The Life Aquatic

{Prompt: What was your best boss like? What did you learn from them?}

The Telemetry Ward

In 1994, I was a family practice resident on a cardiology rotation at Richland Memorial Hospital, in Columbia, South Carolina. I was getting paid to care for unassigned patients in a teaching hospital while increasing my exposure to and familiarity with different medical problems—cardiology problems in this instance.

A few weeks into the rotation, the cardiology team was doing rounds on the telemetry floor — a floor where every patient was wearing a heart monitor for one reason or another, and the heart monitor readings and waveforms were displayed in real time at the nurses’ station.

The attending cardiologist, who had been assigned to lead the inpatient cardiology team (and be on-call with them for the month) decided to hold rounds at the nurses’ station, in the midst of those telemetry monitor displays, with the residents (including me) and the medical students.

Rather than marching from room to room, we were sitting at one end of the hall, behind the station counters, looking out on bare tile floors and sterile vinyl walls, lined by pastel-colored handrails and door trim. The smell of disinfectant and the muted sound of EKG monitors surrounded us.

I was preparing to provide my update on a young patient, who had been admitted for suspected endocarditis, but I was distracted by the heartbeats… her heartbeats… that were displayed on one of the telemetry monitors right beside me.

There were many premature ventricular contractions (PVCs), but that wasn’t unusual. It was more disturbing to see fairly frequent runs of ventricular tachycardia (V Tach) — four or five beats at first, but then, even longer runs.

…And the time her heart stayed in a normal sinus rhythm was dwindling.

…And there were pauses between the runs and between the sinus rhythm that were even more frightening.

I felt a knot in the pit of my stomach — a sinking feeling as I was thinking, “$#!t, that’s not good.”

I wasn’t worried about my case presentation anymore. That was the least of my worries. I was worried for my patient’s mortality.

“Dr. Roberts. Would you look at this?”

PVCs… sinus pauses… V Tach scrolling across the screen.

“What’s up?” We look at the monitor together.

Longer pauses… erratic waveforms… ventricular fibrillation scrolling by.

“My patient…”

A period of asystole.

“She’s in asystole.”

We look at each other. A beat. A moment of hesitation.

He says, “What are you waiting for?”

“…GO!”

So I ran off down the hall. As I ran by, I yelled for the nurse to call a “Code Blue” — a code for cardiac arrest.

I ran into my patient’s room and gave her a precordial thump.

I started CPR. At least, I think I started CPR. I think I entered a fugue state in which adrenal took over and secondary processes (like my memory) were overwhelmed.

At some point, a crash cart was brought into the room.

At some point a bag valve respirator was used to give rescue breathing.

At some point, chest compressions might have been administered.

Perhaps none of those things occurred, and her heart beat spontaneously returned. The point is that I was spurred into action by my supervisor’s directive, but my actions were wildly chaotic and poorly executed… and still, somehow, the patient survived.

My First Red Cross CPR Course

I first took CPR ten years before the incident on the telemetry ward — in 1984. I had to take it to become a lifeguard. But even before taking CPR, I had taken Advanced Lifesaving, at NC State University. I took it in 1983 as a sophomore, probably to prepare myself for a better job — better than a morning paper route or fast food work.

Since I successfully passed the lifesaving course, I applied for a summer job with the Raleigh Department of Parks and Recreation, and I was hired to work as a lifeguard at the outdoor pool at Pullen Park. (Sidebar: Now, that pool has been filled in, and there is an open space next to the carousel for small events and gatherings. I went to a community drum circle event there in 2024.)

As part of the job, we were required to take the American Red Cross class in Adult and Pediatric CPR. The course was taught to the group of us — incoming lifeguards for the City of Raleigh. We had our first introductions to Resuscitation Annie, and our first introduction to the adrenaline rush that occurs when you are called to perform, in public, those skills that you’ve been reading about and have memorized for the occasion.

We also went through the more specific drills required for resuscitation of a drowning victim, and the skills required to manage a patient with a broken neck (such as might occur from diving into the shallow end of the pool).

That’s probably the first time I met my upcoming “boss”, my supervisor, Terri Stroupe. She was the Parks and Rec employee — a Pool Manager for Pullen Park Pool — who was giving the instruction that was specific to being a lifeguard. She taught us everything we needed to know to put these lifesaving measures into action.

Terri Stroupe (standing, on the right).

She went through the process of how to give resuscitation breathing to the drowning victim… while still in the water, if necessary.

She taught us how to move an unresponsive victim from the water to the side of the pool, and then from the side of the pool to the concrete surface—things that are not easily done with an unconscious person.

She taught us how to move the trauma victim from the surface to a backboard, while cradling and restricting the neck from even the slightest movement, until the head and neck could be strapped in between two bright orange cushions and stabilized for the arrival of the paramedics.

We also learned to use the “Jaw Thrust–Chin Lift” maneuver (for CPR), instead of the standard “Head Tilt” maneuver, in any case of suspected neck trauma, to keep a bad situation from getting worse.

Working at Pullen Park Pool

Terri was young, nearly as young as I was — only a few years older than me, at best. She loved to swim, and she was usually wearing her navy blue City of Raleigh lifeguarding swimsuit. Sometimes she was wearing khakis and a City of Raleigh short-sleeved golf shirt with the Parks and Recreation logo.

Even though she was young, she was confident. She seemed so sure of the procedures, and so in-charge of the proceedings, that later, when the pools opened and she took on the role of pool manager (instead of instructor), her oversight and management seemed like a natural progression.

She supervised not only the vital roles we had to fulfill (like lifesaving), but also the mundane roles: enforcing the safety rules, patrolling the locker rooms for trouble, collecting entry fees, and maintaining the pH balance and chlorination of the pool water.

Teri was friendly and approachable. The job under her tutelage was so chill and interactive, it was easy to relax. As lifeguards, we sat and watched the social dynamics of school-age kids at play, younger children learning to swim, or parents blowing bubbles to their babies.

The “Baby Pool.” (Benches for “Spectators” in background.)

We spent the hours sitting in an elevated chair looking for trouble, shaded by an umbrella, spinning the lifeguard whistle on its lanyard, first clockwise, then counterclockwise — back and forth as the minutes ticked away.

Or we walked around the perimeter, looking out into the pool for any signs of potential mishap, or back around the edges of the pool deck for any transgression of the rules.

“Shallow End” of Pullen pool (“Deep End” beyond the bar).

Or we took a break and got to relax inside the cool shelter of the pool offices, chatting with the pool receptionist and cashier, or chatting with the manager… chatting with Terri.

The only downside of working at Pullen, at that time, was the incessant jangle of recorded music playing (at full volume) from the Carousel, only 50 feet away.

“Deep End” of Pullen. Locker Rooms & Carousel in background.

It was an otherwise idyllic summer job. Even the merry-go-round’s music can be remembered with humor. But we didn’t just sit around. We did save people. I never did put notches on my whistle, but I’m sure I kept at least five people from requiring the CPR that I had learned to perform. And no one had to be strapped onto a body board.

On one occasion I was walking the perimeter, and I had stopped to chat with Terri about nothing in particular. We saw an older boy who was trying to swim from the edge of the pool to the metal bar in the middle. (Yes… a metal bar. Almost any pool these days would use a row of buoys instead, but at that time, a fixed metal bar, painted bright red, served to separate the deep end from the shallow end of the pool.)

But this boy was in the deep end, and he was not a good swimmer. He was making very slow progress. His arms were low in the water. He was taking big gulps of air whenever he raised his head to breath. He looked like he might not make it to the other side.

I pointed out the boy to Terri and asked if she thought maybe he needed some help. With a nod from her and her agreement, I took off my whistle and dove into the water. It took me only a second or two to reach him near the middle of the pool. As I slowed to offer him help, I kept a distance of three feet, as we had learned (to be sure to avoid any onslaught from a swimmer who might panic).

I think he was happy to see me. He was more than willing to accept a helping hand, and without any fanfare or commotion, I gave him a little support as we made our way back to the side. No need for rescue breathing or CPR.

Our pool was quite busy that summer. We saved a number of swimmers, who came to enjoy the cool water, but were not able to swim, or unable to swim and breathe above the water at the same time.

On one occasion, a big kid jumped off the diving board and tried to make his way back to the side of the pool, while still underwater — swimming in a long underwater arc. That wasn’t too unusual, but this time the kid got disoriented and didn’t reach the side before he ran out of breath. He really couldn’t swim, so when he ran out of breath, he tried to come to the surface. From his ineffective movements — his splashing and reaching for air — it became obvious that he would have to be rescued.

We had already been watching him closely, so it only took a moment for the lifeguard at the chair beside the diving boards to grab the long aluminum hook and extend it out from the edge for the boy to grab. He was pulled back to the side with no need for CPR, but he was not allowed back on the diving boards or in the deep end. But that was the least of his worries. He was more upset and mortified about having to be rescued in front of his friends.

On another occasion, on a very busy day — maybe even the Fourth of July — a smaller child got into water that was literally over her head. She must have been about 3 foot 6, because her head was below water that was exactly 4 feet deep. She was bouncing up and down, every few seconds, off of the pool bottom, to come up for air.

She was only a foot from the pool’s edge (a kind of blind spot for a lifeguard, because, normally, we are looking toward the middle of the pool, away from the edge). I consider it a miracle that I noticed her at all because there was no spectacle —no frenzy or evidence of panic. She was simply hopping up and down, trying to get a sip of air, and stay alive.

All I did was reach out and pull her to the side. I guess we found her parents to make sure she would stay in a safer area. Maybe we offered to sign her up for swimming lessons. It was probably the most anticlimactic save you could think of. But life-threatening conditions can be harder to spot than you might imagine.

A view of the iconic “Island” in Pullen Park pool on a busy day.

Working at Optimist Pool

There was virtually no danger of a drowning at Optimist Pool. At Pullen Park Pool there were many who waded in, or jumped in, not knowing how to swim, or swim well. In contrast, I feel sure that everyone at Optimist Pool, which was located in a wealthier part of Raleigh, knew how to swim, and swim well.

“Master’s” swimmers (Working or retired adult senior citizens) got up early in the morning to swim laps at Optimist. Swim teams from the nearby high schools trained at this Olympic-sized pool. And there was no playing, or virtually none, at Optimist. There certainly was no horseplay. Rules were rigidly enforced.

Optimist Pool had a “bubble” — an inflatable plastic dome, which allowed it to remain open all year-round. Optimist Pool is where I went when Pullen Park closed for the season. I was taking shifts in the morning, while taking my college classes in the afternoon. Not every morning, mind you. I was only working part-time. Nevertheless, I spent a number of mornings in the fall of 1984, trying to get up at some god-awful time, drive across town (from my NCSU dorm to North Raleigh), and open up the pool for all those early morning swimmers.

A picture of Optimist Pool with its modern “bubble”.

This job was no fun. There was usually only one or two lifeguards on duty in the Fall and Winter at Optimist. There wasn’t much opportunity for socializing. The job required some cleaning of the locker rooms — moldy and rank. The floating lane lines had to be unrolled and pulled across the pool. That meant that you had to get wet to pull the lines across, with no summer sunshine to dry you off. And the need for attentiveness was virtually nil, as everyone could swim. This was not the dream job that I had enjoyed for the summer.

Terri was no longer my boss, and I had no camaraderie with my new boss… whatsoever. Honestly, I don’t even remember who he or she was. I wonder if I even saw them in person more than once or twice.

The first time I slept through my alarm to get up and drive to work, I got a rather terse reprimand.

The second time I slept through my alarm, I woke up about a half hour later, looking at the clock with consternation. I dressed in a terrible hurry and drove to Optimist as quickly as possible, cursing my plight all the way down the Beltline and up North Hills Drive. As I arrived to open the doors, the elderly clientele looked on with silent disapproval.

The third time I slept through my alarm, I was unceremoniously fired.

Honestly, I was thankful. No more frigid drives across town in the dark to cater to Raleigh’s needful swimming elite. That was my thinking.

I figured that was the end of my career in aquatics.

Study at Home and Study Abroad

I wasn’t too concerned about my water safety career. I was deep into my sophomore and junior years at NC State in a pre-med degree, taking courses that included biochemistry, genetics, physiology, microbiology, and histology. I packed 1984 with tough classes filled with Zoology degree requirements because I was planning to go off on an international student exchange. There, I would take nothing but electives — pass/fail courses of little consequence. And I was certainly not planning to work while I was away. In 1985, from March to November, I attended Flinders University in Adelaide, South Australia.

When I returned, I completed my degree, and I received my diploma, but while I was technically still a student, in the summer of 1986, I went overseas again, on a work exchange program. I took a summer job at Lightwater Valley amusement park in North Yorkshire, in England. I didn’t think twice about applying for an overseas job, since it gave me another chance to travel the world.

When I returned to Raleigh from an exchange program, for the second time, I still had a year in purgatory. I couldn’t go straight into medical school, because I had been unable to take the Medical College Admission Test (MCAT), a prerequisite for all medical school applications in the US. The MCAT wasn’t given in Australia, during my study abroad, so I opted to take it a year later and postpone my entry to medical school. Consequently, I needed to take a job for the year between my college degree and medical school.

I still wasn’t ready to apply for a lifeguarding position. I didn’t know if I even could, after the black mark of my dismissal. And besides, the summer season of 1986 had already passed at the amusement park in England, so I took a job as an assistant in the deli department of the local Harris Teeter, where one of my friends was working.

Working at Harris Teeter gave me a greater appreciation for the range of exotic cheeses and cold cuts, and for the vagaries of customer service, but it also gave me a loathing for the smell of a deep fryer (which I was assigned to clean) and a deeper respect for the dangers of a rotary slicer (which sliced my pinky).

When the time came again for applications for summer lifeguarding positions with Raleigh Parks and Recreation, I was willing to give it another try. Maybe they had forgotten, or would forgive, my history of habitual tardiness.

Working at Biltmore Pool

Well, guess who had become the Raleigh Parks & Rec aquatics supervisor — the one hiring the lifeguards for the summer? None other than my former boss at Pullen, Terri Stroupe.

My chances of getting a lifeguarding gig seemed decidedly improved.

The conversation at the time of hiring went something like this:

Terri - “Hey Steve, it’s nice to see you again.”

Me (optimistically) - “Hi Terri, I’m looking forward to working as a lifeguard again.”

Terri - “Yeah… Listen, I’ve got this opening at Biltmore Hills pool… for a pool manager. I think it would be a good job for you. What do you think?”

Me (befuddled) - “Pool manager?”

Terri - “Yep. Pool manager. You’re older than the other lifeguards. I think you should be the manager.”

Me (confused because she knows I got fired, right?) - “Biltmore Hills?”

Terri - “Yep. Biltmore Hills is a pool over in south Raleigh, off of Rock Quarry Road.”

Me (optimistically) - “Um, okay, I can do that.”

Terri knew I was anxious, maybe even out of my depth. But she was moving up the career ladder, and it seemed like she was taking me with her. More importantly, she needed to find warm bodies to staff and to manage eight or nine public swimming pools across the city. She knew me, and she trusted me. She was willing to give me a second chance.

So she trained me for the job — a crash course in business management. I learned to schedule personnel, enforce office policies, manage cash intake and bank deposits, take care of pool security, create a pleasant work environment, deal with the public, and maintain water quality. Basically, she gave me, and all the new pool managers, a lesson in leadership and accountability.

And things went surprisingly well. The lifeguarding staff was satisfied and responsive. The chemical balance in the water never strayed. Life-saving measures were not required. (In fact, Biltmore Hills was a piece of cake compared to the pandemonium of Pullen Park.)

We organized a swim team for the members of the community. I even had time to swim laps between my essential management duties.

The only difficulty was navigating through downtown Raleigh during rush hour. And on one occasion, we had to call the police to investigate some locker room thefts.

But, as it turns out, I was a pretty good pool manager.

On the whole, my career in aquatics went well, and it could have been an ongoing career. But after three months on the waitlists of the medical schools of Emory, University of Virginia, and Duke, I was finally accepted to the Duke University School of Medicine.

I had to give notice to Terri and the Raleigh Parks and Recreation department, and turn my attention to an even broader expanse of life-saving endeavors.

Life and Death

Working as a medical doctor (or doctor in training), is more like an apprenticeship, and the supervising physicians are changing every month or every rotation (two months). There is relatively little continuity.

Learning medical skills is a process of study, observation, and performance. The mantra of medical school is “See one, do one, teach one.” Although occasionally there is time for true preparation and instruction in the performance of skills and procedures, it is frighteningly rare. I shudder to think of the rather painful lack of skill (or at least lack of patient preparation) with which I placed a number of nasogastric (NG) tubes during my medical residency.

A lot of medical skill came from learning on the job. Sometimes we had to do things that we weren’t sure we could do. Sometimes we just had to do our best, and hope that our best would gradually improve. Sometimes the attending had to say, “Go!” to prompt us into action.

My endocarditis patient ultimately died of her illness. She died after I left the cardiology rotation. Her condition was too grave… her heart too badly damaged… to sustain her.

I did everything I could to aid in her diagnosis… to facilitate her treatment… to extend her time on Earth. I must have done at least six separate blood draws for blood culture testing — an attempt to identify a treatable infection. I studied the treatment options — medical and surgical — that might be beneficial, and I tried to find a solution for a no win situation. I spent time with my patient and her parents, as a liaison with the medical team, and I tried to be a comfort to the patient and family on a professional and a personal level.

Her death was one of the hardest I had to accept in my entire career— a life full of promise, cut short. The futility of our efforts seemed so great. Her death at such a young age seemed so tragic.

And unfortunately that’s the nature of medical practice: trying to fight off death and disease, even though you know that both are inevitable; trying to mix effective therapy, objectivity and productivity, while maintaining compassion and preserving your humanity.

Epilogue - My Medical Career

After residency, I took a job at a group practice called Sanford Medical Group. I built up my proficiency in treating all the conditions seen in a family practice.

Then I worked at a group practice called Garner Family Physicians. I became confident in my diagnostic and therapeutic skills. Ultimately, I left in the hope of having more time to see each patient and provide them with personalized care.

I opened a practice called Village Family Practice of Holly Springs, where I became “self-employed”, working as my own boss… as an entrepreneur. Working without a safety net — making your own decisions and facing the consequences — is the most enlightening work of all.

I paid myself less than I made even as a resident, and I worked harder and longer by working as both the physician and the office manager. I learned a ton about running a business when I had no boss or mentor at all. And I was happy to do all that because of the independence and the feeling of accomplishment.

I took one more job, as the physician and medical director of the UNC Family Practice of Fuquay Varina before I retired. And during that last job, I finally provided some mentorship and guidance for the mid-level providers under my direction.

I think I saved a few lives in the course of my profession. I think I diagnosed a few significant medical conditions. I think I made life—and sometimes death— a little easier for a few patients.

I had a lot of encouragement along the way. Many physicians passed along their knowledge and their experience. Many doctors inspired me to take action — to put my heart into the practice of medicine.

But even before I got into medical school, when I wasn’t sure if I even would get into medical school, at least one person had confidence that I had some life-saving ability and leadership potential, and that was Terri Stroupe. She took a chance and she gave me a second chance.

Teri’s radiant smile (off the clock).