunity to flourish. All transcripts received minimal editing that included the elimination of fragments, false starts and repetitions in order to enhance the researcher's understanding of the material. All measures have been taken to preserve the style and language of the narrator. In several cases, photographic images accompany the collection and have been included in the bound edition of the interview. Claytee D. White, Project Director Director, Oral History Research Center University of Nevada Las Vegas - University Libraries iii Table of Contents Personal background; schooling; moving to Las Vegas, 1956; memories of Southern Nevada Memorial Hospital (now UMC), Eighth Street Hospital, and St. Rose de Lima in Henderson; description of SNMH; differences between hospitals back east and hospitals in Las Vegas; reference to Highway 95, route to the Test Site, aka “The Widow Maker”; mention of Drs Middleton, Waters, and Lacana; responsibilities in ER; evolution of equipment over the decades; description of autoclaving.................................1-5 Memories of working at SNMH as supervisor; two years with Dr. Swartzwager; further descriptions of SNMH; brief mention of racial integration in hospitals, segregation of blacks on the West Side, and Dr. West, who treated both blacks and whites; work history at Sunrise Hospital, with orthopedic doctors, and for the State Industrial Insurance System; recalling Drs Payne, Miller, Boyer, Taylor, and Midland........................6-10 Mention of RN Bonnie Davis; Carter and Ryan, pediatric doctors; children seen for accidents, snake bite, dehydration; patients flown to Los Angeles for more detailed care; incidents of whooping cough and meningitis in children; vaccinations for children; ether for women delivering babies; working with husband in air-conditioning and refrigeration business; known as “hatchet nurse” while working for SIIS; constant traveling to find best evaluation center for industrial accident victims, including such places as Reno, Los Angeles, Long Beach, Houston, and Arkansas...........................................11-15 Positive changes in Las Vegas hospitals began in the sixties; mention of Dr. Cherry; personal experience at Sunrise following infection after hip surgery; opinions on patients using ERs for general care instead of true emergencies; brief discussion on hospital bills and insurance; changes in nurses’ responsibilities and quality of care over the decades; specialty cases once referred out of state; closing reference to RN Betty Blevens and husband’s work in telemedicine with Children’s Shrine................................16-19 IV Preface Helen Smith, bom and raised in New Jersey, came to Las Vegas in 1956. She intended to visit relatives for a couple of weeks, but ended up staying. Her aunt convinced her to interview at Southern Nevada Memorial Hospital (SNMH) and Helen worked there for a year. She recalls three hospitals at that time: SNMH, the Eighth Street Hospital, and St. Rose de Lima in Henderson. Helen worked in the emergency room back east, so it was natural for her to start in the newly opened ER at Southern Nevada. She recalls treating many victims of accidents on the “Widow Maker”, or route 95 to the Test Site, and compares the more advanced treatment and staffing back east with the Las Vegas small-town conditions. In talking about the medical advances she has seen over the years, Helen gives a detailed explanation of autoclaving, describes the duties of an ER nurse, and mentions the shifts that nurses used to work. She also discusses her own progression from relief nurse to day nurse to supervisor, and comparisons are made between hospital stays 30 and 40 years ago to hospital stays today. Helen refers to doctors and nurses that she worked with or knew of, talks about the types of things children were treated for, and shares several anecdotes and stories of patients and their treatment. She also expounds further on her work history at Sunrise Hospital, with her husband in their air-conditioning business, and as case manager for SIIS in workman’s compensation. As Las Vegas grew in population, a process which started in the sixties, Helen notes that more specialists were attracted to local hospitals. She shares her own more recent experience as a patient and gives her opinion on the use of ERs for general care rather than true emergencies. Her closing remarks include descriptions of changes in nurses’ responsibilities and comments on her husband’s work with the Children’s Shrine in telemedicine. v 1 This is Emily Powers. It is Tuesday, March 4th, 2008. And I am in the home of Helen Smith. How are you doing today? I'm fine. Thank you. Great. Thank you. Well, we'll be talking a little bit about the history of health care in Las Vegas. But first I just want to learn a little bit more about you, Helen. When did you first move to Las Vegas? March of 1956. And you came with your parents? No. I had relatives living here and I came to visit and I stayed. What did you like about it? Well, I was living in New York City and I didn't like New York City. I think the desert climate kind of brought me here. Yeah, a nice change. Where were you born and raised? I was bom in New Jersey, raised in New Jersey. Where in New Jersey? Near Phillipsburg, New Jersey. It's across the Delaware from eastern Pennsylvania. And what did your parents do there? My father had a service station and garage, and my mother was a home keeper. And did you have siblings? I have a brother, an older brother. Great. So once you — well, what did you do in New York while you lived there? I was in nursing there. I had been going to postgraduate school there. Where did you go to school? I went to Jersey City Medical Center School of Nursing and then did postgraduate work at Polyclinic Hospital in New York. Did you have any family in the medical field? Oh, my dad's cousin was a doctor. That was about the closest. 2 What made you decide to go into medicine? Well, at the time that I was going to high school, there were only three things girls could do really and that was teach or go into nursing or just be housewives. I wasn't about to be a housewife and I didn't feel I could teach. I was more interested in the nursing profession at the time. And I had several friends that were in the nursing profession. Did you work with them when you were living in New York or were you at different places? No. Every one of us spread in different directions. What were the differences when you came to Las Vegas? Is that what you initially started — I came out here to visit my aunt and uncle and they talked me into staying. In fact, my aunt took me over to Southern Nevada Memorial Hospital to try and talk me into staying here. And I had an interview over there. I particularly liked the interview and thought, well, I'll try it for a year. It was just a year. And I stayed here and did work at Southern Nevada for that year, but I didn't go back. I stayed on and on and on. What did the medical community in Las Vegas look like when you arrived? How many hospitals? Antiquated. There was just Memorial Hospital and then there was Eighth Street, a small hospital. It was a private hospital. And, of course, Henderson had Rose de Lima. And it was small too. So you worked at the largest hospital. It was called Southern Nevada. It was the county hospital at the time and still is. Do you recall when you first came about how many patients the hospital was able to hold? What the size was? I don't really remember, but it wasn't very big. When I came here they had just opened that three-, four-story that's in the front of the building. It's still there I believe. And that was a big thing because everything else was one-story. And it was these real funny one-stories that went like a long hall in these — well, sections went off of this long hall. Like one section was orthopedics. One section was medical. There was orthopedics and surgery, OB/GYN - you know, it was that type of thing — and geriatrics. It was kind of separated, but they were like hallways off of the main hallway. So like a wing for each. 3 Yeah. And the high-rise had two. It had pediatrics and surgery in it. I was wrong about that one. And where did you work? I worked the emergency room. I was emergency room nurse in the east. I did postgraduate work in the emergency room and outpatient care. And I came here. They had just opened their emergency room at the time and I just fit right into the pattern there. It was quite an education because the medical care here at that time was rather antiquated. Having worked in teaching hospitals in the east and then coming here, it's really — you had to unlearn an awful lot. So what do you mean by that? What were the differences you saw in the East Coast hospitals versus here? They were more advanced. They were more advanced in treatments and they were more advanced in the cares they gave. And here they were not that far advanced. A lot of things that we were doing routinely they weren't doing here. And one big thing — I had a big problem with being in the emergency room - was the treatment and care they were giving patients when they brought them in by ambulance. We had a lot of problems with accidents out on 95, which went to the Test Site. There was a two-lane highway called “The Widow Maker” and they had a lot of accidents. And, of course, the ambulance went from here up there to get whoever. Occasionally, the Air Force Base at Indian Springs would bring them in, but they weren't routinely allowed to do that. And when they transported them they more or less just threw them in the ambulance and nothing was done about splinting a fracture or trying to - so, of course, you had a lot of fatalities. And that was one thing that I couldn't understand. I really had a lot of arguments with the fellow that owned the ambulance department because of that. And then, of course, the doctors are — let's see. There were three doctors that ran the emergency room, one on each shift. And they were all - the one on days was retired. And he really wasn't too ambitious. Can you tell us who that was? His name was — I believe it was Middleton or Milton, something like that. My memory's not too good with that. And then we had one from three to eleven. That was Dr. Waters. He was a 4 retired Indian physician. He was a physician on a reservation before he came here. And the one we had at nights was Dr. Lacana. And he practiced OB/GYN during the day and worked nights in the emergency room. He was a little more up on his medical. They were good, but I was used to — you know, right out of medical school, the teaching doctors like they have now at Southern Nevada — well, it's UMC now. But you have your residents and your interns and your teaching physicians and all your new technology is brought out. Well, this is what we were getting in the east. But here it was just a hospital in a small town because Las Vegas was a small town at that time. Right. How many other nurses were typically on staff with you? In the emergency room there was just one, one on staff. And you had either a maid or an orderly work with you according to which shift you were on. So there were only two of you in the emergency room and one doctor. That was it. That's very small. It was. What were your typical responsibilities when you handled emergencies? Everything. The nurse did a lot in the emergency room. You assisted the doctor. You did anything that needed to be done for the doctor and also for the patient we did general taking care - I don't know what they do today. But then we pitched in and did everything. Do you remember any unique cases you handled or anything that came into the E.R. that was exceptionally difficult to handle? The biggest thing I can remember right now is — and I think I was just working there a very short time - when we got a murder suicide in. Both of them were alive when they came in, but they didn't make it. And that was about one of the biggest things because we had two people, one doctor and one nurse, trying to work on both people, which was rather hard each time. And other than that there were just a lot of accidents off the highway. We didn't have a lot of people with colds or anything like this coming in. You didn't see that like you do today. You know, people use the emergency room as a doctor's office. We did in the east, but not here. Why do you think that is? Do you think it was the health care here; that people had more 5 access at the time to basic remedies? I don't know. It was just unusually noted that we didn’t. You know, like if somebody had a severe bloody nose that they couldn't stop or something, we'd get those. That was just typical, but you wouldn't get a sore toe or a sore nose or whatever. What was the equipment like that you used and how did you see that evolve over the years? It has changed tremendously because you reused all our — talking about needles and syringes — we reused all those. And you autoclaved everything. You had packs, like suture packets that you re-autoclaved. You scrubbed up, packed them and autoclaved them and that type of thing. Everything was reusable. And the nurse was responsible for autoclaving everything. Can you describe what autoclaving is? Well, it's sterilization under pressure. They have sort of a round — how would I say it? You just put the stuff in it and it's sealed and then it builds up pressure. Like a pressure-cooker type thing except it was up to a real high temperature where it sterilized whatever you put in it. Okay. And then you would reuse all of those. Because now we have the current problem with some medical facilities here in town reusing syringes and up to 40,000 people being affected by that. And you never really had any cases where that was a problem? No, because you used a syringe on a person one time and immediately you washed it and put it aside to be autoclaved. A needle, the same thing. You would never use a needle twice. Even on the same person you wouldn't use the same needle twice. Right. Not something you knew back then, but that is a problem now. We're kind of going backwards it seems. Any equipment that you used on a person, you never --1 mean once it touched a person, it wasn't usable again. Right. That makes sense for health purposes. Even like your examining tables and everything, you wiped them down. After every person you wiped everything down. You didn't just bring somebody in and put them on the same table after having someone in there. Right. Well, that's good that was done at the time. Were you at Southern Nevada Hospital the whole time you lived in Las Vegas? 6 No. I worked there for about three years. Well, I went from emergency room into supervision. And I did supervision there — oh, I guess during the three years about half of it was supervision and half of it was in the emergency room. And then I went to work for the police physician, Dr. Swartzwager. And I worked for him for a couple of years. And where was his office? At 2020 West Charleston, right where the hospital is now. The UMC there now? Yeah. Our back doors opened into each other. That's more or less -- that's how I went over there. And I worked for him as I said for a couple of years. And then I left there. What did I do? I think I went over to Sunrise. And I worked pediatrics at Sunrise. Do you remember what year that was? I don't remember now what years they were. So you were at Southern Nevada for a few years. And you were a supervisor at Southern Nevada? Yeah. And what did you do as supervisor there? Well, you supervised all — went to all the floors if they needed help. And any problems they had, they called you. You had the director of nursing and then she had her help, which were the supervisors. I'd work sometimes the 3 to 11 shift. I'd be supervisor of it and relieve on the night shift. So I bounced around quite a bit. What was your schedule like? Would you work just a few days a week for very long hours? We worked seven to three five days a week or three to eleven five days a week or eleven to seven five days a week. Like in the emergency room there were the three-to-eleven nurses, eleven-to-seven nurse and a day nurse. And then you had a relief nurse that worked there every one of the shifts. Well, I started out doing that. Then I was the day nurse after that, and I went into supervision from there. So I went from relief to day nurse to supervision. So you did a little bit of everything there. Everything. About how many patients would you be responsible for on a given shift? Do you recall? 7 As far as the emergency room, you never knew. It could be you would have ten to 20 to 25 or maybe only three in a shift. It varied so much. So when you were supervising all the different floors, what did your typical patient look like? Was it someone recovering from a car accident or did you have a lot — You had everything. Well, we had maternity. We had surgical floors with surgical patients that typically — well, years ago as you know the patient stayed in the hospital a lot longer. Surgeries were a lot more invasive than they are today. And then you had your orthopedic patients, the fractures from injuries of auto accidents, falls or whatever. And then you had your medical patients — cardiacs, strokes, diabetics — anything you could think of. And then your geriatrics, of course, the elderly — let's see what else — pediatrics, your children. It varied. I guess they averaged about 20 patients on a floor at a time. And a lot of them would be in the hospital's care for a while for most of these things? Oh, yeah. Your geriatric ones were there for a long time, normally. Even your surgical patients were there most of the time for five days or more where now they're in and out and some of them are outpatient. Right. Did Southern Nevada Hospital specialize in any services or was it especially good at handling certain situations and not as good at handling others? Yeah. It was the hospital because it was the county hospital. It was the biggest hospital. It was the main hospital. The Eighth Street hospital was a private hospital. It was owned by — I don't remember whether it was four doctors or what. And it was just their patients who were in that. And Rose de Lima, of course, was in Henderson. And that was the Catholic hospital. Basic Magnesium and the different companies in Henderson more or less supported that hospital whereas Southern Nevada served all of Las Vegas. Do you know what the difference was between the private and public in terms of affordability for people? Do you know if you had to be especially wealthy to go to the private hospitals? I don't really — no. I think it was just the fact that they were patients of the doctors in the private hospital. I don't know how — you know, I don't recall about the insurances at that time or anything. And, of course, in those days you treated the patient first and then you sent them or the 8 family to the office about paying afterwards. You didn't send them first to find out if they could pay, which is the way they do it today. That's very true. And it seems like care was more personal. Yes. It was. I wanted to ask you, too, when you arrived if the waiting rooms in the hospitals were integrated in terms of race or if that was an issue at the time? It wasn't here. As you know the town was integrated (sic). But the hospital, as far as I can remember, was not because we did get a lot of people from the West Side coming in. We have a lot of — I remember we had two policemen from the West Side and they were both black. And they were highly respected. But they were feared by the people on the West Side. And every time they brought somebody in, of course that person was the best patient you ever saw. You know, we never had a problem with anything here as far as — but that was a little different for me because coming from the east our hospitals and our towns were integrated back then. And to have the West Side as strictly for the blacks at that time — but at least the hospital was not. So patients would be integrated on floors? No. Nothing like that. Huh-uh. In even your doctors' offices you saw the black as well as the white. You were able to use the same facility. And there were no separations. What about the staff? Was the staff predominately white? Let me try and think. Our nurses were all white at that time because I don't think there were any colored nurses at that time that I knew of here. We had one black doctor as I recall, but I can't remember his name now. West or something. His name is West. I'm not sure. And he treated both whites and so on. So they weren't integrated (sic) then. Some of our orderlies were black. And I think some of our aides were black. So we had both. It didn't really seem to be an issue. The hospital — the medical situation was nothing like the rest of the town as far as the separation. And I don't remember about — see, I had little to do with the rooms, about placing them. So I don't remember anything about them being separated even in the rooms. Were most of the nurses married? Most of them were. 9 And when did you get married? I got married my first year here. Did you meet your husband in Las Vegas? Yeah, I met him here. At the hospital or somewhere else? Well, yes. He was in the sheriffs office. He was one of the detectives in the sheriffs office. And you know how they would bring in people all the time. And that's how I met him. What is your husband's name? My husband at that time was Carl Smith. And I married another Smith. Oh, did you? Smith's a common name. So you got to keep it. Yes. Yeah. So in terms of insurance, you weren't quite sure how that worked between the hospitals — I didn't know. I didn't have much to do with the insurance part of it. Do you know how the fees worked or if people were able to pay off their medical bills easily? Again, see, that's a lot of the things that we didn't deal with. That was all dealt with through the business office. And once we took care of them, they went to the business office and we never saw them again. So, in other words, they were taken care of and then sent to the business office. And whether they paid there or whether they made arrangements I haven't the slightest idea because we never followed up on that part of it. All we were interested in was taking care of them and then getting rid of them. Were there any education requirements that you had to keep up on? Not then. All you had to do is you had to pass your boards. With certain states you had reciprocities with Nevada. And I had a license in New York, New Jersey, Pennsylvania and Florida. All four of them — and my main license was in New Jersey — had reciprocities here. So all I had to do was apply for the license with the reciprocities. And I got them immediately. So during your entire time in Las Vegas, you were licensed -- Yes. I was licensed up until — I think 1 gave it up when I was 68. I kept it up for a couple years 10 after I retired. And how long, then, were you working in Las Vegas as a nurse? Well, I worked in the hospital until my son was bom. And then I was off for a couple of years. I stayed home. And then I went back to work at Sunrise. And I worked there for about three or four years. And then my husband and I went into business. And I worked more or less for him. And then I went back to work in about, oh, the late 70s. And I worked for the orthopedic doctors for a while. And then I went to work for the state on the State Industrial Insurance System. And I worked for them until I retired. So you said you spent some time at Sunrise Hospital. How was that different from your experience at Southern Nevada Hospital? Well, it was newer. It was more on the private side, too. And I worked pediatrics with them mostly, which I liked. By that time we were getting more doctors in Vegas and things were starting to change where you had a better medical care than they did -- well, when I first came here, it was so different. And then it just gradually started to get better all the time. It has really improved with age. Do you know where most of the doctors were coming from? All over. All over. I'm trying to think where all they came from. They came, some of them, from the Midwest, some from the east, a lot of them from California. Some of them grew up in Nevada and came back here. Do you remember any of their names, some of the big doctors at the time? Ah, let's see. Well, when I first came here, the surgeon in town was Dr. Smith. The orthopedics doctor was Dr. John Payne, but not the John Payne that's here now. It was a different John Payne. He retired and moved to Utah. Let's see. Who was — oh, Russell Miller was the medical. And were these at Sunrise Hospital or just all over? They were both after a while. Dr. Boyer, of course, was the dermatologist. And then there was Dr. Taylor and his wife. They were the x-ray people. They had the radiology department there. That was before Steinberg came. Let me think. Midland was here. He was orthopedics. Do you remember Dr. Martin? No. The name's familiar. I'm trying to think. 11 I just read a little bit about him. He lives in Utah now, but we were going to interview him. He was here very early on. I'm trying to think who he was. The name's familiar, but — That's okay. There's so many. By the way, did you interview Bonnie Davis? We have her name and we're going to talk to her this fall. Yeah. Because she was here long before I was. And I worked with her for a short while. Over at the first hospital? Dr. Swartzwager's. And what did you do there? We were just office nurses. And did your experience differ much with the pediatrics, the way they handled children's cases at Sunrise? Were your responsibilities -- Well, pediatrics -- the doctors were fairly up on everything by the time I got to that point. We're talking about five years down the road when I got to that. And they were starting to really have a different — everything was changing by then. Do you remember who the doctors in charge of pediatrics were when you were there? Dr. Ryan. Oh, gosh, what was his name? There was a Carter I think. Heavens, I can't remember that now. I can see faces, but names I can't think of. That's what happens when you get to be almost 80 years old, you know. Your memory's great. You've given us a lot of information. With the children who came into the hospital, were there any dominant reasons they were there or was it because of accidents? A lot of them were, of course, you know, the diarrhea that babies get. We had a lot of those. They get dehydrated. We had a lot of those problems. We had bums. We had injuries. We had young kids with motorcycles. I remember one particular boy that we had who was injured on a motorcycle. Of course, he broke his leg and his arm and everything else. And he was in the hospital for quite awhile. We had a horrible time trying to get him to eat, so we finally — patients weren't supposed to bring food 12 in - had to ask the parents to bring him hamburgers and hot dogs and things like this because that's all he would eat. We had to get him to eat. Of course, we had snakebites. We had one real snakebite that — in fact, I was a friend of the mother and knew the children. And this child came in for snakebite. And he really — we did all the treatment with the antivenins and so on. And, eventually, we had to - through Nellis Air Force Base — fly him to the Children's Hospital in Los Angeles because he wasn't reacting to the medications that were being given. And, of course, it had to be on my shift and I knew the child. And that was really hard. I'm sure that was difficult. Did that happen very frequently that you would have to fly people to other hospitals? There were occasions. Later on we had a man that had an ambulance airplane that he would fly out. And we did occasionally have to fly somebody out. But it was usually something very unusual where they weren't able to treat or the person wanted to be transferred. And in that case it was typically to Los Angeles? Yeah, to Los Angeles. And was he okay once he got to Los Angeles? Yeah. He did okay after he — he was there for — I don't remember how long. But then when he came home I saw him and he was fine. But we almost lost the little boy. What happened was they were playing outside and behind the house there was a vacant lot. The kids were playing there and he picked up a rock and there were small snakes under the rock. One was a baby rattler and they killed it and brought it in, you know. And believe it or not, even a small snake has a lot of venom. And they're dangerous. I didn't even think about snakebite. But I'm sure with the desert -- We got them. And we got them in the emergency room, too. But most of the time they weren't as bad. You would just give them the antivenin and hold them over for a day or so in the hospital and they were fine. But this little boy just — he didn't react to it for some reason. Were there any other outbreaks or epidemics you can remember that you had to deal with? Not that I can remember. Not of any diseases or things going around? 13 Well, we had a couple of whooping coughs, which is unusual. It just seemed funny because at that time everybody who went to school was inoculated for whooping cough. And we had these children come in this one year with whooping cough. And we had meningitis, of course. Everything you can think of we'd get with the children and adults. So were the children — as today they're vaccinated before they enter public school, was that the case at the time, too? That was years ago that — I don't know what — I think now it's a choice, isn't it, or something of the family's? I think families can choose to opt out. But for the most part — Well, it's better. Even with the possible side effects, it's better to have the child - because at that time they were all vaccinated before you could send a child to school. I don't know why these children didn’t get their shots. To this day I can't remember why the parents hadn't inoculated the children. And the children, where they got it from I have no idea. Right. It seems like an easy way to prevent a lot of things. You said the maternity ward was operating at Southern Nevada. Do you know if midwives were used at all or if that was popular at any time? I shouldn't tell you this, but the nurses gave the anesthesia because we would get called in there to do the ether. Of course, we weren't trained for it, either. And the doctor would be delivering the baby and telling us what to do. That's how antiquated it was. Wow. So did you have epidurals at that time? No. They just had regular deliveries. And we gave them ether. And they delivered just like — but I don't think it's common knowledge that we did i