1. The Newsletter of the Health Libraries Association of British Columbia Volume 26 Issue 3
Volume 26 Issue 3
April 2003
HLABC FORUM
L IBRARY
Inside …
MANAGEMENT
Elsie Wollaston’s
Notes from the Afterlife
Journal vendor survey
Sharing: a feminist ap-
ap-
proach to management

2. The Newsletter of the Health Libraries Association of British Columbia Volume 26 Issue 3
April 2003
HLABC FORUM
2002/2003 HLABC
Executive
• President
Rebecca Raworth
• Vice-President Elect
Tracy Havlin
• Secretary
Dan Heino
• Treasurer
Shannon Long
• FORUM
Pat Boileau
• FORUM
Krista Clement
The Forum is published quarterly by the Health Libraries Association of BC
• Website ISSN: 0826-0125
Mary-Doug Wright For membership information, visit our website at www.hlabc.bc.ca or write to:
Shannon Long, HLABC Treasurer
c/o Library, Richmond Hospital
7000 Westminster Hwy
Richmond, BC V6X 1A2
Phone: 604-244-5165 Fax: 604-244-5524
E-mail: shannon_long@rhss.bc.ca
Fees are $20.00 (regular) or $10.00 (student, maximum 2 years) and include the Forum.
Submissions and story ideas are welcomed.
Publication is not guaranteed and manuscripts may be edited.
Contact the editors:
Pat Boileau
Email: pboileau@vanhosp.bc.ca
Phone: 604-734-1313 ext. 2339
Krista Clement
Email:
Phone:

3. Page 3 Volume 26 Issue 3
JOURNAL VENDOR SURVEY
Krista Clement
When Pat suggested taking a snapshot of journal subscription management
among HLABC members, I proposed using a WWW-based survey tool to survey the
listserv. I had completed a survey by Zoomerang (www.zoomerang.com) before,
and set up a basic questionnaire on their free service. The concept was great, and
I thank each respondent (16 altogether).
I must remind you that participation in this survey is entirely self-selected, so that
only HLABC members who belong to (and read) the listserv, have computers and
software able to access the web survey, and who had some curious motivation to
answer, actually filled it out. Not all questions were answered by each respondent,
so that introduces further bias. And the total sample is very very small. In fact, this
is not any sort of scientific or balanced poll, but a starting point for sharing and de-
bate. Please don't try to extrapolate from the answers, to the entire membership!
I hadn't considered two aspects of using a web-based tool for this. First, that as a
free service, Zoomerang does not allow straight reprinting of their data displays -
for obvious reasons. They have a service to sell, and would like paying clients. So,
although the data displays on their site are clear, dramatic, and easy to read -- I
still had to create my own data reports for the Forum. The second issue is that the
data expires after a fixed date. I suffered computer problems, lost my initial
download of the information, and then couldn't retrieve it again from the website!!
This was a thrilling reminder of how temporary Internet sources are. Fortunately,
Zoomerang took mercy on me and re-opened access to our survey without charge.
Finally, although I think I am pretty good at questionnaire design, at least one re-
spondent noted imprecise wording of question 7, and the answers to other ques-
tions made me wish I had thought them through more carefully. The popularity of
free online journals showed in many answers, although the questionnaire was only
intended to address paid subscriptions. Perhaps a future survey could look at how
we are using free online content in our libraries.
So, here is what the panel reported. I have only added my own editorial where the
data could not easily be summarized in a chart. I hope this provokes discussion,
letters to the editors, and creative ideas in all of us.

4. HLABC FORUM Page 4
1. Are you a member of HLABC?
All but one respondent answered 'yes.' I sent the survey invitation only to the
HLABC Listserv, however, participation was not restricted
2. What journal vendor do you use? If more than one, name the main vendor
.
3. If you use other journal vendors or journal related services (e.g. online full text
subscriptions) in addition to your main journal vendor, please list them here.
here
1 MD Consult (for docs via MLS)
2 Sage Collections
4 each publisher needs an individual contract. We have contracts with
some publishers, but not all.
5 Ovid
6 Elsevier, Kluwer, Wiley, Academic Press Ideal, Springer, Bioone, High -
wire, etc.
4. Do you still subscribe to any paid journals outside vendor agreements, that is,
directly?

5. HLABC FORUM Page 5
5. Rate your overall satisfaction with the service from your journal vendor.
vendor
6. In the past five years, has the number of journal titles you manage through your
journal
vendor:
Notes: I found it counter-intuitive that about half of respondents had kept their vendor sub-
scriptions the same or higher in number. However, I know that I moved many direct subscrip-
tions into vendor-management in order to save my own time. So it seems this is a true reflection
of our management strategies. - KLC
7. How many subscriptions do you have in the following categories?

6. Page 6 Volume 26 Issue 3
Notes: These answers amply demonstrated the diversity in our libraries! The pie chart is only a
summary of the totals. The total numbers of subscriptions managed ranged from over 800,
down to seven. Although many libraries still report 100% of their paid subscriptions are in
print only, at least two libraries now have fewer than half in print alone. Five respondents re-
port over a third of their journals have some sort of combined print / electronic access or con-
tent. Another five have access to at least some journals only electronically. The weakness of my
question was in not specifying whether free online journals should be counted, or only paid ar-
rangements. - KLC
8. As journal prices increase (and budgets decrease), which of the following strate-
strate-
gies have you used in journal management? (check all that apply)
Other ideas suggested:
Cust most titles that are available via MDConsult
wrote proposals
9. Any other comments on managing journals and vendor relationships?
• I managed to negotiate a very low service charge, so have benefitted greatly
from that.
• Since the demise of faxon/rowecom/divine I have had to switch to EBSCO for
the hospital departments' subscriptions. Service from EBSCO is FABULOUS!!!
Subscribing directly to publishers is cheaper but a pain in the rear to set up.
Library will use EBSCO next year if funds are available.
• Librarians should try to lobby vendors to prepay publishers on our behalf & bill/
invoice us after they've transfered funds to the publishers. the recent divine
fiasco has made me very leary of subscription vendors.

7. HLABC FORUM Page 7
• Our serials "subscription" list for end-users includes free online journals such
as BMJ, but we also subscribe to the print version. However, it also includes
online free journals such as PNAS (see http://www.freemedicaljournals.com)
You don't have a category for that.
• Our subscriptions were with Faxon/Divine until the end of 2002. The continuity
of the customer service rep was a critical factor in achieving a responsive ser-
vice.
• am very dissatisfied with my vendor because it went bankrupt. Service was
good prior to this. I do not look forward to using another vendor and will con-
sider doing everything myself using DB Text.
• Claims are always a problem, constant monitoring and re claiming are neces-
sary.
Let us know what you think of the survey answers - did you agree? Disagree? Are
there other surveys you would like to see in the Forum? Send an email to me at
bibliacat@shaw.ca with your feedback and suggestions. - KLC
BOOK RETURNS
Linda Howard, Fraser Health Library Service
Surrey Memorial Hospital
Email: linda.howard@fraserhealth.ca
CHALLENGE
A few years ago a doctor came to me to complain about the lack of an af-
ter- hours book return. This doctor was a frequent library user and I thought he
had a very good point. I decided to investigate the feasibility of an outside book
return. Much to my horror, I discovered that book returns in library supply catalogs
cost at least $4,000. There was no way I would be able to find operational funds
to purchase such a luxury.
I decided to discuss my challenge with colleagues in the Education Department.
We brainstormed a little and came up with a few alternatives. Could the mainte-
nance department build a library book return? Could we cut a slot in the library
door to accommodate book returns? Could we steal a mailbox?
STRATEGY
We decided to pursue the idea of acquiring a mailbox. The Education manager
volunteered to contact Canada Post to inquire about possibilities. We found out
that we could write a letter to Canada Post’s public relations department to re-
quest a “retired” post box stating our plans for the box. Much to our delight we
were offered a “retired” mailbox on the condition that we pick it up and paint it an-
other colour. We also had to agree not to use it for the distribution of mail. Voila!

8. Page 8 Volume 26 Issue 3
We arranged with our materials management department to have it picked up and de-
livered to the maintenance department to be repainted. A few months later the library
had a beautiful blue book return located outside the library door ready for 24-hour
book returns. The doctor was delighted with our results. We continue to use the book
return today.
LESSONS
What can be learned from this management challenge? I believe one of the most
important lessons in this tale is to encourage and take seriously “complaints” or
feedback from one’s customers. Some would argue that a complaint is a gift be-
cause it is free feedback. How often do we feel defensive and fearful of com-
plaints? If we adjust our attitude to see complaints as opportunities for improve-
ment, then I think we are on the right track.
Another lesson from this challenge worth noting is that it is often useful to brain-
storm with others in one’s “neighborhood” about ideas for dealing with challenges.
I was truly grateful for the opportunity to discuss wild and crazy possibilities with
Caption describing picture or up with the “victory” together by not dismissing silly ideas.
colleagues. We came
graphic. the idea of stealing a mailbox seemed quite preposterous, but look how it
Initially
developed.
In closing, I think it is useful to thank our users for their “complaints” and sugges-
tions. We may not always be able to do something about it, but we can accept the
suggestion gracefully and give it some serious thought.
SHARING: A FEMINIST APPROACH TO MANAGEMENT
Judy Neill, Librarian/Co-Manager
College of Physicians & Surgeons of B.C. Library
CHALLENGE
When our Director, Jim Henderson, left for McGill in September, the College of Phy-
sicians and Surgeons took the opportunity to restructure its Library. Recent
changes in the provincial health authorities, the expansion of the UBC Medical
School, and a desire to fully integrate the Library into the structure of the College
rendered some of our traditional activities redundant. Here was an opportunity to
streamline processes and save money.
STRATEGY
We started at the top: the three remaining librarians proposed to continue in their
current positions, dividing responsibility for reference, circulation/collection devel-
opment, and cataloguing/database management as we previously had, but shar-
ing the administrative functions as co-managers. Our proposal was greeted with
skepticism by some and admiration by others.

9. HLABC FORUM Page 9
One Vancouver Island psychiatrist sent his congratulations, calling our triumvirate
an “intelligent, feminist approach to management.” Others just shook their heads.
But six months into it, we can honestly say it’s going pretty well. Stats are up, our
budget is balanced, the staff is contented, and the thank-you chocolates from our
patrons are rolling in.
It hasn’t always been easy. We have dealt with a number of major management
issues in our short tenure, and, with our upcoming move to join the College in its
new digs in Yaletown, the future still looks busy.
LESSONS
The bumps are smoothed by sharing responsibility-many shoulders carry both
Caption describing picture or graphic.
praise and blame when decisions must be made. Meetings are regular and sponta-
neous, as communication is a key component to consistent management deci-
sions. We are aware that each of us possesses a set of distinct skills, and this ac-
knowledgment of our individuality forms the basis of the most important ingredient:
mutual respect. From the outset, we determined that management decisions
would be fueled only by our shared vision of providing an excellent medical library
service, not by individual self-interest. Managing by consensus means not just co-
operation, but also divesting ourselves of the desire that our own opinions must
prevail. It means working hard for someone else’s idea as though it were our own.
A paradigm shift in the usual hierarchical management structure? Yes, but as
Harry Truman once remarked: “There is no limit to what you can accomplish when
you don’t care who gets the credit for it.”
We’ll keep you posted.
STAFF PLANNING
Beth Morrison, Acting Head
Library / Cancer Information Centre, BC Cancer Agency
Cancer
bethm@bccancer.bc.ca
CHALLENGES
Learning to read budgets!! I am arithmephobic, so this has been difficult for me.
I'm still not very good at it, but luckily I have lots of support. Also, I'm involved in
planning TWO new libraries! - definitely a challenge there!
There was also a staffing challenge. When David Noble retired, he had started the
process of changing the staffing mix for the Vancouver Island Centre's library. He
had pointed out the uneven levels of service to the branch Centres, and got some
agreement on a solution, but all the awareness David had raised might have been
lost by the time a new Head Librarian was permanently hired. describing picture or
Caption
graphic.

10. Page 1 0 Volume 26 Issue 3
STRATEGIES
It was important to capitalize on what David had already done and "finish the job."
Once there was agreement all around, from the various levels of authority, we
were able to move ahead. This change will happen in April, and I'm so thrilled
about that! I'm also hoping that we can add a Library Technician to the Fraser
Valley Cancer Centre staff - keep your fingers crossed for us on that one.
LESSONS
Once a project has been started, don't let the initial ground work and consensus
building go to waste. Also, take advantage of other changes (retirements, staff
turnover) to make moves which have been waiting for some time.
THEFT & COLLECTION CONTROL
Shannon Long , Librarian
Richmond Health Services
ph (604) 244-5165
CHALLENGE
As the manager of the small but well used Richmond Hospital Library I have sev-
eral challenges to deal with on a regular basis. The one that has been at the fore-
front of my mind recently is security and theft of library materials. I am currently
trying to find a balance between security and "open" access to information. Allow
me to explain.....
Upon returning to the library in early January, after being closed for two weeks, my
co-worker and I noticed that several items were missing: a brand new diabetes
text (put on the shelf in the 2nd week of December) and multiple issues of our
most widely read medical journal. Investigating further, we did a quick scan of the
shelves and found that 13 issues of various journals were missing from 2002
alone. The cost of replacing these journals and the text is nearly $900.00 !! Last
week we did an inventory of our book collection and noted that several other texts
have gone missing over the past year or so.
I know that theft is a common problem in most libraries but I had never given it
much thought -- until now.
STRATEGY
RHS staff and physicians can gain access to the library after hours by two meth-
ods: (1) signing out the key from the switchboard/information desk, or (2) having a
security guard let them in. I regularly check the key sign out book for statistical
purposes and notice that people's writing is often illegible. It is often the case that
neither the switchboard staff nor I can read people's names, despite requesting
that they PRINT when signing out keys.

11. HLABC FORUM Page 1 1
In addition, the security staff doesn't keep a detailed record of who they let into the
library. I have had numerous conversations with the security and switchboard staff
about theft and access issues, but cannot seem to convince anyone that a change
in practice is required. I will keep trying....
In my darkest moments I have thought about not allowing access to the library after
hours, installing a video surveillance system and/or having my entire collection be
non-circulating. But in my heart I know that I cannot seriously consider these options
as they directly contradict the library's mandate (access to information 24/7). What
am I to do?
LESSONS
How do I balance access and theft in my small medical library?
1. Have a clear policy in place for after hours access to your library.
Call a meeting with all concerned parties (in my case it would be the managers of
switchboard, security, my administrator and myself) and decide what is best. Agree
on a policy and have procedures in place for seeing that it is followed. It is essential
that you know exactly who has been using your library.
2. Clearly label all of your library materials with large non-removable stickers or
write "property of the library" on the books using a big black marker. People may be
less tempted to steal and have in their possession what is obviously not theirs.
3. Try to set aside some money in your budget for replacing lost or stolen materials.

12. Page 1 2 Volume 26 Issue 3
FROM THE EDITOR
Krista Clement— Co-editor
Clement— Co-
This issue of the Forum looks at management in our libraries: journal subscription
management, and management issues in diverse health library structures. The Fo-
rum will act as, well, a forum for us to share our ideas and experiences in manage-
ment.
We all have things we like and dislike. Personally, I really enjoy searching, and tink-
ering with various catalogues. But "Management" wasn't what attracted me to li-
braries, not by a long shot.
My first job in a health library was pretty basic, mainly library "clerk" duties. It was
low stress, a straightforward list of things to do each week. Someone else was re-
sponsible for all the decisions. Then, in 2000, I took on two new jobs with greater
responsibilities. I eagerly anticipated getting in there and doing some of the fun
stuff - like reference and cataloguing.
Within just a few days, however, the journal vendor renewals for both libraries
landed on my desk. My eagerness waned as I dug through the stack of approvals,
sorting out complicated department payment schemes, tracking down the people
responsible for approving price increases, and weighing cancellation decisions... I
asked myself why, exactly, I had wanted to be a librarian? Clearly the "fun stuff"
came with a side dish of.... management.
As the year progressed, I also had the privilege of hiring a library clerk to work
with me in one location, and of supervising multiple volunteers in the other.
Wonderful people, all. But who knew that staff management consumed so much
time? Not to mention traversing the union labyrinths, bless their red tape! Again, I
thought back to the simpler duties, filing the circ cards and processing new jour-
nals.
Recognizing that I am not naturally gifted to love management, I really value the ad-
vice and experiences of colleagues who have "been there, done that." In this issue,
we will feature short features from several HLABC members, giving us insight into
their best strategies and recent challenges. We are also reporting on a web survey
about journals management and vendors. I hope that we all find something here to
help us actually enjoy, not just endure, our management responsibilities.
For those wondering about my own role as a co-Editor of the Forum, well, I'm
certainly not the Manager!! Pat Boileau has been putting out newsletter after
newsletter, quite successfully, while I cheer her on. Many thanks to Pat.

13. Page 1 3 Volume 26 Issue 3
News from your CHLA/ABSC Liaison - March 2003
Cathy Rayment
CHLA/ABSC President, and Liaison to HLABC
MEMBERSHIP YEAR TRANSITION - Although feedback from the membership was over-
whelmingly positive, plans to move to a calendar year membership have bee put on hold.
A change of this scope requires multi-year planning and budgeting, so for at least the
upcoming year, membership will still be on the June to May schedule. Renewal forms should
be in the mail shortly.
BMC CHANGES - BMC is going electronic! The NRC Research Press will start producing an
online-only BMC starting with volume 25. Volume 24 will be completed in print by a merged
Summer and Fall issue(No. 3/4), and volume 25 will start electronically in the first quarter
of 2004. Another change to expect will be a different name. Some recent confusion of our
BMC with the BioMedCentral BMC has prompted the Editors and Board to end the debate
that we’ve been engaged in on whether to change the name ofthe BMC. We’ve decided that
with the start of volume 25, 2004, the name will change to: Journal of the Canadian Health
Association – Le journal de l’Association de bibliotheques de la sante du Canada.
INDEXING - Other news about BMC is that it has been picked up for indexing by IN-
SPEC. This database provides access to published information in the fields of phys-
ics, electronics, and computing, as well as biomedical engineering. The Board had a
lot of discussion about the relevance of INSPEC to our primary user group, and ulti-
mately decided that expanded coverage is a good thing for raising the profile of our
journal. Webmaster and PR Director Tim Tripp pointed out that INSPEC is a great
database when searching for any computing-related articles.
REWARDS FOR CONFERENCE HOST CHAPTERS - As recognition for the huge effort
CHAPTERS
that chapters put into organizing the annual conference, starting with the 2002
conference, the Association has decided to award 5% of any profits to the chapter
(s) hosting the event. Regardless of whether a conference is organized by a single
large chapter or by collaboration between several smaller chapters (as happened
this past year), hosting the annual conference takes significant initiative and en-
ergy. The annual conference is one of the major ways that CHLA/ABSC achieves its
goals regarding professional development, continuing education and chapter devel-
opment. Chapter involvement is what allows the conference to move around the
country, making it more accessible to all our members, so it is mutually beneficial
to offer some tangible rewards to the chapters for their hard work.
CONFERENCE FEE WAIVERS - As well, the 2002 conference marked a change in
policy regarding the payment of registration fees by planning committee members.
This was the first conference for which registration fees for the planning committee
(chair and subcommittee chairs) were waived. CHLA/ABSC runs on volunteer labour,

14. Page 1 4 Volume 26 Issue 3
and there isn’t any monetary recompense for the time that everyone puts in – on
the Board, editing the BMC, serving on committees or task groups. However, the
Board recognized that serving on a conference committee is a different obligation.
It demands time from the volunteers, and also requires the payment of registration
fees in order to attend the conference, to ensure it run smoothly. Often the plan-
ning committee members miss large parts of the actual conference, as they attend
to the organization of the event itself. This fee waiver is another tangible way to
support the chapters that host the annual conference.
SPEAKING OF CONFERENCES - This year the CHLA/ABSC conference is being held
much closer to home, so I’m hopeful we’ll have a strong western presence. Edmon-
ton, AL is hosting the conference from May 31 - June 4, and by now HLABC mem-
bers should have received their preliminary programmes. If you haven’t, it is also
up on the website at <http://www.chla-absc.ca/2003/>.
Make the most of your travel arrangements by planning to attend the 2nd Interna-
tional Evidence-Based Librarianship Conference, also in Edmonton immediately fol-
lowing our conference June 4th to 6th. The EBL website is: <http://www.ualberta.
ca/~pryan/EBL2003.html>
The next two CHLA/ABSC conferences will be held in St. John’s, Newfoundland
(2004), and Toronto (2005).
STANDARDS REVISION - The working group to revise the “Standards for Library and
Information Services in Canadian Healthcare Facilities” will be formalized at the
PreConference Board meeting. It is hoped that a policy statement on the use of vol-
unteers in health libraries will be included in this revision. Past-President Jessie
McGowan has had several volunteers step forward, but would be delighted to have
more, so email her if you’d be interested in participating: past-president@chla-absc.
ca.
ORAL HISTORY PROJECT – I had mentioned this project at our AGM dinner in June
2001, but the project had stalled as the three person volunteer committee had too
much other work to do. Now, however, the committee has kicked into a higher
gear, and they hope to send the Oral History interview kits out to each chapter this
fall. The purpose of the project is to preserve the experience and recollections of
members who have played an important part in CHLA’s or the local chapter’s his-
tory. The collected and transcribed interviews will contribute to the body of knowl-
edge about medical / health librarianship in Canada. Chapters will do the real work
(selecting individuals to be interviewed, and individuals to do the interviewing). The
HLABC Executive will be looking for volunteers, when they finally receive the Inter-
view kits and instructions, but in the meantime, if you think you might like to get in-
volved with this project, or if you would like to recommend names of people that
should be interviewed, send me an email.

15. HLABC FORUM Page 1 5
NOTES FROM THE AFTERLIFE
A SERIES ON RETIREMENT AND CAREER CHANGE
DISABLED: MOI?
The phone rang at 3 p.m., the caller was my surgeon’s office assistant, and the
message was urgent. The patient scheduled for a hip replacement next day had
suddenly cancelled. I’d spent nine months waiting for the same operation, with at
least four more to go. Now it could be done tomorrow morning, if I could drop eve-
rything and check into Vancouver General Hospital at 7:30 a.m. Was it possi-
ble . . . ?
It was indeed. For one thing, I was retired, as was my husband. So, no need to deal
with work schedules, and my five days in hospital would give Leslie time to set up
most of the systems I’d need at home during rehab. The other factor was simply
that my arthritic right hip had been in the so-called “bone on bone” state – no car-
tilage left – for most of 2002. I relied on a cane for the painful walking I could still
manage, and was now worried about my (so far) normal left leg. How long could it
take the strain until it too began to go?
The wait for surgery had taken other tolls. I’d been fit before, but lack of aerobic
exercise had boosted my blood pressure to the point where I was on daily medica-
tion. We’ve all seen the statistics on B.C. waiting lists for O.R. facilities. Spending
months as one of those statistics, I learned first-hand how untreated patients tend
to develop serious new problems related to the wait itself. Result: still more medi-
cal intervention, all at a cost to the overall system.
************************
Here endeth the first lesson. On to VGH and a week on the orthopaedic
endeth
ward!
************************
Surprise #1 was having a bed by a window with a fabulous view, in a week of bril-
liant October weather. What a picture to return to after virtually painless surgery –
even though my 10” incision, closed with over 30 tiny staples, had friends calling
me the Human Zipper.
Surprises #2 through #6 soon followed.
#2 Nursing Staff Far better, and less obviously stressed, than I’d expected. All
the same, our four- person ward never got the same team twice, and the senior
nurse on my first day turned out to be on HER first day too. She was still unpacking
after a move from Winnipeg.
#3 Food Another surprise: soft-boiled eggs, forsooth, arriving both piping hot
and soft-boiled! (So those urban legends about VGH having all cooking done in
Burnaby in exchange for laundry are possibly untrue?) At breakfast we chose next
day’s meals, and the options were healthier and more creative than our group had
expected. Even the coffee rated at least a B+.

16. Page 1 6 Volume 26 Issue 3
#4 Surgeon’s Followup But how I envied my three roommates, who all got
4
prompt, friendly and informative post-op. visits. My surgeon, a hotshot specialist,
had been brisk and taken an engineer’s approach to my hip before the actual op-
eration, but I’d hoped for more of a bedside manner afterward. Ha. Surgery was on
Tuesday, I saw no one but his resident until Thursday, and my longest conversation
with Dr. G. was on Friday morning, by which time the head nurse was concerned
enough about my red blood cell count to recommend a transfusion. El Supremo
seemed annoyed, since he’d hoped I could be discharged that day, and asked ME
whether I wanted one or not! This gave a whole new meaning to “patient-centered
care”, and the nurse’s expression was a study. [P.S. Eventually all agreed on one
unit of blood, which made such a difference that I was homeward bound the next
day.]
#5 Ward Equipment Ouch! Three of the four beds were standard, but I had the
fourth. It seemed to be equipped with the hospital version of an air mattress, which
kept deflating – the one event that, ironically, went unnoticed in all those checks
of vital signs that had us wearily offering up our wrists at 5 a.m. Finally a friendly
nurse hijacked a temporarily unoccupied bed, a huge aid to sleep and recovery.
Speaking of vital signs, it was about then that our blood pressure readings were
found to depend entirely on which of the ward’s two machines was used. When
checked, both systolic and diastolic results averaged about 15 points apart. None
of the VGH staff had been aware of this, or knew how long it had been going on. All
these readings, right or wrong, had now become a permanent record on our charts.
Ouch again!
#6 The Human Factor I learned just how much ward mates can affect the first
few post-op. days. Room #619 proved a good place to be. The three of us with hip
replacements – especially the young woman who’d just had her second – could
trade experiences and support each other. Our fourth member had just had her
horse throw her, then fall on her, the day before her son’s third birthday party. In
comparison, we “hippies” felt almost guiltily fit. Happily, all four of us were dis-
charged in good shape on almost the same day, feeling as bonded as a winning
team.
Rehab; or, Home Was Never Like This
Hands up, those who knew that there are different types of hip replacements.
Hands up again, those who did, but thought that younger patients get the one with
the shortest recovery period. Before surgery, I would have answered both ques-
tions wrong. There’s an epoxied “cement job” for those who will likely be too old for
surgery before the two artificial components need replacing. The rest of us get a
tightly-fitted cementless installation. Those prostheses have a special textured
coating on their outer surfaces so that bone will adhere to them in time and create
its own organic bond. Both groups need to, literally, tread very carefully for at least
three months after surgery, as the pain-free but slippery hip head and socket can
dislocate rather easily, and the new muscle attachments are prone to sheer off un-
der stress. Further, the “cementless” patients have to avoid damaging the bonding
of new bone to their artificial hip inserts.

17. HLABC FORUM Page 1 7
The list of things I couldn’t do from November 1 till February seemed endless. No
walking except on crutches or a walker; no driving; and no sitting on ANYTHING –
toilet included – unless it’s raised several inches above knee level and, preferably,
has arms to help take your body weight. (For a toilet, this means renting or buying
a second-storey seat with hand grips) No sleeping on your newly raised bed unless
you also have a pillow between your legs at all times. No crossing your legs ever,
asleep or awake, even at the ankles. No baths for the first two months; showers
only while sitting on a special bench, using a handheld shower head. And the
clincher: no bending forward at the waist beyond a 90° angle to your upper legs.
This means no sitting down or getting up without careful thought, no standing and
reaching lower than your knees, no deep knee bends, and certainly no putting on
shoes, even from a sitting position, without special aids. Actually tying those shoes
requires a second person, unless you’re better with a long-handled reacher than I
am.
Don’t worry: if that second person isn’t available for a good part of every day,
home-based rehab would be impossible anyway. As we live in a one-level condo
with an elevator outside the door, at least I never had to tackle stairs. But I DID
think I could use my walker/crutches and still help with cooking and housework.
That idea lasted about 48 hours. Gripping walking aids, you can’t hold or carry any-
thing. Leaning on a kitchen or bathroom counter, you have the use of your hands,
but now can’t move. Either way, say goodbye to things like accessing stuff stored
below knee level. You’ll also miss being able to move food or drink more than a
few feet without help, reach the lower levels of the fridge, oven and cupboards,
make the bed, deal with garbage, or even water most plants.
Shopping means more tough lessons. Unless a store is within a very few blocks,
you probably can’t make it on crutches for the first two or three weeks post-op.
Even then, better hope they deliver. (For one thing, picture trying to just get things
to the checkout unaided, much less carry them home.) If you have a companion to
run errands or drive you, as thank goodness I did, don’t forget you can’t ride along
unless the passenger seat is topped with a rehab-thickness cushion. Unless you’re
double-jointed, good luck too on getting in and out within the “no bending” rules.
Then there’s the worst-case scenario: multi family birthdays, a special anniversary,
Christmas and New Year’s all coming up before you can hope to graduate to a
cane. I’m here to say it can be done. Watch those bright ideas about celebrating
outside your own home, though, or having a bit of a night out when it’s all over. Re-
member, you still can’t use any bathroom near or far unless it has (all together
now …) a 5” raised toilet seat with hand grips!
Notes From The Afterlife is a continuing feature, focusing on retirement or life-
career changes. Editor Elsie Wollaston hopes to be walking unaided again -- pref-
erably in Mexico – well before this is published. We welcome your ideas for stories
or interviews. Phone Elsie at (604) 684-3036 or e-mail elbruijn@interchange.ubc.

18. HLABC FORUM Page 1 8
• Awaiting a hip replacement, you check more arthritis-friendly climates. Next
thing, you’re. . .
-- 2000: renting a small cottage in the Mexican lake country for $10 a day.
-- 2001: adding a car -- i.e. driving an aging mini-SUV convertible 6,000 km.
down from Vancouver. Bum hip and all, a great October adventure -- sun,
scenery, and no tourists (all back at work or in school.)
-- 2002: bunking overnight guests in living room until -- olé! -- landlord offers
a 10-year lease on new 2-bedroom view house for same price. Still time to
choose paint and tiles. So what if your husband is colourblind?
• Meanwhile, friendship grows with the owner/chef of Patzcuaro’s only South
American restaurant. She wants creative new recipes for local ingredients. You
guessed it: now both working on an informal mult.-cult. cookbook. Still search-
ing for more things to do with fresh quail eggs.
And that’s just the top 10 on the Unexpected Retirement Stuff list. Don’t
askabout the 5-month condo renovation from hell . . . the daughter who’s
confessed she writes Harlequin paperbacks in her spare time. . . or finding
that for some volunteer library jobs, you actually have to join a queue. (So
forget it, you can’t have my Sunday spot pretending I run the amazing
5,000-volume VanDusen Gardens collection -- but you CAN visit and see
what I mean.)
_____________________________
* Oh yes, about writing this in a tomato bed. No, nothing to do with VanDusen. That
condo renovation paved over our former roof garden, and when the tears dried, it
turned out the tomatoes had been sitting on prime real estate. Now it’s a pocket
patio outside the bedroom, just big enough for two people and their favourite flow-
ers. Another reminder to go with life’s surprises and enjoy the results. Even if
you’re no longer working, trust me: you won’t be bored.
_____________________________________________________________________
Notes From The Afterlife is a continuing feature. We welcome your ideas. Phone
ElsieWollaston at (604) 684-3036, fax (604) 685-9335, or e-mail el-
bruijn@interchange.ubc.ca.