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Credit: Camea - Texas Trails of Care
The evening was hot and I had already worked 9 hours that day.  Texas summers and 112 degrees in the shade weather have a way of sapping your energy when you work in and out of your car all day. 

An hour in a house with a hospice patient is just enough time in those temperatures to turn a car into an oven inferno and took a toll on the hospice team every summer. 

Heat exhaustion, dehydration, weight loss, fatigue and let’s just say when I would hear office staff complain about little things, when they had been sitting in the AC all day it was a little difficult to be understanding.  

 It was my night to take call and before I could even make it back to the office from my last case management visit, the first call came from the answering service.  I turned the car in a different direction. 
Racing down the rural road, headed somewhere I had not been before to see I patient I didn’t know, responding to a crisis call, I reached over and grabbed a bottle of water.  It was hot but my thirst was worse than my disdain.  I unsealed the cap and with resignation took a big drink.  Who would have a clue it was hot enough to scald my mouth and tongue.  

Finally I made it to the address I had been given.  It was the wrong address and after multiple calls and searching I found the location, inner Dallas-Forth City.  Finding the entrance to the walled away fortress more like finding the way through a maze. 

Once there I went to one entrance finding it locked, carrying my computer and nursing bag, complete with all the tools needed to do an assessment, change a wound, and more, I walked around the facility finding the entrance I was told to use, it had a keypad and required a code to enter.  I knocked no reply.  I called the phone inside the fortress rang and rang. 

Standing directly in the sun I could see the heat waves rising up from the pavement.  My mouth blistered, sweating and frustrated it was one of those moments you question your sanity in choosing your profession. 

Finally a staff member returning from break let me in.  The unfamiliar place was huge.  I worked my way through the labyrinth of halls to one of many nursing stations in the building.

A young RN sitting with charts open and a couple of Nursing Textbooks I recognized sitting to the side, greeted me with a sigh of relief, “thank goodness you’re here, what took you so long?” I thought of the ten minutes I had been standing outside in the sun. 

As she spoke the phone was ringing and ringing, the lights buzzing and she complained her help was in the lunchroom feeding patients and she was alone, she couldn’t do her charting, she was going to school too and had a test in the morning and had wanted this shift off. 

I smiled pleasantly asking show me to the patient, no time or energy to talk especially with a scalded tongue and beside I wasn’t there for her but to tend to the patient. 

 A little later the situation resolved I was preparing to leave.  She shared she felt incompetent and unable to make it through the RN to BSN program she was in the middle of.  I listened a few moments and then a call light required her attention. 

I went to the car and quickly retrieved something I had been given a couple months before and left it on top of the documentation she was working on with a sticky note attached.

                               Another sticky simply read...turn the page.   
The story inside the paper posted above told how I had graduated from the same nursing program she was presently enrolled in...but under completely different circumstances.  

Problems are simply challenges to be overcome.  In so doing we can use them as opportunities to help inspire, encourage and motivate others.  

Each day is a new chapter with opportunities, lessons and stories to be told.
If I can U can too!
Photo credit: Boston WCVB 5 ABC www.wcvb.com
Storytelling is like pulling teeth?

I have found that after a life of shyness and silence now the intriguing people I have met, things been and done, history and stories I have seen and read, runs through my mind like a massive video storybook. 

Sharing stories about others victories for me comes easy but telling my own is like pulling teeth, something I dread.  

You see, life is not about me.  Life is about humanity, service, love, joy, beauty and resilience.  It is about doing your best no matter what circumstances come your way. 

For me Life is also about being curious, eccentric, unique and willing to laugh at your self too and post blogs full of typos, grammatical and punctuation errors. 

A world famous blogger and Social Media expert advised don’t worry about all that stuff – it’s the story, write your story.  So other friends, family and people have urged. 

Well let the tooth pulling begin…


John Peter Smith School of Nursing-Tarrant County Hospital District LVN Graduation 1988 Camea (left) graduating and Paula (right) in uniform but graduated 6 months later. Paula's story of resilience and recovery from a stroke one night four months into the nursing program, left her suffering paralysis of her right side, unable to talk, difficulty swallowing, difficulty with vision and comprehension with only the social support of a visiting classmate and mom that came when she could with young baby in tow. I persisted through nursing school visiting Paula each day a mutual love grew. Little by little tiny progress was made each day. Paula relearned to eat, talk, articulate with her fingers, and painstakingly how to walk, with many a fall and tears along the way. When she could write on her board before she could talk, the first thing she wrote was that she was going back to nursing school. It appeared there would be no way possible she could progress fast enough to enter the next class. One started every six months. Above is a picture of the miracle. Once she began recovering things went faster. Often when I appeared she would be crocheting. She told me they had told her she must, she had ripped it out a thousand times because of errors. At my graduation Paula had just restarted school. She still had some residual problems but her desire to become a nurse had not burned out. At graduation she handed me a wrapped box. I was speechless, I knew she had no means or income and couldn't imagine. Her mother had left, she had found a sitter so she could resume school and was working things out. We retreated to a corner where I unwrapped the gift. As I reached inside the tears began to flow. No you can't do this Paula...she pushed back, yes I can, I wanted to die and if you hadn't come each day I wouldn't have had the will to try. Unfortunately life took us in wildly different directions and we lost touch. We wanted to be nurses and willing to sacrifice but remembering to laugh and smile. She is a miracle and inspiration to nursing. Without amazing nursing mentors who advocated for these two young ladies neither Paula or Camea would have become nurses. The importance of showing care, compassion while mentoring and leading should be core concepts that are taught and embraced by everyone nurse.

Bliss!!! Did you say you love your nursing job???


I do not visit the nurse forums on Facebook much but yesterday a comment popped up from a nurse I met a few months ago.  It so inspired me I engaged in the conversation.  The nurses name is Alene Nitzky.  She is a wellness and cancer coach at   sunspiritwellnessservices.com.  With her permission I am reprinting her comments and my reply.  

Alene: Just had one of those moments of bliss today that tells me I'm on the right track and reminds me of why I went into nursing in the first place. I realized, while working with a client across the country, that being an independent practitioner allows me so much more freedom and time to do a good job researching the resources and possibilities, and I'm not limited to my local area or the narrow list of providers my employer or the insurance company might deem acceptable, reimbursable. or not competing. This frees me to find the BEST available resources and rely on the wonderful contacts I've made here and on social media. So many knowledgeable nurses, patient advocates, and other professionals are here and can help me when I need to solve a problem or find expertise in an area I'm not familiar with. I *LOVE* what I do! Thanks for making this possible!

Camea: Fabulous Alene. I have been reflecting after responding last week to a comment on compliance, mandatory and other adherence terms in relation to patients. As I responded I also thought of nurses. Mandatory was overused in my last workplace and tended to sour the environment. 

As Healthcare Leader,  servitude leadership, compassion, respect, dignity and love for what we do as professionals will draw and lead our patients to health, our peers to support and hopefully bring about a different corporate culture. 

If not, we can rejoice and jump. As I talked with physicians who early on took the jump to different types of practice when no longer ethically, physically, or professionally able to keep up with the demands metrics placed on their practice, I wondered about nurses. 

We approach care from a different perspective. It is supreme now to see Nurses 'coming out' on social media, determining their own destinies, which now can be any number of a thousand choices. 

                  “Don’t only practice your art, but force your way into its secrets, 
                                                        for it and knowledge can                                                        
                                                         raise men to the divine.” 
                                                      ― Ludwig van Beethoven

I am forever grateful I chose nursing as an occupation. John Peter Smith School of Vocational Nursing Graduation 1987. Dr. Jennifer Gray, Loretta Mahaffey Nursing leaders and mentors. Many years (22 yrs) and miles down the road when Camea stood in Texas theater at UTA for BSN pinning, Dr. Jennifer Gray, RN, PhD. Associate Dean and Chair, Department of MSN. made a surprise appearance with Dr. Janean Boyd, Camea's Dean while completing her ADN at Hill College, now Dean of ADN to BSN program at UTA. Professor Gladys Maryol, Camea's Nursing Mentor and Leader also appeared on stage and together the nursing leaders pinned the graduate.
Nightingale forever will be an inspiration. She was an amazing leader. She did not conform to standards expected of her, rather she followed her inspiration and vision and far exceeded them. I share your love for Nursing and so refreshing to see your positive comments. Although there are many negative things we deal with, embracing gratitude, professionalism and servitude while grasping ethics, compassion and independent spirit will inspire more to do the same. Best! 
Photo: Camea The Chapel at Arcadia Academy
"Art is our one true global language. It knows no nation, it favors no race, and it acknowledges no class. It speaks to our need to reveal, heal, and transform. It transcends our ordinary lives and lets us imagine what is possible."           
 Richard Kamler

A Chance momentary experience that reminded the importance of the arts.  

Last week I was invited to attend to attend #hcsmca twitter chat about the importance of the arts in healing hosted by Colleen Young.  Sometimes you can't be everywhere you want to be at just the right time to participate but support and promote the idea.  Only 2-3 weeks prior I had an experience I had journaled on my Facebook feed about the healing of the arts.  

As a hospice nurse I used music, picture, lighting and more to help bring comfort, change mood and yes even relieve anxiety and reduce pain.  Art exists in many forms. In a society of healthcare that is used primed to trying to solve all the answers with pharmaceuticals, treatments, invasive therapies, I wonder how many times a more simple approach might be helpful.  

  • This is a massive historical chapel only one part and one hall on the historical grounds of what used to be known as Urseline Academy now as Thee Abbey Kitchen - Arcadia Academy privately owned. I got quick pics of the chapel with in no way captures the stain glass windows, murals and high high arched domes. I went to hear what i thought a piano recital then was stunned as the place filled. Then to my surprise row after row after row after row of individuals of all ages all dressed in black evening dresses and suits came out and the crowd hushed as the conductor started. Brahms 'Requiem'.
Photo: Camea Arcadia Academy
  • The pianist was exquisite, the acoustics could not have been better in Bass Hall in Forth worth or Dallas Music Hall. And to think only 5 min away no fighting traffic and crowds. 

  • The choir sang in such harmonious perfection it moved me so and lifted me as it were to the very gates of heaven and unconsciously one song even brought a tear. 

  • My sons when little and I drove them places became acquainted with Mozart, Beethoven, Bach, Brahms, Van Cliburn. and many of the masters, then they started lessons with an accomplished music professor at the University as little boys.

  •  Sometimes I worry in innovation and industry, technology, and bizarre shows that we will forget at times to disconnect. WE NEED THE ARTS, THEY BRING HEALING. 

  • I was tired, grumpy and not feeling so social but used to tell people music works quicker than any drug known to man. 

  • Attending the other night brought such joy. Yes other night Glee my friend said, we may have some hillbillies but have culture, history and class too...

  • all I could do is smile and nod.  It was absolutely superb.  

  • It's listed on National Historic Registry, the serve food from scratch, have a bed and breakfast that even allows a family to take out as many as six rooms. They have a home made ice cream shop and using 2-3 nights a week or more they have plays, and other live 

  •  http://www.arcadiavalleyacademy.com/


    photo credit: http://www.tsksoft.com/
    The Day Social Media, by the Grace of God, Saved My Life
    A True Story of Medical Crisis Intervention

    Key words:  Social Media, Rural, Healthcare, Crisis Intervention, Communication


    The piercing cry of terror came from the inner depths of my existence.

    My lonely seemingly endless scream bounced off the walls of the mountain valley reverberating and mocking me. It sounded back and forth fading into the distance swallowed by the gorge where the nearby stream started and the valley ceased to exist. The forest walls seemed to loom overhead speaking lack of forgiveness, taunting my calls, reminding me they were fading into the abyss of unanswered pleas. It speaks haunting loneliness that keeps ringing in your ears reminding you that you are the only human in these woods, potentially for miles. 

    Silently I listened, body racked with waves of pain and stars floating in an out of the path of my vision. The instantaneous slam without warning had caused my head to hit the rocky ground and bounce. Now everything was spinning. The electrifying lightening bolts of pain down my leg and body sent adrenaline rushing through my veins.

    The gray cold mist falling from the dark cold clouds overhead seemed to muffle my cry and speak of impending doom. Should it become a degree or two colder the mist would become sleet and the rivulets of muddy ice that had soaked through all my layers, biting my skin, would freeze again with me in it’s clutches.


    Time and again I cried.  I tried to lift my leg, I felt the grinding crunch and saw that my attempt took the top of my leg in one direction while the bottom lay decidedly in a different direction.  It was rather detached except for the muscled and boot on my foot that held it all together. 

    I tried time and again, but unable to stand the pain.  My screams echoed faded through the mountains, not another human sound could be heard.

    I was in a rural region staying with a friend until I decided which town or region to settle.  She and her husband were rarely home, her parents lived about a half a mile up the road. 

    I had been in culture shock discovering no cell phone reception, limited dish availability for Internet that most often timed out and slowed as the month wore on.  No unlimited plans, limited upgrades were the best that could be had.

    UPS and Fed-X refused to deliver on our curving mountain ‘road’ unable to scale the steep logging path that had been carved out and became the road of choice because the creek tore out the old road when it turned into a roaring flooded raging river several times a year. The delivery men also did not care for the part of the road that required driving through the creek.  Although it was further up the canyons and not as deep as below ,where more tributaries fed in, it still required courage, grit and skill to pass through the gauntlet of challenges and arrive at our door.  The delivery services determined we were an undeliverable address. 

    Photo credit: Camea Part of our Road.
    It was quite a change for me from living on pavement streets on the edge of the “Metroplex”, one of the largest urban areas in the country.   

    I had ordered a new iphone6 plus and finally managed to meet the Fed-X man at the main road to accept delivery but had not downloaded social apps because the internet usually timed out.  The only thing I had used it for was the exercise App that I found preinstalled and the camera.

    Intrigued by the app that seemed to be accurate measuring the distance I walked so I went back today to retrieve it to put it to the test again.

    Now suddenly instead of walking and testing my phone,  I lay staring at the sky, the fine mist falling covering my face.  I tried to stay awake.  I felt as though I was fading and fatigue was winning. 

    Mentally I reviewed my situation.  My friend and her husband had left at five that morning, I had bid them farewell for Texas.  They would be somewhere in Arkansas right now where reception was sketchy or non-existent in many places.

     I lifted my head looking around to assess my situation one more time. I was way too far from the house to make it and if I did would have to drag myself up several feet of stairs and about 20 more feet to reach a phone.  Movement caused blinding pain and with each movement of the leg I could feel bones grinding, crunching and moving in wrong ways.  I did not want to cut a major blood vessel or damage a tendon or cause more damage than had already been done.  

    No one was scheduled to come by. No one would miss me as I had nowhere to be for several days, No one ever came out here.  Her parents although close had their own life and when their daughter not home did not usually stop by.  When they came and went I could hear them but our drive and where I lay was out of sight.  My situation looked bleak, with the dark gray clouds spitting cold freezing mist, and the half melted snow and ice soaking through everything I had on ensuring I was soaked with muddy icy moisture all the way through every layer biting my skin with freezing wet cold.  I swore it went well beyond the skin freezing me down to the bones. 

    Then out of the corner I caught the glint of something Gold and shiny sticking out of the mud and snow.  It was the iPhone6 plus I had retrieved to take on my walk. My heart sank.  No cell reception here at all.  No way to make a call. 

    I spotted the shiny gold apple from the phone sticking up out of the mud and ice several feet awah
    Still I crawled and reached the phone.  Even though it had a protective case and tempered glass extra face to keep it from breaking the phone was shattered.  Not only that it had cell reception here at all.  No way to make a call. 

    My heart sunk but survival is an innate trait that somehow time and again has pulled me out of deaths door.   My hands were frozen.  I could not feel my fingers anymore.  I pulled off my gloves and wiped away the mud and watched as I pushed on the buttons, not feeling what I was doing. 

    I felt detached and had a hard time making my numb nubs respond.  I pushed and waited, and tried again and again.   I held my breath. I didn’t see anything and in exhaustion my head fell back into the muddy ice while I lay the phone upon my chest. 

    God why?  I need you now, I don’t know what else to do…in what was almost a whimper between a cry and pain and desperation, in somewhat of a last pleading gesture a whispered plea ascended to the courts above. 

    The cry was so faint it disappeared into the wind….it was not echoed through the mountains, it appeared all hope gone, it was one last plea sent and it’s only hope that it would be carried on the wings of angels to the mercy seat. 

    “God please help me…I am weak…help me gather strength, oh God please…” 

    A tear ran down my cheek.  At first I had shivered lying in the icy river of mud that soaked every layer I had on.  Now a different shaking had taken over my body.  It was something I had experienced twice before, not from physical trauma but rather shock from experiencing horrific traumatic emotional shock.  It was a convulsive type shaking that caused your entire being to shake way beyond shivers or tremors.  It was a physiological response that was completely autonomic and uncontrollable.

    As I lay shaking, the convulsions sending even worse bolts of pain through my body, suddenly I noted a bright light from the phone laying face down on my chest.  

    The broken, mud impacted phone had come to life.  With my numb hands I grasped it.  I looked again toward the house and faint hope emitted a tiny spark.  It would be a long shot, every attempt I had ever tried had timed out but it was my only hope,

    Would it pick up a connection?  Was I too far from the house?  Would I be able to download the only App that my friend used?  Would she have her phone and be in a reception zone?  Would her parents be home or gone as they often were?  Would all things work together in just perfect unison? The statistical probabilities were not good, in fact nearly impossible but I must try.

    I was shaking so hard, and my vision blurry. I tried and tried to focus and see past the cracks and mud.  My vision kept going blurry and as I held the device in my convulsing hand I wanted to scream help with fury while realizing if viewed from the distance what a bizarre unbelievable scene.  A woman with her leg snapped off in a different direction, laying hidden far in the forest in the mud and ice, trying to reach humanity with a cracked mud impacted device, no reception and poor hopes of a connection.

    Somehow I focused for a moment, I pushed my numb fingers trying to make my mind hit the right buttons. It connected, I felt as though the world was swirling is some strange unfocused dream. Nothing seemed clear. 

    My vision kept going In and out, I was trying to hit the right spots and make out was it said on the cracked face while the phone shook in my convulsing hand.  I held my breath with terrified anticipation.  It had never worked the many times attempted before.  It would take a miracle of vast proportion to actually see it through an entire download.  I couldn’t breath, watching, would it finish before timing out. 

    I tried to carefully wipe more mud away, tried to focus my vision to make out what it said behind the shattered glass.  Then the questions began, do you authorize.., do you agree.., can we have your connections too? 

    One by one I answered the questions, wanting to scream…Are you serious? this is an emergency, cant we take care of this later, I am about to time out at any second. 

    Somehow I managed to get Facebook downloaded and attempted to send a private message.  Again disappointment intensified the gut wrenching pain from my broken leg. 

    A message indicated I must download the App ‘Messenger.’ It gave me no other choice.  Once again my head fell back into the mud.  I took a couple of deep breaths.

    “God I am fading here, I can’t see, I barely have strength to hold up my head.  God the pain is swallowing me up and the cold taking me away, God please keep me awake, please God I need a miracle to pull through this one, please….”

    I lifted my head, fixed my blurred gaze on the phone and had to attempt several tries to get the cracked phone to respond.  Somehow I began to download messenger.

    Again the suspense caused me to unconsciously hold my breath.  Again the questions began again; authorization, want my connections, and and my pictures too.  I wanted to scream take anything you want just help me save my life. 

    Finally it said I was connected.  I fell back for a second and took another breath. I drew deep from the reservoir where passion meets survival within one’s soul.  

    Already the day was growing colder and the ice would refreeze with me in its grasp. I fumbled sending a message, hoping above hope to connect.

    “Hey this is a 911 message I need help now.  I am laying in the road below the house and my leg is broke and I can’t move, Call your Dad to come help.” 

    The message sent I set the phone back on my chest a fell back waiting.  One chance in a million she would be looking at that moment. 

    The falling mist was biting my face, and spitting in my eyes as I looked up at the dark swirling clouds swirling, looming overhead in the sky. My dog sat at my side, looking perplexed and concerned not knowing what to do.
    As I lay there I tried to figure out what happened and piece things together. I had greeted my 70 pound German Shepherd-blue healer, and returned to retrieve my phone after letting out a loud wolf whistle that echoed up the canyon.  It was an invite sent to the Great Pyrenees dog that far outweighed and outsized my dog Spirit. 

    As I came back out of the house, phone in hand, I saw the big white dog I had called bounding out of the forest. 

    Spirit and Bruno
    Then began a routine carried out each day at the start of the mile hike through the woods.  Although the dogs had free range to take off they would run at top speed away, then circle and come running back to me, circle around me like I was a barrel in a rodeo, then race away again. 

    They ran so fast and with such power but their show of obvious exuberance that I was attending them through the woods, always caused me to laugh.  One would just have to see it to understand. The more I laughed the harder they ran.  Today their excited race even took them all the way around the house, up the steep hill, then I heard them running back down as I beckoned them come.  I turned my back walked around the house and started down the trail. 

    When suddenly the world came to a crashing stop as pain racketed my leg, and I fell so fast and with such force I bounced as I hit the ground.  I remember seeing the dogs suddenly stop their race and both came and lay at my side.  Eventually the great white dog left while my dog Spirit stayed. Every time I yelled out he repeated my call with a distressed resounding bark.  All we heard was the echoes of our call on the valley walls. 
    This is stupid I thought.  Denial always seems to be part of shock.  Surely it’s just a sprain, I tried to lift my leg again.  It seemed bizarre to see my lower leg hang when my upper leg lifted, the jolt of pain and grinding reinforced the truth.

    After all I had seen this before.  My oldest son broke his leg once.   My youngest had come running and answering I followed. When I saw my oldest son with his leg broken off at a 45 degree angle and twisted in a bizarre direction, despite being an nurse,  I felt faint and sick.  And less than three hours later that night he was taken into surgery where two skilled orthopedic surgeons put him back together with screws and plates. 

    i had been around healthcare and seen enough injuries and trauma. I knew when they cut my farm boot off it would be evident that my lower leg bones had no connection with the top. 
    The pain was so horrific i didn't realize it but was gritting my teeth so hard throughout the day, unable to handle it any other way, later i discovered my teeth were painful and a some  a little lose. I kept quiet but grit teeth so hard it's a wonder I didn't break my jaw. 

    While my mind was whirling, Almost 15 minutes had gone by.  Then i felt the phone buzz.  My prayer had been answered.  My friends were going through an area of Arkansas that had reception and Lisa was looking at her phone and got the message.  I told her to call her dad, I have a badly broken leg.  She started to ask questions, tell me her dad be there in 30 min. I had not the strength, energy or vision and deferred further questions.  I had to face the next issue. 

    Yes Indeed I had help on the way but in order to get me, but if I was going to get the dog, Lisa's dad, and who ever else tried to rescue me, all out alive, I would have to figure out some things quick. 

    Wouldn't it be interesting to tell people....the dog did it!  No he really did I promise. 

    But the most amazing thing is by the grace of God I landed in the right place, somehow kept my wits about me despite having a severely broke leg, downloaded not one but two social media platforms because there was no cell phone reception. 

    Social Media had indeed saved my life. 

    What I did not know many challenges were yet to be faced before I could get help.  It took some ingenuity, quick thinking recalling from lessons learned years ago. I discovered UPS and Fed-X were not the only ones who did not provide services on the road. 

    When I asked Lisa's dad to call 911 for an ambulance he informed me they did not provide service.  I also had an unbelievable experience at the closest hospital we went to and deemed much of healthcare
    is having a nervous, ethical and moral breakdown. After a frightening experience we 'escaped' and went another 26 miles to the next hospital. 

    More of the story to follow next time. 

    This evening frustrated.  I have a couple of posts ready to blog but my computer keeps locking because it is full of all the photos I have taken and ...well for mothers day, birthday or nurses day it would be nice if someone above just grant me the Universe for my cloud storage.  Sounds like a big dream ...but I am a big dreamer. 

    Had to post this snap I took from a 24 hour business trip with a friend.  We were flying down the Sea Wall of Galveston the morning we were leaving as I clicked with a smile. 
    Capturing dreams......  

    How life changes, this Easter has been reflective and quiet. Via social media I have seen posts that remind me of many Easters past.  My friends are posting various pictures of the massive Easter Pageant taking place in the town I lived in for years.  Now I have relocated half way across the country and smile as I remember for two or three weeks leading to Easter each year the town transformed itself into Jerusalem and I saw stages built across the large campus in preparation for the Pageant that drew thousands of visitors to town. 

    Today it seems appropriate to reprint words I wrote last year.  A very Unique Easter experience. 

    Journal Entry Easter 2014

    Smiling at the beautiful weather. Some in Stephenville are ready for the party to be over and dodging drunk drivers because of the huge music fest. Here in Keene I am laying low and not working for the first Easter in so many years can even count yay! The town has turned itself into Jerusalem. 

    I am not sure how many stages but the Easter Pageant is truly a thing to behold. Indeed the entire campus of SWAU and beyond turn into the scenes of Christ's final few days on Earth. I already saw Calvary a couple of days ago when I was heading out.


    I remember working a few years ago on a Saturday morning. I was in Hospice Crisis RN work mode and when I arose that morning it was snowing and sleeting (rare but has happened 3-4 times that I recall.) A call came patient having a pain crisis, I quickly scraped the ice off the window and took off up the hill.

    I live right down the hill from the massive church in town. The snow was coming down heavy and I wondered if the roads were going to get worse in that direction. Suddenly I came to a slippery halt. Oh my goodness I was speechless. I sat and waited. Oh my, time was elapsing and I hadn't even made it three blocks to get out of town. My phone rang and I looked. Oh no Triage, probably a second call. Stress mixed with humility I answered. Yes it was another call.

    My response, "It may take awhile because I am waiting on Jesus."

    My friend the triage RN replied, "your waiting on who" ????"

    "I am waiting on Jesus and the Centurians to cross the road - I am stuck a car behind and police before yikes."

    As I waited the windshield wipers were doing a mad dance to keep up with the falling snow. I bowed my head and a tear fell from the corner of my eye!

    A man the likeness of Jesus, clad in a thin white snow soaked robe and flip flops with a crown made of thorns the likeness of mesquite bushes (an inch deep) and the appearance of blood dripping from his face and back slowly drug a massive cross just a few feet in front of my car. He fell right in the middle of the road unable get up. Men on horses with whips were screaming at him. A crowd of his friends, enemies and onlookers were there too. His mother and other women were crying.

    A friendly looking man was ordered to get the cross while the soldiers drug Jesus back to his feet and whipped him, spat on him and said the worst of things.

    While the snow fell I cried.

    This weekend I hope for the thousands that will visit and travel stage to stage across the town that the beautiful weather remains. I also pray not to take for granted the promise of eternity that was purchased at such cost.

    Picture credit: Keene Star -Easter Pageant
    A broken leg led to a gem of a discovery.  Often traveling the rural roads of Texas as a hospice crisis nurse I envisioned many ways #telehealth, #telemonitoring could be used to improve patient care and help clinicians.  My imagination coupled with the disparities and troubles encountered while covering large territories fueled my avid desire to support and share ideas about #telehealth use. 

    Recently I relocated to rural Missouri Ozark Mountains and due to a freak accident broke my leg in 5 places.  Surgery was required to put screws, plates and pins in place with a clunky cast to complete the ensemble.  Since they could not let me return home alone to rural location with multiple stairs I was given a couple of options of where to do a few days of rehab.  Private room was a plus, Wifi in all the rooms, excellent reputation made the choice easy and I transferred to a tiny 14 bed rural hospital.   

    While visiting with the nurses telehealth came up.  They told me they had a telehealth robot right there.  I often tweet #telehealth follow it’s progress and was determined to check out their robot if allowed.  Sleep eluding me late one night my nurse and I were chatting about telehealth and the robot.  I was thrilled when she invited me to come see him if I like.  So at 3am I hopped out of bed to meet the interesting technical innovation.  Excited afterward I wrote a post on my Facebook page about the bot.  Friend Annette McKinnon @anetto who I met on twitter replied asking for a picture.  Below is a copy of the reply that was sent with the picture above. 

    Normally I do not post pics of me in pj's at the hospital but friend Annette McKinnon a mutual supporter of ‪#‎Global ‪#‎Telehealth asked for pic so here goes: Annette and other friends I would like to introduce you to ICHAbot a member of the Iron County Medical Center staff I had the fortune of meeting the other night.

    He is a telehealth robot at this tiny 14 bed inpatient center, ER with a busy out patient specialty clinic. The center located in Pilot Knob, MO where it serves the residents of Arcadia Valley and rural reaches beyond. Much of this part of the state encompasses the Mark Twain National Forest where narrow winding scenic roads twist and turn up and down through the woods, crossing creeks and rivers to form connecting threads between farms, rural homes and tiny communities that dot the countryside.

     Many in these regions drive up to an hour or more just to see their primary physician at his office in a rural town. With St. Louis over two to three hours away, sending patients to larger comprehensive centers for evaluation and ongoing appointments limits or eliminates access to timely affordable life saving diagnostics and care. The good news is that by using #telehealth, robotics and other emerging tools, patient access, engagement, satisfaction, and outcomes result in saved lives.

    When we center care around the patient, serving his or her needs, the needs of caregivers and families in the communities they live, we get closer to the patient centered care and engagement all are seeking.

    The above picture is a typical rush hour in the Dallas Fort-Metroplex. We have these massive mix masters all over the entire region.  Now can you imagine elderly waiting two hours in the waiting room because the doctor is overloaded or had an emergency.  Perhaps mom and dad went together because their children live elsewhere, not available or they have none.  He is driving nervous with thick bifocals and hasn't had cataract surgery yet.  She is trying to read the signs but confused.  They sit an hour just in this intersection.  All their doctors are located near the hospital district in the heart of the city.  Parking charged by the hour and the extended time used up the money they were going to spend on a cheap supper at a fast food place - they are living on limited income and the price of their utilities, food, taxes have increased causing them to live with less and less.  Meanwhile the facilities and ACO's are charging more, Medicare reimbursing less.  

    They struggle to keep up the yard. City Code Enforcement has fined them before. Used to be that Joe, down at the city would call and if they were sick would contact the Boy Scouts or Local Community Service Group or one of their good hearted neighbors would do it for them.  

     No one in the neighborhood where they moved 30 years ago seems to notice.  They don't attend church as much because of health and what used to be a simple drive down an uncrowded road is now the busy shopping district and the traffic is increased on the weekends by people who are getting their errands done on the weekend  because of the long hours they work during the week.  
    The fatigue from the day,poor vision, construction and massive traffic causes intense anxiety and stress. The wait in the doctors office just to have him rush in, open his computer, type while looking at it and kind of speaking to them.  A quick 2 min assessment and due to metrics and mandates given by the ACO/Hospital corporation he works for he is off to the next patient.  The entire visit took ten minutes.  Then back to the waiting room to wait for lab work, finally she calls.  Lab is done.  They still have no answers, the staff is so "professional" and objective they have no expression, their is no friendliness to the patients or talking among the crew but they are all wearing their nicely matching ACO/Hospital Corporation Uniforms.  The couple forgot to ask a question, they sit and wait to talk to the nurse, the nurse says she can't interrupt the doctor until after office visits are complete.  She will call them later this week.  

    Sounds a little bizarre but true.  This describes my last visit to my physician at the big ACO/Hospital owned corporation in Fort Worth.  As I looked around the waiting room I saw people on walkers and others with debility.  They had to drive in and wait.  I saw a man arrive at the counter and he had missed his appointment, it was yesterday.  He was treated rude and I saw him struggle back to his car on his walker, I ran and opened the doors for him and gave him a comforting pat on the shoulder.  The look on is face was defeat and helplessness.  Couldn't they at least squeezed him in with the nurse practitioner.  Would he end up in an ER? 

     I wanted to help him, use my nursing experience, listen to his problems, perhaps someone could email the situation to the nurse who could get answers from the physician.  Oh forgot, I have tried before.  Once just wanted to let him know in response to a letter telling me he was prescribing a new med, I knew their were other alternatives and was changing my diet instead.  No email allowed, not to the doctor, nurse, not to the appointment secretary not to anyone.  We DO NOT accept any incoming patient communication. 

     I tried to call the nurse, received a recording, she called 4 hours later, and said the doctor had left for day.  Would call tomorrow. My time was not important to them and as I looked around that waiting room, these poor sick and elderly, well with the way people were rushed in and out without show of compassion, I wondered.  

    Had Accountable Care been developed for the accountants?  What about the patients?  Oh by the way my doctor  informed me by the time my next visit rolled around he would be gone, leaving in a month to practice on his own.  

    Last week I read that physicians want to charge $25 dollars an email. Appears Dr. Google will be getting more hits because patients and families are learning to self treat, alternative measures or just skip the visit or taking care of issues that would improve their health.  

    Doctors and Nurses are frustrated.  The increased task work, documentation, "quality" and compliance reports have left no time for caring for patients.  Analytics show in the last 3-4 a cliff screaming plummet in nursing wage index.  So Nurses and Doctors are leaving. They humanly can't keep up. 

    Corporations no longer treat their employees like family members showing care, company picnics and adequate compensation.  Rather they have become task masters demanding managers drive their crews. Because of the stress, corporate culture, lateral violence, verbal abuse, and back stabbing,  distrust is growing in volumes that now it is becoming a national issue.  

    Remember honor and respect the firemen were given after 911.  How it gave a sense of unity to their teams?  How firehouses became groups of family looking out for each other and taking care of their fellow workers? How they know their communities and are located in every neighborhood?

    Wouldn't is be nice to bring that to healthcare.  Healthcare is in a crisis, our elders and others are being dismissed.  Someone must speak up and be a voice.  How long can we stand by and keep the code of silence while veterans, elderly and others are dying without care?

    So for years I have been studying, analyzing and listening to clinicians and and patients in communities and their homes.  ER's, ICU's, Wards, Nursing and Assisted living homes and a beautiful hospice house too. Inner city and rural has been my research lab.  Listening to the pulse of healthcare from the doctors, nurses, healthcare workers.  Also to family, caregivers and patients in the place they feel safe and open up, their homes.  They have been very verbal about their feelings, experiences and frustrations. The last few years I have taken several massive trips traveling through state after state on my journeys and taking off roads, alternative routes through small towns and stopping frequently in interesting places.  Funny when someone hears you are a hospice nurse almost everyone has a story to share. I listen.  

    The system we used to have is crumbling before our eyes.   Perhaps it will take drastic changes and a rallying of communities and neighbors to meet the oncoming challenge.  Your voice and story matter, each one of you.   Communication and connectivity counts but we must also be in touch on a personal basis and call Servitude Leaders to come to the front. Empower and strengthen our system.  

     Suppose we mix old community and neighborhood values, help to educate and sustain families and blend in green living, new technologies and train our youth at a young age to honor and respect the aged.  Suppose we engage the aged to teach gardening and other skills and crafts to our youth and they work on projects together.  It has been said it takes a village to raise a child but suppose not only raise a child but care for our old and for each other.  Would it reinforce pride in community and promote collaboration?  Wisdom and knowledge would be shared with the younger generation and historical stories shared from the people who had seen and lived them.  

    Whoever you are a clinician, researcher, part of my town, member of my church,  peer, class mate, or patient, caregiver, politician or randomly catch this post - It starts with you and me my friend.  Befriend your neighbor, do a good dead or something nice for someone without expecting a fee and write your local politicians, physicians and hospital corporations.  You will be amazed at the blessings it brings into your own life.  

                                                               THE PLAN 

    There is a group on Linked In that was started by Rob McClenahan, Home Care and Healthcare Advocacy. He often proposes case studies that are true to life examples of what senior and others face and asks for input.  The answers are intelligent and intriguing.  We have discussed anything from Robots for seniors (one of my favorites I may have someday find the archive to and post). 

     Last night I ran across a post that mirrors situations that are happening in numbers.  In the last several years I have had two doctors retire and a couple months ago informed by my physician and friend that although a young doctor would be gone in a couple of months.  Here was my response to his post and a rough description of an idea/plan that might help with the oncoming crisis of healthcare shortage and growing numbers of seniors and others needing care. 

    Aunt Bell’s doctor is closing his medicine practice after 50 years… Manager's Choice

    Rob McClenahan Social Media Specialist at Right at Home, IncTop Contributor

    Hi Group Members, 

    You were in a staff meeting at work the other day when you received a text message from Aunt Bell. Dr. Thompson is Aunt Bell’s PCP {primary care physician} for more than 30 years, but Dr. Thompson mentioned to Aunt Bell in her recent annual physical examination that he is closing his medicine practice. 

    Dr. Thompson is 79-years-old an entered private medical practice after successful completion of his medical residency 51 years ago, but he mentioned to Aunt Bell he preferred to no longer work several hours a day. 

    You called Aunt Bell, your 81-year-old aunt who is a retired librarian, after coming home from work. It was hard to calm her down because she was shaken by Dr. Thompson’s decision to leave his successful medical practice because Aunt Bell always felt comfortable with Dr. Thompson’s medical judgment. 

    If, interested, the article below courtesy of “Market Watch” discusses the growing shortage of geriatric doctors. With the rapid growth of the elderly population around-the-globe, a shortage of geriatric doctors and other care professionals, i.e., nurses, social workers, geriatric care managers, case managers, etc., could happen in several countries because citizens in the advanced years of life might have the necessity to reach out for medical care, especially citizens in each country with chronic or multiple medical conditions. 

    “How can the healthcare industry better prepare for the shortage of aging care professionals and plan for the growth of the aging population?”

    Join our conversation and share thoughts with us on our intriguing discussion topic today. Thank you for your participation on our Home Care and Healthcare Advocacy group on LinkedIn! 


    Rob McClenahan 
    Social Media Specialist 
    Right at Home 
    Group Owner & Manager 
    Home Care and Healthcare Advocacy

    Camea Kirkpatrick, RN,BSN Educator, Patient Advocate & Consultant, Promoting Positive Innovation via Technology & Social Media

    Experienced nurses in the community could solve much of the dilemma. Unfortunately nurse ratios, increased task work and miles covered added to the recent plummet in nursing wages gives little incentive for nurses to enter the field anymore. ANA is covering nurse staffing issues in the hospitals, but communities are where healthcare is moving and we need to recruit, mentor and enable nurses to work without being driven by such tight metrics and demands. Achieving quality when you're running so fast you cant take a minute if a patient has a more extensive problem is an issue. We have the ability to communicate via telemed and telemonitoring. I tested some of these at Stanford MedX last year there are many cost efficient easy to use non-invasive models that allow comprehensive monitoring from a distance. I also see geriatric and palliative research being done but somehow it never gets put into play in the 'field' usually due to budget controls. Let's bring pt. centered care. 

    A trend I am noting is speedy innovation but the ACO's and Mega home health and hospice companies rather than embracing are running leaner and forgoing innovation, cutting staff and leaving patients at greater risk. This is a true concern. The situation is almost at a level of being out of hand in some cases.. Sometimes 2 debilitated geriatric patients are struggling to care for each other at home with no support. 

    I have been discussing with Regina Holiday, National Healthcare Advocate that we are nearing a crisis and must encourage communities and neighborhoods to rally, care for each other. I envision a community house where nurse practitioner sees patients and if there is a case of concern calls a physician or send the patient to a hospital. In these community houses perhaps there are four or five beds in case someone needs palliative or overnight care after surgery. 

    These small houses or centers should be place where community gather and support, perhaps a community garden and a telemed center staffed with a triage nurse to man the monitors for those on home health, palliative or hospice care. The nurse can face time with the patient and because she works with a team member she can send the other RN to check on the situation. 

    Instead of working 60 hour on call weekends alone these nurse work in teams staffed like the firemen crew and perhaps the community pays for the service like they do the firemen and suppose the community center and care house is a safe place for people to go 24/7. It is supported by the benevolence of local faith based groups, community organizations and perhaps has a thrift or bakery and coffee shop to help bring income. 

    Wouldn't it be nice for nurses to have teamwork, support, and community pride rather than the wave of lateral abuse that is causing great concern and even trickling down to patient abuse. Organizations must provide care for the caregivers. The nice thing is the physician can check monitors, face time the nurses or patients from anywhere at any time via his device. . 

    Reimbursement?. That remains the crux. The entire healthcare reimbursement system, staffing issues, corporate and workplace culture and values need to be revamped. 

    The community centers should also be places where children can play outside, a community garden, a large kitchen and perhaps a coffee shop area. If every neighborhood or rural community had a place where neighbors cared for neighbors and nurses and physicians get paid for their services, where communities could take care of the young and old alike.  Education and technique for healthy living, activities scheduled, and yes a domino and card table. It would provide amazing mutual benefits for our youth to learn from our wise elders.  

    Caring for beloved elderly neighbors, and father, often when they thought they needed to go the doctor, many times attention and engagement from a neighbor, daughter, son or friend took care of the problem. Community/neighbors- Dreaming big-praying for America. Thinking pt centered and aging in place. 

    Thankyou!  Rob & team
    @kamiyamay (twitter)

     Here is a link to the original article posted in Market Watch:


    Any input or ideas please feel free to comment.  Working together, embracing new ideas while retaining the core values our country was based on.  

    Addendum:  these centers would also be used as center of command during emergencies such as flood, tornados or other disasters.  They would work closely with Firemen, EMS and Police.  Lacing healthcare, community, neighbors in a network of support.  Perhaps law enforcement could work in defense of it's citizens helping align services when needed and take a less offense approach to fining the policing.  Police officers once again become friends to the community and mentors to our kids. 

    Embracing HOPE! 
    Camea Kirkpatrick, RN,BSN 
    Healthcare Advocate, Consultant and Servant of Humanity
    Twitter:  @Kamiyamay  @GoldenwavesAdv

    Camea: Texas Trails of Care - Riding Golden Waves to next patient.

    This week much has gone on.  Weddings, birthdays, graduations, Nurses week and Mothers Day too.  My Grandpa is on Hospice so this last couple of weeks I am a family member.  At the same time I have been studying a course on Nursing Leadership and Management online and wondering why I bother to do it again this year.  Is it worth it I ask?  Then Facebook pop-ups and Dr. Brian Stork’s tweet with high school student poems humbled me for even asking myself the question.

     I started nursing people when I was 14 as a caregiver in a private home where there were elderly and bedridden and have been doing it in some form or fashion every since.  Well over 30 years. 

     Some say it is my gift, others tell me it is my calling and perhaps they are right.  You see I love people and treat them with the kindness I would want if it were my family.  Some say you will burn out by caring…to this I disagree.  Caring has given the journey much joy, passion, beauty, excitement and caused me to shed a few tears. Just when I think of hanging it up, well someone like you sharing your words makes it all worthwhile. 

    So if you ever thought of serving others or being in healthcare go for it! Perhaps you will not get paid like the CEO but paychecks of the heart bring everlasting smiles.  And guys, I remember a poster that used to hang in one of the colleges I attended.  It had a picture of various outstanding looking men.  It asked one simple question, ‘Are you man enough to be a nurse?’ 

    I have been a crisis hospice nurse on the weekends and through the long dark nights, riding the roads to towns, communities, hospitals, ranches and homes.  Words both of my patients, their families, friends, caregivers and others in gratitude after helping at such a difficult time has touched me and pressed me forward.  Words matter.   I never knew how much until the term ‘life is full circle’ became a reality.  Respect, words and actions sent out with the tide came back rolling in on the waves.

    One Friday evening I came on duty at five, thunderstorms were crashing through the area.  I live in Texas Tornado Alley and dance with the storms year after year driving like a tornado chaser around the hills and towns.  I dashed into a convenience store for cold water on the way to meet a family at the hospital ICU.  My scrubs and tennis shoes were drenched.  When I got to the register the cashier slammed and locked the drawer and came dashing around the counter. 

    I looked around perhaps there was a fire.  Suddenly arms were about my neck and she had my face between here hands and started to sob, thank you, thank you, you were the one.  The men behind me waiting to buy beer looked a little freaked.  I was too, ha.  Then she reminded me that I had come to a home at 3am and faced a group of 6 upset sisters, multiple grand daughters, aunts and more.  I stayed until grandma was comfortable and called the chaplain at 4am.  He came and sang hymns to grandma and helped bring peace.  I did not realize what I did mattered or anyone noticed. You see the words to the poems are true. 

    Another time I was racing through the halls of a nursing home.  The family was upset and the patient uncomfortable and the nurses stressed.  A young man raced after me and said I need to tell you something when you have a minute.  When the crisis was calmed and I was busy writing at the desk he slipped near and said, “you make a difference.” What was he talking about? 

    He shared that he was in nursing school and had made the decision because of moments shared with him and his family.  I couldn’t place the name or face.  He started to explain then I remembered.  It had been 4am when I received the call and the roads were covered with ice and snow.  When I arrived over 100 people were in a little one-room home. I treated them with respect and waited with them after my shift was over to make sure their wishes were met.  Respect and kind words mattered. 

    I have received letters, notes and cards and know of at least two people that went to school.  I have had a group of tattooed ex-convicts rush me at the grocery store to say hi, give hugs and say thank you.  In the post office, Department of public safety, in church, or going out to eat the scene has repeated itself.  I have even been called to serve people who bullied or bossed me before and dismayed them with kindness and respect.  

    Mothers Day a few years ago got a call after working all night.  Come to ICU.  I cried in the shower thinking this can't be true.  A nurse I had loved as a neighbor and had cared for my parents.  I called her family who were at the time over 1000 miles away.  "We are so glad it it YOU"  Humility and gratitude to be of service replaced the sorrow.  Love and kinds words go a thousand miles. 

    My theory each person counts, big house or small.  In a hospital the people that clean the floors are important too, can you imagine a hospital without them, or a nurse working without doctors, aids, technicians and crew?

    What matters is being mindful, showing gratitude and being willing to go the extra mile.  Nursing is a team sport!

    A Happy Nurses Week Thank you to all of you! Your words matter and so do you!

    Addendum:   Spring Lake High School student’s words touched me and I shared them with nurse friends coast to coast.  The first wave has already come back to you riding on the Golden Waves of love~



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