Petra Howell-Vasale

You gotta meet people where they are. You've gotta remember that they're humans. You've gotta remember that they have extensive circumstances beyond our knowledge that are absolutely none of our business, but you have to offer them the best care every time they show up here.

Kristen Carpenter

Hi, I'm Kristen Carpenter, and this is Appalachian Care Chronicles, a podcast bringing you stories from every corner of West Virginia's health sector. Join me as we journey alongside a variety of problem solvers, change makers and daily helpers who are all working behind the scenes and on the front lines to care for our communities together. We'll explore what they do day to day, the steps that got them there and the whys that continue to draw them back. How, in the face of some of the most challenging situations possible, do they manage to keep themselves and the rest of us from falling apart? Far from predictable, the paths they've walked are full of twists and surprises, discovery and purpose. This podcast is for anyone who's ever thought about going into the healthcare field or has a Passion for caring for others in times of need.

Kristen Carpenter

Today, we're heading into the fast paced, emotionally charged world of the emergency room, our guest is Petra Howell-Vasale, an ER nurse at Raleigh General Hospital in Beckley. Every ER nurse has that one case that is remembered forever for Petra, it was early in her nursing career, a little girl came in after a devastating car crash.

Petra Howell-Vasale

That was me pretty fresh in the ER, and it was really the first young child, you know, we're asking her what her name is. She kept saying, I don't know. I don't know, I don't know. And I said, Okay. I was like, Okay, can I call you Star? And she was like. She was like, yeah, yeah, that's fine. You know, the physician said she's really responding to you. Ask her these questions for me. And I was asking her, talking to her, she couldn't remember what her mom's name was. She couldn't remember what her dad's name was.

Her mom didn't make it. She was, you know, where's my mom? Where's my mom? So we're just, you know, “We'll find out for you. I'm not really sure I'm going to hang out with you. I don't want to leave you.” I had told her a couple times. I said, “My name is Petra. You tell me if you need anything, you know, I'm gonna stay with you. I'm not leaving you.” We had to take her to, you know, get some imaging done, CTS, that kind of stuff. And I got her back in her room. I said, “Do you, do you remember what my name is?” And she was like, “No.” I said, “It starts with a P. It sounds like p- p- p,” she said, “Potato.”

When they leave here, you don't really get any more information, so you always have that like that wonder about it, and when they're little. And I know she doesn't have her mom anymore, that one, I will never forget.

Kristen Carpenter

It was Star's pain and Petras’ reflex to comfort her that cemented what she already suspected: she was meant to be a nurse. Even if she took an unexpected path to get there. Many folks once knew her as the Cake Lady. She trained as a pastry chef in Kentucky and owned a small business for years in Charleston specializing in high end wedding cakes.

Petra Howell-Vasale

I was the pastry chef at a country club. I was a pastry chef at like a mom and pop and meat store, slash grocery store. My very first job was I was a pastry chef at the Hyatt Regency in Lexington. But that one didn't really like fill my soul, I guess because a lot of stuff. Stuff was mass ordered, pre made. It was my job to put a frozen piece of cheesecake on a plate and add the whipped cream and a strawberry.

I moved to Charleston, and I was a manager for Ellen's Ice Cream for several, well, several years. I had my daughter during that time, and Ellen, and I actually talked about me possibly purchasing that, but it wasn't 100% what I wanted. I did want to own my own business, but while I loved it, it just wasn't quite right. So that's when I decided I was going to open a cake shop on Quarrier Street. And that was Cakes By Appointment. I had that for six years, that business is feast or famine, and while I did build a lovely clientele, there's definitely slow times.

Kristen Carpenter

Petra is proof that it's never too late to learn she changed careers in 2019 returning to school at age 35 to get her bachelor's in nursing from WVU Tech in Beckley.

Petra Howell-Vasale

I started basically as a freshman. The only stuff that transferred for me was English credits, so I had to do the full four years. Have all the classes, have math, after 18 years of not doing anything but culinary math, I knew that I needed to do my BSN, because at that time, I needed to make sure that I gave myself the option that if I wanted to further my career for either, you know, a Master's or PhD later down the road, I already kind of had that BSN under my belt, so I just kind of set myself up for my future, whether I do something or not.

Kristen Carpenter

When she made the big pivot in 2019, it didn't come completely out of nowhere. She'd seriously considered both culinary school and nursing school after high school. Growing up, she'd spent a lot of time around medical providers. Her mom was a postpartum nurse, and Petra would often come with her to work. She helped to usher newborns between delivery rooms and the nursery. She answered phones, even fetched peanut butter and jelly sandwiches for new moms. Petra’s mom got diagnosed with cancer, and Petra was in the hospital to visit her instead. She was only 17 when her mom died. Two years later, her brother died of an overdose. Then, while Petra was running her small business, her stepmother got sick.

Petra Howell-Vasale

I'd go and I'd sit and I'd ask her if she needed something. She needed to be readjusted in her bed. Be, you know, given another blanket. “What do you need?” She was cold a lot. Ask her what she wanted for lunch. If she wanted something, I'd show she loved, love, love Sam's Uptown, Naked, Wings, All Flats, and I would pick that up for her and take it in. And so that way she could have something she wanted. You know, when you're in the hospital, if you're allowed to have a diet, you don't want to necessarily eat hospital food.

But her sister would come in and visit, and she just looked at me one day, and I mean, I was in my cake shirt, in my clogs, powdered sugar on my jeans, you know, that kind of day. And she looked at me, she said, “You do beautiful cake work. There's no denying that.” She said, “But you have totally missed your calling.” And she said, “You ask her things that I wouldn't even think of to ask. And everybody responds to you well, they answer your questions. You know, you don't. It doesn't seem like you're bothering anybody when you ask for something or if you need something, but you take care of her in a way that I just my brain doesn't work that way.” And at that time, she was a professor, and she's on she was on a board at WVU, and she showed up her next visit with an entire admissions packet and information about nursing school, and was like, “Here you go.”

Kristen Carpenter

As Petra stepmom’s health worsened, she was transferred to a cancer center in Columbus for further care. Petra would visit often to help her leave her dad, but it became harder to focus on her cake business.

Petra Howell-Vasale

I just wanted the best for my daughter, and while the cake business is lucrative, like I said, it's feast or famine, there are just times where it's not. But it got to the point that I knew that either needed to expand or change what I was doing, because I had recently been divorced, and I've got a little girl, and I gotta support her a little better.

I literally signed up for nursing school two to two and a half weeks before class started. I was like, I just am not gonna have the money for books. Like, I'm just not and I have three aunts, my dad's sister, my mom's sister and my stepmom sister, and they all paid for all of my books, the entire time, no matter what, whatever I needed for that, they took care of. And they were all so supportive. We had a group chat, they’d check on me all the time and make sure I'm okay and like, a proud kid, like I was sending my report cards to them, and they just kept telling me how proud they know that both my mom and my stepmom would have been of me, just the most supportive people ever.

Kristen Carpenter

West Virginia needs great mental health professionals. If you're practicing in an underserved area and need help repaying your student loans, apply for the Mental Health Loan Repayment Program through the West Virginia Higher Education Policy Commission, visit CFWV.com, to apply. That's C, F, W, V.com.

Colleague

So bed six today. His labs this morning came back. His potassium was 6.2, his lactic was 5.8 he had acute dialysis, and we'll start CRT tonight.

Petra Howell-Vasale

Okay, where was his permacath removed from?

Colleague

His right subclavian.

Petra Howell-Vasale

And where did they put the trial to right? Okay, all right. Do we know what we're waiting for now. Did you get repeat labs yet? Or do I need to get those?

My official title is an Offload Nurse and Flow Coordinator. My primary role is to reset EMS when they show up, get patient information, find out the reason that they're here for their visit, get them to a room quickly so we can get them offloaded so there's no delay in care. EMS communicates with Regional Command, and they're stationed here behind the ER. They will notify us as EMS notifies them, they'll say EMS three minutes or, you know, what sort of kind of what to expect, whether it's, you know, a basic kind of medical issue, it's a trauma. There's different levels to the traumas. So we can kind of get prepared for what that is, and if it is a more pressing issue, a more emergent issue, then Regional will overhead, say, “Charge nurse, call command,” and so they'll call and kind of get a quick update so we can let the physicians know what's coming in, and then we will get that report fully again when EMS arrives.

Sometimes it's just a person of a certain age that's on blood thinners that fell and were concerned about bleeds, if they hit their head, if they passed out, that kind of stuff. We could have a cardiac arrest, come in and have and then we get, like, a quick report, like witnessed or unwitnessed. We have no, no idea how long they were down. So we'll get that kind of information. And then when we come in, they'll give us a full report of because sometimes things may change just a little bit, but usually we're just pretty prepared for what's going on.

Colleague

…actually went from 5.8 to six, okay, but Dr. Solomon ordered for repeat labs. We draw it nine tonight

Petra Howell-Vasale

Okay, all right, I will get that taken care of. Does he have any point of contact? Does he have family?

Colleague

His daughter is at the bedside.

Petra Howell-Vasale

Okay, great, okay, wonderful. Anything else? Okay, thank you.

Hi How are you? My name's Petra. I'm gonna be your nurse today. I have to get some blood work on you, so I've got a couple of tubes here. I know it looks like a lot, but it's really not that much. I'm also gonna hook you up to this heart monitor. I'm gonna get your blood pressure, the cuff is going to blow up about every 15 minutes, and I'm going to put this little sticker on your finger so we can monitor your oxygen and your heart rate. Okay, you might hear some beeps on the monitor. That doesn't necessarily mean that there's any sort of emergency. It just kind of lets us know if things are a little bit out of range. But that doesn't mean that anything majorly is wrong. Okay? Do you have any questions for me? Okay, you gotta feel it get tight on your arm.

Kristen Carpenter

Petra was a full time nursing student and a single mom with a daughter in fifth grade, she commuted from Charleston to Beckley for class every day and assembled a list of a dozen friends and family members who could handle school pickups if she needed some support. Her first year, a friend set her up on a date with an Athletic Director at WVU Tech over pizza and beer, she told him her life story and shared one revealing detail: in high school, she was a competitive swimmer.

Petra Howell-Vasale

And I said, “Wouldn't it be funny if I had eligibility and I could join your swim team, because you only have three females on your team, you need four for a relay.” And he just kind of laughed it off. And I was like, “I'm dead serious. Why don't you check it out and see what's up.” I said, “I need more scholarship money. I'm a single mom.” And he looked it up while I was on the phone with him, and he was like, “Holy crap, you have two years of eligibility.” And I was like, “Can I get a scholarship?” And he's like, “Well, that's gonna be up to the swim coach.” So he got the swim coach. They made me trial swim like I had to get in and prove to them that I could still swim. I, my, my girlfriend, Jen, hooked us up, and Kenny brought chairs and prop themselves at the end of the pool with their arms crossed just watching this. You know, I'm down here. I'm squeezing into bathing suit I've got mom-bod, got my swim cap on, my goggles, I'm ready to go. And I swam. He stopped me at the end, and he looked at Kenny, and he goes, “Well, I think we got ourselves a swimmer.”

So then I negotiated a scholarship with him for the year. I got like, $2,000 this semester. So I joined the swim team at 36 years old, officially, the oldest swimmer ever to swim in the NAIA.

And it was so much fun, and I was really worried these young girls were gonna be like, “Oh, what's this old lady doing?” But for a little while, they didn't know how old I was, and when I'd have these swim meets, they would post everybody's, like, age, and you know what year they were in college. Well, they wouldn't print my age, and we kind of decided they thought it was like an error, until they finally posted because everybody's, you know, like 18 to 22-23 you know. I knew that I would be very close to last, if not last, but I got so excited because I beat several girls also, and I was like, “Yeah!” You know, I feel validated. And our relay actually qualified for two relays at Nationals.

Kristen Carpenter

By the way, she ended up marrying that athletic director.

And just like on a swim team, Petra brings that same spirit of collaboration into the ER. She knows that healthcare isn't a solo sport. If you've ever been in the hospital or with a loved one there, you have probably noticed it takes a team of people to provide the care necessary during your stay. Nurses have to rely on their team just as much as they have to rely on their own critical thinking and skills. This requires excellent communication skills and the ability to jump in and lend a helping hand when necessary.

Petra Howell-Vasale

I help the techs clean the rooms. They're wonderful. They're usually on it, but if there's a bed coming open, and I know we need it, then I'm in there, stripping beds, cleaning things down, cleaning the cords, resetting the room in order to either move somebody else from the hallway into that bed, or somebody's still coming in, more critical from EMS, then we put them there.

“That's not my job.” Is not in my repertoire. That's not something that, you know, I say, or even that a lot of people around here say, that it's important to have supportive care. I mean, that's just anywhere, you know, you need an army of people to make good things happen and to have the support for each other and do this team nursing. Things just get done better. You've got good communication. You're getting things done simultaneously. It's not one person. You know, our nurses have four patients in their assignments, and so if they're really busy with another one, I can be there helping somebody else, or at least getting the communication where it needs to go for what needs to happen.

Kristen Carpenter

That all hands on deck mindset is essential in a rural hospital. In places like Beckley, the ER often becomes a catch all for emergencies, yes, but also for things like chronic conditions and basic care. Petra sees it every day, people coming in, not because it's urgent, but because they don't have anywhere else to go.

Petra Howell-Vasale

The ER can be treated like an Urgent Care. A lot of people want to use it as their PCP. People come in on EMS that maybe just don't have a ride here, and they might have, like, a little bit of a flare up of something, or, you know, they've got a rash, but they don't have a way to get here, so they've got EMS bringing them in. Some of them just live too far away to regularly get to town to go to their appointments. So they'll let things get really bad, and then come here. People that don't take care of themselves, like we get a lot of people with wounds, got people that are diabetic, that don't manage their diabetes, that can lead to those wounds, that can lead to all kinds of things. They can get really septic, really fast, and some of them just wait till the very last minute to get here. And sometimes that's detrimental, and sometimes it just gets them to a point where we can only slap a band aid on it for so long, so I know it's rough.

How many people have you ever said been like, “Oh my gosh, I can't wait to move to Beckley!” A lot of people are here because generations of their family have been here, they don't have the means to move out. So we have a lot of fully staffed areas of this hospital, if not all of them, but there's a lot of brand new nurses, there's a lot of young nurses, there's a lot of new graduates that don't have all that experience. So that's still a growing thing. That's why I think the education is so important. And I think that, you know, the supportive nursing, the team nursing, is so important because they have a lot of questions. And, you know, maybe they were taught something I don't know. I learn something new every day. But if I'm ignorant to something, then I'm going to go ask somebody. And so we just try to teach them “Ask, don't be dangerous.” Because the most dangerous nurse is the one that just is going to blindly do whatever is ordered. And a lot of new grads all over the place taking care of everybody that is more of the things that are going on.

Kristen Carpenter

She also now has students shadowing her.

Petra Howell-Vasale

Yeah, actually, just finished up with one of the Tech students in her critical care. It's her last, you know, nursing class. She's getting ready graduate. She wrote me this beautiful card, and it was kind of funny, because it said something that I said to her on her last day, I said, “Even if I didn't teach you how to do anything medically, I hope I taught you how to be a little bit compassionate for people.” And that's literally what she I mean, she didn't write that I didn't teach her anything medically, but she she was like “You taught me and showed me how you are compassionate and empathetic, not just to the patients, but to the people that you work with.” And I just you know that gives you, you know, makes your heart feel good, makes your heart smile.

Kristen Carpenter

Appalachian Care Chronicles is a production of the West Virginia Higher Education Policy Commission Health Sciences Division, which is solely responsible for its content. Guest opinions are their own.

Special thanks to Raleigh General Hospital.

For more information about educational opportunities related to healthcare in West Virginia, visit appcarepod.com that's A P P carepod.com.

This was the fourth and final episode of season four of Appalachian Care Chronicles. If you enjoyed this season, we encourage you to check out past episodes to learn about the career paths of healthcare providers like registered dental hygienist Greta Nelson and Julie Young, a social worker and Director of Social Services who found her purpose at the intersection of life and death. I'm Kristen Carpenter, thanks for listening and see you next season.