Nurses Remember Why

Tulare - Labor Day in the U.S. is time to celebrate the achievements of workers, but many of our local residents will work that day, continuing to provide essential services to others.

Among those who will be on-the-job Monday are Tulare Regional Medical Center nurses, who were invited by their bosses earlier this year to recall why they chose their profession and share their thoughts as part of an essay contest.

Chief Executive Officer Shawn Bolouki – a former army nurse – and Chief Clinical and Nursing Officer Pat Mathewson came up with the idea in part because, as they put it, “every nurse has a story.”

But the essay contest did more than just allow nurses to tell their story. The exercise – one that others might want to replicate this Labor Day – allowed them to tap into the passion that prompted their journey, to rekindle the spirit that carried them through years of training and to inspire colleagues who may have temporarily lost their sense of purpose.

“In order for us to have a meaningful life, we need to have a purpose,” Bolouki told nurses who were feted at a special luncheon during which the four essay winners were announced. Without purpose “you go on a journey without a destination.”

Maintaining this connection between job and purpose seems especially critical for nurses because of the special roles they play in the lives of patients.

“We all care about patient care, but you have the most impact,” Mathewson told them.

Now for the winners and their stories:

Mary Ann Rojas LVN
First Place

Mary Ann Rojas, a licensed vocational nurse at Hillman Healthcare Center, was 10 years old when she decided to become a nurse.

“'I want to help people,'” was my motto. I was however clueless to how this decision would unfold.”

Her “humble journey,” she said, began her sophomore year in high school as she waded through anatomy and physiology classes that “captured my heart and soul.”

A few years later, while serving as a hospital corpsman in the U.S. Navy, she learned the skills and techniques that allowed her to become a licensed vocational nurse.

“However, several skills cannot come from a classroom. There is no such curriculum for compassion, understanding or empathy – the very skills nurses must possess if they are to be an instrument of healing for a patient.

“My quest to 'help people' came alive as I worked with patients on an oncology ward. It was not longer about me. My job was self-less. Nursing is self-less. It is risk taking. It is giving comfort, empathy and compassion on a daily basis. It can be arduous, tearful and frustrating. This is nursing. It is never about me. It is about my patients.

These skills – “skills of the heart,” she called them – come from “tiny seeds” in the hearts of men and women who want only to help people.

Those seeds are nurtured and soon blossom and are transformed into givers of mercy. The skills of our hands demonstrate our ability to take care of our patients but it is the skills of our hearts that enable us to 'care' for our patients.

“As I continue learning the skills for my hands, I do not forget that it is my heart and the skills that have been borne in it that guides my journey. I now know what it means to 'help people.' I go forward on my humble journey.'”

Charlene Dawson RN
Second Place

Charlene Dawson journey to become a registered nurse began the day her son Ethan was born, weighing a mere 2 lbs, 5 ounces.

“He was 13 inches long, had no pigment in his skin and no cartilage in his ears. He was unable to breathe on his own or feed from a bottle, so he was placed on a ventilator and fed through a nasogastric tube. Ethan had become septic and I was told to prepare for his possible death; but he was a fighter and not only survived but thrived.”

Dawson and her husband took their son home two months later, “blissfully unaware,” she said, that her son had many more fights ahead of him.

He was home barely a week when he was diagnosed with a condition that required immediate brain surgery. His trachea was severely scared in the process and he required an emergency tracheotomy, after which he developed pneumonia and almost died. The next two years saw 13 more surgeries and numerous hospital stays for a variety of infections.

“Throughout all the surgeries and hospitalizations there were these incredible women and men who taught me to change a trach tube, encouraged me to touch my ventilated infant, helped me do IV therapy at home, held my hand and gave me hope when there seemed to be none. They were nurses, my kind and patient angels.”

When Ethan was a few months old, Dawson said she realized “I wanted to be for others what these women and men had been for me.” It took 13 years, but she became a nurse.

“I'm happy to report that Ethan is now a sophomore in high school, healthy and happy. I have been a registered nurse for more than three years, striving everyday to be a credit to the profession I so dearly love.”

Crystal Guzman RN
Honorable Mention

Crystal Guzman became a registered nurse because she wanted to be the person patients relied on when they needed someone the most; she decided to become an obstetrical nurse after the birth of her son – “a miracle baby.”

“My son was born with a triple nuchal cord around his neck that was tied into a tight true knot; he was being deprived of oxygen for who knows how long. His first Apgar score [an assessment of health] was a zero, he was not breathing, heart was not beating and his color matched the white sheet that he laid on. After chest compressions and ventilation, my baby was wrapped up in that white sheet and taken out of the room.”

Guzman's baby had been gone for a long 30 minutes when her labor and delivery nurse came into her room with a photograph of him and the wonderful news that he was now breathing.

“That day changed me forever and had it not been for the nurses who took care of me and were so quick to act, my story today may not be the same. Those nurses that day took action and without hesitation did what they needed to keep me and my baby safe. They went above and beyond, worked together as a team, communicated effectively, put all my needs above theirs and did what they needed to do to save my baby.”

As an obstetrical nurse, Guzman said she feels a strong connection with the moms in her care and it feels good to be the person who can help them through their labor, no matter how difficult.

“I take my experience as a fire that pushes me to do my job the best that I can and to keep my patients safe and to be their advocates.”

Norma Velvick, RN
Honorable Mention

Nearly 30 years ago Norma Velvick was in trouble and did the one thing she said she thought she could count on. She prayed.

“I asked God to bring me comfort and healing and should I receive these, I promised to return it by serving others who might need the same.”

Her answer came a few days later while she was helping a neighbor determine whether she qualified for a nursing program. The neighbor didn't.

“She said 'Oh, too bad I can't go but, Norma, why can't you?' I could not find a single answer for her. My journey had begun.”

Overcoming the challenges of not having money or a working car, Velvick earned an LVN degree in 1983 and an Associate Degree in Nursing in 1987.

Determined to keep her promise, she worked long hours, making frequent changes from acute care to skilled nursing to administration to staff education, to home health and finally back to acute care. She earned specialty certifications along the way.

She met her husband while working in skilled nursing. Andy, she said, had a kind spirit, love for life, a strong compassion for the sick and a kidney disease.

“I did not see Andy's kidney disease as most people did. Many questioned, 'Why would you marry someone with such a devastating illness?' I saw a person with so much life and happiness. It was just simply too easy to love this man.”

After Andy died, she considered all that had happened:

“I became a nurse to fulfill a promise to God to serve his people. I never thought I would be the recipient of that same promise. I understand now it was not about the promise I made 28 years ago, it was God's way of leading me on a journey. A journey of healing with compassion.

“Nursing has given me the same promise I made long ago.”

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AMVETS Opens New Service Office

Tulare - Local veterans, meet Carl Bates. He is here to help.

Bates is the service officer at the newly opened Veterans Service Office at 120 North M St., which is also the new headquarters for the State Department of AMVETS.

As the AMVETS celebrated their grand opening Friday, Bates and his boss, Doug Bradley, director of services and rehabilitation for the AMVETS Service Foundation in Anaheim, were busy outlining to visitors the services offered through the office.

Nationally certified and accredited, Bates can help veterans get into the VA hospital system and file claims for injuries or illnesses related to their military service.

Prior to the opening of the Tulare office, the nearest AMVETS service officer was in Fresno. While Tulare County also offers similar services, budget constraints have reduced staffs and veterans who call today will have to likely wait until mid-October, Bates said.

“Right now I can get you in to see me in two or three days,” he said.

Because of the large concentration of veterans in this area, the AMVETS Service Foundation expects to add another service officer to Tulare by the beginning of next year, state AMVETS Cmdr. Charlie Ramos said.

Bradley said the Service Foundation has or is in the process of developing several programs local veterans will be able to access here in Tulare, including one for women and another for Native Americans.

“We also have a Veterans Recovery Program for veterans that we, quite frankly, didn't reach in time,” Bradley said. The program will help them get into drug and alcohol recovery programs.

Bates also is working with College of the Sequoias and other Valley community colleges to reach out to veterans who recently have returned from the service.

Bates spoke bluntly, telling audience members not to believe veterans who are drinking heavily or abusing their spouses or children when they say they don't have problems.

“They do and they need help,” Bates said.

Ramos, a Tulare businessman and a veteran of the Persian Gulf War, spoke passionately about the importance of helping returning veterans.

“We learned a lot of lessons from Vietnam,” he said. “They were hard lessons and we can't let a generation go again.”

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Festival of Hope Starts Saturday

Tulare - Using music and art to attract people of all ages, Festival of Hope will attempt this weekend to create more awareness about suicide and help reduce the stigma of seeking help.

The two-day event is scheduled from 10 a.m. to 9 p.m. Saturday and 10 a.m. to 7 p.m. Sunday at Preferred Outlets at Tulare, 1407 Retherford St.
The festival will feature a number of events, including:

• Street painting workshops led by three professional chalk artists, which will begin at 10 a.m. and 10:30 a.m. Saturday and 10 a.m. Sunday, at the Galaxy Theatre and later move outside for participants to get hand-on experience.

• Children's chalk drawing starting at 10 a.m. both days at the main fountain in the heart of the outlet center. There is no charge for participation. Adults must accompany children at all times.

• Showings at 10 a.m. and 11:45 a.m. both days at the Galaxy of the Academy Award-winning short film “Trevor,” which is about a young gay adolescent struggling with bullies and socially isolation, which leads him to contemplate suicide. Admission is free.

• Showings of “The Shaken Tree” at 10 a.m. and 11 a.m. both days. This is a documentary on mental illness and suicide. Admission is free.

• A series of outdoor Sound N Vision Foundation concerts that will start at 3 p.m. and run to closing time each day. Admission is free.

The Suicide Prevention Task Force held a Community of Hope Conference in Visalia in May that drew 700 people, including not only health professionals but members of the general public who wanted to learn more about suicide prevention, said Cheryl Lennon-Armas, executive director of Tulare Youth Service Bureau and task force leader.

“Again with the festival we're targeting all people,” Lennon-Armas said. “We want to reach out to all generations of the community.”

Tulare County reported about 40 suicides in 2009 and by July 31 already had recorded 30.

“That's a public health issue as far as I'm concerned,” Lennon-Armas said. “That's 30 people who had a depression or mental health issue who are lost.”

Of the 40 deaths reported in 2009, all but three were men, which Lennon-Armas said is not unusual.

“Women attempt suicide more often; men chose more lethal means,” she said, adding that some studies are showing a change in that pattern.”

At the May conference in Visalia, more than 200 people attended a workshop on suicide within the agricultural community.

“What that tells us is there's an interest and there's not a lot of information about that,” she said.

A session on teen suicide also was very well attended.

“Our numbers are lower than you would anticipate…I think we do a good job but even one is too many,” Lennon-Armas said.

More attention is also being given locally to new mothers, because suicide is the second leading cause of death for this group, she said.

Funding through Proposition 63 has allowed for the screening of all new mothers and clinicians throughout the county are receiving training for this, she said.

The task force recently sent a representative to a Tulare Association of Churches meeting in an effort to engage the faith-based community in the on-going attempts to prevent suicides.

“Many times they [people who are suicidal] might talk to their pastor or someone in their congregation,” Lennon-Armas said.

One of the messages the prevention community is trying to get across to people is that they have to become comfortable asking a person if they are thinking of suicide.
She gave the example of a woman who answered “no” to family members who asked her if she was thinking of “hurting herself,” but then responded “yes” to a sergeant who asked her directly if she was thinking of suicide.

While the topic of suicide is about as serious a subject that you can find, Lennon-Armas said the hope is that people attending the festival also will have a good time in addition to learning more about the issue.

Speaking of fun, the concert schedule is as follows:

Saturday
· 3 p.m. – Indosurf, rock/reggae music.
· 4:30 p.m. – Mezcal, Latin and world music.
· 6 p.m. – Strange Fine, blues rock.
· 7:30 p.m. – Band of Brotherz, root, reggae and rap.
Sunday
· 3 p.m. – Distrito Torre, Latin rock.
· 4:30 p.m.—Fierce Creatures, indie rock.
· 6 p.m. – The Whiskey and the Devil Chaplain, folk, Americana.

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Responses Give New Twist to $1 million Transfer

Tulare - In individual responses to the Tulare County Grand Jury, City Manager Darrel Pyle and two council members said Tulare Motor Sports Complex developer Bud Long in 2009 did not need the city's permission to remove the $1 million he had in a Tulare bank and move it to a Fresno bank.

The money was placed in a Citizens Bank account to demonstrate the developer's intention to repay the city for cost of an environmental impact report.

The grand jury, in one of its findings pertaining to an allegation of a Brown Act violation, said an agreement was amended on Dec. 29, 2008 – the night the City Council approved the EIR – to prevent the developer from withdrawing funds from a Tulare bank without city permission.

Pyle, Vice Mayor Phil Vandegrift and Councilman Richard Ortega said that was not the case, thus disputing publicly for the first time what generally has been thought to be true.

The handwritten modification drafted by TMSC attorney Myron Smith at the direction of then-City Attorney Steve Kabot was neither dated nor approved by the council, thus making it invalid, Pyle said.

“This action was taken without the knowledge and consent of the City Council, demonstrating that it was not signed by 'all parties'” as required, Pyle said.

He also said he heard Kabot tell Smith he would “kill the deal” if he didn't agree to the modification, which hardly amounts to “mutual consent.”

Because the council never acted, the original agreement, which allowed Long to remove the money after the EIR was approved, remained in effect, he and the council members said.

Mayor Craig Vejvoda agreed with the grand jury that an amendment was made, but noted the change happened without the knowledge or action of the City Council, leaving “some question” as to its validity.

Pyle said he reached his conclusions after the grand jury raised its concerns in July, prompting him to review relevant documents to see how matters got to this point.
This is just the city manager talking,” he said. “I'm not an attorney.”

News to Kabot

Kabot said he was surprised by Pyle's comments because the city manager knew about the amendment before the Dec. 29 meeting and agreed it was necessary to protect the city.

Before that meeting, he, TMSC attorney Smith, Bud Long, Pyle and others met at City Hall, where he raised the issue about the original agreement, Kabot said.

The prohibition against the developer taking money out of the account was going to dissipate with approval of the EIR and that was something the city did not want, he said.

“The simplest solution was to draft that amendment,” he said. “Darrel Pyle was fully aware of it and agreed that it was necessary.”

He believes at least one council member was present at the meeting but he could not recall which one.

“The fact it [the amendment] was undated does not mean anything as far as whether it's enforceable or valid or not,” Kabot said. “It was very clear the developer – Bud Long was there – understood that was changing the agreement and it was very necessary to do so.”

As for threatening to “kill the deal,” Kabot said he didn't recall using those words.
“I said I would recommend the EIR not be approved and the development agreement not be approved that night unless there was a modification,” he said. “But

I can't kill the deal and I know that.”

Kabot called Pyle's responses “absurd” and said the city manager is in effect saying he knew full well when the council approved the EIR, the city would have no control over the $1 million and he didn't care, he said.

“That's the only way to interpret that,” he said.

Pyle said whether he knew is not the point. The point is the rules to change the amendment were not followed and that was the city attorney's responsibility to see that they were.

He maintained it was the city attorney's responsibility to see that the amendment got on that night's agenda – perhaps as an urgency item – and he didn't.

Asked why he didn't raise the matter that night, Pyle said: “I don't write contracts. I don't amend contracts and we pay attorneys a whole bunch of money to do that very specific task.”

Pyle also said that while TMSC attorney Myron Smith signed the agreement and believed it was binding, Long apparently after reviewing the documents, determined it was not and attempted to remove the money from Citizens Bank a few days later.
But the bank balked and called city Finance Director Darlene Thompson, who said permission from the city was needed.

When the money was transferred to a Fresno Bank, Smith prepared a document that would give the city continued control over the funds. Vejvoda – with Kabot's blessing – signed the document at the Fresno airport that would have done that – but Long refused after Smith brought him the paper.

Pyle later approved transfer of the money, again with an OK from Kabot.

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