I led the move of three hospitals from paper charts to an electronic health record system. It took eighteen months, and it was a nightmare. There was one go-live weekend I’ll never forget, when I didn’t leave the building for fifty-one hours.
I became vice president of operations. And I created the program I’m proudest of in my whole life.
I’d noticed a pattern in our data. Patients went home after heart procedures, hip replacements, and pneumonia, and a shocking number of them came back within thirty days, sicker than before. Some didn’t understand their new medications. Some had nobody to drive them to follow-up appointments. Some were simply scared and alone.
Every one of those readmissions cost the hospital money. Medicare penalizes hospitals with high readmission rates by cutting their reimbursements. But it cost the patients far more.
So I proposed that every discharged patient get a phone call from a real nurse within forty-eight hours of going home. Not a robocall. A real nurse, with a script, a checklist, and a heart.
The board fought me for two years. It would cost $1.1 million a year in nursing salaries. They called it “soft.” I kept bringing them numbers until the numbers won.
In the first full year, readmissions dropped by eleven percent. By our finance team’s estimate, the program saved Northwood $6.8 million a year in avoided penalties and costs. Nobody can count the lives.
Fourteen months before that Christmas, the board named me chief operating officer.
I called my mother from the parking garage that afternoon. My hands were shaking.
“Mom, I have news.”
“Can I call you back, honey?” Her voice was bright and distracted. “Kelsey’s showing me a house.”
She never called back.
My grandmother found out two days later from the Toledo Blade. She cut out the article, a column and a half with my photograph, and stuck it on her refrigerator with a magnet shaped like a lighthouse.
My mother stood in front of that refrigerator at Easter. I wasn’t there. Grandma told me about it later.
“Paula looked at it for about a minute,” she said. “And then she said, ‘Must be a different Lydia Kerr.’”
I laughed. It was the only thing to do.
Then I went into Grandma’s bathroom, locked the door, and turned on the faucet so she wouldn’t hear me.
The week of the attack, my phone never stopped.
Vendors. Regulators from the Ohio Department of Health. Federal investigators. Our lawyers, preparing the breach notifications that federal privacy law requires when patient data may have been exposed. A reporter from the Blade. A ransomware negotiator from a firm in Virginia, hired through our insurance carrier, who spoke in a calm, flat voice about “decryption timelines” and “exfiltration risk.”
On the morning of December 22nd, my mother called.
I answered on the second ring, afraid something had happened to her.
“I need three pies for Christmas,” she said. “Pumpkin, apple, and pecan.”
I was standing in a hospital corridor in yesterday’s clothes, holding a clipboard.
“Mom, there’s a situation at work. A big one.”
“It’s filing, honey.” Her voice was gentle, a mother managing a fussy child. “And Christmas is Kelsey and Grant’s day. Please don’t start in about your little office things.”
I closed my eyes. A nurse hurried past carrying a paper chart.
“I’ll bring the pies,” I said.
At noon, between a call with the FBI and a meeting about whether our blood bank’s inventory could be tracked on paper, my assistant ordered three pies from a bakery on Monroe Street. They cost $64.50. I paid with my personal card.
Then I went back to work.
Two nights later, at four in the morning, the freight elevator at the Northwood Heart Institute died.
It’s a big, groaning steel thing at the back of the building that carries supplies up to the cardiac floors. Since the attack, the building’s automated systems had been running in a half-awake state, and the power to the elevator kept cycling. It stopped between the first and second floors. In the lobby sat a stack of boxes of blank paper forms bound for the third floor.
The cardiac unit had run out of medication sheets.
I picked up a box myself.
I’d love to say I was making some kind of point. I wasn’t. There was a stairwell, a box, and nobody else nearby. I carried forty pounds of paper up three flights of cold concrete stairs in my work flats, my badge swinging against my chest.
The cardiac floor was hushed, lit by desk lamps, and heavy with dread.
I’d never seen it like that. Doctors in scrubs sat on stools at the nursing station writing orders by hand in block capitals. Nurses moved from room to room with clipboards. Paper charts leaned in tall, tilting stacks. The air smelled of old paper and cold coffee.
I set the box on the counter. Then I knelt on the floor and started sorting the loose charts by room number.
My hands remembered. They’d been doing it for twenty-five years. A chart, a number, a slot. It’s a rhythm, like breathing.
A cardiologist stopped beside me. He was tall, in his late forties, gray at the temples, in a wrinkled white coat. His ID badge read GRANT WHITAKER, MD, CHIEF OF STRUCTURAL CARDIOLOGY.
I knew his face from forty framed photographs on my sister’s mantel. I’d attended his wedding. I’d given a toast at it.
“Have we met?” he asked.
I opened my mouth.
“That’s Ms. Kerr,” said the charge nurse, a heavyset woman named Darlene, without looking up from her clipboard. “She runs the place.”
Grant looked at me for about two seconds.
He nodded. “Thank you,” he said, and meant it. Then he turned back to his patient.
I knelt on that tile floor in the dim light and kept sorting.
He hadn’t recognized me. He’d seen me in a pantsuit at his wedding, in a black dress at a funeral, in a sweater at Easter brunch. He’d never once seen me working.
Neither had my mother.
I didn’t correct him.
