Becoming a Medical Librarian

an Old Librarian and her firstborn male child (c. 1988)

We were still living in California, and Jerry was working for the Upjohn Company, when we were invited to a retirement dinner for one of his salesmen. That evening, I was seated next to the branch manager’s wife. She had recently returned to college, and was working on a library degree at San Jose State, and she was full of enthusiasm about her work. It came to me, in a flash, that being a librarian was a job I would love. It was something I had never even considered as a career, when I was in college.

After we returned to Seattle, I called the office of the University of Washington School of Librarianship. I was returning to graduate school, and wanted to inquire about the requirements for entering the school. The woman I talked with was so discouraging about job possibilities in the field that I called the school of Home Economics to see what they would say. They immediately offered me a graduate assistantship and assured me that they were finding wonderful jobs for their graduates. In the end, I did resume my work for my Master’s degree as a Home Economist.

Jerry took a transfer to the Bellingham territory that next summer, and I started looking for a Home Economics or elementary school teaching job. None were to be found. Some school districts did not even answer my letter of application. It was 1974. We started building our house in Bellingham, and moved into the house on Camano Island for the mean time. I kept looking for work, and did sign up as a substitute in the Bellingham district. The assistant superintendent for hiring teachers told me that there were really no openings in either Home Economics or the primary grades, but he was looking for a school librarian.

Our house was finally completed in the spring of 1975 and we were able to move in. I substituted twice, once at Sehome High School and once at the middle school. I rather enjoyed the high school, but the middle school was awful. I was really glad to finish the day, and sincerely hoped that I was never called back to teach there again. Summer came, and I still didn’t have a job.

One day Jerry came home from work and told me, “I was at the hospital today to deliver some books that Dr. Barnhart had asked me to donate to the new medical Library. I looked all over St. Luke’s and couldn’t find it, so I went down to the personnel office to see if they could direct me. The manager laughed, and told him they were trying to find a medical librarian, but no one qualified had applied. This is the perfect job for you. I was dubious. I didn’t even know there was such a thing as a medical librarian. When I thought about being a librarian, I pictured myself in a public school. After all, I was a teacher. “Go and apply for it”, Jerry urged me. Hospital librarians do reference work for physicians. You would love the work, and anyone who had spent as much time in graduate school as you have won’t have a bit of trouble doing medical reference.” I was sure they wouldn’t consider me, but I did go and apply for the job.

I was hired to start work in mid-September. The library was a joint project of the two hospitals, and the Whatcom County Medical Society. I would work half time at each hospital, and the Medical Society would buy the books and journals. I would be in complete charge of the library. They had never had library service at either hospital, so I would be establishing the service in Bellingham.

I spent several days at the University of Washington Health Sciences Library, acquainting myself with Index Medicus and their cataloging system. I bought a couple of books on medical libraries, and read what I could. I started the job completely unprepared.

I did have one lucky break. My first day on the job, I was told that there was a library meeting being held in Victoria at the end of that week, and I should attend. The consultant from the University had urged them to send me, and the hospitals had agreed. It was the annual meeting of the Pacific Northwest Chapter of the Medical Library Association, and it started me on a twenty-five year active membership in the group. I took a CE course on planning hospital libraries. I met wonderful, supportive librarians, who welcomed me and gave me much needed encouragement. I became acquainted with the services of the Regional Medical Library, and went back to work feeling much surer of myself.

The physicians had a collection of books at each hospital, and a few donated journals. I started in at St. Luke’s only to find that the library had been moved to a new location because Medical Records needed that space it had formerly occupied. The new room for the library was next to the two, locked mental health units on the second floor. A prisoner from the county jail occupied one room, with an armed guard outside his door. There were no electrical outlets in the library, so they also gave me the use of a former bathroom across the hall. A board was placed over the tub, so I could have a place for my electric typewriter. All the books were in boxes. The next day, I went over to St. Joseph. The library there was being remodeled. I was given an office in what had been the men’s restroom on the first floor. The medical staff secretary was in an adjoining room. We shared a phone. When the phone rang, the switchboard operator, who was located just outside our offices, would point at the one who should answer. We learned to keep the door open all the time, as several startled men came walking in, expecting to find the restroom. Here again, all the books were in boxes.

After this inauspicious beginning, I began to get things organized. The consultant from the Regional Medical Library came to advise me. He set me to writing a grant proposal from the National Library of Medicine. He suggested a good book on hospital Librarianship. The medical staff was delighted to have a librarian on board. My first question was on the Heimlich maneuver. The doctor had been asked to give an interview on the subject for the local paper. I was able to find just what he wanted. He was pleased. Other fairly routine questions followed. Business was slow, and I was learning how to do my job.

In 1975 all medical literature searches were done manually. This meant that the researcher went to a print index of medical or scientific literature and looked up the relevant information, writing out the bibliography. Index Medicus was the preferred index, but we sometimes used Science Citations Index. The National Library of Medicine was just introducing an online system called Medline. It had been in trial on a limited basis, and was just being offered to universities with medical schools. The tapes used to produce Index Medicus were put into NLM’s mainframe computer, and academic librarians were learning how to search the database from remote locations with terminals attached to telephone lines. These “dumb terminals” were merely keyboards, with no memory. The computer was in Bethesda, MD.

At library meetings, everyone was talking about this wonderful new technology. Hospital librarians hungered for a chance to try it. We all wanted to learn. Terminals cost several thousand dollars. Mainframe capacity was too limited to allow more users. Finally, more users could be accommodated. The hospital librarians in Seattle got together and shared a single code. They divided up the day, and each hospital had a designated hour in which to search. You paid by the minute for your online time, and prime time hours were twice as costly as non-prime. Prime time was 8am to 4pm EST. Those of us in the outlying areas were left out. Telecommunication nodes with local telephone numbers were unavailable in areas with a population of less than one hundred thousand. Long distance charges added to online charges made the cost prohibitive. Finally, Whatcom County’s population reached the magic number. I begged for a terminal, and online training. The terminals now were a little lower in cost. We bought one that cost $1800, and I carried it back and forth between the two hospitals. I went off to UCLA for a week to learn how to become an online searcher.

You cannot imagine how this changed my life. We no longer needed to purchase the costly and space consuming print indexes. The computer magically put together our search terms, and found only the most relevant articles. They were printed out for us on paper. Okay, so it was a continuous strip of thermal paper, and the printing faded over time. It was still a miracle. Everyone said that with a computer terminal, a librarian could do three times as much work. I believe it was true. Of course, there were limitations. The database was only a few years deep at first, only indexing material back to 1974. Not all journals were included in the beginning. Costs could still be high. The United States government subsidized Medline, but some private indexes cost several hundred dollars an hour to search. You were always aware of the minutes ticking away.

The first personal computers were marketed in 1975, but few people owned them until quite a bit later. Hospitals are notoriously tight with money. I requested a PC in every budget from the early 1980’s until I left Bellingham in 1988, but my request was always denied. I kept searching on my terminal. I was able to have email, and it was a wonderful tool for librarians. We were able to request materials on interlibrary loan with email, saving at least two days time in the mail. Articles had to come back by mail, but the request got there in minutes. We all agreed to read our email several times each day. Then NLM introduced Docline, an automated ILL system. I could also access this system with my terminal, and it was even more efficient. If the first library could not fill your request, it was automatically sent on to another library that owned the material. You didn't even have to look up which library held the journal, as the system had all that information imbedded in the program. More and more magic for librarians. I stopped buying interlibrary loan forms.

I got my first PC when I went to work For Evergreen Hospital in 1988. There was never any question about it. The medical staff told the hospital that I couldn’t possibly do the job without a computer, and one was waiting for me when I started to work. What heaven! I could now do things I had never even dreamed of doing. Our journal holdings could be stored in the computer, and systems were available for ordering and checking in and out. I could keep the libraries statistics on a spreadsheet, and write my reports on a word processing system. Everything was so much easier. I had finally caught up with the rest of the library world.

At library meetings we started hearing about the Internet. They had it at the University of Washington. Other academic libraries started to get access. It was expensive. An institutional Internet account cost several thousand dollars. I began to think it would be better if I could retire, so I didn’t have to fight this particular battle, but as usual, the technology came on too fast.

In 1994, I was elected Chair-Elect of the Pacific Northwest Chapter of the Medical Library Association. The Board wanted to keep in touch by Internet. I was the only board member without access. All of a sudden, it became vitally important for me to have this tool. As soon as I got home, I began to investigate possible methods. The Regional Library had put together a list of providers. Most of them wanted to hook up the entire institution, but in Bellevue, I was able to find a new business that would provide individual access at a cost of $300.00 a year, as a group rate. I called to ask for a definition of a group. They told me that they would consider the Seattle Area Hospital Library Consortium a group, if I could get ten members to sign up with them. We would have to pay annually. The company was Northwest Nexus, and their Internet service was halcyon.com.

At the next meeting of the consortium, I suggested that we sign up as a group. Those hospitals that actually had Internet service were paying thousands of dollars a year and this sounded like a real deal. We agreed to join as a group. The owner himself came to my office to show me how to sign up and use the service. His wife came with him. She had been a nurse lactation specialist at Evergreen, and was excited that we were going to be a customer. I learned to love the Internet.

As always, technology improved, and the Internet became a windows-based program. My old computer no longer had the memory to do the job. Another budget request was made. The old computer was ten years old, after all, and my friends, the medical staff went to bat for me. This time, I got my new computer without a hassle.

With the Internet, library programs started coming by leaps and bounds. We got an Internet Medline in PubMed. Now online searching became free. In 2000, Docline also became Internet based. Who knows what the future will bring?