By Gary Dowd

We’re all painfully aware of how the economy has affected our lifestyles. Many people are forgoing expensive vacations because they’re just too, well, expensive. Today, everyone wants to get more value out of their vacation, but many have found that budget travel can be unfulfilling and not really much of a vacation. Well, there’s a way to cut trip costs without cutting corners—and still have an enjoyable and relaxing family vacation.

Consider a road trip. Sound boring? Too much work? A little old fashioned? Listen—there’s a reason that car trip vacations are on the upswing. More and more families are taking to the road today to enjoy time together and see new places.

The key to a successful road trip is to plan ahead and, at the same time, be willing to go with the flow. I know it sounds a little contradictory, but stay with me, here.

The Central Valley is close to many natural attractions that be easily accessed by car. We have a veritable treasure trove of places to see and visit. The Sierra Nevadas, for example, are home to three parks, twenty wilderness areas, and two national monuments.

So here was my plan:

Yosemite National Park and a day of visiting El Capitan, Half Dome, and Yosemite Falls. Next, drive across Tioga Pass and arrive at Mono Lake in time to catch the sunset. Next, Zion National Park to photograph scenes I carry only in my memory. After that, mosey over to the Grand Canyon South rim. I’d also be searching for old sections of historic Route 66 to see what I could find along the way.

Day One

I fell in love with Yosemite the first time I saw that magnificent panoramic view as you emerge from the tunnel overlooking the valley. It’s really impossible to fully appreciate the grandeur and sheer size of Yosemite unless you see it in person.

Once on the valley floor, I visited Yosemite Falls, walked the meadows, got lost in the views—and attacked by the mosquitoes. Remember to pack the mosquito repellant! Itchy welts aside, it was a wonderful day. But the real treat was yet to come as I left for points East.

I had never crossed over the Sierras at Tioga Pass before, to visit the small town of Lee Vining on the edge of Mono Lake. Driving over the 9,000-foot summit, I was treated to amazing vistas. John Muir wrote about Tuolumne Meadows and the wilderness beyond Yosemite. Every turn revealed another breathtaking mountain view.

Mono Lake was everything I had expected. This briny, smaller cousin of the Great Salt Lake in Utah is home to geographical features called Tufas—calcium carbonate towers formed thousands of years ago.

I had timed my arrival so that I could be set up to photograph the lake in the late day light and on this day, it was a stunning sunset. Later, I treated myself to an amazing tri-tip dinner at Brodie Mike’s, one of three local restaurants. Then it was time to call it a night and turn in to my room at Murphy’s Motel (I highly recommend it) and regroup for the next day.

Day Two—On to Mount Whitney!

First on the list, coffee! I had a really nice organic Ethiopian from the Latte Dah coffee shop in Lee Vining, and a little brekky (breakfast) along the way to Mammoth Lakes.

Driving south on Hwy 395, my plan was to spend a little time in Mammoth and several hours visiting Mt. Whitney’s Portal.

This was a very important day for me. Mt. Whitney, according to family lore, was named for one of my ancestors—Josiah Whitney. Today’s visit was really thirty years in the planning.

Mt. Whitney is 14,505 feet above sea level—the highest mountain in the contiguous United States. I wasn’t able to hike the summit (there’s a lottery system in place to obtain one of the cherished permits to do so), but I did make it to the starting point of the Mt. Whitney trail—8,365 feet.

Reluctantly, I tore myself away, traveling further south on 395 past Inyo National Forest. Years ago, I spent a lot of time hiking in the high country behind these mountains and just seeing the names of familiar trails brought back a lot of good memories. There were also a few oddities to photograph along the way, too.

Dropping down into the valley from 7,000 feet, the drive to Barstow and beyond may not be classically picturesque, but beauty is in the eye of the beholder and I managed to find a few segments of old Route 66 to enjoy.

Days Three and Four—The Grand Canyon

Brake problems interrupted my schedule enough to make me bypass the drive through Zion National Park. Oh well—next time. Go with the flow, remember? The good news is that it gave me more time for my next location: the Grand Canyon. Getting to a motel earlier in the day allowed me to relax and find the perfect spot to view sunset.

I have heard that you could drive a mile away from the Grand Canyon and never see it, and it’s true. You don’t see the canyon until you step out on the paths along its edge. Wow! If seeing the Grand Canyon isn’t on your bucket list, it should be. Words can’t describe what it felt like to stand on the rim of one of the Seven Wonders of the Natural World.

Total miles covered from Visalia to the Grand Canyon and back: just short of 1,500. Sounds like a lot, I know. But with the right attitude, and some judicious stops along the way, this might be one of the most enjoyable and memorable vacations you’ll ever take.

You just might forget you were on a budget.

Infobox:

Make Your Road Trip Vacation a Success

• Be flexible. If you like a place enough to stay longer, do it. This is supposed to be a vacation, so relax and enjoy.

• Traveling with children? Plan more frequent stops along the way to break up the drive.

• You don’t need to have the best, most expensive camera to take amazing photos. Invest a little time in a local photography class, learn to use that point-and-shoot, and get ready to amaze your friends.

• Blog about your road trip along the way. It’s fun, a great way to save the memories, and lets you share with friends and family.

By Anna Palecek

It’s a common scenario: You’re ill and can’t get in to see your regular doctor. You’re not sure what to do. Visits to the emergency room can involve long waits and high fees, but you feel that you need to be seen right away.

Enter the urgent care center, offering quick and efficient medical treatment until you can follow up with your regular doctor.

Urgent care is just one of the options available to you, along with emergency and walk-in care. And knowing the differences between emergency, urgent, and ongoing treatment services available locally can help save both time and money.

John Leal is the manager at Visalia’s Kaweah Delta Urgent Care. He explained the key differences between the emergency room, an urgent care center, and a walk-in clinic. The emergency department at Kaweah Delta Medical Center is set up for any kind of major trauma, including car accidents, and takes ambulance traffic.

Kaweah Delta Urgent Care’s function is to take care of minor lacerations, fractures, coughs, colds, and fevers. It is open seven days a week from 9 a.m. to 8 p.m. and has operated since 1995 in the former Community Hospital emergency room, about 2 miles from Kaweah Delta Medical Center.

The Kaweah Delta Health Care District, or KDHCD has two walk-in clinics, in Exeter and Lindsay. The walk-in clinics follow the family practice model, and are recommended for patients who don’t have a local primary doctor. The walk-in clinics are set up to take care of patients on a long-term basis.

Despite the differences, patients aren’t turned away if they arrive at a facility that may not be appropriate to their illness or injury.

“We’ll take care of anybody anywhere,” Leal said. “If the patient’s needs are more than we can provide at our walk-in clinic or urgent care center, we refer them to our emergency department after a medical screening exam by a physician.”

Unstable, high-risk patients are transported via ambulance after a call to 911, while other cases may be sent by private vehicle, though, Urgent Care Medical Director Dr. Steven Larsen explained, most people aren’t happy to make more than one stop for medical care.

Kaweah Delta Urgent Care typically sees about 110 patients daily, with six to nine of those patients referred on to the emergency department.

“I would urge those people that have complex histories to think twice before they come here,” Larsen said. “They always will be welcome. But they also may be transferred.”

A Waiting Game

KDHCD emergency department and urgent care center staff work together to decrease the number of patients that visit the emergency room. Emergency Department Medical Director Dr. Steven Carstens explained that the turnaround time for visits to the emergency department is one to two-and-a-half hours, which is low compared to the national average, two to three hours, and can go as high as six hours in some hospitals.

For Kaweah Delta Urgent Care, the time from door to discharge averages between fifty and fifty-five minutes.

Carstens said that there is a growing trend toward faster turnaround times in emergency departments. He said that his staff wants to see patients as soon as they arrive. The time it takes to be seen, what he called Time to Provider, is directly associated with patient satisfaction.

Leal explained that the top complaint of emergency patients is that they arrived first, and then see other patients being treated ahead of them. The emergency department is not run on a first-come, first-served basis.

After visiting an RN in triage, emergency patients with the most life-threatening and urgent needs are tended to first. Some patients have life-threatening symptoms and need to be seen by a doctor in the next five minutes; others in the emergency department probably should have gone to an urgent care center.

Except in extreme cases, urgent care center patients are seen in the order they arrive. In addition to shorter wait times, fees for an urgent care visit are typically lower than for a visit to the emergency room.

“People love to come here because they’re in and out very quickly,” Leal said of the urgent care center.

Judging Each Situation

Despite the quick turnaround time, the urgent care center isn’t the place for everyone. Patients experiencing chest pain, difficulty breathing or swallowing due to allergic reaction, or any pregnancy problems should always visit the ER.

Larsen stressed the importance of personal history in determining the appropriate facility for each type of patient.

In people with complex histories, “relatively minor complaints can become very significant problems, and they need to be in the best place for their needs,” Larsen said. “A lot of patients don’t necessarily want to go to the ER because of prior experience with wait times, but the fact still remains that may be the place for them.”

When in doubt, both Larsen and Carstens agreed, the emergency department is the best choice.

“There’s some black and white, but there’s a huge gray area,” Carstens said. “Sometimes it’s difficult for the general public to be able to isolate the really severe from the very minor. And really, if there’s any uncertainty, they should come to the emergency department.”

Despite the range of services offered by KDHCD, Leal stressed the importance of having a primary care physician. He said that when possible, before a visit to the ER or urgent care center, the first call should be made to an individual’s primary physician.

“No one can replace your primary doctor, they are the best person to take care of you, hands down,” Leal said. They know your background much better than someone who is meeting you for the first time, so it’s always better so see your primary physician first, Leal said. But if you feel that you can’t wait to see your physician, know that there are other resources available.

By Jim Blanks

As an experienced firefighter and paramedic, Eric Espinoza is used to facing challenges. Raised in Los Angeles, Espinoza worked his way through the fire academy and paramedic school before relocating and working with the Dinuba Fire Department. It was a long, difficult process, but working throughout Southern California and later in the Valley has given Espinoza broad experience. However, even after ten years in EMS and six years in the fire service, he knows that he can still learn something new — and in late September in Sequoia-Kings Canyon National Park, he did just that.

On September 20, Espinoza packed his bags and traveled to Kings Canyon to help a collection of firefighters and medics work to quell the Sheep Fire Complex, a wildfire that had been burning since July 16. The fire had been started by a lightning strike, and firefighters from many area agencies teamed up to stop it from spreading too far into the Sequoias. And although Espinoza was officially there as a medic, he quickly found himself using his full range of experience.

“I was there as a line medic,” Espinoza said. “But I didn’t like standing around and waiting for something to happen, so I helped out with some of the firefighter parts, too.”

Some of those “firefighter parts” involved working in high elevations and braving the elements to fight the Sheep Fire.

Roughing It

“This was definitely something new for me,” he said. Although he had worked on out-of-county assignments before, in Los Angeles, Kern, and Orange counties, he said that working in Kings Canyon “was nothing like that.”

In those situations, Espinoza said, “we would have designated areas or camps where they would set us up with restrooms, showers and food.”

He compared the two-week tour in Kings Canyon to camping. “Except all we had for food were MREs for breakfast, lunch, and dinner.

“At 8,000 feet in elevation, the weather was pretty cold and wet at times,” he continued. “The guys up there would ‘spike out,’ which means they would just lay a sleeping bag on the ground and go to sleep at night. Some mornings we would wake up and it was very cold, and during the day the weather was dry and hot.”

As challenging as dealing with the climate and elevation, he learned, was adapting his own skills to fight a wildfire. Although he has years of experience as both a paramedic and a firefighter, Espinoza found that there is really no end to a good firefighter’s development.

Adapting Skills

“I think that mentally I was prepared for this assignment,” he said. “I really enjoy being a paramedic and I knew going up there that it was going to be my main duty. As far as the firefighter part goes, I must say that being a firefighter in the city is very different from being a firefighter in the wildland.”

Espinoza worked closely with experienced wildland firefighters, specifically the Horse Meadow and the Arrowhead Hot Shot crews. And one of the first and more significant lessons he took away from these crews during his tour was that fighting a fire in undeveloped land and varying levels of elevation can be extremely physically taxing.

“I’m not used to hiking hills like those Hot Shots,” Espinoza said. “We would hike some pretty steep areas and for a few miles at a time, and I usually carried about sixty pounds of gear with me.” His gear included all of his medic gear, a cardiac monitor, water, food, and a hand tool.

“As a structure firefighter, we train for fire by running and keeping our cardio up and also developing upper body strength,” Espinoza said. “But hiking is a different game.”

Lack of Water

Espinoza also gained a new perspective on the different ways to slow a fire — particularly how to stop a fire when water is limited or unavailable.

“As a city firefighter we go to these big fires and do structure protection, which means protecting the homes. But being up there with those Hot Shot crews was a lot different. We were right next to the fire. Out there they have no hydrants like we do for a water supply, so they have to do things such as cutting line or fighting fire with fire.”

This was a hands-on and eye-opening two week tour for Espinoza; essentially, he was being put through another level of training – training that he couldn’t get from any classroom exercise.

“I’ve been to many training classes and they would talk about some of the things that we did out there,” Espinoza said. “But actually seeing it and sometimes doing it was a great experience.”

And, the unique work environment gave Espinoza the opportunity to do something that he ordinarily wouldn’t have the chance to do as a city firefighter.

“Getting to some of the areas was very difficult due to terrain and the time it took to get there,” he said. “So we got to fly into some areas on a helicopter.”

After two weeks of hot, dry days and cold, wet nights, after hiking for miles through Sequoia-Kings Canyon wildland and fighting wildfires with experienced crews using methods that previously he had only learned about in the classroom, Espinoza says that he is both humbled by and thankful for the experience.

“I want to give special thanks to the U.S. Forest Service and Mike Pasias, as well as Sequoia National Park for giving me the opportunity to be a part of the Sheep Complex,” Espinoza said. “And I especially want to thank all the guys on the Horse Meadow and Arrowhead Hot Shots.”

Although he worked for two weeks with these crews, the impression that they and the entire experience left on him will last much longer.

“This is something that I will carry with me for the rest of my firefighter career,” Espinoza said. “I have a lot of respect for those guys up there. They do their job and they do it very well.”

By Corey Ralston

For fifty years Imperial Ambulance in Porterville has upheld a gleaming reputation. The locally-owned and -operated business has been proud to call themselves the “ambulance of choice” in the area for half a century and shows no signs of stopping.

The humble beginning was in 1960, when the company was purchased from the Porterville Fire Department. Back then, all that was required to run an ambulance was a special permit and a CPR card, and co-owners Charles Hargis and Myron Wilcox ran the calls themselves in either a 1956 Cadillac or a 1958 Pontiac ambulance. In the ’60s they also had a funeral coach and a limousine service.

Miriam and Myron Wilcox attended the fiftieth anniversary celebration and health fair at the business. Although time has changed their appearance they feel the same inside for the company as they did when it opened. A slideshow showing images from the past fifty years of service played in a heated tent on a loop and the Wilcox couple were flooded with memories.

“The best decision I ever made was fifty years ago when (Myron) wanted to help fund this operation. He asked me for my advice and I left the room scared at how much it was going to cost,” Miriam Wilcox fondly remembers.

In 1974 Tulare County required that all ambulance personnel become certified as Emergency Medical Technicians. This forced the company to expand its workforce and buy an ambulance van. They donated the 1958 Pontiac to a poverty-stricken city in Mexico and still give ambulances to the town whenever they upgrade.

Manager of Operations Scott Scheer boasts that employees of the company easily know half of the city. He often runs into former employees and people that they have helped in an emergency situation.

“Being a part of this company is an exhilarating experience. We are helping people and making a difference in people’s lives. We take extreme pride in our work,” Scheer said.

On top of providing a vital service to the city of Porterville and the outlying areas, including Strathmore and Lindsay, Imperial Ambulance is known for community involvement. They are regular fixtures at parades and football games. They visit classrooms to educate children on life-saving techniques. Recently they have teamed up with Porterville High School to assist in the school’s new Health Academy, which prepares students to go directly into the healthcare workforce upon graduation.

“We are trying to get students interested in this field of work,” said Public Relations Director Tracey Skaggs.

At the anniversary celebration, the company was honored by the Porterville Chamber of Commerce and local dignitaries. At the health fair, community members learned about services and checked their vitals.

Imperial ambulance now employs forty-three people and has a fleet of eight ambulances that enables them to provide a high level of care and compassion to those in need.

“Our employees are proud to wear their uniforms around town because of the friendly recognition they get,” Skaggs said.

By Aaron Collins

Few one-day-old babies must fight for air by fighting for air space with a U.S. president. But that’s exactly how Abigail Morley of Visalia began life, due to her potentially fatal lung condition, which required her medical providers to take drastic measures.

Abigail’s remarkable encounter — overcoming the national security concerns that underlie Air Force One’s strict air space privileges — proved to be one of the easier hurdles that she would surmount as her caregivers ardently fought for her life.

On her first full day of life, after she entered the world at Kaweah Delta Regional Medical Center in Visalia, Abigail found her sick little body on a plane bound for the Bay Area and University of California at San Francisco. On approach to San Francisco, as Abigail barely clung to life on wing and prayer — lots of prayer — the air ambulance crew was required to leap the strict security barriers involved in landing alongside Air Force One as President Obama was about to depart.

“At that moment I did not care where or what the president had to do at the time, because we all know that Abigail is way more important to me than the president,” says Rick Morley, the newborn’s anxious father who works for the Tulare County Sheriff’s Office.

The flight nurse reported that the air ambulance was cleared for landing next to the president’s plane, a remarkable scenario even for veteran ambulance crews whose dramatic daily encounters might give them a sense that they have seen it all. But this was no routine airlift.

Early Trouble

Born with Severe Meconium Aspiration Syndrome (SMAS), Abigail’s rough landing in life meant certain death without extraordinary intervention by the best care available. That meant transporting her for treatment using UCSF’s ECMO technology: Extracorporeal Membrane Oxygenation. The machine provided life-sustaining artificial aeration of Abigail’s blood while the medical team attempted to clear her tiny lungs of the meconium, or in utero feces, that she had inhaled upon delivery as she struggled to take her very first breath of life.

But the first signs of trouble had appeared well before delivery.

“I remember being so happy that we finally had to go into the hospital because my contractions were finally close enough,” says first-time mom Katie Morley, a registered nurse who works in cardiac telemetry. “While waiting for admission and a room, I remember thinking, ‘This is it; we have waited nine months and four days for this.” But all of her medical training could not prepare her for what was about to happen.

It was the expectant mom’s turn to be the good patient at Kaweah Delta and Rick and Rose Morley, Rick’s parents, and Katie’s parents, Randy and Jodie Faiman, gathered to welcome their new granddaughter.

But around 4:20 p.m. on the day of Abigail’s birth, things went south quickly. “The baby’s heart rate dropped from about 160 to 60,” Rick recalls. “And my wife, being a nurse, knew to hit the call button.” Nurses ran to Katie’s room and alerted her Ob/Gyn, Dr. Wiseman. He knew that an emergency c-section was a possibility, but asked Katie, who was fully dilated, if she was ready to push. Knowing about the earlier appearance of meconium as Katie’s water had broken, Dr. Wiseman requested precautionary support from the Neonatal Intensive Care Unit (NICU), whose personnel came on deck. Vacuum assistance was used to hasten Abigail’s delivery — a baby with Abigail’s heart rate issues is better off outside mom’s confines where she can be helped if something were to go further wrong.

Whisked Away

An hour later, at 5:20 p.m., Abigail arrived. The plan called for Rick to do the umbilical cord-cutting honors. But he knew something must be wrong when any ceremoniousness was scrapped and Dr. Wiseman took over without notice, clamping and cutting the baby loose and turning her over to the NICU team immediately. “I did not hear a scream or a cry from her,” Rick recalls. “And I was very scared because she looked a little discolored,” he says of her ashen pallor.

Katie, too, knew things weren’t right. “When I realized Ricky didn’t cut the cord, and I realized that I never heard her cry out, and I didn’t get to see or hold her, I remember saying, ‘Is she OK? Why isn’t she crying?’”

Equally alarming, Rick could see the NICU nurses “bagging” her, the term for the inflatable infant cardio-pulmonary resuscitation bag that assists a distressed infant’s breathing. He asked mom how she was doing as her epidural for the scrapped c-section waned. Katie said she was fine, as she vomited into a container.

The trip to NICU seemed to take forever, Rick recalls, Once there, Katie and Rick were happy to see one of the nurses, Bill, who had been an instructor in her nursing program. They felt that Abigail was in great hands. “When I got there, they had her lying on a small bed and she was so alert, with her eye wide open looking around. But she still looked discolored,” Rick says.

Last Hope

A nurse told him that she had ingested quite a large amount of meconium into her lungs. Nurses from Children’s Hospital were summoned, transporting vital medicine that was unavailable at Kaweah Delta. “I was hysterical in the hallway,” Katie recalls. “I mean, this was something I read about in my nursing textbooks. And it couldn’t be happening to us and our baby. But reality was that it was.”

The nitric oxide ultimately proved ineffective. Doctors quickly knew that Abigail’s last and best hope would be to summon the ECMO team from UCSF. Rick and Katie were encouraged to learn that UCSF would fly the ECMO device on the plane to Visalia in case in-flight surgery were required before they could reach San Francisco. But their one bright spot was clouded with the knowledge that the potential peril for Abigail was so significant due to normal aeronautical vibration and potential turbulence that she would require what was essentially paralysis through pharmaceutical means to make the trip. It was a lot to accept, knowing their newborn would be put upon this way in addition to her existing suffering. While they waited for the plane to arrive, Katie says, they held Abigail’s first photograph in their arms as if it were the baby: A shot of their tiny infant, gray and full of tubes.

Around 8 on the morning following her delivery, the ECMO team “left with our baby girl to go and try to save her life,” Rick recalls of the heart-wrenching moment they placed Abigail into the hands of others for her hour-long journey into uncertainty. They got her past the Air Force One restrictions, and didn’t have to perform surgery aboard the plane. Rick and Katie drove to San Francisco.

Once at UCSF, the ECMO team placed the needle in Abigail’s neck that would deliver the life-saving oxygen that her lungs could not, allowing the lungs to heal while the team suctioned the remaining foreign substance. The anti-clotting drugs did not result in excessive bleeding, a normal concern. The Morleys placed a Dorothy outfit on Abigail’s crib and frequently repeated the mantra, “There’s no place like home.”

Breathing Easier

Five days later — on the anniversary of the day nine years earlier when Katie and Rick first got together — Abigail was successfully removed from the ECMO device. In subsequent days, other tubes were removed and soon Katie was breastfeeding the baby girl she was required to hand over immediately after her birth. Nineteen of Abigail’s first days were spent at UCSF. The nurses there signed a pillow for Abigail, whose parents plan to return there for a reunion with those who saved their daughter’s life. Although Abigail will be monitored for developmental delays by UCSF’s high risk infant team, she is expected to have no long-term effects.

Rick and Katie, who met while both were students at Mt. Whitney High School, are thinking about having a couple of siblings for Abigail.  “I find it hard right now thinking of having more children because frankly, I am scared of what could happen. But I know that with time and faith, these feelings will heal and we will have a beautiful family,” Katie says. “I never knew I could love someone so much that I had just met, but it is amazing that suddenly Abigail is the most important thing to us. Life is so fragile, so we try to make each day count.”

By Bill Corliss

As technology is developed and techniques are improved upon, even lifelong drivers need to update their skills. Don’t throw your years of experience and good habits out the window, but add new concepts to your time tested skills as well. The changes in the traffic system and the normal loss of information over the years mean many drivers exhibit high-risk behaviors that are completely avoidable.

The margin of safety at the front and rear of a vehicle has been updated. In past years, safe following distance was determined by car lengths. The rule-of-thumb was to leave one car length for each 10 mph. Therefore at 60 mph a safe following distance would be six car lengths. This method is very high risk. It requires math skills and knowing the length of a car!

Actually, the weight of a vehicle is more critical than the length. It takes time to stop vehicles. If a driver does not have enough time to stop, this leads to collisions. Automobile tests have shown it takes three seconds to stop at 60 mph. This three-second margin of safety is needed in front and to the rear.

Some driving environments require more than three seconds to safely avoid accidents. Four or more seconds should be used when drivers cannot see well. Driving at night or under poor weather conditions, or when following big vehicles like pick-up trucks, vans, or semi-trucks, you’re going to have a harder time recognizing a problem. At high speeds you need more time to stop a vehicle. Three seconds may not be enough time!

Tailgaters require drivers to have more time. Increasing following distance to four or five seconds is the perfect solution to problematic tailgaters. Drivers have total control of the space to the front and little or no control of the space to the rear. If drivers slam on the brakes while being followed by a tailgater, a collision is inevitable. By leaving extra time in front, you eliminate the need to stop quickly. Many people increase their speed when being tailgated, giving up precious time in the front and creating the potential need to use the brake abruptly.

There are several positive side effects to increased following distance. The extra space cushion is more relaxing because there is more time to react to other drivers’ errors. It allows easier and safer lane changes for everyone in traffic. The most surprising result of increased space is there is no need to drive any slower. Always create the three second space to the front prior to accelerating to you desired speed.

Training the eyes to recognize three seconds is simple. It can be done as a passenger or as a driver. First, pick a fixed checkpoint on the road ahead. This could be a sign or an overpass. Second, when the vehicle ahead of you passes the checkpoint, slowly count to three, for your three second count. If the front of your vehicle does not reach the fixed reference point, you have at least a three second distance. If not, ease off the accelerator and build a safe three-second space cushion.

It is easy to count to three. As your eyes see this space on the freeway, it will look large because using car lengths has not given the eyes good training. Counting to three and training the eyes gives us time. We need time to do things, like stop, swerve, and be with our families next Christmas.

Space is the gift we give ourselves. Take a moment to retrain your eyes to a safe and less hectic technique.

Medical staff and patients alike welcomed a new medical center to the community in December. The Adventist Medical Center, located on about 15 acres at Mall Drive and 7th Street in Hanford, officially opened on December 5 at 6 a.m. Construction on the $114 million-medical center began in September 2007, and after earning state approval, the hospital was ready to accept patients.

There had already been events leading up to the December opening. The Dedication and Blessing Ceremony on October 8 featured community dignitaries, hospital and corporate leaders, and physicians. Two days later, the hospital held an open house with live music, a heritage trail walk along the hospital’s park, and a teddy bear clinic for children. These important events were only the warm-up acts for the main event: bringing patients into the new facilities.

Once the doors open, said Malissa Rose, the Public Relations Coordinator for Adventist Health, “ninety to ninety-five Medical/Surgical and Intensive Care Unit patients were transferred at three- to five-minute intervals from Central Valley General Hospital and Hanford Community Medical Center.” Both hospitals are in Hanford.

“For months, our employees, staff, and six sub-committees have worked through a task list of over 400 items, have written countless pages of new policies, and have installed thousands of pieces of new equipment to prepare for the move,” Rose said. “Almost 300 staff members from Nursing, Clinical Engineering, Information Systems, Administration, Admitting, Safety and Security, and Patient Relations, along with volunteers, were working at all three sites to ensure that the move was safe and properly executed.”

The new medical center has 142 in-patient beds, including twenty-two intensive care beds and twenty-six emergency room treatment stations. Because of its size — over 200,000 square feet — and ability to accommodate an increased number of patients, Adventist Medical Center-Hanford has become the main medical center in the area, while other local hospitals are transitioned into other roles. Hanford Community Medical Center will be renamed Adventist Health/Central Valley Network-Support Services and will house business and support services. Central Valley General Hospital Medical/Surgical and ER has moved to the new hospital, but will retain most of its other services. And Selma Community Hospital will be renamed Adventist Medical Center-Selma.

This new medical center was the product of years of hard work and generous gifts and private donations — one of the points of pride of this hospital is that it did not rely on public taxes to fund its construction.

More to Come

Richard L. Rawson, President and CEO of Adventist Health/Central Valley Network, described his pride at the new medical center and its role for the future: “Planning for this hospital has been in the works for years. We broke ground in 2007 and now our dream has finally come true. It has been a privilege to serve Kings County and we are continuing that mission to serve our community through a new facility with leading-edge technology.”

And the work is not done, Rawson said. “An additional 32,000 square feet total will be shelled in for nursing expansion areas on the second and third floors to accommodate a total of sixty future beds.”

Now that the hospital is fully operation, it staffs 780 full-time employees. And these employees are energized to work in the new location.

“The most exciting thing about working in our new facility is the increased size and space,” said Kirsten Johnson, Vice President of Patient Care Services. “We have been running at full capacity at both of our current facilities for over a year and it is nice to have expanded space. Our new private rooms provide the patient with a quieter, more relaxing environment in which to heal. That is why I became a nurse — to care for people.”

Johnson oversees the nursing care to patients, and has an office on the first floor — and the space is not the only new thing that has Johnson and her team of nurses, supervisors and therapists eager to be in the new facility.

“We have new, state-of-the-art equipment in our surgery suites, radiology department, and throughout our facility,” Johnson said. “And we have a new, interactive television system that allows the patient to be in control of their stay as it provides movies, video games, and educational material specific to their diagnosis or medications.”

The new television system, called the GetWellNetwork, is just one of the new technological advancements that will improve a patient’s stay. But the quality of the hospital that seems to have the staff most excited is simply the increased capacity to care for patients.

“With our patient population increasing at such a rapid pace, I am very excited about the additional fifty in-patient beds at Adventist Medical Center, compared to the number of combined beds at Central Valley General Hospital and Hanford Community Medical Center,” said Cindy Lane, Director of Nursing Administration.

“The new hospital will help us to provide expanded services to the community, and with all of our advances, will help continue to build the confidence in the community that Adventist Health is the best place to practice medicine.”

On the day of the move, the patient transfer took place until 1 p.m. Following the transfer period, the hospital opened visiting hours at 3 p.m.

And with that, the hospital was up and running. The patients were comfortably in their new beds. And the medical staff, the nurses, doctors, therapists, and administrators, were able to do what they do best — provide quality care to patients in the community.

“I am very blessed to have an excellent team,” Johnson said, “that truly cares about people as much as I do and strives to make our hospital the best place to receive care. The new hospital will help us continue to provide excellent services to the communities that we serve.”

The community eagerly received the news of the opening of the new medical center, a center that boasts great improvements in size and technology. But the real jewel, the greatest part of the Adventist Health Medical Center, will always be the people inside — the medical staff that works tirelessly for their patients.

“Quality is our top priority,” Johnson says. “And while our facility will enable us to raise the bar on quality care, quality care actually begins with our staff and our physicians. Quality comes from our employees, our physicians, and our vision to be the best.”

By Paul Main

We are back to the cool of Valley winter and I, for one, long for food that brings warmth as well as nourishment. Whether you need something to get you through a cool day or a rainy weekend, or just want to stick to simple foods, I have the recipe you’re looking for.

This is a return to the basics — a bowl of tomato soup with a grilled cheese sandwich on the side. There are as many versions of tomato soup as there are varieties of tomatoes, but this is a tried and true creamy tomato-basil soup that will warm up your day.

Most good soups have an equally good accompaniment, so I wanted to do a simple take on a grilled cheese sandwich to go with the soup. The best things don’t have to be complicated, but if you want to be a bit more adventurous, I offer a grilled ham and brie sandwich with a bit of raspberry preserves. The savory ham paired and the tangy brie are balanced beautifully with sweetness from the preserves.

Creamy Tomato-Basil Soup

Ingredients:

3 tablespoons olive oil

1 small yellow onion, peeled and chopped

1 carrot, peeled and chopped

1 stalk celery, chopped

1 red bell pepper, seeded, stem removed, and chopped (substitute with canned or jarred)

4 cloves garlic, minced

5 cups vegetable or chicken broth (preferably low-sodium) – reserve ¼ cup

1 28-ounce can whole, peeled tomatoes with liquid, roughly chopped (or substitute with 10-12 roasted tomatoes)

1 6-ounce can tomato paste

1 tablespoon dried basil (substitute with 2-3 basil leaves rolled and then chopped fine)

1 tablespoon sugar

½ teaspoon dried thyme

½ cup heavy cream (substitute with half and half or non-fat evaporated milk)

½ teaspoon salt (add more to your taste)

½ teaspoon black pepper (add more to your taste)

¼ teaspoon white pepper (optional)

2 tablespoons cornstarch mixed with ¼ cup of broth or water

Method:

Heat olive oil in a large soup pot over medium-high heat. Add the onion, carrot, celery, and bell pepper. Cook, stirring occasionally, until veggies are softened, about 6-8 minutes.

Add the tomatoes and half of the broth. Add the basil and thyme. Simmer for 20 minutes on low to medium heat.

Using an immersion blender, puree the mixture until smooth. To use a blender, place a towel over the top of the blender and blend the mixture in thirds to avoid burns or splashing.

Placing a sieve or fine strainer over a large bowl, strain the tomato puree. Discard items in strainer and pour the tomato mixture back into a clean pot. Reheat using medium-low heat. Whisk in the tomato paste. Add the remaining broth in small amounts to adjust consistency. Taste and adjust seasonings with sugar, salt, black pepper, and white pepper. Whisk in heavy cream and bring back to a simmer. If the soup needs to thicken a bit, whisk in cornstarch mixture.

Serve in a bowl, cup, or crock along with a grilled cheese sandwich. As a topper for the soup, consider shaved Parmesan cheese and a basil leaf for presentation. Serves 4.

Grilled Jack-N-Cheddar Cheese Sandwich

Ingredients:

8 slices whole wheat bread (or bread of your choice)

4 slices aged cheddar cheese

4 slices jack cheese

4-5 tablespoons butter, softened but not melted (substitute with butter spray or olive oil)

Method:

Preheat your favorite sandwich grill press or skillet over medium heat. Generously butter one side of a slice of bread. Place bread butter-side-down onto skillet bottom and add 1 slice of jack cheese and 1 slice of cheddar. Butter the second slice of bread on one side and place butter-side-up on top of sandwich. Grill until lightly browned and flip over; continue grilling until cheese is melted. Repeat with remaining slices of bread, butter and cheese. Serves 4.

Grilled Ham ‘N’ Brie Sandwiches with Raspberry Preserves

Ingredients:

12 slices deli ham (black forest or your favorite type)

8-ounce wedge Brie cheese, sliced thin

8 slices whole wheat bread (or bread of your choice)

6-8 tablespoons raspberry preserves

4-5 tablespoons butter, softened but not melted (substitute with butter spray or olive oil)

Method:

Assemble the sandwiches by layering the ham, brie cheese, and raspberry preserves in equal amounts on four pieces of bread, topping with the remaining four slices of bread. Spread butter on top of each sandwich.

Heat a grill pan over medium-low heat. Once the pan is hot, place the sandwiches buttered side down in the pan. Gently spread the top of each sandwich with butter. Cook each side until the bread is golden brown, about 3 minutes per side. Serves 4.

Quick Tips Microwave Oven Safety

Most homes and break-rooms have a microwave oven. As with all kitchen appliances, they can be dangerous if not handled safely. In addition to adjusting the time for that bag of popcorn, a few other items should be considered when using a microwave.

The following tips are from About.com’s guide “How to Use a Microwave Oven.” More microwave oven safety tips can be found at: http://busycooks.about.com/od/microwaveovens/a/microwavehow_2.htm:

• Use oven pads or mitts when removing hot foods from the oven.
• For covered food, make sure to leave a small portion vented, or uncovered, so steam doesn’t build up and burn you when the covering is removed.
• Don’t eat food directly from the oven. As most ovens have hot spots, a few areas could be superheated and will burn.
• Follow stirring and rotating instructions carefully as there can also be cold spots where the food doesn’t get hot enough to kill bacteria.
• Don’t use metal containers unless the recipe specifically directs you to. Follow the instructions carefully when using any metal (including foil) in a microwave.
• Make sure any glass, plastic containers, and plastic wrap you use are labeled microwave safe.
• Don’t heat water or other liquids beyond the time recommended by the manufacturer or any recipe.
• It’s also a good idea to stand 3-4 feet away from the microwave when it is operating — just to be on the safe side!

Be sure to be safe when in your kitchen, and enjoy this edition’s recipes!

By Aaron Collins

Who would have thought Viagra would be such a boon for the private investigation business? A little too much of a good thing, say some detectives. But the law of unintended consequences is always in effect — even for private investigators.

Viagra was marketed with a wink and a nod to Puritanical propriety as a marital aid when it was introduced by Pfizer over a decade ago. But it’s the drug’s extra-marital effectiveness that has caused a deluge for private detectives. According to Visalia-based private investigator Rocky Pipkin, Viagra drove his firm, Pipken Detective Agency (PDA), out of the infidelity business. “After Viagra, we quit doing spousal infidelity cases because of all the requests for service,” Pipkin says. “In most cases, older married guys started using it, and they apparently felt they needed to have girlfriends or affairs. And even though we had black-and-white evidence of their affairs, their spouses didn’t want to believe it and would use the evidence to confront the cheating spouse and try and convince them to stop. And usually it didn’t work.”

Pipken has many stories about these types of cases. The one that convinced him to stop accepting them was when a wife used the information gathered by PDA, and was conducting her own surveillance. She found her husband at a no-tell motel and confronted his girlfriend. Things escalated, and she rammed the girlfriend’s car with her pickup. “Luckily, we were able to stop her before anyone got hurt,” Pipken recalls. But the drama was too much, and that spelled the end of that line of work for PDA.

Reel vs. Real Drama

The drama can be a little too real at times, but unreal dramatizations can be troublesome as well. “I could go on and on about misconceptions,” Pipkin says. “Mainly, Hollywood has produced movies and television shows that portray mainly illegal activities. For instance, the placing of tracking devices on vehicles not owned by the client, or wire-tapping someone’s phone.” When asked if he sees any onscreen portrayals that come close to reflecting his and his agents’ reality, he says that, “Hollywood PI characters are so dispatched from legal reality that I can’t say I relate with any of the characters portrayed.”

If the entertainment industry makes you think cheating spouses are the profession’s bread and butter, think again. Depending on the day, casework could include workplace violence, anti-competitive threats, counter-surveillance attempting to determine who is following a client or making death threats, or surveillance on allegedly fraudulent workers compensation claimants.

Firms like PDA augment efforts by law enforcement agencies, as well.

“We could be investigating a commercial burglary,” Pipkin says.

Child abductions by parents have created another aspect of private investigation work, Pipkin says. “This is occurring more frequently. We recently located a 2-year-old who was kidnapped in Arkansas and brought to Visalia by the mother. We located the child and convinced the mother to comply with the court order advising her to give the child to our agents and ultimately back to the father in Arkansas.”

PDA provides security for several counties when inmates are admitted to the hospital and must be guarded twenty-four hours a day while hospitalized. The firm has previously contracted with the United States Office of the Inspector General as Workers Compensation Analysts and was responsible for several successful prosecutions for workers comp fraud. Pipkin says the firm is bidding on contracts for civilian support services for law enforcement agencies, reflecting an ongoing trend toward privatization of services that were previously offered by governmental agencies.

All those complex cases and functions must be costly, right? Well, it depends. Some basic services of a private detective agency can be quite affordable. Typical day-to-day service costs include pre-employment background investigations, which run around $95; skip tracing or witness locating, which also starts at $95; asset searches, which start at $475; service of process at $69.50; and live-scan finger printing at $20. The firm’s basic rate is $105 per hour.

Defusing Threats

“The more complex the case, the more expensive,” Pipkin says. “For instance we had a client whose business was receiving bomb threats, which required (him to) shut down production and ultimately lose a lot of money. We initially placed covert cameras near the area where the bomb threats were being dropped off, in his office reception area.” Pipkin says that law enforcement officials had seized the threats, which had been cut and pasted from magazine text, but due to budget restraints they were unable to have the threats forensically examined for DNA, fingerprints, or other potential evidence left by the perpetrators.

“We were able to convince the law enforcement agency to release the threats to our lab that we use in the Bay Area, which was able to confirm DNA on the paper. We then used a ruse to obtain DNA from possible suspects from soft drink cans that they had discarded in a trash can near their work station,” Pipkin recalls. Ultimately, they got a match from a security guard who worked for the independent security firm hired to guard the client’s plant. The guard was placed under twenty four-hour surveillance, uncovering a connection to a competitor of the business. “The rival company was paying the security guard to make the threats so as to disrupt our client’s production, in an attempt to land one of our client’s biggest customers.”

PDA had a recent embezzlement case that took agents all over the U.S. “The reason that we have to send our agents is that if the case is going to prosecution, many times the agent must testify in court on multiple occasions,” he said. So instead of subcontracting with an agency in the remote location and having that subcontractor come out to the Valley to testify again and again — accruing travel costs with each trip — he sent his own people out to do the legwork. “Thus, if the case involves witnesses or evidence obtained from back east, it is more cost efficient to send our agents to gather the evidence and interview witnesses” rather than having to fly a subcontracted agent in to give testimony, Pipkin says.

Advantages and Obstacles

He provides a number of insights into the unlikelier side of his profession. Women make excellent undercover detectives he says, “because women are not as intimidating as men in many situations, and certainly in issues involving children and other females. They are also more effective when we trying to obtain information covertly, women are less likely to arouse one’s suspicions.” He also feels that women are “generally more detail-oriented and try to gather more specifics of the needed information. If the female has a pleasant personality people are more willing to share personal information with them than men.”  That’s somewhat ironic, since most private detectives are often male former law enforcement personnel, usually retired.

The least well-suited to be private eyes are “dishonest people and do the industry a disservice because they bend the rules and sometimes break the law. Probably the most important aspect of being effective in the PI business is to educate the general public as to what a PI can lawfully do for you or your business,” Pipkin says.

The San Joaquin Valley heat is another regional obstacle for detectives conducting surveillance, one of the primary tactics of the trade. “Because of our heat, it sometimes gets very difficult to perform static surveillance from vehicles. You cannot perform covert surveillance with your engine running so that you can have A/C cooling the interior of your surveillance vehicle,” he says.

To adapt, detectives improvise by using twelve-volt water coolers, which usually can keep the inside temperature tolerable up to around 100 degrees, he says. “However when the temperature inches up beyond that number it becomes very uncomfortable. Surveillance isn’t like the movies, where it has been portrayed that you can follow someone with one agent. Many times it takes eight to ten agents to provide covert surveillance of a target and you must change up vehicles to prevent your team from being ‘burned,’” as unintended exposure is call it in the business.

In addition to the heat, Pipkin says that the Central Valley is unique in its population, its attitude toward law enforcement and its attitude toward crime. “Our work is tailored to our Valley’s needs for privatized law enforcement, which includes ag crimes and the scourge of methamphetamine abuse that has spread widely throughout the Valley,” Pipkin points out, suggesting that — even without infidelity cases — Pipkin Detective Agency will have plenty of work for the foreseeable future.

At the end of each year, I try to spend a bit of time reflecting on my life and how it has reshaped itself over the course of the past twelve months. In hindsight, I typically discover that I’ve made a few relatively significant accomplishments, grown closer in some relationships while more distant in others, stuck to at least one of my new years resolutions, and have overcome and survived a variety of disappointments. Fortunately, 2010 was not an exception.

Although my disappointments may not have been easily dismissed at the moment, I’d go through all of them again if I knew I could be where I am now as a result of what I’d learn from them. And while my accomplishments may have been few, I am grateful for each and every one — both the minor and more notable — as it is important that we take time to recognize when something good happens to us.

Back in December I told a friend who was coming off of a rough year that although the past several months had been challenging for her, the possibilities for the new year were open-ended; anything could happen. Although at the time I only meant to offer solace to a friend who was hurting, the sentiment is something I have thought about a great deal as 2011 gets into swing.

One of our Special Features in this issue is a story about the Morley family and how close they came to the idea of losing their newborn baby. A circumstance that would only be resolved by one of two outcomes took a fortunate turn and left a family with the happy ending they were praying for. Miraculous tales such as this should leave us all with the comfort that anything is possible — even when we’re expecting the worst.

Throughout the new year, including all of the unknown elements that come with it, I find myself hoping for another year that offers both successes and failures, as one can’t truly be appreciated without the other; new relationships, both professional and personal; and more unexpected achievements and disappointments that will offer me new awareness and appreciation in the following year.

I hope that you and yours will find this year to be full of unexpected joy, exciting surprises, one or two dismays from which you’ll learn, and an overall great year upon which you may later reflect with pride.

Here’s to a wonderful year in 2011!