Shock Trauma’s Violence Intervention Specialists Help Break the Cycle and Change Lives After Violent Injury

It’s heard in the news cycle pretty often in Baltimore – the victim of a gunshot wound or stabbing is taken to Shock Trauma, where they survive their injuries.

However, it’s NOT often you hear about what happens to these survivors. How are they recovering from their injuries, mentally and emotionally? What are our teams doing to help them get access to resources to avoid violent injury again?

That’s where Leonard Spain and David Ross come in.  They’re both Violence Intervention Case Managers at the University of Maryland Shock Trauma Center.  Anytime someone suffers a violent injury and survives their injuries at Shock Trauma, they are seen by Spain and Ross.

Spain and Ross work to connect victims of violence with resources to get them on the path to success – including employment and schooling opportunities, mental health support, legal assistance and more.

Cut from the Same Cloth

Leonard Spain grew up in West Baltimore and, as a young man, was involved in the drug trade.

“The population that we serve – I was them. I sold drugs, I was a victim of gun violence and I spent time in prison,” Spain says.

That time in prison is what caused Spain to change his way of seeing things. When he arrived home, Spain realized the lack of resources available to help people like him get back on their feet.

He went to several career and job centers, attended job fairs and tried to do everything he could to stay out of trouble. After working a temp job for minimum wage for three years, Spain knew he wanted more for him and his daughter.

He enrolled at Sojourner Douglass College and received his Bachelor’s Degree in Human Services. He always knew he wanted to get into violence intervention and came to Shock Trauma after an internship with the Baltimore City Health Department.

When approaching patients at the beside, Spain focuses on building a relationship with patients as the first step of starting the case management process.

“I try to let them know I am just like them, just not out on the streets anymore,” Spain says. “Sometimes I gotta pull my shirt up and say ‘I got bullet holes just like you.’”

Poetry in Motion

Ross, also a Baltimore native, is a spoken word artist by trade.  He was discovered by the Shock Trauma team after performing at an anti-violence rally at Mondawmin Mall.

At first, Ross was a volunteer with the hospital with another friend.  By commission, he would come and talk with victims of violence and worked with the peer support group.  He then rose to his current position.

Now, when Ross learns of a new potential client, he will get background information on social media and online court records before meeting with them at the bedside.

“I’ll have that information in the back of my mind, but my next step is to speak and have a conversation with them and get their perspective,” Ross says.

Ross says he likes to ask the clients what they would like to gain from the situation and what they see as barriers.

“It’s not an easy thing to get them to trust you, and I understand that completely,” Ross says. “We’re usually asking them to change major aspects of their lives – and it definitely has to be broken down so we can work on one thing at a time.”

Usually, Ross starts with helping his clients get registered for health insurance so they can get their medication and get healthy. Next, they tackle employment. If it’s a criminal record holding the client back, they work to see if anything can be expunged. If it’s the lack of formal education, he works to get them in a GED class to receive a high school diploma at the least.

“I try to remove the obstacles to get them from point A to B,” Ross says. “Then, once we get them to point B, we see what other obstacles we can remove to get them to C.”

Spain and Ross both acknowledge that they are asking their clients to make massive life changes with not many resources, but overall, know it’s worth the trouble in the long run.

Spain is getting his Master’s in Conflict Resolution in University of Baltimore, and Ross is working towards his Master’s in Social Work at the University of Maryland, Baltimore.

Learn more about Shock Trauma Center’s for Injury Prevention and Policy.

University of Maryland Ear, Nose & Throat Team Preparing, Fundraising for Annual Volunteer Medical Mission

The University of Maryland Ear, Nose and Throat (ENT) team is gearing up for their next volunteer medical mission trip – and they’re hoping you can help them help more people. The team, led by head and neck surgeons Rodney Taylor, MD and Jeffrey Wolf, MD, has begun fundraising for their March 2017 medical mission to Ho Chi Minh City, Vietnam.

Fiji Team

The ENT Team during last year’s mission trip to Fiji

Every year, the ENT team travels to different under-served parts of the world to provide their services free of charge. The crew is dedicated to providing world-class care to those in need. They pay 100 percent of their own way, including airfare, shipping costs for their equipment and the cost of purchasing additional supplies not available onsite.

This year, the funds raised will also pay for patient transportation. While there is one hospital in Ho Chi Minh City, many Vietnamese citizens living in the rural hills don’t have easy access to health care. In fact, some of them have never even been to a hospital. This year, the ENT team will be covering the funds to get patients from their homes to the hospital to receive the care they need.

In Vietnam, Dr. Taylor says there is a higher rate of cleft lip and cleft palate, so they expect to see a lot of patients suffering from those conditions. The team also is planning to treat many patients with goiters (enlarged thyroid), parotid tumors (in the salivary glands), sinal nasal masses and even some cancers.

“It’s an area where we can make the biggest impact during our time there,” Dr. Taylor said. “We will also get the chance to soak in the culture, and learn valuable lessons from the patients we serve.”

Another huge win for the team, and the patients in turn, is the addition of a pediatric anesthesiologist to this year’s crew. That means the team will able to operate on children needing surgery, not just adults.

The ENT team is working with the Project Vietnam Foundation, a nonprofit humanitarian organization working to create sustainable pediatric health care in Vietnam, while providing free health care and aid to impoverished rural areas across the country.

All of the ENT mission trips are made possible through donations. If you cannot make it to the happy hour, donations are welcome on the Maryland ENT Mission website: http://www.marylandentmissions.org/donate.


­­­­Last year, the team traveled to Fiji for their annual medical mission. They performed 15 surgeries and saw 150 patients before the island was rocked by Cyclone Winston. Learn more here.

Volunteering at a Medical Center

By: Andrea Rizkallah, Editorial Intern

AndreaVolunteering is a rewarding activity, which is why I love my position as editorial intern in the Corporate Communications department at the University of Maryland Medical Center. I thought that I had to be a medical student in order to volunteer at a medical center, but luckily I was wrong. I was able to get an administrative position that still makes a difference and offers me great experience.

The Corporate Communications department coordinates blood drives that help save lives, updates the website with valuable information for patients and families, keeps Medical Center employees updated on training events and interviews patients to communicate their stories. Even though we are not transplanting lungs or performing surgery, we are still deeply involved with the hospital. I have completed projects that really make me feel like I am part of the team, and these contributions make me feel accomplished and useful.

The volunteer program here at the University of Maryland is great because I am getting hands on experience. I get to learn how the hospital works and what goes into the everyday functions of a medical center.  Although my role is an administrative one, I feel that I am making a difference, and that is a lot to take away from a volunteer position.

Volunteers work in all areas including the Emergency department, Shock Trauma Center, Medical Records department, Dental Clinic, Psychiatry department, and many more.  There are some requirements to volunteering at the hospital:

  • You must be at least 13 years old and be able to commit to four hours a week.
  • To receive credit, recommendations or certificates, you must volunteer at least 75 hours of time.
  • All prospective volunteers must return the required paperwork to the volunteer office prior to interviews.

Learn more about how to have a rewarding volunteer experience.

Therapeutic Music Program Helps Cancer Patients

By Sharon Boston

Media Relations Manager

Music and sound, such as a happy song on the radio or the frightening score of a scary movie, have the ability to change our moods. Many people have a physical and emotional connection to sound, and scientific research has shown that music can be beneficial in healing.

Now, through a grant from the Gabrielle’s Angel Foundation for Cancer Research, the University of Maryland Medical Center is offering live therapeutic music to patients receiving treatment at the Greenebaum Cancer Center.

Therapeutic musician Terri Fevang plays keyboard pieces tailored to each patient’s mood or emotions, so each visit is different. Some patients may be anxious while awaiting test results, while others may be tired after receiving chemotherapy or radiation.

“The music is peaceful and calming, and takes my mind off my pain and worries,” says Jessica Montgomery, a 29-year-old leukemia patient. “When Terri comes in, we turn the TV off and just listen to her play. My dad is usually there too, and he often falls asleep because it’s so relaxing.”

The live therapeutic music program is part of the Medical Center’s Integrative Care team, which offers treatments such as acupressure, guided imagery and yoga breathing to patients throughout the hospital, including the Shock Trauma Center.  The goal is to help patients relax, optimizing health and healing.

Terri playingThe Gabrielle’s Angel Foundation grant also allows researchers from the University of Maryland School of Medicine to study the potential benefits of live therapeutic music for these cancer patients. The grant will fund a pilot study to see if the therapy can affect patients’ anxiety, mood and quality of life as well as some physical indicators such as pulse oximetry, which measures the pulse and oxygen in the blood.

“We have received a great deal of positive feedback from patients about the music program. Now we want to see if the data supports this encouraging anecdotal evidence,” explains Chris D’Adamo, PhD, director of research at the University of Maryland Center for Integrative Medicine, which is part of the University of Maryland School of Medicine.

If the pilot program with 30 patients is successful, researchers hope to launch a larger study on the benefits of therapeutic music.

 Click here to see a WBAL-TV story about the live therapeutic music story.

 

Occupational Therapist Shares Joy of Watching Lives Change

Lila Nappi, OTR/L, an occupational therapist in the Department of Psychiatry at University of Maryland Medical Center, wrote a moving letter to her colleagues after the culmination of a project they had worked on for more than three years. Last November, 14 adults became the first graduating class of the Academy of Independent Living, a unique program developed by the Division of Community Psychiatry. To read more about the event, see the previous post, Life Lessons for Independent Living Within a Community.

Dear All,

I just wanted to take a moment to share a few thoughts I have had since the graduation.

This has been quite a pilgrimage we have been on and, given the season, I just wanted to thank each of you for the privilege.  It is days like 10/10/12 and 11/14/12  that make it possible for me to be very proud to work for an organization that supports programs that transform people’s lives, members, family and staff alike.

Consistently, I heard from members and staff that they took the risk of getting outside their comfort zone in one way or another and were all the better for it.  I am struck by how we have learned to lead by example from the top down.

One example of this is Jill pushing us all to dream big. And then having the audacity to set the example and invite Kay Jamison. (Editor’s note: refers to academy founder Jill RachBeisel, MD, and keynote speaker Kay Redfield Jamison, PhD) I hear through the grapevine she is sending the graduates an autographed signed copy of her book — simply a class act.

Not to mention her inspiration, which was palpable on Wednesday. I kept looking at our graduates wondering what they were thinking and feeling and so hoping this is a turning point in their lives. Again we all made the seemingly impossible, possible. I hope as a result you see the world a little differently. We did not let fear, obstacle or negativity stand in the way of our goals and as a result we met them with meaning and purpose for all of us.

I have worked very hard during my 25-year career to create joy at work but I have never known joy like this. And for that, I thank you. It is role fulfillment I could not have imagined.

Best wishes for a wonderful holiday season and look forward to seeing you in the new year.

Fondly,

Lila Nappi

Redwood Pharmacy Moves to a More Prominent Location

By Jeffrey Cywinski, RPh

UMMC Ambulatory Care Pharmacy Manager

You could say the new UMMC Pharmacy at Redwood has taken the community by storm. Although Hurricane Sandy threatened our neighborhood with flooding and high winds on our opening day Oct. 29, pharmacist Charles Donohue, RPh, and pharmacy technician Vernette Neely stepped up to open the pharmacy in its new location despite the hostile weather.

Our newly designed and easily accessible pharmacy has been relocated to the corner of Paca and Redwood streets — across the street from the Redwood Building. It’s open from 9 a.m. to 5 p.m., Monday through Friday. The pharmacy includes an expanded prescription processing area and a larger variety of over-the-counter products for our patients.

The new storefront entrance also means quick access for staff and students throughout the University of Maryland Baltimore campus, and for West Side residents and others who work or shop in the neighborhood.

Pharmacy technician Shawnta Toney stocks the empty shelves with topicals at the new pharmacy.

Moving a pharmacy is a complex endeavor that requires attention to detail. Support from other departments is also crucial.

Because an extra layer of security is necessary when moving controlled substances, the Baltimore City Police, University of Maryland Campus Police, and UMMC security officers ensured safe passage for the medications from one building to the other.

The relocation involved more than 12 total hours with the assistance of about 30 staff members, which included a team of pharmacy technicians and pharmacists, assisted by Bret Elam, pharmacy business and operations manager, and Marc Summerfield, MS, director of Pharmacy Services for UMMC.

Everyone had a specific role. The technicians stocked shelves and organized the pharmacy supplies, while the pharmacists performed inventory counts on narcotics and controlled substances.

Our pharmacy department is known for using innovative technology: The Script Pro Robot counts over 40 percent of prescriptions filled and the Omnicell securely stores narcotic medications and documents any access to them. The Pharmacy IT team connected the point-of-sale cash registers and the rest of the technology. We also had the support of Agnes Ann Feemster, PharmD, assistant director of clinical pharmacy and investigational drug services, and Deborah Fay, project manager.

Thanks to our dedicated staff and partners, we were able to finish the move ahead of time.

We’re here for you. Whether you need to fill a prescription or just buy a bottle of OTC headache medicine, come visit us on the corner of Paca and Redwood streets!

Super Staff Beats Super Storm — Every Time

The forecasts and predictions around Hurricane Sandy had much of the eastern third of the country braced for disaster. Baltimore saw heavy rains, wind and flooding. But the University of Maryland Medical Center didn’t skip a beat, thanks to the dedication of staff members who planned ahead or braved the elements to get to work. Their inspiration: hundreds of patients and colleagues were depending on them.

 We heard about staff taking extraordinary steps to be available for patients and to one another. If you have a story of your own, or you know of something that somebody else has done, drop us a line at communications@umm.edu.

 In the meantime, here are a few:

 From Karen E. Doyle, MBA, MS, RN, NEA-BC, vice president for nursing and operations at the R Adams Cowley Shock Trauma Center and for emergency nursing at UMMC:

“While I was making rounds yesterday [Oct. 29], I stopped and spoke to Darlene Currin, a housekeeping staff member in Shock Trauma working on 6 North.  I thanked her for being here, and told her that her work was really important.  She told me that she had just arrived (it was around 10:30 or 11:00 a.m.).  Darlene had walked all the way from East Baltimore to UMMC.  But, she knew she was needed and made the trek anyway.  Really unbelievable.  I was so inspired.”

 Currin (pictured above) said she doesn’t think she did anything that most of her colleagues wouldn’t do. “We all work here, we know it’s 24/7,” she said. On Monday morning, she was unable to get a taxi or sedan service (public transportation was shut down), so she decided to walk. It took her about 90 minutes.

 “I was soaked when I got here,” Currin said.

 From Monika Bauman, MS, RN, CEN, nurse manager for women’s and children’s ambulatory services:

“The hospital-based clinics officially closed on Tuesday due to the storm, but Ometriss Jeter, a scheduling and preauthorization coordinator who works in Pediatric Hematology and Oncology, reported for duty Tuesday morning at about 6 a.m.  She rounded in all of the outpatient registration areas offering her services and making sure they had adequate staffing for the day. Once she determined all was well, she reported to our clinic, even though it was closed, to be sure we were ready for operations as usual for tomorrow [Wednesday].”

 From Karen Cossentino, MS, RN, CCRN, senior clinical nurse II and charge nurse in the Cardiac Care Unit:

“I was in charge in the Cardiac Care Unit on Monday, Oct. 29, and it was an exceptionally busy day. So I would like to thank all the staff for working together. Two nurses deserve an extra thank you, but they asked that I not use their names. One of them had a vacation scheduled this week but offered to work for a nurse who is a new mother who would not have been able to get home after work on Monday to her 3-month-old baby.  Another nurse from Professional Development came to the unit and asked if we needed any help. I immediately took her up on her offer and she stayed most of the day and went from room to room and nurse to nurse and offered her assistance.”

From Rehana Qayyumi, MLS (ASCP), medical lab scientist, Microbiology Laboratory:

After making up my mind to stay [at work during the storm] on a very busy Monday, I did not have time to think about where I would stay after my shift. Then, our wonderful Microbiology Technical Specialist Donna Cashara, MLS(ASCP), asked me what I was  going to do.  I just told her, ‘Yes, I’m staying somewhere,’ while very busy with my assigned work.  Anyway, she personally walked two blocks away to the Marriott [as phone calls were not helpful] and reserved a room.  She was like an angel for me when I finally reached the room around 7 p.m. and took a shower and my medicines and bowed my head down for my unexpected landing in full luxury. Did I deserve it? Yes, I think all of us who decided to pay for comfortable accommodations to be ready for the next busy day deserved it.  We deserve all the best to provide the best services. TeamWORK works!”

Rehana Qayyumi and Donna Cashara

Rehana Qayyumi and Donna Cashara

Cashara said it was tough to get a room at an affordable rate that night at the downtown hotels, but the Marriott finally came through. She said many other seasoned lab staff know when storms are coming, they need to look out for each other. She and another staff person led a department-wide effort to make sure the hospital had enough lab staff and that those employees had either safe passage home or a place to sleep. The hospital provides dorm-like accommodations, but some staff prefer to split the cost of a nearby hotel room.

From Cassandra Bembry, MLS ASCP, outreach customer service supervisor for the Clinical Pathology Laboratory:

Jamillah Johnson, my front-end coordinator of the Clinical Pathology Laboratory (a.k.a. “Accessioning”) volunteered late Sunday night to pick up more than 80 percent of our day-shift staff for Monday who rely solely on public transportation.  She also took these employees home and picked up our evening shift crew.  Jamillah has consistently shown a great deal of care and concern for our staff that is unparalleled, in my opinion, and acts of this nature are routine for her.” 

 From J.V. Nable, MD, NREMT-P, clinical instructor and chief resident in the Department of  Emergency Medicine:

“The [physicians in the] UniversityofMaryland Emergency Medicine Residency met the challenges posed by Hurricane Sandy head-on. Despite the incredibly inclement weather, residents continued to provide vital services at emergency departments and other hospital units throughout the region, including: UMMC, the Shock Trauma Center, the Baltimore VA Medical Center, Mercy Medical Center, Bayview Medical Center, and Children’s National Medical Center in Washington, DC. Because some residents have lengthy commutes, those who live near the medical facilities invited them to their homes for dry and safe shelter during the storm. Many residents volunteered to rearrange their schedules, taking extra shifts to cover for those stranded by the storm. As part of the backbone of clinical services at UMMC, emergency medicine residents demonstrated unwavering dedication throughout this unprecedented event.”

From Shawn Hendricks, MSN, RN, nurse manager for 10 East (Acute Medicine Telemetry Unit) and 11 East (Medicine Telemetry Unit):
 
During Hurricane Sandy, the dedicated staff on 10 & 11 East showed up ready to work, with smiles and a determination to provide excellent care despite the weather outside. I gave personal thanks to patient care technicians Theresa Hicks and Danielle Brown for coming to assist with the patients on 11 East after completing their care on 10 East, until help arrived from Monique Thomas, a student nurse who had been off duty but came in to help. And, also, to Jocelyn Campbell, one of our unit secretaries, who came in even when she wasn’t scheduled, to help with secretarial duties and other tasks on 11 East. Finally, a big “Thank you” to all my staff who stayed late or came early to ensure the shifts were covered! These staff members showed loyalty, teamwork, and caring when it was needed the most!

Country concert raises $12,000 for organ donor clinic

living donor clinicFrom Left: Event organizers Marla Blackwell and Lee Adams; Jo Funk, LCSW-C, living donor clinic social worker; Debora Evans, David B. Leeser, MD, chief of kidney and pancreas transplantation, and Janice J. Eisele, senior vice president, UMMS Foundation.

By Caroline Killian

UMMS Foundation

The UMMS Foundation is proud to report that the Fifth Annual Living Donor Country Concert raised a record amount this year – just over $12,000 dollars!  This year’s concert took place on September 11  at the Harmony United Methodist Church in Falling Waters, W.Va., providing an intimate venue for guests to experience a “Night with Nashville.”

Attendees listened to acoustic performances from country stars James Wesley and Dustin Lynch, and were treated to a “meet and greet” with the artists after the show. The show also featured a silent auction with items signed by country superstars, including Tim McGraw, Kenny Chesney, and Taylor Swift.

Dustin Lynch performed his hit single, “Cowboys and Angels”, which reached No. 2 on the Billboard Hot Country Songs Chart. His self-titled debut album recently entered the Billboard Country Chart at No. 1, making Lynch the first new male artist to debut at that spot this year.

The concert was attended by several UMMC Transplant team members, including David B. Leeser, MD, chief of kidney and pancreas transplantation at the University of Maryland Medical Center.

 “It was an outstanding event in that it was about giving and donation, and they opened up the sanctuary,” Leeser said. “We had a bunch of young people in a church listening to music and learning about transplantation. It was an amazing event.”

Dr. Leeser recalled a powerful moment of the night: “One of the artists sang a song he had written late one night at a time when he was frustrated and he hadn’t broken through and become successful yet. He said ‘This is a song, a prayer I wrote, that I said I’d never sing unless I was in a church.’ So he sang it.”

The money raised from the concert will support UMMC’s Living Donor Follow-Up Clinic, which provides follow-up care for living organ donors who have generously given the gift of life.  After surgery, living donors have four follow-up visits within two years after donating a kidney.  In supporting the post-operative care for our living donors, the Living Donor Country Concert helps to ensure the Clinic’s ability to provide world-class, long-term care for our donors.

To learn more about the Country Concert and to donate to the Living Donor Clinic, please visit: http://www.ummsfoundation.org/concert.

Blue Holiday Service Acknowledges Darkness While Seeking Growth and Hope

By Susan Roy, DMin, BCC
Pastoral Care Director

As hospital chaplains working with patients, families and our fellow staff members, we know that the stream of cheerful holiday messages and images might only make it harder for individuals experiencing grief or loss. Each year, we offer a series of services for people who seek a more reflective way of coping with the holidays.

I am just finishing the program for our Blue Holiday services later today (12:45 p.m.; 5 p.m.; and 6:15 p.m. to 8:15 p.m.) and hope that it will be meaningful for anyone who is feeling a bit blue this holiday season. Around the country, similar services might also be called a Longest Night service because it occurs on the winter solstice — Dec. 22, the day of the year that has the fewest hours of sunlight. Regardless of the name used, these programs acknowledge the darkness that may also be part of our holiday season.

Arranged in four parts, the service is reflective – not depressing – and moves from darkness to light while keeping a balance between the two. The four parts are loneliness, death, growth and hope. Each of the four parts includes lighting a candle, a reading, and a musical selection. During each of the four parts of the service, participants will be invited to come forward to place flowers in a wreath to represent those whom they remember.

For example: during the first music segment – about loneliness — I might place a flower for my frustration at work; during the second, I might place four flowers to remember three people who have died and a friend who is estranged from me; during the third, I might place a flower for the way I am growing in my faith; during the fourth, I might place two flowers, one for world peace and another for hope.

The service acknowledges the darkest night of the year and symbolically allows us to acknowledge the darker parts of the human condition and our own lives. In the midst of darkness, we still experience moments of light and hints of hope.

In addition to the spiritual help needed, here are some practical tips from two physicians at UMMC.

A Legacy of Compassion and Understanding

By Iris T. Smith, MSW, LCSW-C
UMMC Clinical Social Worker

Editor’s Note: Jean Tucker Mann (right), a long-time UMMC social worker who was a pioneer in her field, has been selected by The National Association of Social Workers (NASW) , to receive its 2010 National Lifetime Achievement Award today (April 28) at the Annual Leadership Meeting at the Hyatt Regency Hotel in Washington, DC.

Mann has worked for 35 years in the public and nonprofit sectors, most recently as director of social work and human services at University of Maryland Medical Center. She retired from UMMC in 2005 after leading a multidisciplinary effort that established the Palliative Care Program for patients with life-altering or terminal illness.

In recognition of her leadership and accomplishments at UMMC, “The Jean Tucker Mann Award” was established in her honor to recognize those who make a difference in the way Jean did for so many years.

Below, Iris T. Smith, one of Jean’s former co-workers and a UMMC clinical social worker, shares her thoughts about Jean and what makes her so special.

It is with a great deal of pride and affection that I write a few words about Jean Tucker Mann and her accomplishments while she was director of social work and human services at the University of Maryland Medical Center.

Jean was a dynamic leader who communicated with all. Her door was always open and staff felt comfortable in stopping by her office to discuss a variety of subjects. I feel that Jean was a special leader because of her commitment to excellence and her ability to take on new tasks, like establishing the Palliative Care Program at UMMC, and her work as founding member of UMMC’s Diversity Council. She used a situation that I had confronted and dealt with in regards to race to illustrate the need to the administration for a Diversity Council.

Jean nominated me for the Gold Award, the highest employee award given by UMMC, because of the professional way I handled the situation, which reflected the medical center’s mission, vision and values. Thanks to Jean, I received this award in 2004. Jean was an advocate for all.

Finally, Jean’s legacy and impact will live on through the programs she established and for the manner she was able to engage all levels of staff. She was a role model and encouraged all to work at a high level. She was warm, caring, inspirational and able to engage all around her on tasks that needed to be accomplished. Jean was special, which is why she was so loved.