Moving Mountains - Creating the Nurse Practitioner and Rural EMS

Excellent book. Informative and inspiring.

Part memoir and part anthology of tales about Idaho’s back country, in the final analysis this book is an homage to an extraordinary woman. That woman, Marie Osborn, fought her way into her position as the lowest paid, hardest working, and most dedicated nurse practitioner in the country—or at least in Idaho. In the process she opened the doors to the many nurse practitioners and dedicated physicians and physicians assistants who walked through the doors of the Salmon River Clinic to learn the art of medicine from the ground up.

Marie had already lived a rich and full life before moving with her husband and family to the remote village of Stanley, Idaho, cradled in the Sawtooth Mountains. Once there, she fell in love with the mountains, the community, and her position of back country caregiver in a region that had previously been devoid of reliable medical care. Not only did Marie establish the Salmon River Clinic and Stanley Ambulance service, she also cracked open and nurtured a new type of medical practice by becoming the first licensed nurse practitioner in the state.

Much of the text is Marie’s first-person account of her life before, during, and after her career as one-woman health complex for the remote Idaho backcountry. The eight parts of this book introduce the reader to Marie’s family. She shares a clear-eyed assessment of the toll her work took on her marriage. A host of dedicated volunteer first responders who worked with Marie during her years as director of the clinic come to life on these pages. Through Marie’s and her colleagues, we learn how she repeatedly butted heads with genderism in the field of medicine. We have a nail-biting peek over the shoulders of Marie and her special cadre of EMTs as they tend to the cavalcade of injuries both small and deadly that occur in the back country. These case studies are written in such a way that the reader feels like they are right there in the midst of the struggle. By the end of each episode when the outcome is revealed, news of survival lifts our spirits; the report of a life ended is a sucker punch. Marie’s memories are supported by first-person accounts from a slew of backcountry heroes: town leaders, EMTs, ambulance drivers, government resource managers, doctors and teachers that she worked with, as well as some of the medical school students that she mentored along the way. The coda to each of these personal stories is gratitude and respect for all that Marie did for the writer and for the Stanley community.

I felt my own life connecting with Marie’s adventures in many unexpected ways. I was surprised and thrilled to learn that she had worked at Harborview in Seattle and speculated whether she had crossed paths with my now-deceased relative whose nursing career played out at Harborview also. I could relate to Marie’s involvement with the Bogus Basin ski racing program. I couldn’t believe the number of names that I recognized from my years living in southern Idaho and even that of a retired Forest Service employee with whom I now volunteer alongside on Idaho Fish & Game projects.

It is clear that the reason Marie was so good at what she did, and was able to accomplish so much, is her innate humble approach to life. She never stopped learning, never stopped asking questions, never stopped striving for the best possible outcomes, never stopped recognizing the contributions of others. When describing her self-made position as nurse practitioner, she says, “A nurse practitioner is not a mini doctor; a nurse practitioner is a super nurse.”

Brief but heartfelt plugs from Marie and her colleagues about the many issues that small communities face in a changing world are cradled within the personal stories. A few topics include: salmon sustainability and the lower Snake River dams, dwindling funds for the already starved Forest Service and National Park Service, motorcycle safety—if there is such a thing, financial support for rural EMS, and gentrification of mountain communities. The influx of second-home owners who don’t or can’t (because they’re not present) volunteer in the way original Stanley year-round residents did threatens the sustainability of an all-volunteer health service, yet funding is ever inadequate to pay for professional healthcare.

A serious book about serious subjects, there are plenty of humorous turns of phrase peppered throughout the text, as well as fabulous photos and a solid index. My only complaint about this beautiful book is why such a text-heavy book that needs to be read from beginning to end was designed in such an awkward coffee table book format.

I received my copy of Moving Mountains this week and I am absolutely gobsmacked. I can't begin to find the words to describe my response. This is SO much more than the story of one woman—although it wouldn't be a story without her at the center of it. I expected to learn about a pioneering NP, but I didn't expect to enter this whole world of people in a small mountain community, and the woman who was the anchor that held them together and changed their lives.

I don't know when I have read a book that has moved me this much, and I haven't finished it yet. Of course, I started by picking it up and leafing through it, and then reading personal stories, and then sat down and started at the beginning. In a very busy week, I have had a hard time putting it down—reading it during my commute, staying up too late when I had an early morning and telling friends and family about these amazing people who I have gotten to know. Some of the stories moved me to tears . . . really. The toddler who was running across the road to her mother, the man who raped her and threatened to kill Mousse, the young sisters found in their ice cave close to death after the rescue team put their own lives in danger . . . on and on and on.

The stories of the emergencies she and the community responded to are both heart wrenching and heartwarming. Marie's relief when a life is saved and her reflections when a life was lost are conveyed so beautifully in the writing. She connected so strongly with the families, especially the women and the children (and the dogs and goats!). And the personal stories of how her commitment to this work affected and influenced her family were so very moving and real. Marie’s daughter and ER nurse writing about working in New York City during the peak of COVID should be required reading for anyone who dismisses the seriousness of that pandemic and its impact on our healthcare workers.

I have learned so much about the everyday heroism of Forest Service workers, the hard political activism and persistence needed to bring EMS to rural areas, the barriers to providing the needed resources to NPs working in underserved areas, the challenges faced by a lone woman whose skill and determination were dismissed by male medical doctors in the state while others supported by her. I laughed when I read that Marie, as a student nurse in the early 1950s, was expected to stand when the (male) doctor entered the room.

All of this is especially poignant now when rural healthcare, EMS, the Forest Service and other critical first-responder and health resources for rural America face Draconian cuts.

I could go on and on, but I don't need to. It truly could be an award-winning TV series. It certainly deserves a wider readership. I felt an affinity with Maire having grown up in Tennessee dreaming about the Frontier Nursing Service, and having received my FNP education at Ball State University in Indiana.

I too am the daughter of a nurse, one of those strong women of that generation. The daughter of Swedish immigrants, she was on her own with her brother in NYC at age 12 when their mother died and their father abandoned them. An Army nurse in WWII, in the mountains of Burma for 2 1/2 years, caring for Merrill's Marauders when they emerged from the jungles, going to work in the housing projects in Chattanooga as a public health nurse when my father was diagnosed with early onset Alzheimer's when he was 51. Her brain tumor was diagnosed the same month he died. My mother working in healthcare was another "tough cookie." So, a huge thank you to this book for honoring our mothers and women in healthcare.

A huge thank you for this book. It is a treasure. I can't wait to get back to it now, finish it, and tell my nursing friends about it—and my medical friends who have worked in community health and underserved areas.

And please, please, give my highest regards to Marie, and tell her how very much her story has moved me! I would have loved to have met her and worked with her in the mountains of Idaho.