What a great way to describe the night staff of Hospice of Palm Beach County (HPBC). When the world is asleep, they are there to be a friend to their patients. “With less hustle and bustle than the daytime, the night shift staff really has the opportunity to connect with our patients,” said Bill Rascoe, HPBC Regional Manager – WPB Central Area. “They listen to them, as a friend, sometimes sharing their own stories or feelings, even a laugh. Most importantly though, they create a bond with a patient or family member that many are thankful for at such a difficult time in their lives.”

“Here at Hospice of Palm Beach County we are lucky to have some of the most incredible staff, said Jennifer Martinez, Communications Manager for HPBC. “We have the most compassionate, autonomous, empathetic nurses to care for our patients and families at the time of their greatest need. Whether it is just a small gesture like stopping by to say hello, or being somebody to talk to, every thing our staff does makes a huge impact on a patient’s well being and a family’s comfort at such a challenging time.”

William Lazo, R.N., Dora Berrio, R.N., Marie Louis, C.N.A.

And, as the rest of the world sleeps, HPBC’s night shift keeps everything running smoothly. “I have worked the night shift for many years,” said Barbara Cameron, Charge Nurse at HPBC’s Gerstenberg Inpatient Unit. “I feel it gives me a better opportunity to connect with my patients. Though we still have a lot of work to do, we don’t have to worry about meals or visitors. We really have the opportunity to have a conversation with our patients.”

Being a part of the night shift also gives staff the opportunity to serve as the eyes and ears for the rest of the care team. They can monitor the patients while making them feel safe, feel cared for and feel like they truly have friends here. And, though everyone has a different perspective on how they can help, everyone makes a difference.

So, the next time you lie awake at night, unable to sleep, think of the impact the night staff of Hospice of Palm Beach County is having on someone at that very moment. They truly are an invaluable part of the Hospice of Palm Beach County team.




Healthcare is in the midst of tremendous change. 2010 promises to be a year filled with changes that will impact all of us and the patients we treat. One of biggest challenges facing all of us is that we do not know what healthcare reform will look like. It is hard to plan and anticipate for a change that we cannot fully predict. Significant change is clearly coming. How that change will manifest is not nearly so clear. Actions are taking place right now in Washington that will have a huge impact on healthcare for decades to come. These changes are being hammered out in the committees and subcommittees in congress. The conclusions they reach and decisions they ultimately make will affect us, our children and our children’s children.

It has often been said that the best defense is a good offense. Now is exactly the time when we All need to be very pro-active. We all need to be aware of what changes are going to be proposed at a minimum. Ideally, we all need to become more politically active. Reach out to your elected officials. Let them know what is important to you. If you have ideas of how things could be better, share those. There is no question that change is coming. The only question is how much of a say we all will have in how that change will manifest.

There is strength in numbers. All of us who work in healthcare need to be united in our efforts to be active participants in this change. Regardless of our political backgrounds, we all share a single overriding goal: to provide the best care possible to whose who entrust their healthcare to us. We need to put aside our personal differences and stand together bonded as we are by this common goal.

The challenges facing all of us are tremendous. Living with uncertainty can be very stressful. I urge all of you to channel this uncertainty into something positive. If you do not know what healthcare changes are being proposed, find out. If you do not have a good understanding of how the process of healthcare reform is being percolated through congress, get informed. If you have an interest in getting involved in the political process, do it now. There may never be a more crucial time for all of us who care for patients to stand up and be heard than right now. Find out what the issues are, let your opinions be known, and get involved in helping put those opinions into action.

Times of great challenge are invariably times of great opportunity. Let all of rise to this occasion. Our patients deserve nothing less. If we do not speak up for those who rely on us, who will? Let 2010 be remembered as the year that we all stood up, all spoke out, and all did all we could to help our nation emerge from this time of tremendous change with the best possible healthcare system.




Hurricane Frances came roaring into South Florida with copious rainfall and ferocious winds, but her astonishing power and endurance were no match for that of the dedicated and brave people who work in the region’s hospitals. Interviews with staff members at a number of South Florida health care facilities reveal a common thread of heroism and teamwork that enabled the health care professionals, administrators, support staff and volunteers to rise above the crisis and prevail, continuing to care for patients and for each other despite the daunting obstacles presented by Frances.


The aftermath of Frances at Columbia Hospital

Columbia Hospital in West Palm Beach remained open and functional throughout the storm, although the staff and physicians worked under conditions that challenged their problem-solving skills and tested their personal resources. Spokesperson Jean Wicken recalls, “The storm lasted longer than expected and there was a lot of uncertainty. The phones were down temporarily and the power failed, and although the generators kicked in, there was minimal air conditioning and it was hot and humid. But the staff was incredible! Many of the key staff, along with the physicians, brought their families and remained here throughout the storm and worked around the clock. The resilience and commitment of the staff was amazing to see.”

Wicken, Columbia’s Marketing Manager, says that the hospital prepared as much as possible, reviewing the disaster plans and holding drills in the days preceding the arrival of Frances. “We had adequate preparation time and that gave us the chance to set things up to support the staff and patients. Everyone brought in sleeping bags and air mattresses and we converted our gym into a shelter for the families of the staff. We provided child care and even pet care.” In addition to handling media calls, Wicken, along with the Human Resource director and Controller, took on the care of some of the 13 dogs and 6 cats that came to Columbia with their owners to wait out the storm. “We converted the Human Resources department into a kennel. We had 2 rooms of dogs and 1 room of cats – all in cages, of course. We fed them and walked them in the halls and on the grounds, and comforted them, too.”

Valerie Jackson, Columbia CEO, says “It was amazing to witness the incredible teamwork of the employees and medical staff who literally made the hospital their home for 4 or 5 days, working endless hours. Despite the limited air conditioning, few working elevators and reduced phone service, every crucial department such as the OR, the ER and dialysis units were operational. I am extraordinarily proud of our employees and members of the medical staff who pulled together under such stressful circumstances and provided excellent care through the entire disaster.”

South of West Palm Beach, in Boca Raton, there is a sense of pride in a job well done as the employees of Boca Raton Community Hospital look back on their experiences with Hurricane Frances. The 394-bed hospital was at full census when Frances arrived, and thanks to the willingness of the staff to do whatever necessary to conduct business as usual, patient care services continued in a nearly seamless fashion.

Hospital spokesperson D.B. Wienke reported no structural damage to the hospital and no loss of power, although there was a great deal of debris on the grounds. “We were fortunate in that we had electricity and were able to work closely with the police and the paramedics,” she says. “As a precaution, we closed our top two floors and we set up our meeting facilities as a hospitality center for the staff and their immediate families.”

The Emergency Department at Boca Raton Community Hospital has been designated as a “Best Practices” facility by the Agency for Health Care Administration, and the ED staff proved themselves worthy of that label as they confronted the storm and its complications. According to Wienke, “There were 37 nurses and 8 doctors who stayed in the Emergency Department from Friday morning to late Monday. They took shifts and slept in the offices. This was especially difficult because it was a large storm that lasted longer than anyone expected.”

The ED set up a “MASH”-like unit to care for people who sustained relatively minor injuries during and after the storm. They also dispensed free ice to people whose homes had no power and who needed to have medications refrigerated.

“We are so proud of everyone who volunteered to be here,” Wienke says. “People were upbeat without knowing if their own homes had been ravaged by the storms. They showed up wanting to help and everyone managed to come to work the next day. We honored our hometown heroes with a public thank you in the local daily papers and had huge pizza party.”

At Pinecrest Rehabilitation Hospital in Delray Beach, the Disaster Plan was implemented with great effectiveness and the 90-bed facility approached the storm with confidence and calm competence. Anna Cohen, Marketing Manager, says that the staff and the facility were extremely well prepared.

“We had Before and After Teams to deal with the preparation and the aftermath. We had good staffing because of the willingness of the staff to work around the clock. We had designated sleeping areas for them and for members of their immediate families,” she says. “But as prepared as the staff was, it was still very impressive to see their response. I think these people are local heroes. They went above and beyond, doing extraordinary things. The entire Pinecrest team is to be applauded for rising to the occasion and providing quality care under very stressful and uncertain circumstances.”

Pinecrest is planning to publish a special issue of their newsletter, spotlighting the many stories of heroism, resourcefulness and sacrifice that took place during the storm.

One of the hardest hit hospitals was Martin Memorial Medical Center, in Stuart, where Hurricane Frances literally blew the roof off the North Tower. The 7-story, 236-bed hospital had to cope with water pouring in through the exposed elevator shafts and was forced to temporarily reduce their bed capacity to just 50. Despite this trauma, the staff at MMMC dealt with things resourcefully, even forming human chains in the stairwells to pass supplies to the upper levels in the absence of the elevators. Melinda Glasco, hospital spokesperson, raves about the camaraderie and generosity of the employees.


Martin Memorial associates help clean up in front of the Cancer Center.

“There are amazing stories coming out about the teamwork and cooperation. Hurricane Frances actually brought us closer with a real sense of family. We all made new friends and learned that you can count on others when you need to. We saw people ‘out of context’ such as when the administrators were in their jeans and T-shirts, drilling alongside the facility staff. We saw everyone pitching in. I think we all have a greater appreciation of each other and of what a great workplace Martin Memorial Health System is,” Glasco says.


Hurricane Command Center staff at Boca Raton Community Hospital during the lockdown from Hurricane Frances.

The Federal Emergency Management Agency (FEMA) sent a mobile Disaster Medical Assistance Team from New Mexico to help out at Martin Memorial Hospital South. The crew of doctors, nurses, pharmacists and chaplain set up three tents and assisted the Emergency Department by caring for persons with storm-related injuries such as lacerations, while the more seriously ill and injured were seen inside. Martin Memorial Hospital South saw its Emergency Room utilization jump by more than 50% after the storm, so the assistance was needed and appreciated.

And in the midst of all the preparations, emergency plans, drills and long dark days and nights of this long, savage storm, there was one very bright spot for the staff at Martin Memorial – and that was the birth on Saturday, during the worst of the storm, of a baby girl whose mother was brought in by paramedics. Her parents had a name already chosen before her birth but, in consideration of the circumstances, changed their minds and named her – what else? – Frances.




Religious issues and spirituality are as much a part of the nation’s best hospice programs as are adequate pain control and home care visits.

Many think of end-of-life healthcare as a somewhat disconcerting departure from medicine’s traditional “fix-it” mentality. When a curative approach is no longer the best option, palliative care takes VITAS patients to a different place—both physically and spiritually.

At VITAS Innovative Hospice Care®, “a good death” is hardly an oxymoron. It is the ultimate goal we strive to meet for the almost 9,000 patients we serve every day. Our interdisciplinary teams of physicians, social workers, chaplains, nurses, home health aides, volunteers and bereavement specialists are as alert to a patient’s spiritual needs as they are to decubitus and diarrhea.

The common misconception is that hospice is about death. In fact, hospice is about life—some of the most important moments in life. In 20 Common Problems in End-of-Life Care (Barry M. Kinzbrunner, Neal J. Weinreb, Joel S. Policzer; 2002; McGraw-Hill), the end of life is embraced as an opportunity for growth by:

  • Moving through fear to peace
  • Moving through despair to hope
  • Moving from isolation to community
  • Moving from loss to closure

Any one of these can improve a hospice patient’s quality of life immeasurably. For that reason, every VITAS hospice team includes a social worker and chaplain with extensive training and experience in spiritual awareness, end-of-life issues and bereavement. Often they are the only spiritual advisors a patient sees, but they also can work with the patient’s physician and religious advisor to ensure a holistic prescription for quality of life.

Not every patient is open to spiritual care at the end of life, and those wishes must be respected. “Spirituality is an individual concept,” notes Thom McLeod, Bereavement Services Manager of VITAS’ Palm Beach County Program. “But patients who say they don’t need spiritual support to help them through the dying process are sometimes the very persons who need it the most.”

Paul Veliyathil, Home Care Chaplain for the Miami-Dade VITAS program, agrees. “There certainly is no formal religious aspect to our team members’ visits unless the patient and family specifically ask for it. But our training helps us gain acceptance from the patient and family, hear their concerns and offer non-judgmental support.”

When spiritual care is declined, VITAS hospice team members work together to find non-threatening, non-intrusive ways to include support and companionship in the patient’s care plan. Perhaps the chaplain accompanies the admitting nurse at the initial patient assessment. Or the social worker is introduced by the nurse as a member of the team who occasionally accompanies her on her rounds.

Whatever the method, the results are always worth the effort. “The level of intimacy achieved when we address the spiritual concerns of any patient,” Veliyathil has found, “opens the door to a vulnerability that can be rich with meaning.”

Spiritual support is so important in end-of-life care that it is legally mandated. “Psychosocial/spiritual support is a basic component of the Medicare Hospice Benefit,” notes Dian Backoff, General Manager of VITAS’ Broward program. “Here’s a case of the government doing the right thing, because the last days of life don’t need to be painful or lonely or confusing. With spiritual support, the last days of life can be an opportunity for growth, remembrance and closure.”

Professionals and lay people who would like to know more about providing spiritual care and companionship to the terminally ill should read Parting: A Handbook for Spiritual Care Near the End of Life by Jennifer Sutton Holder and Jann Aldredge-Clanton, published in 2004 by UNC Press in association with the Foundation for End-of-Life Care and the P.L. Dodge Foundation. It is available at bookstores or at www.uncpress.unc.edu.




Regular exercise is an important preventive and therapeutic treatment for heart disease and other health disorders. Studies show that a family practice doctor’s attitude toward exercise can greatly influence the activity level of patients. Consequently, a physician that emphasizes physical fitness as a priority can significantly enhance both the length and quality of patients’ lives.

The Squeaky Wheel

Family practice physicians routinely recommend exercise for patients at risk for heart disease, including type II diabetics, hypertensives, hypercholesterolemics, and the overweight and obese. Many physicians currently recommend exercise programs to help patients with non-cardiac disorders as well, including lower back pain, arthritis, osteoporosis, depression, and pulmonary disorders. At the advice of his family physician, Joe DeTeresa attended a pulmonary rehabilitation exercise program at Holy Cross Hospital in Fort Lauderdale to treat his emphysema. According to Joe, if his doctor had not told him of the healing benefits of exercise, he would never have considered beginning a program. “When I was finished, I felt 100-percent improved,” states Joe, who became a member of Holy Cross’s Zachariah Family Wellness Pavilion [ZFWP] after completing the pulmonary program. “The staff at the [ZFWP] put together a program [to improve] my lungs. The oxygen content of my blood has since increased dramatically and my stamina is very much improved.”

Whereas most family practitioners are now taking the benefits of exercise seriously for their chronically ill patients, many doctors do not discuss the importance of exercise with their apparently healthy patients. Michelle Fiorillo, D.O., of Holy Cross Medical Group is an exception to this rule. Dr. Fiorillo views all of her patients’ exercise behavior as an essential component of their medical histories. “Everyone must exercise and be educated on proper diet,” states Fiorillo. Rather than simply telling patients to exercise, she counsels them on how to fit regular workouts into their busy schedules. Physicians like Fiorillo, by inspiring positive health behaviors in their patients before the onset of disease, are actually helping to prevent cardiovascular and other disorders in their patients.

Practicing What They Preach

Doctors who exercise can more easily inspire their patients to stay active than can practitioners who do not exercise. Dr. Fiorillo, a regular exerciser at Holy Cross’s Zachariah Family Wellness Pavilion, concurs. “You can teach others how to balance exercise, work, family, and good nutrition when your own lifestyle incorporates these goals,” Fiorillo asserts.

Unfortunately, many physicians do not practice healthy lifestyle behaviors. For these doctors, assuming the responsibility for their patients’ fitness programs is a daunting task. Fortunately, there are myriad resources that can help such practitioners. One such resource is the non-profit “Shape-Up America’s” website, www.shapeup.org, which offers educational materials that physicians may distribute to their patients.

Physicians should always urge higher-risk or older patients to initiate exercise in a supervised environment, such as a hospital-based wellness center. It is therefore crucial that physicians find a local facility that they feel comfortable recommending to such individuals. For example, many Fort Lauderdale physicians refer individuals to the Zachariah Family Wellness Pavilion at Holy Cross Hospital, confident that these patients will receive the extra instruction they need. At this facility, patients undergo thorough health and fitness screenings and personalized exercise prescriptions from experienced exercise physiologists. Not only do patients feel safe in this environment, but they might even rub elbows with their own physicians, many of whom are also members of the ZFWP.

Spread the Word!

According to the National Health and Nutrition Examination Survey (1999-2000), 7 in 10 American adults do not participate in leisure-time physical activity. Sadly, physical activity is also dwindling amongst children, as physical education is no longer a staple in our school systems. It is therefore not surprising that 64% of U.S. adults are either overweight or obese, along with 20% of children. Because family practice doctors typically serve patients of all ages for both preventive and therapeutic purposes, they have the power to transform the health behaviors of a wide scope of Americans. Not only can these practitioners help to foster healthy habits in the younger generation, but they can also inspire adults to reverse some of the damage caused by a lifetime of inactivity. If all family doctors begin to convey the message that exercise is essential to one’s good health, they will significantly lessen the economic impact of obesity- and inactivity-related disorders in this country.