Royal Review May 29 2015 - Royal Victoria Regional Health
Transcription
Royal Review May 29 2015 - Royal Victoria Regional Health
Royal Review May 29, 2015 Remembering ‘Black Friday’: 30 years later It’s a bird! It’s a plane! No, it’s... TEAM RVH Appreciation Days From June 9–11 will celebrate our favourite superheroes – YOU – during the 2015 TEAM RVH Appreciation Days. For this year’s department spirit award, staff are encouraged to decorate or dress up a superhero in their department or unit. June 9 Morning greeting Kick-off event Games/activities Kool FM photo booth Superhero dinner for evening staff June 10 Superhero luncheon Games/activities Superhero dinner for night staff June 11 Morning greeting Games/activities More details coming soon! Barrie Examiner If you lived in Barrie on May 31, 1985 you remember the day like it was yesterday. A devastating tornado—an F4 with winds of up to 400 km per hour tore through the city killing eight people, injuring 155 others and destroying 300 homes and businesses. As the Barrie Examiner reported: “The Barrie tornado crossed Crawford Street, blowing cars hundreds of metres into the bush and stomping down houses. Twelve factories were destroyed and another four just downwind were very heavily damaged. The tornado followed an eastward track, crossing Highway 400 ripping through the Barrie Raceway, tearing down outbuildings and making a mess of a huge parking lot. It then raged into the Allandale residential area, heading east destroying warehouses near Highway 11 and crossing Yonge Street at Minet's Point Road. Damage at the Brentwood Marina was severe. Thirty-five boats disappeared, cement anchors embedded in the bottom of the lake were gone. The tornado then skipped over Kempenfelt Bay and disappeared. Debris from Barrie was discovered 5 km out into Lake Simcoe.” According to a paper written by Dr. Brian Morris and Dr. Tom Armstrong for the Canadian Medical Association Journal, “It had been a normal day at the hospital when the power failed at about 4:30 pm. There were just a few physicians in the hospital at 5:05 pm when an injured man walked into the Emergency department and announced, “A tornado has flattened Allandale”. The paper went on to describe how, “Staff and physicians arrived without being notified because they had seen the tornado or heard the sirens. Within an hour 20 physicians and 30 nurses were working feverishly. Triage was performed in the Emergency department entrance where four teams cared for the injured. The less seriously injured patients were sent to the cafeteria where most of the suturing was performed. A mobile triage unit went to the most devastated area to treat patients at the disaster site. Within five hours, RVH cared for 155 tornado victims, including 16 cases of multiple trauma.” Despite having never encountered a disaster of this magnitude, the team’s response was outstanding. This is due, in part, to the new Disaster Plan and comprehensive training RVH had conducted the previous year when Barrie hosted a large hot air balloon festival and Pope John Paul II visited Midland. We learned a lot from the tornado and today RVH has a variety of well-planned and practiced Emergency Plans that have prepared us for any kind of disaster. The Barrie tornado remains one of the worst tornados to ever hit Ontario. In its deadly wake, parts of Barrie looked like a war zone and residents called that fateful day ‘Black Friday’. As always, TEAM RVH responded with outstanding skill, dedication and compassion. RVH Royal Review May 29, 2015 Avoiding tragedy: How the Young family came within inches of losing a child On May 31, 1985 Susan Young, her husband and her two young kids were driving on highway 400 when a wall of debris hit their car and a light standard toppled onto it. They were very lucky to have survived. One daughter, Caitlin, was at RVH in traction for five weeks with a broken leg. Susan Young, is very grateful for the care her family received at RVH. “If I could say one thing to RVH staff, it would be a heartfelt and humble thank you for their loving care and concern for our little girl,” says Young. “It was a very long time for Caitlin to be away from us but, from the outset, we were secure in the knowledge that she was in caring and competent hands. We have never forgotten Barrie Examiner them.” Susan will share her Ontario Premier Frank Miller and Housing Minister Dennis Timbrell. story at the Barrie Tornado Remembered event on May 31 from 7 to 9:15 p.m. at the Mady Centre for the Performing Arts. The event is nearly sold out, however, some last minute tickets may be available. For more details, visit www.eventbrite.ca. Barrie Examiner (Photo, right): Some of the staff entrusted to Caitlin’s care gathered around her wheelchair to celebrate her discharge. Where were you on May 31, With information supplied by: Judith Banville—Word Portraits 705-790-6490 [email protected] 1985? TEAM RVH recalls where they were and what they were doing on that fateful day Cindy Perry RN, Occupational Health and Safety I drove through the worst area of destruction with my six year old just minutes before the tornado went through. We saw a canoe flying in the air and several treeblocked roadways. Some houses had roofs missing. People were walking around disoriented and some were bleeding. I volunteered at RVH for the remainder of the evening, assisting with discharges on our inpatient unit to make room for potential admissions. I remember how well we all worked together and was so thankful there were not more fatalities! Page 2 Frances (Frannie) Poole, RN, Emergency Department Upon hearing about the tornado I jumped in my car and headed with all the bandages I could find, stethoscope on the dash, to the St. John's Command Centre, volunteering overnight. The army moved in to help from Base Borden. All together it was an amazing experience of teamwork amidst such tragedy, suffering and loss. I still have tornado nightmares and am very watchful of the skies during unsettled summer weather. Cheers to the folks of Barrie who lost so much, survived and moved forward. Cheers to TEAM RVH! Kim Selkirk, RN, Cardiac Care Unit For me, it's one of those dates like the day JFK was killed, for my parents, or 9/11 for our generation. I recall that suddenly the wind really picked up and the sky turned an eerie green/black and yet it was oddly bright like something was reflecting light. I remember seeing a huge wave of rolling blackness coming through the field and forest behind our house. The roof lifted off the house across the road in one piece and started spinning until it broke into many pieces. The very specific sounds, sights and smells have stayed with me since. Inspiring care... RVH Royal Review May 29, 2015 Where were you on May 31, 1985? TEAM RVH recalls where they were and what they were doing on that fateful day Dr. Rob El-Maraghi I was only 11 but I remember exactly where I was! It was at my mom’s (Dr. Laura Crook) and we were getting ready for her birthday party when the sky turned green! Her party was a bust, as she and all of her guests were helping out in RVH’s ED! Dr. Brian Morris Barrie Raceway I got a call at home when the tornado hit. I ended up working in the cafeteria, by portable lights, sewing up cuts all evening. Dr. Tom Armstrong and I published a scientific paper in the Canadian Medical Association Journal about a year later, entitled "Medical response to Dr. Bryn Pressnail and John Dubroy were a natural disaster: the Barrie Tornado". recently reunited for a CTV Barrie news Anna Moller—NP, Geriatrics There were about 11 of us nurses and doctors who escorted patients to Toronto that night. We were all transported back to Barrie in an ambulance bus through the area in the city that had been devastated by the tornado. It was quite eerie and dark, as there were no city lights. On one side of the street a home would be destroyed and on the other side, a home would still be standing. When we arrived back at the hospital, the ED was stripped of supplies—cupboard doors were open and shelves were empty. We spent the rest of the night comforting folks in shock, treating people with chest pain, giving tetanus shots and treating those with less serious wounds. story, 30 years after Pressnail helped treat John’s devastating injuries. Dubroy was thrown from his vehicle during the tornado and credits Team RVH for his miraculous, albeit slow, recovery. Dr. Bryn Pressnail I reported to the ED and there were many, many casualties. I was assigned to care for an unconscious young man (John Dubroy, above) with a head injury and multiple other injuries. We stabilized him and transported him to Toronto for neurosurgery. The entire hospital community was present, caring for injured people until the emergency situation was declared over at about 11 p.m. The most striking memory is that there were many injured and many caregivers, but everything was managed quickly and efficiently. I was extremely impressed with this disaster management. Kay Morrison—RN, Regional Stroke Education Coordinator At that time, I was Nursing Director of the Special Care Services which included the Emerg, Critical Care, Medicine, Psychiatry and Outpatient Services. I had just left work when all the lights went out and the sky became very black-green with high winds. I then immediately came back to the hospital. I just knew I needed to be there. My most profound recall was the incredible silence as we triaged patients. Even extremely injured patients waited silently for their treatment—they did not scream. Some were so covered in mud we could hardly recognize them. Some moaned quietly, but most were in shock, I approached one man who was sitting with a large bandage on his knee. I asked him what his injury was and he held up his partially severed arm; in shock, silent, making no comment. One to two hours later we started to see the families or friends that were away from home at the time of the tornado. Many were hysterical and in shock, looking for family. The noise level in the ED now became overwhelming with people screaming, crying and hyperventilating. Breathing in paper bags was now a key part of our management. We had a very small team, but a more effective, efficient, professional and dedicated team has never existed. We ran like a well-rehearsed machine, reminding me of a MASH unit on TV—a truly high functioning inter-professional team, knowing intrinsically what to do next. Sadly we have lost many of the silent heroes of that day -- Dr. Duncan Patterson, Dr. Terry Porter, Dr. Amir Nazerali, Dr. Homa Khonsari and many others who have retired— but are not forgotten by those who were there and lived the moments with them. Dr. Bob Lewis-Watts I was asked to go into the “trauma/resuscitation room” to help out. On the table was a young woman obviously the victim of some major trauma. As a group of us worked feverishly to assess / intubate, establish IV access and try to resuscitate her the word came that she’d been in a car on the 400 that had been directly hit. Meanwhile every time the doors opened we could hear the urgent calls for other staff to go to help other severely injured in the other three treatment rooms. I remember being close to tears. She just looked so young, innocent and helpless lying there on the table. The cafeteria had been rapidly transformed into a giant assessment and treatment area for less severe injuries. The tables were now covered in sheets and a steady stream of patients were brought in, many cut and bleeding from the flying projectiles. Despite the huge volume of patients I remember remarkable cooperation amongst all the hospital staff. There seemed to be a tremendous amount of focused but selfless energy throughout. I finished the evening suturing I don’t know how many patients. It was during this time that they shared their harrowing experiences often with remarkable tales of escape from what seemed to them to be certain death. By the time I got home I was both wired and exhausted and was filled with feelings of sadness but also gratitude that out of the devastation the death toll hadn’t been three or four times greater. Inspiring care... Page 3 RVH Royal Review May 29, 2015 Where were you on May 31, 1985? TEAM RVH recalls where they were and what they were doing on that fateful day Lynne Penton—RN, Emergency department I was working in the Critical Care Unit and it went very dark. The back-up generator kicked in and we were paged to bring all spare stretchers to the ED, where ambulances were lined up at the door. People were sitting in the hall covered in mud and blood and they were so dazed they couldn’t find any words to tell us what had happened. No phones were working and in those days there were no cell phones, so none of us knew what had just happened. I recall starting to cry because I had no idea what we were seeing. I went out (to the site of the disaster) in the first ambulance with a doctor and R/T Kim Downey to see if there was anyone buried in the rubble. Kim asked us to hold hands and pray that we not find anyone dead. We were silenced by seeing the racetrack all blown away and buildings collapsed and in shreds. I remember how small RVH was then and how much we knew each other and supported each other and how the community of Barrie all pitched in to help us. Mark Moreau—RN, 4GC This was an emergency situation and I knew they would need as many staff as possible to be on hand for whatever injuries there might be, so I wasn’t going to wait to be called to work. I ended up doing a one-to-one care on a patient who had sustained a head injury in the tornado. After viewing the destruction first-hand over the next few days, I realized it was remarkable that more people weren’t more seriously injured or killed. It was great to see how well the health care team at RVH pulled together in this crisis. It made me feel so proud to have chosen the nursing profession and thirty years later, I am still proud to be an RN at RVH. Dr. Mitch Whyne I had only worked at RVH for a few months and was driving up Highway 400. I was listening to music on my 8- track player, so not listening to the news. All of a sudden traffic was backed up and as I approached Barrie, vehicles and debris was strewn across the highway. I worked with police to weave my way through the mess to the hospital and then spent the night in the cafeteria triaging and treating patients. It was quite a night. RVH OR (top) and Emergency triage/registration Sharon Partridge—Retired Chief Nursing Officer As Head Nurse of the newlyopened Surgical Day Care Unit (SDC), I had just gotten home when I got a call that a tornado had hit Barrie. Immediately I headed back to the hospital. As the Emergency department managed the multiple trauma victims, SDC became a staging area for stabilization and further diagnostic testing of patients. At one point I walked out to the Emergency entrance and all I could see was a sea of people on foot, in cars, police, fire and ambulances filling the streets. It was not until the disaster plan was called off later in the evening and communications in the city were restored that we were able to comprehend the full scope of the disaster. David Rogler—Logistics Attendant I heard on the car radio a tornado had hit the Barrie area! I had a feeling RVH would need my help so I headed back there as soon as I could. I ended up helping in the cafeteria as patients were being treated there because the ED was so busy. Then I monitored the main entrance because we had no hospital security back then. It was tough as people came to me who were frightened and concerned about their missing family members and friends. They wanted to enter the hospital to look for them. I still remember to this day how so many staff members pitched in and did whatever they could during those critical hours. There were also many who came back to RVH after having worked all day because they cared. Simone English—Mental Health I was seven-and-a-half months pregnant and on my dinner break when the announcement was made recalling us to our units. I took a stretcher to the emergency department and when I rounded the corner to the ED, it felt like another world. Although it appeared chaotic to me, I quickly realized that it was organized chaos. It felt surreal and I thought someone might tell me it was just a drill. All hands were on deck and I was impressed with the nurses and doctors who seemed to take it in stride, although it was a faster pace. Page 4 Inspiring care... RVH Royal Review May 29, 2015 Where were you on May 31, 1985? TEAM RVH recalls where they were and what they were doing on that fateful day Suzanne Legue—Chief Communications Officer I worked as a reporter at CKVR Television at the time, just up the hill from the worst of the disaster scene, so I viewed RVH’s response from a different lens. I remember Dr. Tom Armstrong talking about the incredible focus that kicked in as the injured started streaming into the Emergency Department. Everyone juggled priorities, triaged patients on the fly and just did what needed to be done. The response by RVH, other first responders, the military, and the community at large was outstanding during, what remains, one of Canada’s worst natural disasters. Dr. Wes Cutbush This day is burned into my memory. I received a call that a tornado had ripped through our neighbourhood, doing significant damage, including a gas leak. I drove as far as I could and ran the rest of the way home. Sadly on the way I came across a fatality, a young boy who had been swept off his bicycle and into a tree. I pronounced death, and continued to my neighbourhood. Nothing was desperate, so I was able to catch a ride on an ambulance back to RVH. There, along with others, tended to all manner of injuries in the ER. Every patient had a harrowing tale of what had happened. I remain amazed that there were not more fatalities. Karen Winter—RN, Manager, Pre and Post Surgery, and ACT, Surgery Program I remember that shift as if it was yesterday. I was at home and was called into work as a part of the disaster response. I was a casual RN in the Critical Care unit and was sent to ED to help with the critically ill patients coming in. I worked alongside Dr. Pressnail to care for a critically ill gentleman until he was transferred to Toronto. In the middle of transporting this gentleman to the CCU my manager at the time Sue offered me my full time job. I accepted and I have worked full time at RVH ever since that day. Donna Danyluk—Corporate Communications Representative At the time I was just starting my career as a reporter-photographer with the Barrie Examiner. I remember the weird green colour of the sky as I drove to work. As a junior reporter I was not assigned to photograph the carnage left by the tornado, but rather to process the film brought back to the newsroom. My view of the disaster came through film processed in a tiny dark room. As each image appeared in the chemical tray I saw more and more the destruction and death the tornado had left behind. It was hard to believe the pictures I was seeing were taken in my own city. Barrie Raceway Glenridge Road, Allandate Rosie Sage, Staffing Analyst, Human Resources That night is still clear as can be in my mind – at home seeing a bolt of lightning that seemed to go from the top of the sky and get buried in the earth; how the sirens made it sound like a war zone; being so happy that my son was safe and sound; the chaos; and the way everyone worked together to get through the night. On that night some staff opted to work without pay and the ones who were paid gladly donated that money to the Red Cross because we felt so blessed to have come through that night with limited damage. We all knew someone who was personally affected by that day and I think most of us watch the skies closely when that hot and humid weather begins. Judy Klementti, OR Clerk I was just cleaning up in the operating room and they called for all stretchers to Emerg. At first I thought this was a mock disaster exercise. I worked outside Emerg directing traffic as patients began to arrive but because of poor communication with the disaster site, I went with Dr. Green and several others to Allandale to assess the situation and see if we would be receiving many more patients. A sad part to the story was that my 12 year-old son’s best friend was killed in the tornado. I still have the eulogy that he wrote for the funeral. Many talked about the damage to homes and businesses that the tornado caused, but that could all be repaired. Angie Clark—Physiotherapist I was 9 years old and at home with my family during the storm. My mom, who was -- and still is -- a nurse at RVH was called into work. We drove her there and I remember the ER was overflowing with injured people arriving by ambulance, cars, & even the back of pick-up trucks. I remember feeling proud that my Mom was a nurse and could help these people. Later, some kids, including a friend, never returned to school. I learned that her brother and mom were killed and she was at Sick Kids with a head injury. I never saw her again. For a 9 year old kid, it made a permanent impression. Inspiring care... Page 5 RVH Royal Review May 29, 2015 A tale from the centre of the storm For Allison Ethier, Clerical Analyst with the Simcoe Muskoka Regional Cancer Program, the scariest thing she recalls about the 1985 tornado was the danger her two daughters, Katie and Jaclyn, faced as their car was tossed into the air on Springhome Road in Allandale. In her detailed telling of the event, Allison recalls her fear and reaction when she realized that she and her family were in the middle of the tornado. Here is an chilling excerpt from her account of that horrific afternoon, written one week later. “I realized that the big cloud was coming directly down the street. My first reaction was to pull off the street, but before I could turn off the ignition, things started hitting my car. My first thought was to get the kids out of the car and into a house, but I never had time. The windows started bursting, I got my seatbelt off and reached behind to protect Jaclyn’s face from flying glass and yelled at Katie to bury her face in her lap. The whole car was shaking, trees and parts of houses were coming toward us. The next thing I know the car was in the air. I couldn’t tell you how far we went. Katie was screaming, “Mommy, what is it? Help me!” The car landed on its roof. I was laying flat on my back looking up at both girls. They were both suspended in the air by their seatbelts—the wind was so strong I thought they would be ripped out of their seats. It was like somebody was yanking their hair, trying to suck them away from me. Jaclyn’s twoyear-old eyes held such a fearful look and her little arms and legs weren’t hers—someone else or something else had control of them.” Allison and her daughters crawled out the back window of their car to escape once the tornado passed. Residents on the street rushed out of their houses to check on their injuries. They were then picked up by an ambulance and taken to RVH to be treated. (Bottom, left) Allison and her family visited her destroyed car the next day after it had been towed from the wreckage. IGNITE Research Conference: Call for submissions Presentation abstract submissions are now being accepted for consideration at the RVH Research Conference 2015. DEADLINE FOR SUBMISSIONS: THURSDAY, JULY 30, 2015 SUBMISSIONS: Abstract must be submitted via email to [email protected]. All abstracts should follow the following guidelines/format: Preference – Oral or Poster Presentation Title of the abstract (must be in CAPITAL LETTERS, and bolded, with no abbreviations (max 125 characters including spaces) Names of authors with credentials (maximum 3 credentials or degrees) Presenter(s) indicated by UNDERLINING the name(s) E-mail address of the primary presenter which will be used for all communications. Abstract must be single spaced, Arial Font, size 11 and be a maximum of 350 words Abstract must be formatted as follows - TITLE, Authors, Affiliation(s), Introduction, Rationale/Objectives, Methods, Results, Conclusions (bold these subtitles) Abstracts will not be edited and will be reproduced in the exact form submitted in the abstract booklet to be distributed at the conference. Please proofread your abstract carefully because once submitted, it cannot be revised. For more information and details about abstract formats, please contact Susan Devine at ext. 41350 or [email protected] Page 6 Inspiring care... RVH Royal Review May 29, 2015 Member of RVH family to bear Pan Am torch Barrie's Meghan Carlisle is going to be in good company when the Pan Am Games Torch Relay passes through the city in June. The 24-year-old daughter of RVH’s Susan Carlisle, will be the City of Barrie’s community torchbearer on June 10, joining approximately 3,000 torchbearers who will complete, on average, a 200-metre segment during the 41-day journey that culminates with the July 10 opening ceremonies in Toronto. Pan Am Games officials say she was selected because she embodies the core characteristics of the relay: community, celebration, participation and pride. "Meghan has demonstrated an outstanding dedication to community service and sport," officials said in a media release. And that's no exaggeration. Carlisle received the Lieutenant Governor award for outstanding community service — she completed 500 hours of community service while in high school compared to most students who squeak by with 40 — and for the past seven years, she has volunteered as a coach with the Barrie Special Olympics swim team, coached the North Bay Special Olympics team and instructed the Nippissing Association of Disabled Youth in skiing. She has also volunteered at summer camps for children living with childhood cancers and works with children at an after-school program in Barrie. “I am honoured to represent the City of Barrie in the 2015 Pam Am Games Torch Relay,” says Meghan. “I take pride in being a role model for the young people I teach, so being a torchbearer will be a proud moment for all of us. I'm excited. It's going to be a very rewarding experience. I'm really looking forward to it and meeting the other torchbearers and other people involved with the Pan Am Games." Carlisle said one thing stands out in her life. "I love helping people. You improve their quality of life," she said. "I've also helped out in numerous emergency situations — car crashes — I've happened to come across. If something like that ever happened to me, I'd like someone to help me."Carlisle was selected by the city’s torch-relay committee from a number of qualified applications that were submitted to the city late last year. The torch will be carried by more than 60 modes of transportation which will take it more than 5,000 kilometres on the road and 15,000 kilometres by air. Susan Carlisle (left) with Meghan Within the Human Resources department, some role re-alignments are currently taking place. Kayla MacDonald has taken on a combined HR Consultant/HR Analyst role. Laurie Johnson, who has transitioned to a permanent role as an HR Analyst, will cover Kayla MacDonald’s maternity leave of absence until June 2016. Courtney Brown began an interim role as HR Analyst in May 2015, and Jamie Borland is providing interim coverage in the Administrative Assistant role. From left: Kayla, Courtney, Jamie and Laurie Inspiring care... Linda Shanks is retiring after 28 years at RVH. Linda, who currently works as a Patient Services Clerk on the Integrated Stroke and Rehabilitation Inpatient Unit. Linda is looking forward to relaxing on the beach, spending a month in Florida during the winter and doing some biking. Linda’s last day is June 20. A retirement tea for Linda will be held on June 11 from 3 to 4 p.m. in 4G343-45. New # for CCOT Mission Possible Dress Code Corner RVH’s valuesbased activity is available at the Health Library. Every year members of TEAM RVH should go through the activity. It only takes 20 minutes—so if you haven’t participated gather up some co-workers and head to the Health Library. Time is of the essence when you need the assistance of the Critical Care Outreach Team (CCOT). Valuable seconds can be lost if you are using the wrong number to reach this life-saving team. Effective immediately, the CCOT team can be reached by dialing ext. 66300. New posters and badge cards will be distributed to departments and staff in the very near future. Page 7 May 29, 2015 RVH Royal Review Foundation News On May 20 and 21, Larche Communications’ radio stations 104.1 The Dock and KICX 106 held their annual radiothon at Riocan Georgian Mall. This year’s event—the Radio for Cardiology Radiothon—raised more than $60,000 to help bring advanced cardiac care to RVH. Dr. Brad Dibble (shown front), a Cardiologist and Clinical Director of the Cardiovascular and Renal program at RVH, stopped by the radiothon to speak with Meg Whitton of The Dock morning show. Larche Communications has pledged to raise $500,000 to help equip a cardiac catheterization lab as part of the future advanced cardiac program. Rotary Fun Run 2015 On May 27, just before TEAM RVH departed for the 2015 Rotary Fun Run, the Staff Giving Wall was unveiled. The wall, located at the L1 staff entrance, celebrates the generous contributions of TEAM RVH, both active and retired. The staff total for the campaign is now $180,000—that’s 70 per cent of the staff campaign goal. It’s not too late to contribute to the campaign—just contact the RVH Foundation. The Barrie Half Marathon will take place June 7. For more information or to join TEAM RVH, please visit http:// www.barriehalfmarathon.ca/ or contact the RVH Foundation. Some funds raised at the event will benefit Hearts & Minds (advanced cardiac care). Walk in My Shoes Nearly 300 members of TEAM RVH, friends and family participated in the 2015 Rotary Fun Run making RVH the winner of the corporate challenge for the largest team. Despite some inclement weather, the team enjoyed their 5 km run/walk and 10 km run. Congratulations to Leslie McArthur of the Pharmacy who was also a big winner—finishing first in the women’s 5 km run out of 208 runners with a time of 20:37. Thank you to Larche Communications which provided KICX 106 and 104.1 The Dock buses to transport TEAM RVH to the waterfront. Page 8 Inspiring care...