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Interview with Michael Smith, November 14, 2006 | UNCW Archives and Special Collections Online Database

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Title:
Interview with Michael Smith, November 14, 2006
Date:
November 14, 2006
Description:
In this interview, Michael Smith, a 1972 graduate of UNCW's School of Nursing, recollects his memories working at Wilmington's Babies Hospital while in high school, as well as his experiences as one of UNCW Nursing School's first male nursing students-- and the remiander of his career, which has included time in England's national health care system and his training as a nurse anesthetist.
Phys. Desc:

Interviewee: Smith, Michael Interviewer: Mims, LuAnn and Parnell, Gerald Date of Interview: 11/14/2006 Series: Voices of UNCW Length: 60 minutes.

Mims: Today is November 14, 2006. I am LuAnn Mims with Jerry Parnell, as we continue our interviews with medical personnel of Hanover County, and we are able to speak with Michael Smith, who is a graduate of the UNCW School of Nursing, 1972, okay. Thank you for being with us today.

Smith: My pleasure.

Mims: If you would give us some of your background, where you're born and raised, your family life, et cetera.

Smith: I am a Wilmington native. I was born in Wilmington, grew up on a farm in Castle Hayne, attended local schools, graduated from New Hanover in 1970. I would later, in the late sixties, move to Wrightsville Beach for a couple of years, and it was there that I got a summer job at Babies Hospital, and it was probably the catalyst or the exposure that kind of got me into the health care career that I now participate in.

Mims: What kind of work did your parents do?

Smith: My father actually worked for the state, the research station, which is across from General Electric, the Horticultural Crops Research Station. He was site foreman there, and therefore, we were provided with a house and grew up on what was a 60-acre farm, had all the benefits of farm life but none of the responsibilities of actually having to work the farm, or, you know, worry about a crop being made. I'm the youngest of three children, two sisters, and actually my eldest sister is a '68 graduate from the nursing program.

Mims: And her name is Cheryl, right?

Smith: That's correct, yes. And my father is from North Carolina, originally. My mother was a war bride. My father was stationed in England, married my mother, and that kind of plays in a little bit of my choice in nursing. And I actually lived in England for two years, and worked as a nurse before going back to school to be a CRNA, which I am now. So, one side of my family is from England, English-based.

Parnell: You said you had a summer job; have you talked about that? What did you do there?

Smith: I did. Well, I was really an orderly, basically. I cleaned the operating room, mopped floors; it was-- changed oxygen tanks-- just a little bit of everything, as you probably know. It was sort of an intimate building and facility, and did a host of jobs, whatever was needed. But I worked weekends, and in the summer, I'd work fulltime. And actually, I continued to work there while I was in nursing school here.

Mims: We're very interested in Babies, with it being torn down. How did you get the job there? Did you know somebody?

Smith: Well, actually, I was living at Wrightsville Beach at the time, or very close, but both my sisters had worked there, in the business office as a summer part-time job. And so, it was through their experience there, and I was very close to, again, physically, living at Wrightsville Beach, it was easy to get to, and I just applied, and-- actually, I worked there my Junior, Senior year, four years of nursing school, so I had a long association with them.

Mims: Did you have any contact with the physicians there?

Smith: Absolutely. Dr. Crouch, who was, that's the name...

Mims: Auley Crouch?

Smith: No, he had died; it was Walter, I think.

Mims: Walter, okay.

Smith: But certainly, those families were well-seated in medical history in this community. But Dr. Crouch, Walter Crouch, I think it was, was still practicing, and Willa Dickey.

Mims: Yes!

Smith: Who was his office nurse, and probably, what was an early nurse practitioner or PA, really. She was not a nurse; she was not trained, sort of professionally, but she did so much for him, and particularly, he later developed hip problems, and physically, didn't get around as well, and she would round for him. He saw patients in the hospital, and, you know, obviously took care of them. But his office was on the ground floor of the hospital, at the time. But, it was a great spirit there; there were just two floors. They still did operate there. It was late enough that fewer and fewer physicians were using that facility, because New Hanover had been built, and to admit or round on two different hospitals was a little more, and that probably was a little bit of the reason for the ultimate demise of the hospital, in terms of patient use and physician use. Because New Hanover seemed to have state-of-the-art equipment, and a large facility, and I think that was probably a contributing factor to beginning...

Mims: What were the major portion of patients?

Smith: Well, just mostly, ENT. They did do some general surgery; there were a few physicians who came down to do hernia repairs and tonsils. They had, I think, the building had two operating rooms, and sometimes in the summer, I remember, I would clean up the operating room at the end of the day, but they would do mostly ENT procedures, and a small amount of general surgery, hernia repairs, things like that.

Mims: Who were some of the surgeons?

Smith: Dr. Robert Williams was an early pediatric surgeon. There was a black physician who actually did, Dr. Wheeler, was still operating there. Actually did a lot of tonsils, but he was not ENT trained. But I think many in those days kind of crossed over; it was not the rigid specialty that you find today. Who else? A Dr.-- I guess I'm really dipping way back here with some of these names.

Mims: I know.

Smith: There actually was an ENT physician, that...

Mims: It wasn't Dr. Black, was it?

Smith: Dr. Black was still working, Dr. Black, but there was another, oh gosh, Campbell, Dr. Campbell.

Mims: Okay, I think I've heard his name.

Smith: Actually, was an EMT physician. Actually, still-- Dr. Black was still working when I came back here in 1979, as a nurse anesthetist, or CRNA. I did a few cases for him, gave the anesthetic at New Hanover; he was still doing some ENT work. So he was practicing up until then.

Mims: Well, we've talked to Dr. Lockhart Mason who had some connection with Babies; was he there with you?

Smith: I don't remember him too much.

Mims: Well, he kept bringing up Willa Dickey, that she was sort of the historian, and had a lot of pictures, and we've had trouble trying to figure out where that stuff would have gone.

Smith: I would imagine the Crouch family; she actually remained very close to them, not only in employment, but when their children were small, actually stayed with them and was very involved in their family. And some of those children are the Crouch that's in real estate; I can't think of his name now. He is actually the son of Walter Crouch.

Mims: Really?

Smith: Yes, and if that was, I certainly believe they probably had some sort of memorabilia, or would know what happened to her things.

Mims: Because you hear about all these wonderful pictures of the diapers being hung in the back of the hospital.

Smith: Right. Well, I actually would carry out laundry. There was a-- that was another duty of mine-- but the linen chute went to the basement of the hospital, and the laundry was out back in a separate building. And I would really just take a bedspread, and pile up laundry, and pull the four corners together and kind of throw it over my shoulder, trudge up these stairs, and go out to the laundry, and leave it. Course, it would come in folded, in a big trolley or dolly or something, to get it back in and distribute it. But the laundry was out back at that time. I tell you who you also could talk to, is, what's her first name? Northrop, she was one of the director of nurses, actually, she was my boss. There was a Ms. Stone who was the nursing director, but when she retired. I can't think of Ms. Northrop's name, but her niece is a CRNA I worked with at Hanover. But she is still living, and certainly could give you some information about Babies.

Mims: Well, we'll definitely get you a card, and maybe you can pass it to the niece.

Smith: I will.

Mims: So, in your high school experience, were you thinking about nursing during this time, or medical?

Smith: You know, I really didn't have any clue. I always knew I would kind of go on to school. That was encouraged in our family, but I had no strong pull towards any career choice. And it really was probably during my junior year in high school when I began to work there, that there was some suggestion-- I enjoyed the environment within the hospital, and the activity, and hadn't thought about medical school. And it was certainly during those two years, before I finished high school, that I actually made the choice, and was encouraged by some of the nurses and some of the other staff there, that nursing might be a choice. I tie in my English background because my cousin on my mother's side in England was married to a male nurse, and we had actually had some visitors to come over and one of them was a psychiatric nurse, a male nurse. So, in Europe or England, I knew that men were in nursing; you just didn't see it too often in this country, or in this community. But it certainly was my exposure and work experience at Babies that kind of got me started.

Mims: Even with the schlepping of the laundry?

Smith: Even taking out the laundry, but just again, cleaning out the operating room, and just rounding, and seeing the wards, and you know, and it absolutely has been the right choice for me. I have loved my career, and felt so fortunate to have chosen a career that has been very good to me, one that I've enjoyed, one that's been secure for 30 years. So it was a great choice for me, and one I've never regretted.

Mims: Did you have a high school counselor that you approached with this?

Smith: No.

Mims: Because they have health occupations in the school now, don't they?

Smith: They do. I've actually been out to the school for many, many years, to speak to the class about what I do now, in terms of anesthesia, and career choices. But I didn't take health occupation class in high school, and I don't really remember a counselor influencing me in any way. It was really through my work setting on weekends, and actually, people in the industry, that encouraged me to do it.

Mims: And you never thought about being a doctor?

Smith: You know, no, I really, no, I didn't; because I didn't think my grades were good enough. And that, no, I didn't ever really entertain the thought of medical school.

Mims: So you had this notion in your head that you would like to go to nursing. How did you come to make your decision about which school to choose? Because there were more options than here.

Smith: Well, economically, I had worked, but our parents were committed to helping us go to school, but my father never made a lot of money. And my mother worked, but again, didn't bring a lot to the household. And I think they provided well for us three children, and I never remember growing up feeling that I was compromised in any way, in terms of things they gave us. But we always were encouraged to work part-time, and supplement. My sister was going to nursing school at the time, when I was at UNCW, Wilmington College, then. So, I had some, I think, I just believe that economically, it would be easier for me, and less expensive, to just live at home and go to school here. And that's how I made the choice. I did not apply at any other nursing schools. At the time, there were three options on the table, that ADN program, the diploma schools were still very much active, and then BSN program. And I just applied to the program here at UNCW.

Mims: What do you remember about that process?

Smith: Well, I do remember that during the interview, there was, Louetta Booe, was the head of the nursing, program director at the time. And actually, I think she had some reluctance to accept me, because I was told, and I think she maybe even shared during the interview, that she would never accept one student, but two. But I don't know, because it was so new, but she felt like it would be easier for someone to have a comrade, or someone to share the experience with, rather than be one of, what was still a very small class. I think there were 12 of us that started, so it wasn't like today, in terms of numbers. But, fortunately, she did accept me into the program, and I was the only one. But I think she shared with me that she always held out if she had had other students to apply, she had turned them down, but for some reason, she allowed me to enter the program.

Mims: She has a military background, or had a military background?

Smith: She does; she was a Major, I think, she was.

Mims: Right, so she would have been exposed to Corpsmen.

Smith: Men, exactly.

Mims: So, she never tried to push you into a military?

Smith: No, she did not.

Mims: I just wondered what kind of counseling you got once you hit here. I mean, were there walls?

Smith: No, and I must have involved the faculty, which, again, was very small in those days. There was Ms. Booe, Ms. Dixon-- who had been associated with the James Walker program and taught there. And Ms. Whitfield, who really was, she had her Master's in public health, but she had a career in public health, and she taught the OB section of our curriculum. And that was it, except for some clinical instructors. Jane Lowe being one, and Ms. Barfield, Toni Barfield, and that was the extent of the faculty in the nursing program in the early '70s.

Mims: And the primary classroom, was it Hoggard?

Smith: Yes, it was.

Mims: Did you have the patient simulation labs over there?

Smith: Yes, yes.

Mims: Was it just one or two or something?

Smith: Yeah, it was all one classroom, and all that was set up in the back.

Mims: I've seen some pictures of that. Yeah.

Smith: Yes, you know, again, we took other courses, psychology and various things, English, throughout, with the mainstream student group. But our nursing classes were there, but again, very small. Mrs. Booe taught a few classes, Mrs. Dixon. We affiliated at Cherry Hospital, for our Psychiatry in the summer. But pretty much everything, all clinical experiences were at New Hanover; we didn't run take through any other, we didn't go to Cape Fear, we didn't affiliate with Babies. All of our clinical experience was at New Hanover.

Mims: Well, probably on the clinical side, you were probably in your element, having been exposed here?

Smith: Well, exactly; it offered enough for the student to get the experience he or she needed, to have a well-rounded education, clinically, when you finished; to prepare you for whatever setting, or choice you made. And I must say, I never felt isolated in any clinical experience. I think that the staff worked very hard to gain those experiences for me, and then, even, would-be nurses that I worked with, or any sort of setting, I never felt that it was a problem. I never did. Even OB, which was probably more of a challenging setting for a man, but I spent a lot of time in the clinics, but actually, postpartum and labor and delivery, I still had that full, rounded of experience the female nurses had.

Mims: I told you that we've talked a lot to the diploma nurses, where a part of their training was this camaraderie that was developed in the resident home, so we know there's a big bonding with student nurses in particular, and you never felt like you were not part of that?

Smith: Right, right. No, I actually studied with a lot of my classmates. We would get together and study. The nice thing about the programs that came along, even today, for people who want to go back and advance their degree, it is different than the diploma schools, is that there were all age groups in my class. There were some, I was the student right out of high school, but we had quite an age span of students in those 12, that class of 12, and levels of maturity. So, it was, I think we were pretty close, again, in numbers, but some were mothers, going back to school. Some were my age, but it was-- and everybody had a sort of different history background, in terms of what brought them. Some were more LPN's; some had been homemakers and their kids were in teenagers now, and they felt they wanted to go back, had always wanted to be a nurse. The curriculums, and I'd have to applaud UNCW in terms of having a system in place now, whereby nurses can continue to build on their careers, and not have to stop full-time, and they can do it over a period of time. And that was needed in this community.

Mims: Now, you were in the two-year program?

Smith: That's correct, and that's what was offered. I remember when they moved up to the BSN program, but it was ADN program and the only ADN program in a university at that time. Most were in community colleges or technical colleges.

Mims: Well, we had only hit university status for a few years.

Smith: Right; that's right, and I'm sure they had an eye to migrate the program to move to that curriculum.

Mims: We know that while you're a student, you're taught the professionalism of being a nurse, and one of that aspect is the uniform.

Smith: Right.

Mims: So, as a male, your uniform was a little bit different; can you tell us about that?

Smith: Well, I wore in those days, pretty much a top, like Dr. Kildare would have worn, you know, the snap that snaps.

Mims: I've seen your picture.

Smith: Oh, have you? [laughs] I wore white, and I don't think, even as a student, the nurses had a blue uniform, blue and white; you've probably again, seen pictures of that. I didn't have anything separate that they made for me in those days. Again, it was so new, and I think now, that the UNC students all of the various nursing programs that come to New Hanover or affiliate, all are sort of coordinated. But I didn't, in those days. As a student, I think I wore a white top and white pants, and I continued to when I became a staff nurse at New Hanover, after I graduated.

Mims: What about the cap issue?

Smith: Never came up, actually, you know. It never came up.

Mims: They had capping?

Smith: Well, they did, yeah, they did have that ceremony.

Mims: Right. So, how did that work with you?

Smith: You know, I don't remember. I'm sure I went, but I don't remember that experience; I just blocked it out. [laughs]

Mims: The way I, we've, read it, is that the capping ceremonies is when you had the Florence Nightingale lamps, lights, or whatever.

Smith: Right; I got all of that, well, a lot of that is tied to the pinning ceremony. That's more at graduation, when you are actually awarded the pin for the School of Nursing that you've finished. And I remember that. That was one of the smaller buildings, and it was just for nursing, and of course, I got a pin from the nursing program.

Mims: But don't remember the capping?

Smith: Never remember the capping ceremony. [laughs]

Mims: Because we've seen pictures of them with the caps all laid out and putting them on the nurses' head.

Smith: Yeah, no they didn't put anything on my head. [laughs] Nope, I don't remember that. No, that I would, never-- no. And I wouldn't imagine that it would have been, and I don't remember any discussion about how it would be handled, or that I didn't go. I'm sure I was there, but I just don't remember the experience. I do remember the graduation ceremony.

Mims: In the clinical environment, you're identified as a student nurse, and part of that is the cap and uniforms, so when you walked into the patient's room?

Smith: Yes, I'm sure there probably was, and again, it was a new experience for both patients and staff alike in some ways. And to not misrepresent who I was, or what I was going to do, I don't remember there being significant discussion about it or explanation to the staff. I think nursing instructors in the clinical area are very good about setting the scene, and making patients know that a student is going to be participating in their care, so, I don't think there's any misrepresentation in terms of my qualifications. But I never felt particularly uncomfortable, made to feel uncomfortable by a patient. I did have one experience later in my career, when I was working in intensive care, a gentleman, who became very upset. He called in and I was having a discussion, giving him some information about his wife, and he was very irate that I would be taking care of her. That's the only time in my whole career as a nurse that I ever felt someone, or someone verbally shared their concern that a man would be taking care of their wife.

Mims: Once you became a nurse, did you find any other male nurses on staff?

Smith: You know, after graduation, I did continue to staff; I got a job at New Hanover. And, within a couple of years, there was a male nurse that was working in the emergency room. I remember meeting him and talking to him briefly, but our paths never crossed, and I'm not sure he was there very long. He was older than I was, but I think he and I were the only two. And I was somewhat of a novelty, obviously, not only because I was the first, sort of, from this community-- they may have had others. Actually, the director of nursing, Gaylord Snyder, at New Hanover, at the time, was a nurse. And again, he was in his mid-40's or something. So he would have, certainly in a larger city, been a male nurse, trained. But I was, again-- New Hanover, in those days, was really; I think it was seven floors, originally, but it was an intimate setting. It was an intimate building; you knew everybody, but I certainly was known, just because I was unique, and the only one. And I actually went to work in intensive care.

Mims: Okay, I was going to ask.

Smith: I never worked as a floor nurse to begin my career. And that was kind of a first, also. They rarely would accept a graduate, in those days, in to...

Mims: Because it was a technicalities.

Smith: Exactly. My feeling is that it is the graduate who really will mold himself or herself to what's required, needed, in a specialty unit like CCU, intensive care, surgical trauma, anything like that, and in fact, they do now accept graduates into those settings. But it was a perfect mix for me, because you were able to pull all aspects of your nursing background together. And it was pretty high-tech in those days, and even more so now, but-- and a real professional team. And I feel real fortunate to have been able, again, to be accepted into that work environment, when it hadn't been allowed, pretty much, before.

Mims: It seems like if you had been put on the floor, your patient assignment may have been a little bit different.

Smith: It could have been; I don't-- in those days, it might have been. It's certainly not, today. I think that we find men in pediatrics, actually, several years ago, there was a male nurse on labor and delivery. So you do find them today in all walks of nursing. In the early 70's, that might have been the case. Certainly, it probably would have been on the surgical floor, or emergency room...

Mims: Or orthopedics, yeah.

Smith: ...or orthopedics or something like that, yeah. But I thoroughly enjoyed my experience, and it would later play into my returning to school, because that is the background that is required for acceptance into anesthesia. At one time, emergency room OB was an acceptable background for going into anesthesia, but not anymore. It was all critical care experience in intensive care. And I actually laughed-- I was only at New Hanover about two years. After, in '74, I moved to England, and worked in the national health system there, gained licensure, and worked there for two years.

Mims: Wow.

Smith: It was there that I decided that I wanted to go back to school, and kind of felt like anesthesia was going to be a choice for me, and came back and applied to the Watts Hospital program in Durham. I actually interviewed and was accepted there. It's where the math and science center is now. But that hospital closed, and they moved to Durham County, which was-- they closed the Black Hospital, Lincoln and Watts, and built Durham County Regional, and all of my training was there. So I didn't...

Mims: Kind of similar to what happened here in Wilmington. [Inaudible]

Smith: That's right, that's right. In terms of merging small-- Yeah. And it's a movement away from segregation, and they just combined some hospitals. But the experience of going to England was much more basic than I had been exposed to, in terms here, in terms of the physical layout of the hospital equipment.

Mims: Where in England were you?

Smith: In the County of Worcester, Worcester Royal Infirmary. The British Medical Society had been founded in their boardroom there, and was quite a rambling hospital. Somewhat like James Walker. Again, they don't abandon their building quite like we do in this country. But lots of staircases and wards. In fact, there were nothing but wards. And you know, after-- with the construction of New Hanover. They had moved away from wards. None were allowed, they were all semi-private and private rooms. Where I worked was a hardwood floor. There were 24 beds rolled up. You know: lined up. Like 12 on one side, 12 on the other. Food trolley came up; you actually dished up meals. That was the charge person's duty. Or the staff nurse. Would just, you know, pick up a plate and sort of serve the patients. They had a nursing school there. The nurses, pretty much like at New Hanover, were the care providers. You had a few trained staff who oversaw the care. But that was just a new experience for me.

Mims: It's a step back, it sounds like.

Smith: Yeah, it really was. It was kind of a look at how training programs had been, or care had been maybe, you know, 20 years before I had come along. I had to affiliate-- in order to work as a nurse, do three months as a student. I did six weeks on a surgical floor and six on medical, to just learn their method of doing things. Their procedures and their some of the medicines there, went by different names. But-- and actually I did not have to take another qualifying exam. My licensures came through, based on my education here. And that was-- became registered under their system. It was a great, great learning experience. And-- both in health care and just being in England. Lived in the community. I chose to go, lived where my mother had grown up, and got to meet cousins and relatives that-- my father had been stationed there. So it was just a great experience.

Mims: So you made a decision to go to anesthetist school, and you picked Watts because of proximity?

Smith: Well, there were five schools in North Carolina, at the time. And actually, North Carolina had-- it was a large number. Some states didn't even have training programs for nurses. And there were several Watts graduates at New Hanover. And it did have a good, long, rich history. And I think a strong program in term of turning out graduates, prepared to go to a small community hospital and work alone. Or, say, come back to a medical center, community hospital like New Hanover. You could step up, or come down, in terms of your ability to function in any settings. I think some of the graduates from the programs, and even the Duke graduates, were so geared to the type patients they saw, and that setting that a transition to a smaller community hospital was more of a struggle for them. I think I've heard some say that. And I've actually seen that with some that I've worked with. But it was, in fact, the only school I applied to. There was always a lot of competition to get in. The classes were only ten students at the time.

And I was-- in looking back I, you know, probably should have applied at two other schools. Fortunately, I was accepted. But, you know, had I been turned down, I would have had to wait a whole another year to reapply, because they did accept a class only annually. And, you know, looking back again, I probably should have applied to multiple schools. There was a school in-- Duke had a program; Watts, Charlotte, Asheville, what was the other one? There were five. And some of those closed. Actually, my school has closed. They are re-opening some of the programs to meet the demand now. But years later, they would-- some would close some would re-open.

Mims: How about the gender issue in this setting?

Smith: Well, it's quite interesting. In my class, there were five men and five women; the class ahead of me, there were nine women and one man. The class behind me, there were nine men and one woman. There is a huge number of men in anesthesia today. I think, for many reasons, one, just the challenge, the specialty. But some of it's the income. I think that it's-- and the shortage, the demand, the security. We have people with PhD's going into anesthesia now.

Mims: Now you were only an Associate Degree.

Smith: Correct, correct.

Mims: So that was the criteria you didn't have, to have the full degree.

Smith: In those days-- you must have a BSN to enter now. Because all the-- everyone comes out with a Masters. So, that is a requirement. It wasn't. And in fact, in my class, there were BSN graduates. There were probably three of us that were ADN, and we actually had two diploma graduates. We actually were offered a diploma in anesthesia, a two-year program. And again, now, once-- years later, the professional organization moved for higher, better training standards, and higher degrees. And so, they went to mandatory BSN to enter the program, and offered Masters. And there is actually some discussion now, to take that to a new level. To a PhD level.

Mims: What was training like for this? I mean, was there a lot of clinical experience?

Smith: There certainly was. Certainly was. It's 24 months of just intense on-the-job. We actually did go into-- I think the first three months or four months, just in class, every day, just getting didactic work. Again, some of it being a review, but we in terms of anatomy and philology and pharmacology, just taking in terms of depth of understanding and exploration, just much greater than we would have gotten in nursing, because we were going to be making choices, taking care of patients. Giving their anesthetic and taking care of them. I just-- Again, I interrupted my education. Always had pretty poor study habits. But I had to study so hard. I did in nursing school. Again, it's my own fault, because I had just perhaps played too much in high school. But I have very poor study habits and foundations. I always loved the sciences, but math was a weaker area for me. And I had to study much harder than some of my classmates. But I really wanted it. I wanted it so hard. And I actually had a couple of nursing students in my class that I think were far brighter than I was. But they just didn't apply themselves, and they just kind of lost out on what.

Mims: So out of the ten students that started, how many finished?

Smith: Yeah. Well we lost two or three, I think. But I think we did graduate pretty close to ten. I really don't remember what our total graduating class was. But we did lose a few on the way.

Mims: Any remediation in this program?

Smith: I don't remember anybody coming back, or if some did, I think probably let go, because of grades. I'm really not, you know, real clear. We didn't lose a huge number, like some of the larger classes do today, in nursing, or in anesthesia. We pretty much stayed together. But we did lose a couple in my class.

Mims: Would you tell us the difference between an anesthesiologist and a nurse anesthetist?

Smith: A nurse anesthetist. Well, anesthesiologists are physicians who go back and do a specialty in anesthesia, a residency in anesthesia. Today, pretty much, they finish medical school and will enter a residency program. We have a few that come through New Hanover, and they'll just do a year of surgery, and then they go into a residency for anesthesia. Nurse anesthetists are nurses who do, essentially, a residency, or two years in anesthesia. And the state looks upon us as practitioners that can function alone. We constantly have seen some legislation that would alter that in our practice. In fact, this past year, there was hotly debated legislation on the table that would have limited our scope of practice, to just working under that of an anesthesiologist. But nurse anesthetists meet a huge demand in rural communities, and it would be very hard to implement that in this. Even the joint commission who sets the standards for hospitals attempted to do that, years ago. And it just-- in rural communities, you cannot meet the demand. And I'm not sure, altogether, that that is necessary for safety to the public. There's not been a proven study that our outcome is any different than an anesthesiologist. And that's fact. I don't say that just because I'm a nurse anesthetist. There are good and bad practitioners in all careers. But the outcomes, insurance claims, all the information you look at, does not separate us, in terms of being a higher risk to the community, than say, an anesthesiologist. We at New Hanover do have a care team concept. Whereby the public have both an anesthesiologist and a nurse anesthetist providing their care. And that's not two people sitting at the head of the table during-- but I actually stay, provide you with your antiseptic, get you off to sleep, stay with you the whole time you are asleep; anesthesiologists cover four or five rooms and move around.

Mims: They're the ones that tell the drug that will be used?

Smith: No, they don't do that.

Mims: Really? Because, on the floor, the doctor would prescribe the medicine and write prescriptions.

Smith: Would write the order, that is correct. I don't-- it's different in our career. Again, I think it's expanded its scope of practice. I'm not saying that there's not some clinical sight that would dictate, pretty much tell you what to give. That's certainly not the case at New Hanover. And it would be, I think, a not very satisfying work environment to be told what to give. I'm not a technician, you know, and it is making right the choice for you, having you awake and comfortable at the end of the operation. That is the challenge for each patient that I take care of. It is based on what the procedure is, what the demands of the surgeon are. What your medical history is, in terms of making choices for you. And then, get you through that, and have you awake and comfortable when the procedure is finished. That is what is satisfying to me. And if that was ever taken away, it would seriously affect how I enjoy my career.

Mims: Well, thank you for explaining this, because it's hard to make that.

Smith: For the public. I'm sure it's very confusing. And we have that voiced by the public, our patients, every day. And we do explain it as, in this setting it is a care team concept. And we conduct interviews. Certainly, the anesthesiologist does, as well. We confer, we share information. They come in and out of the case during the procedure. They are there for almost every induction at New Hanover. Again, that varies from hospital to hospital. They may or may not be, on emergence-- when the patient's waking up. But again, our training and our ability and skills, provide us the tools in which to do that safely.

Mims: So at you have been doing this for how long? Since '70?

Smith: '79, I actually finished my anesthesia training. And I returned to New Hanover right out of school; they actually stipend to go back to school, and gave me an expense. And again, that was sort of a carryover to guarantee. There's only been a very brief period where there were a glut of CRNA's or nurse anesthetist. It's always been real demand. And that was a way hospitals could guarantee, and they continue to do that. They the hospitals stipend students that wish to go back to school, with the guarantee that they come back and work, their education will be paid for, which is very nice, because I think I paid $250 for my textbooks. And some supplies when I reported to anesthesia school, and that was it. And I was salaried; wasn't very much. Now, again, students are just thousands and thousands of dollars in debt. If they don't accept money from a hospital or group, to say, you know, "Will you come and work for us when you get out?"

Mims: There's got to be a lot of continuing education with the changes in medication. How do you keep up with that?

Smith: Well, I attend a conference a year, one a year. We, our association, sets 40 CEUs every two years. So, most of the meetings provide you with 20-something CEUs that you go to-- three or four-day conference of educational hours-- and you must have those to recertify every two years. Our license goes from a two-year period. So you have to show proof of that. And again, New Hanover is such a large organization we have M and M's and lots of in service programs there. And I, usually when I'm at a meeting, buy textbooks that I, you know, read. And I subscribe to professional journals, to, both through my organization, but separate ones that discuss various topics, and they're sort of post tests to take, and you can get credits for those. So, those are the ways that I pretty much keep up.

Mims: I'm surprised someone hasn't gobbled you up for teaching.

Smith: Well, we actually have the Raleigh program affiliated at our hospital. We've actually just separated our agreement with them. The anesthesia students today actually affiliate with, like, seven or eight clinical sites. So, they are on the road all the time. The good side of it is they get lots of experience and exposure. But between this, their clinical, it's the Raleigh school, but their clinical is through Greensboro at UNCG. But they are all over the state getting the clinical sites. I did work with students, and I prefer the green students right in. I felt like I could-- I was excited about teaching them, and introducing them to a career that I enjoyed so much. I think that was my strength. And, I think, telling them, because I've practiced for a long time, trying to impart something about patient care and the interest in the patient. And how frightened they are when they come, and how important it is to make them feel cared for. And they are the only person that matters. I mean, because I think that my colleagues who had been out two or three years probably were sharper, if you will, in terms of just challenging them on current literature and information. I read and kept up. But they had only been out, two or three years. They had it at their fingertips, all the things that you're crisp about when you first come out of school. But I wanted to bring to them a different aspect of their training. And I really enjoyed that piece, and I was chosen clinical instructor of the year, one year.

Mims: Wow!

Smith: But I think we are looking at getting another program affiliated with New Hanover so that the students will in fact come back. But I actually enjoy doing, rather than teaching.

Mims: Okay.

Smith: I know that about myself. I like managing my cases and doing. I like doing. So I don't think that I would ever find myself in a teaching--

Mims: Does Dean Adams ever call you in to come and speak with students here?

Smith: No. I never have. And I actually met her through-- I chaired a fundraiser for the Carousel Center two years ago. And she now is on their board. But I had met her through that organization. That's the only time. But I have, again, spoken to the health occupations class, and, but I've not spoken to-- and some of the classes that come through New Hanover. But I haven't been involved in the UNCW program.

Mims: They certainly get more male students in there.

Smith: Absolutely. It is so commonplace. I worked last night. And took a patient over to intensive care, and again, that is still an area that many men migrate to, either with an eye to going back to school, or just. It's just a more fulfilling teamwork setting, intense. But as I move around the hospital there, just there, men in nursing everywhere. And you know, they just are great, they really bring to that arena the same compassion and caring spirit that was always believed that women could only do, you know?

Mims: Sure.

Smith: And that's nice to see. I think for the public. And I think many migrated; they saw it as a satisfying career but a secure career. You know? In the highs and lows over your lifetime, of what you prepare for, it becomes glutted, in terms of graduates. And you find yourself with great qualifications and degrees looking for a job. You know? You just can't get a job. And healthcare has always been a good choice to meet the secure demand.

Mims: Well let's say that on your interview here with Ms. Booe, she said "No." They can't take you. What would have been your alternative?

Smith: I think I would probably have sought out other programs. I'm not sure I would have ended my interest in nursing, based on just being turned down. I've been very fortunate, both in entering this program, and acceptance into anesthesia, to have moved through, without too many challenges. I always had to work real hard, but I've met the requirements and got in and with lots of help from people. I actually got a scholarship to come here, the American Legion. I actually went through the program with assistance to pay for my books and tuition. Had a family friend who was involved in that organization, and again, the hospital helped me with, you know, stipend me to do my anesthesia training. But I've been very fortunate in the choices that I made, reflecting back. And again, having friends who, through their careers, have had times that, you know, making a job change, would have been very difficult. And-- or salaries based on-- I do a very responsible job. But, you know, I've always, it's always been very secure to me, and financially rewarding to me.

Mims: So your sister graduated in '68, you said?

Smith: Yes. Yes. And she actually worked at New Hanover, for a while, in Psychiatry. She then moved into Public Health for a long, long time. Then she took several years off, and she now is back, working part time in pediatrics. In an office-based job. And my wife is a nurse, also.

Mims: Did she come through UNCW?

Smith: She did not. She went to Chapel Hill, and later, returned and got her Masters in Public Health. We shared a nursing career. Condense a long story to make it very brief. When I went to England-- Celeste is my wife's name-- came to New Hanover as a graduate. She heard about Michael, Michael, Michael and then I came back from England and she had gone out to do some Indian Health service work. And I heard about Celeste, Celeste, Celeste. Well, then I went off to school. And she came back and went to work at the health department. And my sister was working at the health department, so we dated for that summer and then she went back to graduate school, back to Chapel Hill. And I wasn't into, you know-- this is on tape, but I say this to her, and she knows. I wasn't into long term relationships, so she was going to be in Chapel Hill. I was going to be here. At any rate, we would later connect. When she finished her Masters, she went to Dallas to work, but would later come back here. And she never married, and I had not married. And we started dating and we got married. So we go way, way back, but not in terms of marriage, and she's great.

Mims: But two nurses in the house?

Smith: Two nurses. She actually has a consulting practice. When she-- with her Masters, she never actually did any clinical nursing, in terms of application. The home care industry is her specialty. And she is a consultant related to that, and is very well respected, speaks nationally on the subject. And so we're both in healthcare, but in different directions.

Mims: Yeah. Very interesting.

Parnell: We only have six or seven minutes, but two questions. You said that when you were at Wilmington College, you continued to work at Babies Hospital.

Smith: That's correct.

Parnell: Then they let you do more, because of your education? Or you were an orderly?

Smith: I was still an orderly, pretty much. I mean, they may have explained things to me. I did-- actually, once I graduated before I took my boards, I did actually work very briefly as a graduate. But I never-- no, not throughout my training did they say, "Well we'll let you do a little more." I think that was a specialty.

Parnell: Do you keep up with the eleven students in your class?

Smith: Only the ones in the community. Adrienne Jackson, who-- our paths cross. She was in my class and several others. Many have moved away. One Denise Shepherd came back and actually got her BSN and her Masters later, through UNCW, but there were only three or four of the students that I actually keep up with.

Parnell: Any other memories of your education here, time at Wilmington College?

Smith: Well, I think I would-- it would not be fair not to share how-- when I began my training, to be a little uncomfortable to say that I was a nursing student. You know? I think that was true again, just the fact that it was very early. It was not something-- it was something that I loved. But you know, when I was in education, I-- going to classes it wasn't something that I just--

Parnell: Brought out.

Smith: Brought out, you know? And that was perhaps my own securities about entering such a female-dominated profession. But I...

Parnell: At that time, too, there were some Corpsmen coming back from Vietnam.

Smith: Right. And I had not had that experience. And the draft was very much active then. And I had put in for a deferment to go to school, feeling that if I got through nursing school, I would be much more an asset to them than just going with no qualifications. But you know, it-- and I think that probably plays into Ms. Booe's concern about not accepting one student, but two. But that-- but again, I don't feel like it was ever made an issue for me. I didn't have-- I was not made fun of or harassed or anything like that. I think it's just what I did to myself, probably, in terms of just...

Mims: Well, it sounds like your commitment and your seriousness about this-- You know, that that approach kind of shielded you from other people. You know, cause if you'd gone in, you know-- but it seems like from the very beginning, you--

Smith: Well, I'll tell you, nursing is a-- is such a great opportunity to-- I want to say, "take care of people," but it, you know, people are so vulnerable. And not all areas of nursing are-- certainly, in mine, today, I see people, patients at a very threatening time, and I feel very fortunate to try to put them at ease and make them feel special. And educate them and take care of them. And that's a great benefit of what I do. That's a big piece of it.

Mims: Well, I want to thank you for coming in today.

Smith: Thank you, very much, for having me.

Mims: All right.

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