1. Gallo, Madonna

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It's shortly after 6 a.m. when Heather Clark, a visiting registered nurse with Saint Elizabeth, steps outside her front door to survey the damage of one of the worst ice storms Toronto has ever seen. Her driveway is a skating rink, the street is quiet, and the festive lights framing windows and balconies are no longer twinkling. A tree in her neighbor's yard has collapsed under the weight of the ice. Branches are strewn across the road. The frozen scene is both beautiful and forbidding.


Heather takes a deep breath of cool air, thinking about her patients who are spread out over the east end of the city-many of them without heat and water. She says a little prayer, hoping that everyone is finding ways to stay safe and warm. Returning to her kitchen, Heather unplugs her mobile phone from the portable power pack she is using to keep it charged. There are well-laid plans for days like today.


"As nurses, we plan for national emergencies, extreme weather, power outages-you name it- we've pretty much got a plan for it," says Heather. Each year as winter approaches, Heather talks to her patients and family members about what to do in the event of a severe storm. When it is not safe to be on the roads, nurses generally cancel all nonessential visits so they do not become casualties requiring the assistance of the already-tapped emergency crews. Instead, they check in with their patients by phone to ensure their safety and well-being.


After a quick breakfast, Heather pulls on an extra sweater and sits at her kitchen table. The first call is to Norm, an 89-year-old veteran with colon cancer. He is stable but the end is near. When there is no answer on the main line, Heather tries an alternate number-his daughter's cell phone. Diane picks up; she is there with Norm and able to provide an update. The family has built a small fire in the fireplace and found some battery lanterns in the basement. Luckily, Norm's hospital bed is situated in the living room, which is close to the fireplace. They have piled a few extra blankets on him for warmth. A neighbor has brought over some hot drinks and food from a local coffee shop. No real change with Norm, he is barely aware of the storm that has been raging outside. Before hanging up, Heather and Diane run through a few scenarios of what to do if things take a turn for the worst. If Norm requires urgent care, the family will dial 911 and arrange for a transfer to the nearest hospital. Heather hopes it does not come to that. She knows the final stage can be a very difficult time to move someone. Her greatest wish is for her patients to remain comfortable.


As she hangs up with Diane, Heather's phone rings. It's her teammate Julie Edwards calling to check in. Julie recounts how a tree went through her windshield during the first wave of the storm. The power is still out across most of the city, and many gas stations remain closed. Saint Elizabeth's service delivery center that houses the coordination and management staff had to relocate to another office north of Toronto. The two nurses chat quickly about a few patients. As a knowledge-to-practice nurse, Heather is often called on to provide direction and support around palliative care. It is a role that builds on her more than 20 years of nursing experience.


By midmorning, the worst of the freezing rain appears to be over. Heather calls to check on a few more patients but no one is picking up. Their phones could be out, or perhaps they have gone to stay with family or checked in at one of the warming centers that have been set up to provide temporary shelter, food, and water. After a few more calls, Heather reaches Ali. His wife Shani's intravenous bag needs changing and with some encouraging words, Heather walks him through how to do it over the phone. In situations like this, a community nurses' emphasis on teaching during regular visits pays off. Now on speaker phone, Heather asks her patient how she's feeling but Shani is more concerned about how her nurse has been making out in the storm. Heather reassures the couple she is fine and tells them to take care.


"To me, a storm is a storm," says Heather. "I see people who are dying every day. It changes your perspective. Whatever comes our way, we just do what we have to do. That's what makes a good community nurse."


It helps that the front-line staff at Saint Elizabeth are never alone. With more than 7,000 mobile employees across Canada, the organization offers a vast professional practice infrastructure that includes on-call and virtual access to clinical and management supports, anytime and anywhere.


As the city slowly starts to come back to life, Heather decides it is time to venture out. There is one patient she is worried about and has not been able to reach. Ana is an elderly woman with diabetes who lives alone. She is blind and requires daily insulin. Before leaving the house, Heather rummages around the back of her closet looking for a pair of ice cleats she purchased for days like this. With several family members that work for the local safety authority, Heather prides herself on being someone who is prepared for anything. "No one could walk on the ice that day, but in those cleats, I was dancing up the street," laughs Heather. Her car is equipped with new snow tires-not quite as good as ice picks, but a must for anyone who needs to be on the road during Canadian winter.


Heather slowly makes her way through the streets. After several detours around fallen trees and utility poles, she arrives at Ana's apartment building. The power is out, as expected, which means Heather is taking the stairs. She slips out of the cleats and into her shoes before starting her ascent. After 16 flights and a brief rest, she is knocking on Ana's door. Her patient greets her with a warm smile, and then scolds her for being out on the roads. After administering the insulin, Heather asks her client how she is making out with food. She checks the refrigerator and finds it nearly empty. With a glimmer of pride, Ana shows her how she has moved the essentials onto the balcony so that the food won't spoil. Like their nurses, home care clients are clever and resourceful. Before leaving to make the trek home, Heather gives Ana a red bracelet from Disney World with the word "HOPE" inscribed on it. It's a gesture that is inspired by one of her former patients, a 17-year-old young man who passed away some time ago.


Every year, Heather returns to Disney World to get more bracelets to give to her patients. It is just one of the ways she spreads a little hope and happiness every day.