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JOSEPHINE TWILLEY, R.N.
Retired Director, Patient Representative Program
Pitt County Memorial Hospital

June 7, 2000

Interviewer: Marion Blackburn

Marion Blackburn: You are originally from Maryland. When I spoke with you I have some background information but it is rather sketchy so I will ask some basic questions and, of course, ask you how you got to Greenville and you can tell me the whole story however you want to. You didn't start off that way but you ended up being the first patient advocate or representative? I guess that is some story.

Jo Twilley: Well, not really. They just decided that it would be a good idea. Not that we were getting a lot of complaints, we weren't. But sometimes they dropped through a hole in the ground and they never got answered particularly those people who would write to the newspaper and complain to the editor. Fred Brown, at the time, was COO to Jack Richardson and he decided that they were going to put in a Patient Rep Program. About that time I was getting ready to retire anyhow and so Fred and Marilyn Rhodes, who was the Vice President of Nursing at that time, they decided that they would think about a Patient Rep Program and they asked me if I was interested in staying on a couple more years to get one started.

After some consideration I decided that maybe I would try it. I had no idea of what I was getting into. It was fairly interesting as I love people and I love to talk to people. I don't like confrontation but I had a lot of that in this job. I went and talked to the patients and was sort of a liaison between the Administration, the nursing staff and the patients. Anyhow, we followed up on all of the complaints and sometimes there was just a misunderstanding with communications and it sometimes got lost in the shuffle and that is what happened. I enjoyed it and the first thing you know Dr. Pories wanted a patient representative in surgical waiting areas so that they could check on the patients who were in surgery and then get back to the family because a lot of time the surgical patients' families got lost in the shuffle. The docs could never find them.

Marion Blackburn: These would be people who would say their mother was having surgery and ask how she was doing?

Jo Twilley: Yes, how were they doing and then my first position that I hired was a surgical rep liaison for the surgical patient's families. She would check the OR schedule every morning and I think they are still doing that, I'm not sure.

Marion Blackburn: What year was it that you were getting ready to retire and they asked you to stay?

Jo Twilley: It was October of 1984, a new budget year. In 1985 we got the surgical rep.

Marion Blackburn: Something tells me you probably didn't retire on schedule or did you?

Jo Twilley: Yes, I did, I retired in 1988. I worked two more years and I was ready by that time.

Marion Blackburn: What had you done before you became Patient Representative?

Jo Twilley: In the old hospital on Fifth Street I was part time and that is when we had 120 beds. I started out as a staff nurse in a little four-bed critical care unit. We had four beds in one room. We had one monitor and one defibrillator for the whole hospital and the critical care nurse who was on duty had to take that to the patient when we had a code blue. It was a three tiered monstrosity and it was on a rolling cart and that was the year that Dr. Artis got caught in the elevator. Then I worked part time as the night supervisor and I hate to tell you and maybe I shouldn't but I was the only RN there beside the nurse in the critical care unit. The rest were LPNs.

Marion Blackburn: Everybody seems to be more skilled now.

Jo Twilley: That was at the old hospital and then in 1977 I left the hospital and went to East Carolina as a clinical instructor for a couple of years there and then came back to Pitt in 1978 as head nurse on 1 North. That was not the heart unit it was the old 1 North. Then somehow or other I became supervisor in the ER. I did that from 1978 to 1984

Marion Blackburn: I don't want to interrupt you but I have to ask, how in the world did you do that? I feel that I would be a nervous wreck.

Jo Twilley: Oh, it was fun because I hired the nurses, I did the budget. The first budget I ever did was for the ER and Dr. Gradis was the medical director of the emergency room at that time. I don't know, it was stressful but I tell you I really did enjoy it.

Marion Blackburn: I guess you had stress that maybe also was a feeling of really being vital.

Jo Twilley: Yes and I think that Jean Owens when she was Director of Nursing also gave me the Recovery Room. When the patient came out of the OR they went to the Recovery Room. I really did enjoy it and I really enjoyed my work.

Marion Blackburn: When you were hiring new nurses and everything, it almost sounds like what now might be called an Administrator.

Jo Twilley: That's right and I went from Supervisor and then they changed the title to Nursing Administrator for Critical Care. I reported directly to the Vice President of Nursing. Of course, now there are Administrators for Medicine, for Surgery, for Rehab, for Pediatrics, for Critical Care and OB/GYN. There were six of us.

Marion Blackburn: There were six supervisors working together and they all worked according to the Vice President for Nursing. That was quite a responsibility. You did that in addition to the Recovery Room and being a nurse supervisor.

Jo Twilley: I had a little tiny office down in the ER.

Marion Blackburn: You mentioned earlier that you liked people and you liked working with people. You really had an opportunity to work with a lot of people from nursing to administrators.

Jo Twilley: Also the Highway Patrol, people from a lot of towns because we became a regional medical center and you could see the service widening all the time. The day we moved in I helped move the patients from the old hospital. The day we moved in Ralph Hall started tearing out closets to make offices to make more storage room. They actually started tearing down the day we moved in.

Marion Blackburn: I think I heard that and also I think construction began on a new tower.

Jo Twilley: Well, that was the West Bed Tower and we built that in 1983, I think. Then, when the West Bed Tower opened we moved the patients on a Sunday and then part of the building project for the old C3 and C4. C3 was Neurosurgical Intensive Care and C4 was the Surgical Intensive Care. We made C1 as strictly cardiac and C2 was strictly medicine. We had four intensive care units over and above the pediatric intensive care unit.

Marion Blackburn: Are they still using that organization or were they when you left?

Jo Twilley: No, that has turned into post intensive, I don't remember what they were using. Oh, I know it is outpatient surgery that is what it is. As you go down that hall C4 was on your right and C3 was on your left.

Marion Blackburn: So you had a lot of experience. You came in 1968 and then in 1984 you assumed more and more responsibilities from direct patient contact to managerial to budget making oversight and administration and then in 1984 you started the Patient Rep Program. Did they send out feelers about who wanted to do this or did they come directly to you.

Jo Twilley: Well, I think they came directly to me.

Marion Blackburn: I know people don't like to brag about themselves but it sounds almost like they said that you were the one to do this. Did they give you some guidelines or did they say just to go? What were your goals? Did you have any clear ideas from the beginning?

Jo Twilley: Just that I didn't want the patients to fall between the cracks; that I wanted them to be heard. You see, we had so many people from out of town. We had people that couldn't even get on an elevator and know what button to push. The people from out of town they had never been to Greenville before, Greenville was growing and at that time they started the Chaplain Program and we worked very closely with the Chaplain Program. The Pastoral Care Program and the Patient Rep Program set up a program where people would take people from out of town, who couldn't afford a motel, they would take them into their homes and let them spend the night. That was before the Ronald MacDonald House. What we tried to do was humanize our services. Then we had a list of motels with phone numbers and how to go there and what the prices were. One of the big things that we did was chase down false teeth.

Marion Blackburn: In the patient rooms they would get mixed up?

Jo Twilley: Yes and they would get lost. Patients would take out their teeth and put them on the tray and then they were gone. It's a small thing but it is something that you tell your neighbor that they did at that hospital and you tell your friend what they did to your friend and it gets bigger and bigger and the first thing you know it is so big that people are saying that they didn't want to come here. They would say we didn't care enough to help them find their teeth. You would be surprised how much money went into replacing false teeth that got lost. Of course we would turn that over to the Risk Manager. We would try to track them down and there were lost clothes, lost watches. Patients wanted to read their charts which was perfectly legal but they needed somebody to interpret because what is in the chart sometimes is a "foreign language." There were a lot of little things that we did and we were busy. Then I put on somebody from 3 - 11 in maybe 1986 and that was Arlene Hull.

Marion Blackburn: You put somebody on as a patient representative?

Jo Twilley: Yes, as a patient representative from 3 - 11.

Marion Blackburn: I wonder if I know Arlene Hull. That name sounds familiar.

Jo Twilley: She is still in that position except I think she is on days now. Then I brought in Mattie Bryan, so when I left I had put in four new full time equivalents.
That was Marie Jones, Arlene Hull, Mattie Bryan, and Mary Stancil.

Marion Blackburn: I notice that these are all women, I have to ask you?

Jo Twilley: I never had a male patient representation. If they applied they were certainly eligible.

Marion Blackburn: I certainly wouldn't want to imply that there was a choice but it seems like this is a kind of position that requires skills that you may think women are maybe more used to giving to others and taking care of others needs. It almost sounds like a position where you really have to be something of a caretaker in addition to what the physicians and nursing staff and health care professionals would do.

Jo Twilley: But you know ministers do the same thing.

Marion Blackburn: That's true.

Jo Twilley: Of course we worked very closely with the Pastoral Program.

Marion Blackburn: You said earlier that you were trying to humanize the hospital services and the more I listen to you describe your work it sounds like that was just a remarkably accurate way to describe it.

Jo Twilley: We took care of their emotional needs. We also did living wills. We were notaries and we notarized documents. Sometimes we were the only notaries in the house.

Marion Blackburn: You said earlier that you don't like confrontation and you did have confrontation sometimes. Could you describe a little bit more in detail how misunderstandings might arise and maybe how you would respond to an angry, hysterical or weeping patient?

Jo Twilley: Just one example is that you would just let a patient talk and then you go out and talk to the nurse and let her tell her side of the story and you don't make excuses for them and then you tell the patient the truth and nine times out of ten after when you bring in the nurse and let the nurse and the patient talk together, or a housekeeper, and sometimes it is a lab technician. A few of the patients you really had to help with good communication skills and you really had to be a good listener. That is the secret.

Marion Blackburn: Did you ever find yourself having to tell them you just didn't know why that happened and that you were really sorry.

Jo Twilley: A lot of times. Yes, really sorry and then you talk to the head nurse and ask the head nurse to go in and talk to that patient too.

Marion Blackburn: Did some people ever resent you?

Jo Twilley: Oh yes.

Marion Blackburn: How did you maintain a good relationship with your colleagues?

Jo Twilley: I guess by being totally honest. You try to see their side because I had been on that side, I've been there, and I've done that. I know I had a good example when my husband was in the hospital and the doctor had ordered medicine for him and he called three different times for his medication and nobody ever bothered so he called me at home and I called the patient rep and she went down to the unit and somebody had answered his intercom and they got busy and it happened two different times and nobody ever told the nurse. The patient rep came down and I really hated to call. That was one of my personal experiences.

Marion Blackburn: When you think about customer service in the corporate world you think about somebody that is going to type a memo and get back to somebody and talk to this person and then write me back in two or three weeks, it almost sounds as though your responsibility was very immediate and that you needed something right now. Your personal example was definitely an immediate need.

Jo Twilley: It was. It was like "Johnny on the spot".

Marion Blackburn: Now I have to ask this question too, I would imagine that it would be difficult sometimes to try to negotiate the difference between what a doctor thinks is best and what a patient thinks is best or a patient's perception and a physician's perception, in other words you probably had that.

Jo Twilley: Oh my, major diplomacy, that is what it was. It was a very difficult situation to be in. We had physicians that would call us, a lot of them called us and asked us to go talk to a patient or I need to go and tell my patient this and would you come and witness it. Particularly I think the surgical groups would do this. Most of the doctors appreciated what we did. There were some that thought we were interfering definitely. We tried not to interfere with the doctor-relationship. In fact, we tried not to interfere with the doctor-patient relationship at all unless we were asked to come. But you know a patient has certain rights and we would inform the patient of their rights. I am very much in favor of patient rights.

Marion Blackburn: That's something of an ongoing revolution in hospital and medical care. It used to be that you lay there and kept your mouth shut, took your shots, got biopsies and examined.

Jo Twilley: And when you asked what your blood pressure was it was none of your business. It is your business and you need to know that if you have been getting a yellow pill and all of a sudden you get a red pill, you need to know why you are getting a red pill instead of a yellow pill. You have the right to know that.

Marion Blackburn: Do you think that your work actually has helped to make for more communications in general in the hospital?

Jo Twilley: I hope so.

Marion Blackburn: I have to ask you a little bit about some of the future of health care because I know that things are changing dramatically in a sense of the role of the physician and the changing nature of the physician/patient relationships. How do you see that relationship changing in the future? You are out of it now and you can sit back and think about it. Should there be more patient rights or do you think things are about where they need to be?

Jo Twilley: Well I think that the patient knows how he feels better than anybody else. He knows his body better than anybody and I think that the doctors are more conscious of that now. I have found that in the institutions that Reece stayed in. I think that the physicians are as afraid of malpractice as they used to be. There at one time you had to document, document and document. Docs are human too and they are going to make mistakes. I think things are going for the good like HMOs. Of course Medicare, I am on Medicare, and it is so involved that it really is expensive to file all that stuff I can barely keep up with it. It is hard enough to keep up with my own, it's hard enough to keep up with the patients.

Marion Blackburn: In fact, one of my interviews was with Warren McRoy and I had a great time talking to him. He is a financial whiz.

Jo Twilley: I can tell you he is, he is a financial whiz just like you said.

Marion Blackburn: Apparently when he got here from where he was working in Atlanta with BC/BS, he got here and Jack Richardson foresaw the Medicare/Medicaid reimbursements were going to be tremendously important and they put Warren on it and he sort of told me a little bit about how he tried get things set up and I am convinced that it had a lot to do with the financial stability that we have now.

Jo Twilley: I agree with you there. Warren was a mental calculator. He was, he was just great you know you listen to Jack Richardson and I can remember Jack at the old hospital when he first was employed over on Fifth Street. Jack had a vision, he was very visionary and our growth today has a lot to do with him and his objectives. I think he was the fairest man that I have ever met.

Marion Blackburn: That is quite a compliment.

Jo Twilley: I have never seen him, and I have seen him many times since he retired, and he would know who I was and know my name. He was always willing to listen and he was just great.

Marion Blackburn: That sort of allows me to sort of ask a little bit about your feelings about the impact. You mentioned that Jack Richardson is a visionary man and of course the hospital today it is just difficult to evaluate its importance and impact but I would like to ask you to do that. What do you think is going to be the impact for the future?

Jo Twilley: The growth of Greenville. I think its that and the Med School. Look how many people are here today. I can remember when we had 120 nurses; we had 200 and some support staff. Look what they pay out in salary it is tremendous. That puts a big impact, not only Greenville but on Pitt County. I think we are the number one employer, aren't we?

Marion Blackburn: I'm not sure, I know that the hospital, PCMH has over 4,000 employees and then to include the whole system it is somewhere around 6,000 and if it is not the top one it may be.

Jo Twilley: Maybe ECU or the Pitt County Schools can top it. Gosh I can remember when we had 120 beds and it went to 700 and something beds including the Rehab Center, which is one of the most important parts of the hospital.

Marion Blackburn: Just recently I did a tour over there, the Regional Rehab Center, and I had no idea of how modern it was and the fact that Greenville had this. There are only two inpatient pediatric rehab centers in the state, one in Charlotte and one here, not at Chapel Hill and not at Durham, right here. There are just really good folks over there. That is just one component of the system.

Jo Twilley: The pool over there saved my husband's life. I have a great appreciation for rehab, particularly since he had his stroke. Their Therapy Department is top rate.

Marion Blackburn: I have to ask this as well. You talked earlier about people who might get on an elevator and not really know what button to push and then you think about people coming to the hospital today from say Pungo in Belhaven.

Jo Twilley: It is overwhelming. It's overwhelming to me to walk in the front door now. It's huge, you know. Some of the places are where it belongs but it is overwhelming and just think of the people passing through.They feel lost; they feel like a number, they don't know where to go, they don't know who to talk to. You put the patient in a bed and you think now what is going to happen to him? It's frightening.

Marion Blackburn: It sounds like you think patient advocacy is probably more important than ever.

Jo Twilley: Yes, it is more important than ever.

Marion Blackburn: You say you are originally from Maryland and I have to ask how you got to Greenville?

Jo Twilley: DuPont transferred us. My husband was at DuPont for forty-five years. We moved from Delaware and both of us were born in Maryland and of course he went to work for DuPont before the War and then he was in service and came back to DuPont after service and then they transferred us down here in 1952. That was one of the best things they ever did for us. I remember the first time he brought me to North Carolina to look for a place to live he rode me to Winterville and we finally settled in Ayden and we have only been in Greenville now for three years but I love it. I enjoyed Ayden and we lived there from 1952 until three years ago.

Marion Blackburn: Do you have any thoughts on the hospital?

Jo Twilley: Yes, I miss the people. I miss being involved, I really do.

Marion Blackburn: It sounds like you had a lot of energy for it.

Jo Twilley: I think I did. You know I got the Foundation Award. That was in 1985. It was quite an honor and I was overwhelmed. I really didn't believe it.

Marion Blackburn: A couple of years ago I worked with the Foundation on a program they were doing for Dr. Mary Raab. Looking back, that award generally goes to someone who is not only done a good job, done a great job, done an exceptional job, but it seems to be someone or a group of people who seem to have a lot of heart as well for their work and it sounds like that was exactly what you had was a lot of heart for the people you worked with, your coworkers, staff and physicians. That is something you can't really go to school and learn. That is something that you just have.

Jo Twilley: I was not born with it I guess but you know I always wanted to be a nurse, I never wanted to be anything else. I persisted with it. I like to think that I contributed something. I had not nursed for quite a while because my husband did not believe in women working and having children so I stayed home until my youngest was six years old. I was put in the four-bed critical care unit with Grace Arsenau and I thought Grace was an experienced nurse and the first patient I had with congestive heart failure was Dr. Fore's and he isn't here anymore, he is at Johns Hopkins I heard. I turned around to Grace and I told her I was so glad she was there that I couldn't remember what to do for a congestive heart failure and she told me she didn't know a thing and there we were but I soon learned. You have to and it is difficult. Anyhow, we saved the patient.

Marion Blackburn: There is always something to learn-something you haven't done before or a challenge.

Jo Twilley: I miss that challenge. I had never seen a cardiac monitor. There used to be this tall monstrosity sitting between two patients. We had them at every bedside and I think they do have them in every room now just about.

Marion Blackburn: I have asked you a lot of questions, is there anything else you would like to talk about, any particular experience that stands out in your mind that you will never forget?

Jo Twilley: One I will never forget is like the day we moved into the present hospital. I will never forget that day. It was a joyous day and it was fun. I can remember when they had the first salad bar in the cafeteria. I guess it made an impression on me. I remember the old hospital the cafeteria was in the basement and you could get a sandwich or a bowl of soup. There was nothing left after Noontime. That was funny that I remember the salad bar.

I remember very vividly the first disaster drill I ever participated in. I was supervisor of the ER and we had to have a disaster theme and that is when Jack Allison was the medical director-haven't thought of him in awhile either-and just different things like that. I just have very fond memories of people there. The hospital is something that everybody should be very proud of and Dave McRae has been a part of it. I can remember when Dave was in charge of Rehab. I can remember Rick Gilstrap

Marion Blackburn: I just thought of another question. When you were patient advocate what was your official title and did it change?

Jo Twilley: I guess it was Director. First it started out as patient representative and then I think it was changed to Director of Patient Representatives. We had an office and spent very little time in it. My office was near the surgical waiting room down on the first floor on the right. It was a room in there. I had a great big window.

Marion Blackburn: Did you ever work with Hospice?

Jo Twilley: Hospice had not started at that time and it had just started when I retired.

Marion Blackburn: Did you ever find yourself in the position of comforting?

Jo Twilley: Yes, a lot of times. The hardest thing to do is ask for organ donations after a death. That was so hard. That was really difficult and I hated to do that. That was the only part of my job I didn't like. I don't think they do it anymore. A doctor would ask me to go with him when he did it and it was hard.

Marion Blackburn: What would the response be?

Jo Twilley: A lot of people will accept that. There wasn't as much talk about organ donation as there is now and it was a subject that people just didn't get into. Sometimes it made people really angry. We got all kinds of responses. You never knew what kind of response you were going to get. I think that was the most difficult part and I am glad that I didn't have to do it that often.

Marion Blackburn: It sounds like there wasn't a lot that you didn't have some experience with.

Jo Twilley: I think I got my fingers in a lot of pots. I guess I have seen a little bit of everything. We worked a lot with the Risk Management Department with Buck Sitterson and that is before we had a lawyer. We had a lawyer who was just on call for advice.

Marion Blackburn: I imagine they have a staff lawyer by now.

Jo Twilley: I think they do. I know that Risk Management now has somebody. I used to review the Incident Reports and try to follow up on some of them because you had to fill out an Incident Report if there was any kind of trouble or discipline, or anybody got hurt.

Marion Blackburn: Your work may have been beneficial for avoiding lawsuits.

Jo Twilley: I think we did avoid a couple of them.

Marion Blackburn: Did you ever have to testify in a lawsuit?

Jo Twilley: No, I never did except one time in the ED I had to litigate but that was in the old hospital. I was so scared that I put the wrong hand on the Bible.