Author: Kory Lanphear

On Wednesday, December 3, the Laboratory at Rapid City Hospital held a ribbon cutting ceremony, which officially marked the beginning of the new automation line’s operations and the end of the construction project that began in August. The soft go-live date was November 17 and the new lab became fully operational on December 2.

The most noteworthy change is the new automation line. Called the DxA 5000 Total Lab Automation System, designed and sold by Beckman Coulter, the line lends a renewed sense of harmonious, technological productivity within the lab.

According to the Beckman Coulter website, the DxA 5000 offers advanced pre-analytical quality checks and reduced manual intervention. The unit performs 9 quality checks in 3 seconds (tube type, cap type, fill level, sample volume, hemolysis, etc.) and prevents errors before analysis, reducing costly reruns and improving patient safety. Additionally, DxA 5000 automates more steps (tube checks, routing, centrifugation) and reduces manual handling by up to 80%, which helps improve staff efficiency while lowering the risk of human error. 

Gone is the frenetic noise of the air-compressor-powered machinery, replaced by an almost imperceptible computerized whir and clack. The Lego-like automation line is a bit reminiscent of a futuristic Rube Goldberg machine as vials make their way along the track and are shuffled this way and that before being gently plucked and dropped into a tray by a box-like apparatus for analysis at one or the other of the stops along the way. One can watch through the opaque plastic cover, terrarium style, at one of the stations, as the sliding and shifting apparatus functions like a sophisticated arcade claw machine to place and replace samples and perform tests for common blood indicators, such as chemistry, hematology, immunoassay and other specialty testing.

“This new automation line represents years of vision, planning and tremendous team work from laboratory Caregivers, our IT partners, facilities, construction crews, project management teams and support services,” said Emily Leech, Associate Vice President Lab and Imaging. “This line is more than equipment — it’s a commitment to efficiency, accuracy and the highest level of care for our patients. I am incredibly proud of what this team has accomplished together.”

Story by Kory Lanphear

Photos by Erika Bratten-Cianca

On Thursday, December 11, Jim Stevens of Hot Springs was wheeled through the third floor of Rapid City Hospital. A large, emotional group packed the hallways in honor of Jim, who had passed away unexpectedly. At the conclusion of the procession, Jim and his friends and family, clad in Green Bay Packers jerseys and apparel, disappeared through a pair of doors to the refrain of Lee Greenwood’s “God Bless the U.S.A.” Beyond those doors, Jim would make a final, selfless gesture: donating his corneas to anonymous patients so that they might see the world as his eyes once did.

The ceremony, called an Honor Walk, is organized by Monument Health and LifeSource on behalf of organ donors, with the permission of their next of kin.

“Each donor has the opportunity to donate organs to save up to eight lives with their liver, kidneys, lungs, intestine, heart and pancreas. They could also restore sight to two people with cornea donations. Anywhere from 75 to 100 individuals could benefit from one donor for tissue and skin,” says Lamont Mason, Donation Liaison at LifeSource. “Someone’s bone could be used for maybe a replacement. But there’s things that are used that a lot of people don’t realize, like surgical screws, where they use bone for the screw. ACL and MCL tears are repaired usually through donor tissue as well.”

LifeSource, based out of Minneapolis, works with hospital coordinators to speak to family members of end-of-life patients to make them aware of and help facilitate the opportunity for tissue donation.

There is, however, a lot of misinformation about organ donation, and Lamont is hoping to help alleviate the concerns that people might have.

“As long as I’ve been in this field, the biggest myth that I have heard is that if you’re an organ donor, hospitals won’t do things to save your life; they’ll just let you die to be an organ donor. And that’s 100% completely false. We hope for life on either end,” says Lamont. “Organ donation is a beautiful solution to terrible circumstances. Doctors and the health care team do everything that they can to save patients, until the family decides that they want to stop the escalation of care.”

What Lamont and LifeSource provide, though, should not be confused with living donors, which is when a living person donates a kidney, for example. Lamont only works with end-of-life patients. The service is federally-regulated and monitored by CMS. Potential donors must meet certain criteria, such as circulatory or brain death before Lamont and LifeSource begin their process. 

“Some individuals have signed up to be a donor. They can do that through the national registry or at the DMV on their driver’s license. Those are what we call first-person authorized or FPA. If the individual didn’t sign up to be a donor, we would then ask permission from the family to see if they would like their loved one to be a donor. If they agree, then we fill them in on the process, give them a timeline and then get started with the donation.”

Since Monument Health does not have a dedicated organ donation staff, most patients are flown to Mayo Clinic in Rochester, Minnesota where there is a fully-staffed Donor Care Unit dedicated to the surgical procedures for donations. Some patients forgo that option in favor of staying in Rapid City for their surgery.

For Jim’s Honor Walk, the outpouring of support, love and grief continued during the subsequent flag raising ceremony. The mourners gathered at the flag poles, just outside the Fairmont Street entrance, where RCH Spiritual Care Services Coordinator, Rev. Paul Birnbaum, MDiv, spoke as Lead Security Officer Jason Lofton raised a Donate Life flag to fly alongside the U.S and South Dakota state flags. A prayer was shared, at the end of which a shout came up from the crowd, “Make some noise for Jim! Thank you, Jim!”

Thank you, Jim, and all of the donors who help other patients by their gracious choice to donate.

For more information, visit LifeSource.org.

Story by Kory Lanphear

Photo by Erika Bratten-Cianca

For their semester project, South Dakota Mines Assistant Professor of Biomedical Engineering Tugba Ozdemir challenged her students to identify and provide product solutions to common problems associated with wound care. 

The twist, though, was that the students had to pitch their ideas to a panel of five judges. Taking the example of the TV game show “Shark Tank,” and using fake money, the judges then weighed whether or not they wanted to invest in the products.

These Wound Shark Presentations were held in the Maker Space inside Devereaux Library on S.D. Mines Campus. Sarah Mollman of SDSU College of Nursing, Jim Quinn of Quinn Construction, Dr. Jennifer Leberknight from S.D. Mines, Tung Nguyen, an Engineer/Consultant and our own Jessica Hart, CNP, Sleep Center and Wound Care in Rapid City served as the Sharks.

In teams of three, the students pitched their products, which included such innovations as dressing for burns and hypothermia and a detection device that senses infections at wound sites.

The students presented the specifics of the scientific basis of their products, the funding required for initial valuation and the potential market for the final product. The pitches also included profit estimates, roll-out strategies and timelines to significant development milestones. Much like the TV show, the Sharks asked questions then either offered to fund the project for a percentage of profits or stood pat. There followed negotiations with the students, who ultimately either accepted or rejected the offers. 

“Community partnership is exceedingly important between industry and our health care system,” said Jessica. “Also, it helps to foster development of new ideas. There are so many things that I can take away as well and put into practice that I learned from these students. I have learned so much in just two years about what they go through to create products that we use every day.”

Jessica had prior experience with the students in an advisory role. She’d given them lectures on wound healing and what happens when wounds don’t heal. The students also came into Wound Care to spend an hour shadowing Caregivers to witness real life situations. All of this was to help the students understand what they were dealing with, according to Jessica.

“I really enjoy being with these students. They’re very on top of the game. I’m very impressed, always, by their ideas, their presentations, their level of understanding of things,” Jessica said. “I do not come from an engineering perspective. They also have quite a science background, so they’re able to put their microbiology together along with a little bit of clinical observation. And I just see the lights turn on.”

Some of the innovations were still only concepts, some of them had prototypes. And, even though they were just ideas for a college class, that doesn’t mean they couldn’t one day be actual products.

“Wound Care is one of the fastest growing specialties within health care. It’s also one of the most researched,” said Jessica. “Every year there are innovative ideas and products to solve problems that we haven’t been able to solve yet, so these products could certainly make their way into the marketplace.”

Story by Kory Lanphear

Photos by various

Gretchen Emrich, RN, Emergency Department and Magnet Program Coordinator, Rapid City Hospital, doesn’t just save lives at work, she does it in her free time, too.

As the Training Officer for the Pennington County Search and Rescue Team, not only does Gretchen teach other members lifesaving techniques, she also goes out along with the team to find exhausted hikers or lost hunters. The 100% volunteer organization, which operates under the Sheriff’s office, has around 30 active members. 

A hiker and backpacker for about 12 years and a rock climber for seven years, Gretchen started with Search and Rescue in 2023. The team usually performs around 70-100 operations a year across the whole of Pennington County. 

“You go out in the afternoon and you expect, ‘Oh, I’ll be back by dark.’ Next thing you know, you get a little turned around, or it took longer than you anticipated. Now the temperature has dropped 30 degrees. You didn’t bring a layer of clothing. It’s dark out and you don’t know how to get out of there,” she says. “We are those people that, one day, it could potentially be us that needs to be rescued. So why not go out and rescue those that are in my same hobby or are the same type of person that I am? I mean, essentially you’re just helping your buddies out.”

Gretchen’s duties onsite are to lead climbing rescues or assist in general extraction operations. Surprisingly, she is not usually expected to use her health care training. For the most part, local EMTs will also be on the spot for that. However, sometimes even the EMTs can’t go where the Search and Rescue Team goes, so all of the volunteers are trained in basic life-saving and first-aid techniques.

For those who would like to avoid ever needing to call upon Gretchen or her teammates, she has this advice: “Always carry a form of communication, whether it’s your cell phone or satellite phone. Know how to use it and keep it charged. Also, make sure you’re wearing layers that are appropriate for the weather right now and what could be changing throughout the day or the night.”

Monument Health encourage Physicians and Caregivers to be involved in their communities 

by lending their support to programs that improve the quality of life and opportunities for all community members. Physicians and Caregivers who volunteer are asked to submit their hours in Workday.

For more about Pennington County Search and Rescue: pennco.org/pcsar

Story by Kory Lanphear

Photo courtesy of Gretchen Emrich

The laboratories of Monument Health perform over 2 million tests per year. The Rapid City Hospital lab accounts for about 65% of those. It’s an impressive number, considering we live in a state with less than a million people. The lab doesn’t just process and test samples originating at Monument Health locations, either. RCH lab has contracts with numerous other organizations including nursing homes and medical facilities in western South Dakota.

However, the aging lab automation line has begun to break down with increasing frequency.

That’s why last winter, Emily Leech, Associate Vice President Lab and Imaging, and Tina Rearick, Director Laboratory, began the project to update and upgrade RCH’s laboratory equipment. Thanks to our longstanding relationship with diagnostic laboratory company Beckman Coulter, the lab team was able to work up a plan of what the project would look like and how long it would take.

“Once we knew that we were moving forward with the automation line, we determined that we needed a lab refresh, too. To be able to take the automation line out and do new floors, plumbing and electric, we had to do it in separate phases. And we had to get everything out of the middle of the lab,” Tina says. “So we had to displace all of our instruments into hallways and offices. That started at the beginning of August.”

Improvised lab work spaces were created to make room for 5-20 extra construction workers and equipment implementation team members. This ad hoc game of musical chairs with machines and work spaces will continue through November. Yet, the lab team has taken it all in stride. 

“The laboratory team has truly done a tremendous job working in a construction zone with no automation. Everything is manual, and our volumes haven’t changed,” says Emily. “Our turnaround times have maintained at 80% of our laboratory goal, which is truly amazing. It really shows the laboratory staff’s dedication to quality and patient care — being able to work in these adverse conditions and still maintain turnaround times is top quality.”

On October 14, two semi-truck loads arrived full of lab equipment from Germany. Individual pieces were wheeled down to the lab and connected together, Erector Set-style, into a brand new, L-shaped, state-of-the-art automation line for specimen processing. The equipment also includes two new immunoassay instruments, all of which are currently undergoing validation and calibration with Beckman Coulter implementation technicians.

“Specimen tubes are put onto the automation line that then move along the conveyor belt which is equipped with numerous cameras,” says Tina. “The cameras take pictures of the barcode on each tube and the automation line then takes it to the correct analyzer for testing. Machines connected to the line perform chemistry, hematology, immunoassay, and other specialty testing.”

Despite all of the space management and effort to keep the lab operating, the updates are two weeks ahead of schedule. Training the lab team on the automation line begins Nov 4. The soft go-live date is Nov. 24.

“This new technology improves our efficiency, accuracy, and effectiveness which will allow us to process high volumes of samples with improved turnaround times consistently. The team’s goal is to provide fast, quality results to our patients. That’s why we’re here — for the patients,” says Emily  

For the curious, Tina and Emily invite Caregivers to come and take a look at what’s happening in the lab. However, they do ask for a heads up so they can be there to show people around.

Story and Photo by Kory Lanphear

In late September, Jason Knudson, M.D., FAAFP, Spearfish Clinic, North 10th Street, completed the first successful outpatient oral amoxicillin challenge with his patient, James Walton, a Paramedic at Sanford Underground Research Facility in Lead.  

The challenge, which is performed frequently in the inpatient setting, is now available at four of our clinics — Spearfish Clinic, North 10th Street, Custer Clinic, Sturgis Clinic and Rapid City Clinic, Flormann Street — can be used in patients identified to be at low risk of penicillin allergy to rule out immediate allergic reactions to penicillin antibiotics.

The success was an encouraging development for Marilee Obritsch, Antimicrobial Stewardship Program Clinical Pharmacist and the Antibiotic Awareness team: David Delahoyde,

Pharmacy Resident, Ryan Flynn, ASP Clinical Pharmacist, and for all of the Monument Health organization.

Frequently, a patient’s chart will indicate a penicillin allergy because the patient had a past reaction such as a rash that occurred while they were taking antibiotics as a child. However, the reaction may actually have been a symptom of a viral illness. Patients can also be listed as having a penicillin allergy when a close family member has an allergy. This often occurs without actual verification of the allergy in the patient. 

“We’re losing some of our antibiotics because bugs are becoming resistant to them,” says Dr. Knudson. “Penicillin is a great antibiotic. And so to take a big tool out of our arsenal to treat infections really ties a hand behind our back sometimes. That being said, you want to use it when it’s right, and you don’t want to overuse it.”

James, for example, always assumed that he was allergic to penicillins simply because that’s what he was told and because the allergy is common in his family. As an adult, though, he started to believe that it was worth confirming, especially because during his previous career as a flight paramedic, he had some worrisome experiences while on broad spectrum antibiotics. 

“I’ve taken ciprofloxacin (cipro) for other things in the past and ended up rupturing both of my Achilles tendons,” he says. Tendon weakness is suspected as a side effect of fluoroquinolone antibiotics, though thus far the relationship is inconclusive. 

There are some further compelling reasons to undergo the challenge. For one, many common illnesses persist when a penicillin-based antibiotic would be an ideal treatment. Amoxicillin/penicillin are also some of the cheaper antibiotics and have less side effects than other broad spectrum antibiotics. Finally, the challenge is common while patients are already hospitalized, which can be frightening and stressful for them, or, they may not be able to receive certain kinds of antibiotics before, during or after surgeries due to the uncertainty of their allergy. It makes sense for those who are unsure to undergo the challenge in the clinic setting, when the stakes are far lower.

The challenge itself is fairly simple: once the patient has been made aware of all the facts and risks and has passed a preliminary screening, which consists of four questions, they are administered a dose of amoxicillin in the clinic. They then remain under the supervision of a health care provider for thirty minutes. Afterwards, the patient can choose to remain in the exam room or waiting room for an additional thirty minutes for monitoring. The patients are instructed to come back or reach out in the rare case that allergic reaction symptoms are delayed. If no allergic reactions occur, the patient is then considered safe to take penicillins, and the allergy is removed from the patient chart.

“I just think this is a tremendous opportunity for our clinics to be able to have this potential visit type right now,” says Marilee. “Without these visits in Spearfish, Custer or Sturgis, patients have to go to Rapid City to get this testing done, and they have a very long wait. As long as you pick your patient using the tool appropriately, you’ll have good outcomes.” 

The screening tool, called PENFAST, is available within EPIC to all providers in the clinic setting.

Story and photo by Kory Lanphear

Through our partnership with Elevate Rapid City, we are participating in the Department of Defense’s SkillBridge Military Transition Program. This federal initiative helps us attract exceptional talent while supporting military families’ transition to civilian careers and community membership.

SkillBridge, according to its website, is an opportunity for service members to gain valuable civilian work experience through specific industry training, apprenticeships or internships during the last 180 days of service. DOD SkillBridge connects transitioning service members with industry partners in real-world job experiences.

The program addresses our critical need to attract and retain Caregivers across all roles within our health care system. Military professionals bring proven leadership skills, discipline and adaptability that translate exceptionally well to health care environments.

We recently welcomed retired Master Sgt. John Karel, PMP, who brings with him over 20 years of distinguished Air Force experience. Most recently he served as Senior Advisor to the Director of Public Works at Yokota Air Base in Western Tokyo, Japan. There, he led 739 engineers in the Air Force’s third-largest Public Works Directorate and guided an $89 million construction project that saves $15 million annually in utility costs.

John holds an MBA in Finance and began his four month internship this summer in Fiscal Services with Jennifer Schmaltz, VP Finance and Vince King, Director Financial Services. After two and a half months, John pivoted to work with Dave Ellenbecker, VP Facilities Management and Plant Operations and the Project Management team where he will continue until his SkillBridge stint concludes.

“What’s truly surprised me is how many parallels I’ve found between Monument Health and the Air Force,” John says. “The transition has felt remarkably seamless, especially since both organizations share similar core values. Monument Health’s emphasis on the individual Caregiver reflects the same commitment the military had to taking care of its people. That shared ethos has made this shift not just smooth — but meaningful.”

SkillBridge interns don’t just fill positions — they bring their families to become permanent community members and neighbors. This creates lasting community connections that extend far beyond the workplace, directly supporting our mission to impact our communities.

We provide essential relationships and support during one of life’s most significant professional transitions, helping service members understand both the similarities and differences between military and civilian health care careers.

“The SkillBridge program has been an invaluable experience,” John says. “Monument Health has been fantastic, and I’ve enjoyed working with every Caregiver. Even if a direct employment opportunity doesn’t work out, I’ll always look back on this time fondly and appreciate being part of this community.”

John’s SkillBridge internship ends Dec. 12, after which he will seek an employment opportunity at an organization of his choosing.

Story by Kory Lanphear

Photo submitted

Aidan Hermsen, 17, Rapid City Central High School Senior and Junior Certified Pharmacy Technician at Rapid City Hospital is the youngest person in South Dakota to be a certified Junior Pharmacy Technician.

And it all started with a jacket. 

When he was in the fourth grade, Aidan needed a costume for Career Day. On the advice of his mom, Sarah Hermsen, Director of Operational Performance Management, Aidan ended up borrowing a pharmacist jacket from Dustin Horning, the father of a friend from school and an Applications Analyst-Pharmacist at Turbine Drive.

“I’ve always liked math and science and my mom has been saying since I was little, ‘You should consider pharmacy as an option,’” says Aidan.

“Knowing his personality, he likes rules. He likes things clean and organized and so it makes sense,” adds Sarah.

The idea stuck with Aidan. For his Intro to Health Services class at Central his sophomore year, Aidan created a presentation based on a paper he read about being a pharmacist.

“The great thing about the health service class was they came and did a tour of the lab and imaging,” says Sarah. “When I was in school it seemed like you could either be a nurse or a doctor. I didn’t realize that there’s all these other jobs. You wouldn’t know that unless you take a class like that.”

Thanks to some new state legislation passed last spring allowing kids under the age of 18 to do such work, Aidan was able to undergo Junior Pharmacy Technician training and get certified via the Monument Health Pathways program in partnership with Central High School. He took the exam to become certified and passed on July 18.

Now, every other weekend when he’s not running cross country or track for Central, Aidan can be found reloading medications in omnicelle machines on various floors of Rapid City Hospital.

“Over winter break or next summer, I’ll get to learn how to do more stuff in the pharmacy,” he says. “Next year, I plan on going to South Dakota State University for pharmacy. I’ll probably come back in the summers and work to have money for college and to keep my hours up for certification.”

Aidan also jumped right into the culture at Monument Health, volunteering alongside his mom to serve at one of last summer’s Caregiver Picnics so he could meet and mingle with other Caregivers. 

However, he credits the class offerings at Central High School for fostering his career interest. “I just think it’s a great opportunity for kids to dip their feet in the water to see if it’s something that they could do before they go to college,” he says. “I’ve had a pretty good idea since I was little that I wanted to potentially do this, but I would say that the class just really enhanced the opportunity to get experience and further make sure that I want to do it.” 

Story by Kory Lanphear

Photo submitted by Sarah Hermsen

Even though he’s retired, Richard Norman likes to stay busy. In fact, the 70-year-old tree crew veteran still works part time at Willie’s Chain Saw Shop in Rapid City, where he repairs two stroke engines. “Chainsaws, trimmers, augers, anything like that; and some oddball stuff that nobody knows how to work on,” as he puts it.  

Partially because of his background in physical labor and partially because he spent his youth playing sports, Richard has experienced back pain for most of his life. “I used to do some pretty stupid stuff. I used to jump off the top of my truck like a paratrooper. I used to take 10 or so cases of cans — as much as I could pick up with my arms — and carry it. Plus, being on the tree crew for Wilson’s Tree Service and Black Hills Energy, I was always lifting and carrying equipment,” he says. 

In 2019, Richard was diagnosed with cancer of the lower intestine. During chemotherapy, he gained over 30 pounds, which he attributes to making his back pain worse. “Usually, you lose weight,” he says. “After the second year of chemo, it was taking me 15 minutes to straighten up. And the back pain just got worse and worse.”

An oncologist suggested that Richard get examined for arthritis in his back and referred him to 

Steven G. Frost, M.D., of the Pain Management Clinic in Rapid City. Dr. Frost determined that Richard had lumbar degenerative joint disease with lumbar radiculopathy (osteoarthritis of the back with sciatica). He elected to give Richard a lower spine steroid injection, which was administered as an epidural.

“Our goal at Pain Management is to help people and patients live in as pain-free a way as possible,” says Dr. Frost. “Sometimes all it takes is finding the right treatment to give relief for what otherwise might be a whole lifetime of suffering through pain. Richard is a great example of that.” 

Richard received his first and only injection in early July. “The injection was painless. I was like, ‘That’s it?’” Richard says. “As I sat up on the table, I felt it; it worked that fast. It was unreal.” 

Some friends that live down the road from Richard had previously asked him to remove a tree on their property. “It was probably about a 100-foot pine. I went over and looked at it and I told them I’d try to get to it, depending on how I felt. I felt so good that I went back and just took that tree down the same day as my injection,” Richard says. 

Ever since his injection, Richard has been pain-free. “I can actually do what I want to now. I’m more active. I can go out and mow the yard and not suffer from it,” he says. “Before, I was walking like an old man. For some reason sitting on a flight tightened my back up. It would take me a while to get up and unfold from an airplane and stumble out. Well, we recently took a trip with a couple of the grandkids to Washington and that didn’t happen. The treatment has actually been totally life-changing.”

Story and Photo by Kory Lanphear

Due to a series of late-season away football games, Spearfish High School’s homecoming celebration arrived a bit early this year. Scheduled for last Friday, the very edge of the end of summer, it was an auspiciously beautiful day for a parade. It was also a special day for Eric Santure, CSCS, Monument Health Performance Coach at Spearfish High School, who received the honor of being named Parade Marshal. The theme was “No Fly Zone.”

Eric, his wife, Jamie Santure, Associate Head Coach, Spearfish High School girls basketball and their nine-month-old daughter, Sadie, rode in a black Ford Bronco, driven by one of Eric’s former student-athletes. The school’s marching band accompanied the procession through the streets of Spearfish, which was lined with supporters in a show of enthusiastic spirit that has always been the standard for the community.

As a Performance Coach, Eric offers strength and conditioning training to every athletic program at Spearfish High School, including dance, cheer, football, basketball and track. He just began his fifth year with Spartan Athletics and Monument Health in the second week of September. 

Because of his dedication to the student athletes and the high school sports program’s improvement, the Spearfish Booster club reached out to Eric and informed him that they would like him to be this year’s Parade Marshal. Eric gratefully and readily accepted. 

“I met my wife when I came to Spearfish to work for Monument Health. We welcomed our daughter last December,” Eric says. “I do my best to help these kids reach their goals, and this community has welcomed and supported me from the day I got here. So the fact that the Booster Club and community think I deserve something like this means a lot.” 

The gig of Parade Marshal is pretty simple, per Eric. “This is my first time doing this,” he says. “Besides wave and throw candy, there’s not much else to it. I don’t have to wear anything special, thank God. It’s too hot for that.”

There was still work to be done, however, as Eric was due on the sidelines for the Spartans’ evening football game against Aberdeen Central at Lyle Hare Stadium. As soon as the parade ended, he headed right back to the school’s athletic facility to help the team prepare.

“I’m just super appreciative of the community and Monument Health for giving me the opportunity to be here inside the school district and help these kids. The fact that the community is giving back to me as much as I’ve tried to give them is pretty special.”

Spearfish High School came away victorious, winning 21-6.

Story and Photo by Kory Lanphear