Review the VA's medical facilities? No! Do tell!

I found this on Advisory.com today, which is a login-only website with information for healthcare folks (administrators, doctors, developers, architects, and that ilk). I’ve copied it here for your infotainment.

VA secretary orders mandatory quality review of all facilities 03/13/2007

The Department of Veterans Affairs (VA) has issued a directive ordering its 1,400 hospitals and clinics to conduct a “full and immediate review” of facility environments, the Associated Press reports. The order, which was issued last week by VA Secretary Jim Nicholson in an internal memorandum to the department’s medical center directors,comes just weeks after reports surfaced of “roach-infested conditions and shoddy outpatient care” at Washington D.C.-based Walter Reed Army Medical Center. In the memorandum, Nicholson said that the disclosure had “compelled him to redouble efforts to improve the physical environment” at the VA’s outpatient and medical facilities. He mandates that medical center and network directors conduct and supervise the reviews and says that “negative responses are required.” The reports are due by March 14.

In the wake of the revelations about Walter Reed, Nicholson also has increased post-traumatic stress disorder treatment resources, taken action to expedite claims for veterans whoserved in Iraq and Afghanistan, and announced plans to launch an “aggressive hiring program” to hire 500 new
benefits coordinators by June; however, Sen. Claire McCaskill (D-Mo.) has called for Nicholson’s ouster in favor of someone “whose first priority [is] the veterans and not the politics surrounding the agency” (Yen, AP/Washington Post, 3/13).

Really? A full and “immediate” review? And it only took weeks? Not days, but weeks! Well, for government work, I guess that’s pretty fast.

The sort of thing we all saw at Walter Reed angers me for two reasons. The first is obvious: we send young men and women to fight a war and this is the best we can do to treat our wounded? What, we’re only really proud of the ones that don’t step on IEDs or something? Second, any private facility (such as MCRI, my future project), or at least any nonprofit facility in the civilian sector (such as Wheatlands) would have been whipped into shape months if not years ago. Why? Because there’s a lot of inspections going on. Nonmilitary healthcare facilities have to be inspected by first the health department and the state (if not also a city) department of healthcare facilities, and these facilities are inspected periodically after they open. Not only that, but if your facility takes Medicare and Medicaid, then CMS (Center for Medicare Services) will inspect your ass. And if your facility is a Level I trauma center, it gets even more inspections. And if your facility undergoes JCAHO inspection in order to lower its insurance rates, it gets inspected a metric shitload. On top of all this, if a civilian saw a mold-stained wall or plaster peeling in their hospital room, you bet your sweet ass someone would be hauled into court over it.

The point is, someone outside of the VA should be inspecting its hospitals. Just because we pay our soldiers shit doesn’t mean we get to treat them that way when they’re in the hospital.

CPR for my PR

With everyone and their mom in Taterville this week, I had the actual "luxury" today of working on my PR for Wheatlands. Before I begin, now is as good a time as any to review a bit of architectural lingo and explain how we do projects.

The architect draws a set of drawings that show the contractor what to make and for the most part how to make it: what size, what materials, so on. All the engineers throw their drawings in this stack too: structural, mechanical, plumbing, and electrical, as well as (depending on the project) the medical equipment consultant's stuff, the food service stuff, the laundry stuff, and the low voltage/technology stuff. This set that's originally given to the contractor is call the construction documents, or CDs. Sometimes, the design team can't get everything in the CDs before they go out, or they suddenly realize there are things that need clarification, so before the bidding is complete (if you have construction companies bidding on the CDs), the design team will put out an additional set of drawings called the addendum. After construction starts, there are names for the changes made. First and foremost, the contractor sends a request for information, or an RFI, to the architect (or other member of design team) when something isn't clear, or if the documents conflict with themselves or with the existing conditions if you're remodeling. Sometimes, when I realize I forgot something or need to change something, I ask the contractor to send me an RFI and what to say in it--this makes them look smart and allows me to mostly painlessly fix my error. When the owner asks that something major be changed, deleted, or added, or if the design team discovers that they need to change the documents in a major way because they forgot something or messed something up, the architect issues a proposal request, or a PR, that includes drawings and/or documents that tell the contractor how to make the change, addition, or deletion. Now, just because the architect issues a PR doesn't mean it's gonna get built. The contractor gets a price for the PR, then issues a change order, or CO, to the owner, and the owner can decide if they wanna go through with it (if it's something that's a want, not a need).

Okay, so back to the title of today's post. For the past three weeks, I've been working on a PR for an ambulance enclosure and canopy for Wheatlands. It was in the original CDs, but we called it an alternate at the time in case they had the cash to build it later. Well, they still don't have the cash to build it with only 90 days left before they open for business, but the hospital has asked the design team to make the drawings for it so that when they do have the money, they can just git 'er done, as it were. My mechanical and electrical engineers have been toiling away on this thing for a couple of weeks, but I haven't been able to do jack squat on it because I've been all over Pomme de Terre like a handsy prom date last week. Finally, I had a chance to work on it again today, only to nearly pour a little Bailey's in my coffee. I looked at my drawings and called my structural engineer, Danny.

"Danny Minero," he said into his phone.
"Danny, our ambulance barn is gonna be taller than the goddamn building," I sighed.
"Oh, punkin, what seems to be the problem?" he cooed.
Danny and I have worked together on every job but one that I've worked on in the past 6.5 years at DA. He's gone from being a lowly engineer to part owner of his company, Minero Gibb Associates. And he likes to dance. We get along famously. Moreover, he's about Guy's age and they also get along quite well.
I then had to explain to Danny that the ambulance doors have to be twelve feet high, and if the doors coil above the doorway instead of running along tracks above the ambulance parallel to the ground, that's another 1.5 feet, which makes us 13'-6" above the ground, and then he has a beam running across the barn over the door for lateral load-
"--which would have been a W12 beam, but if I've got to attach the weight of a 12-foot by 12-foot garage door to it, then I've gotta make it a W14--" he says.
"--which is another 14 inches on top of my 13'-6" high door, which is now 14'-8"--" I interrupted.
"--and if we're gonna use a minimum slope of 2:12 on this roof--"
"--that puts the top of my roof on this wide-ass ambulance garage--"
"--that no one can afford--"
"--yes, that no one can afford, at 18'-2". And the top of the wall on this side of the building is 18'-0"."

Silence.

"Pixie, our ambulance barn is gonna be taller than our goddamn building."
I sighed again. "Thanks, Perry Mason."
So Danny has to go back and see if we can fit the beam in the wall or fit the door in the wall or something, but I don't know what. I'll just call him again tomorrow morning and hope for the best. This PR is due on Friday.

Well, at least mechanical and electrical are doing well. Someone has to.

God help me, I think I wanna teach.

It seems like a good idea, though I'm sure I can hear Miss Kitty warning me like an academic Cassandra from across the miles, "noooooo!", but sometimes I think I want to teach architecture in college. What would I teach?, I have to ask myself. Studio is the obvious answer, but it's one from which I shy away. Despite the fact that it's the most time intensive and in some ways most important class you take in college, it's not necessarily the one I was best at. Indeed, I was functional in Studio; one A, one C, and every other quarter and semester I took it in six years, I earned a B or B+. My strengths in Studio lay in space planning, buildability, meeting a program, and having all the required drawings and models ready when pin-up time came. Design, however, was not my strong suit. My stuff was a bit on the prosaic side. However, I wish at times I could go back and tell my sad little self at the time not to worry--the strengths that earned me scant Bs in college would earn me accolades and promotions and respect in the workplace. Pixie can make you a hospital, y'all. Or, as my big boss Alex once supposedly said in a partners and associates meeting, "Pixie rocks!"

Nay, I think I'd be better suited to teach a Materials & Methods course, which is the year-long or more class where the kids learn how buildings go together. I'd be even better suited perhaps to teach a more focused design studio in which the kids understand how spaces go together. But most of all, my soul cries out to teach architectural psychology--the hows and whys of the ways a space can make you feel. Architect Richard Neutra used to proclaim that he could design a house such that any couple that moved into it would be divorced in a month, and I don't doubt it. Frank Lloyd Wright understood more so that the Internationalists (Le Corbusier, Mies van der Rohe, and later Phillip Johnson) did that the built environment deeply affected the mind and soul of a person. We've only in the last 25-30 years or so began to understand ergonomics, but when will we really understand and take to heart how a building affects those who use it as well as those who see it?

I take my interiors to heart, perhaps too much. When I was wroking on Wheatlands, my coworker Derek joined the design team in order to do the exterior of the building. "Thank God you are," I told him. "I forgot this building needed an outside." It's not that I don't care how a building looks from the outside, but...well, given that I'm a limited energy system, I kinda don't. I care more how the inside spaces are arranged, will be used, will be perceived. Perception is reality, Howie once said to me, and I believe it. It doesn't matter if you gave someone the most expensive carpet available; if it looks cheap and reminds them of a cheap carpet, they'll be unhappy. If you gave someone the best facility with a great design, if they aren't happy with it or feel like they got left out of that design process, then they'll never be able to accept the "reality" of what you've given them.

What I'd love to do with those students early on is hold up a copy of Domus or Architectural Record in one hand and a copy of Hustler in the other and say, "As far as I'm concerned, these magazines are the same thing: they're porn. They're purely for your masturbatory enjoyment."

I'd then throw both magazines in a trash can and proclaim, "You're not designing your masterpiece, your building; it's their building. It's your client's building. And while you'll have to step in occasionally and save them from themselves, you must never forget that when it's built, you can walk away, but they have to live in what you make them. So make it right."

Then I'd burn the contents of the trash can and move on to the first lesson: learn to listen. Seek first to understand, then to be understood. It's the hallmark of any good professional, regardless of one's field.

Class dismissed.

If everything's an emergency, then nothing is.

I was so exhausted at the end of today that I called the pizza delivery place before I left work so that it would be almost ready by the time I got home. My little plan worked, too, by the way--the delivery guy called from our condo building's lobby less than ten minutes after we walked through our own door. And Lawd, did I need a break.

The morning was spent frantically trying to get redlines done so we could print this afternoon. Susanna, Leslie, and Howie will be on a plane early Monday morning heading back to Taterville and Pomme de Terre for another round of user group meetings. See, architects print out their drawings and mark them up, usually with a red pen, noting things that need to be fixed or making notes of the changes the owners want. Hence, we call these redlines. However, I've had a hard time finishing the redlines from the last round of meetings at PdT, because everytime I'm nearly done, I have to go put out a fire on Wheatlands and someone makes more changes to my drawings on PdT while I'm off working on Wheatlands. The past few weeks have been a neverending battle to finish the redlines I was assigned. I originally designed the ground floor of the new tower as well as the renovated parts of the existing building, so I get to do the redlines for it as well.

So, this morning, I'm trying to do the last remaining redlines on my plans, and Howie lumps a new task on me to be done before the end of the day. Then Thurston asks me if I've talked to the food service consultant and seen the plan he sent (no, I haven't, just give me that plan in your hand and I'll draw it into my CAD plan), then he runs off to scan it--no, he'll make a copy--well, would I rather him scan it or copy it ? (I'd rather you hand me the fucking sheet of paper in your hand right now and I'll draw the goddamned thing.) Then he goes off to copy it. (Jesus God, just hand it to me, Scooter Bob.) Then Leslie comes over to announce for the fifteenth time that she's leaving at one and Susanna will be bringing all the plans to the airport and here's a list of things that need doing and here's why (honey, I love you and you're a great architect and I know you only have a couple of tests on the ARE to go, but I can't get anything done if you stand here and keep giving me unnecessary details) and she has to leave at 1pm but here's a list of what else needs to be done.

I've finally had enough and Sarge talks me into going a few blocks away for lunch. I abandon the salad I brought and run out the door before anyone can stop me. I suppose I shoulda stayed and worked through lunch, but Shorty is fresh ourt of give-a-damn. When every day spent on this project is a fire drill, then I no longer have the room in my head to process. Not only that, but this project has had me so busy I've neglected my own project (you know, the one that's three months away from being done?) and have drawings that are overdue to my consultants. I would have had some of those things done this afternoon, but I spent the afternoon doing more of the same. Combine this free-for-all with a frustrating search for drawings that printed to the plotter on the wrong floor of our office which involved me looking for my drawings and Susanna looking for me to tell me she'd found the drawings, and she and I were both ready for a margarita. We spent the last hour of the day marking up the overall plans with colored markers to show which departments were where and singing lines from the musical "Chicago," which I suddenly can't stop singing.

Also, because I was so busy this afternoon, I didn't have time to put together a kick-ass Detail of the Week (I had to beat the pizza guy home, okay?), so I promise you architectural enlightenment and infotainment on Monday, okay? Okay.

In better news, though, our building's HOA finally got the roof on the pool and I had the most wonderful swim this morning. We're looking forward to a pretty quiet weekend, so I'm gonna go enjoy it. Holla.

Worn out, but my building looks nice.

I spent six and a half hours roundtrip in a car with my mechanical engineer going to and from Wheatlands, which for the most part was good. My building looks so good, y'all, I can't even stand it.

Here's the deal: it takes a long time to build a building, especially a hospital. Design Associates got the Wheatlands job in the summer of 2004, when we started helping them find a site. I started working on the project in the fall of 2005, at which point Howie and I met continually with the departments of the hospital to figure out how the hospital should look and how the plan should be laid out. We completed the documents on the exterior and structure in the spring of 2006, and the contractor started building it. Documents for the interior was finished in early summer 2006, and that construction began shortly thereafter. This building has been a long time coming. It takes so long to get to this point, and I FINALLY get to see my drawings come to life.

It occurred to me as I was walking through the building today that I drew every single piece of casework in that building. That's seven 30" by 42" sheets...30 walls of cabinets and shelves and drawers and doors per sheet. I drew every room in the building...68,000 square feet of doors, walls, and windows...a label on each wall telling them how to build it...a label on each of about 200 doors telling them what the door looks like, how big the window in it is, if it's rated for fire, if it has closers or smoke seals or is controlled by a push-button or electric eye...every ceiling and light...every chair.... Just about everything in that building, I either drew or had to amend a fair amount when changes were made.

Yes, we architects drink. But sometimes, we drink champagne.

...and now for a nice story about my sister.

It was a nice, quiet day today. A few meetings with Howie and the partner in charge of Pomme de Terre, whom we shall call Bosley, and lots of quiet drawing was all I did. Hence, I'm in a mellow mood and would like to share a good story about my sister and fellow blogger, Miss Kitty. This story does not deal with talking in her sleep or kicking me, but rather it's about her generosity.

Now, bear in mind that Miss Kitty is tough. Despite the fact that I used to outweigh her by nearly twenty pounds, and these days I'm all muscle, she can still throw me off of whatever surface I wrestle her on. If I try to fart on her on her bed, body-slam her on a sofa, whatever: doesn't matter. Two flips of her size 6 1/2 feet and my supposedly-strong ass goes a-flying. But she is also a very thoughtful person. At least she tries to aim her younger-sister-shaped projectile towards another soft surface to land on.

Case in point: my visit home for Christmas. Kitty and I took a couple of great shopping trips, one of which included a trip to Small Town Mall to buy some decent fitting jeans for yours truly. On the way to the dressing room, Kitty, Mom, and I walked past the shoe section of a local department store. Kitty and I locked onto the same shoes: shiny, high-heeled with a little platform, round toe, utterly sassifistic. "Ooooooooh!" we both chorused.
"In harmony," quipped Mom. She finally saw them. "Oooooh! If my back was better, I'd wear those in a heartbeat!"
We were short on time, and as any woman knows, shoe shopping takes time as well as patience. Hence, we decided to return later that week to check out those shoes, perchance to purchase them and take them home and look eternally c ute in them.

Alas, our shopping trip took us to a larger town and we never made it back to Small Town Mall for the shoes. Oh, readers, they were not just shoes, they were the Cutest Shoes Ever. After I returned to Denver, I recalled the brand, so I checked every website I could for them: Zappos, Amazon, eBay, even Nordstrom's and Macy's. All for naught. The only site that had them were a website for the department store in the mall, and they only had sizes 8 through 10. I wear a 6, a wee, pesky 6. I was a bit crestfallen, I have to admit. I knew they'd be the Cutest Shoes ever on me, but I would never know.

Until...

A week after Christmas, Kitty calls me from Georgia at work.
"Hi, this is Pixie," I said into my office phone, not even looking at the Caller ID.
"Pix, it's Kit," Miss Kitty said excitedly. "I'm at Small Town Mall trying on our shoes, and they have a 6. Do you still want a pair?"
"Bitch! I've been thinking about those shoes for a week!" I hissed loudly, jumping out of my Herman Miller desk chair. Howie, who still sat next to me at the time, looked at me with a bit of alarm, then tried to act like he didn't notice his trusty intern acting a damn fool over some shoes.
"Okay," said Kitty. "Let's see, a 7 is too loose on my heels--"
"Your feet are narrow anyway," I said. "Try a 6 1/2."
There we were, 1,500 miles apart, trying on shoes and laughing our asses off.
"How do they feel when you walk?" I inquired.
"Not bad, not bad...not too bad," she replied.
"Try walking on VCT."
"What the hell's a VCT?"
"It's that 12-inch tiled, hard, plasticy-flecked flooring in the walkways in the store. It's a ubiquitous commercial flooring material. You do know what ubiquitous means, right?"
"Yes, doofus. I've read a lot of books in my day, and not all of them were coloring books."
"Yeah, yeah, go walk on the VCT."
"Hang on...hm, okay. They're pretty good on the VCT too."
"Fuckin' A. Get a bitch a pair and the check is in the mail."

Another week later, I get a package in the mail, return address "Miss Kitty's House of Tasteful Ladies' Clothing and Accessories." Inside were a few goodies, a pair of the Cutest Shoes Ever, and a note saying "You don't owe me anything for these. Merry Late Xmas!"

This is one of a billion reasons I love my sister.

Architects: not as intellectual as you think

Many out there get the impression that architects are erudite intellectuals in constant pursuit of avant-garde design and brilliant discourse with one another and maybe, if they so deign, the public. They imagine that we sit around in our black turtlenecks and little black eyeglasses with tiny cups of espresso and discuss deconstructivist philosophy while we use words like, well, "erudite."

Wrong. (w)Rong with a capital R.

Granted, we're pretty intelligent. You have to have at least a modicum of intelligence if you can look at two-dimensional drawings and assemble them mentally and envision a three-dimensional space and suddenly know that the soffit over the nurse station is going to hit the door frame. However, this does not preclude us from having conversations like the one we had Friday afternoon.

Our office is mostly open. Only conference rooms are fully enclosed. Desks are located in rows that butt up against a wall that's about 3'-6" high. It's high enough that you can get a little privacy for most conversations, but you'll duck into a conference room if you need to call your doctor or parole officer. What this means usually, though, is that four or five people will get drawn into a silly conversation that gets sillier the more people you throw in. On my side of the wall, I sit between Derek, who's in the process of taking the ARE, and Clarence, who's been licensed for about six years and runs his own projects. Just over the wall from me is Jimmy Ray, an intern for about four or five years who's just getting his licensing paperwork started, and over the wall from Derek is Elliot, who is in the process of taking the ARE as well. I sit by some great people. Derek, Jimmy Ray, and Elliot are about my age and Clarence is in his mid-thirties. Derek really knows his stuff with exterior building systems and is great for checking a detail, and he also has a lovely subtle sense of humor. Clarence can provide great advice at any stage in a project and is a bit on the geeky side; he's the most unlikely to say something bizarre or funny, but when he gets going, he's hilarious. Jimmy Ray is a 3D modeling genius and looks like a redneck from Arkansas but is the most likely to tip a drag queen with a five-dollar bill in his teeth. (He's just really secure in who and what he is and has the widest collection of disco music I've ever seen.) Elliot is a great reality check on projects as well, and we're quite the Mutt and Jeff. Elliot is 6'-6" tall, and I clock in at barely 5'-0" tall. When Elliot holds out his arm, I can walk clean under it. Even wearing heels.

Oh, and Jimmy Ray sits on one side of Elliot, and Howie sits on the other side. When I stand up, I can see Howie's face and get his attention. If he's not on the phone, that is.

Anyway, Derek had to leave early on Friday, just before Sarge strolled up to Jimmy Ray's computer and saw some paperwork on his desk. Hence, I blame Sarge for starting all this:

Sarge: J.R., you finally getting around to filing with NCARB?
Jimmy Ray: Yeah, and I just sent off my shit to AIA. I'm finally an Associate AIA member. Whoo.
Pixie: [standing up so she can actually be seen over the wall] Oh, yeah? Well, I just got my certificate saying that I'm a full AIA member!
Clarence: (not looking up form his computer) Yeah, and your dues jump from $150 a year to $650. Good thing the office pays for it.
Elliot: What? That's bullshit! Kinda takes the shine off your new AIA certificate, duddn't it, Pixie?
Pixie: Yeah, this certificate and four bucks gets me a latte at Starbucks.
Jimmy Ray: How'd you go from associate to full AIA? Cuz you got licensed?
Pixie: Yep. Still haven't gotten my architect's stamp yet.
Clarence: (turning around from his computer) Why should you? I was gonna get my stamp, but the state laws say that if you use your stamp, you have to have liability insurance in case you fuck up something you stamp. I don't need that kind of hassle.
Pixie: I was just gonna use it to make my Christmas cards.
Elliot: Can you be sued if you just stamp a postcard with your stamp?
Clarence: If someone tries to build something off of it, then yeah.
Sarge: Ewok upstairs said he was gonna get his and stamp his ass with it.
Jimmy Ray: Eeuuw. That hairy bastard would put an architect's stamp on his ass?
Pixie: Well, we don't have to worry about anyone building anything from those plans.
[all laugh]
Pixie: Marco said he used his stamp to stamp an entire roll of toilet paper.
Clem: Toilet paper?!
Jimmy Ray: Why, so he can wipe his ass with his own acheivements?
Sarge: Well, then you'd have to use waterproof ink so it wouldn't smear.
Elliot: Or you'd have to wipe again to get the ink off.
Clarence: [turned back to his computer monitor] Not with my toilet paper. I use that recycled stuff. Damn, that paper's rough.
[all but Clarence laugh]
Sarge: So Clarence, you take exfoliation to the next level, huh?
Clarence: Seriously, I mean, have you ever used recycled paper TP for a while and then used some soft name-brand stuff? You're like, "God, this is a Rolls Royce on my ass."
[group cracks up again]
Sarge: [unable to speak, holding sides and laughing] What...how.....!
Clarence: I mean, I'm really takin' one for the team just to save a tree, though it feels like I'm wiping with one sometimes....
Pixie: There are very few things Guy will buy name brand; toilet paper is one of them. He gets that super-nice Cottonelle with Aloe and Vitamin E. I saw it and said, "Jesus! Aloe and Vitamin E belong in my moisturizer, not on your ass!"
Elliot: Save the cash, Pix! Just rub toilet paper on your face!
Jimmy Ray: Man, I bet Guy's ass is nice and smooth.
[everyone does a double-take at Jimmy Ray]
Jimmy Ray: I'm just saying!
Sarge: [still laughing] Why would Guy's ass be smooth? What, does he shave and moisturize?
Pixie: Oh, please! I can't get him to shave his back! How could I get him to shave his ass?!
[group dissolves into laughter; Howie returns to his desk from a meeting]
Howie: [big smile] Hey, everybody! What's so funny?
[group looks at each other, collapses into laughter again]
Sarge: [walking away from the group, shaking head] Some sick, sick people work for you, Howie....