When the Sisters of Charity of the Incarnate Word decided to locate and build their first “replacement hospital” they chose a unique approach. This approximately 100 acre medical campus, located in Texarkana, Texas, was literally “built among the trees” with a natural setting being given a very high priority. As a result, one of the first steps in the development process, in addition to boundary and standard topographic surveying, was a “tree survey” in which every specimen 6-inch caliper and over was tagged, classified and located. Throughout the design process, for everything from site grading to utilities to access roads to parking and building systems, preference was given to preserving unique specimen trees. The resulting medical campus is a truly beautiful and healing environment.