Ashley Z’s Blog   Back to 2013 Students

Wessington Springs, South Dakota
Week 1

Upon arrival in Wessington Springs, we received a tour of the hospital, which turns out is nicely renovated and not what I expected from a small town in South Dakota.  The hospital is connected to both the clinic and nursing home.  The staff were so friendly and excited about our arrival.  We were informed that we would have the opportunity to once again experience dorm style living in room 28 of Weskota Memorial Hospital or the “Weskota Hilton”.  That afternoon Kristi, our site facilitator, gave us a tour of the community, and we began to discuss ideas for community projects.   

Wednesday was a clinic day, and I followed Dr. Lim in the morning, who happened to be hilarious and so easy to learn from.  I attended a Chamber of Commerce meeting with Kristi at noon, where I met several community members.  My afternoon consisted primarily of sports physicals with Dr. Belz. 

With the July 4th holiday, we immediately observed the love and support community members have for Wessington Springs.  Emily and I were responsible for a table and for selling tickets at an early morning 5k walk/run to raise money for a local group providing funding for those with cancer.  They even gave us tie-dyed t-shirts!  Throughout the day, we attended various community activities including the parade and a water fight outside of the fire station. 

Friday was a fairly relaxed day, as Dr. Lim was anxious to start his weekend.  I followed him all day, and we were done slightly early with seeing patients.  Dr. Lim explained the importance of obtaining comprehensive histories from patients and not being so quick to order diagnostics, as this is what he learned while practicing in the Philippines.  I found this interesting, as nurse practitioners are taught to practice in this way, leaning toward a holistic care model.  Emily and I did a little grocery shopping that evening.

Saturday we assisted with organizing the hospital pharmacy and later made our way to the Hideout for some supper.  This was the end of our first week in Wessington Springs.

Week 2

On Monday, I spent the day in the clinic with Dr. Orstad seeing patients.  After the clinic, Emily and I attempted to further organize the hospital pharmacy and organize the medication locations on a spreadsheet for the nurses. 

On Tuesday, I was at the clinic with Dr. Dean for the morning.  He took me with him to his Springs Area Community Club meeting at noon, where I met more people from the community.  That afternoon, we went to Woonsocket where we rounded on some of his patients at the nursing home and later went to the clinic.  In the clinic, he did a minor skin biopsy procedure and saw a couple cases of contact dermatitis.  When we returned, we rounded on the hospitalized patients back in Wessington Springs and called it a day.  Emily and I worked on our community project that evening, which will be teaching a women’s water aerobics class about some important aspects of women’s health.   

On Wednesday, I had a full day at the clinic with Dr. Orstad, and she allowed me to see several of her patients.  I observed an IUD placement for the first time, and we ended up admitting one patient with pneumonia.  Over the noon hour, Emily and I conducted blood pressure screenings at the senior center.  The turnout wasn’t great as apparently they don’t like lasagna, but Emily and I had fun discussing our experience this far with the seniors.    

On Thursday, I had a short day in the clinic with Dr. Dean.  He discussed with me the use of clinical practice guidelines and how they only have marginal value, as most patients have several comorbidities.  We saw one patient at the nursing home and a few others in the clinic.  That evening, Emily and I went to Shakespeare Garden, per Dr. Dean’s recommendation, where we ate supper and watched a local group perform.  We decided we should attend this again next week. 

On Friday, Dr. Lim and I had a busy day at the clinic.  We had a couple of follow-up appointments and saw a guy who had been in the ER the night before with cellulites.  We were done seeing patients early in the afternoon, but Dr. Lim was on call for the weekend.

Week 3
On Monday, I was with Dr. Dean in the morning, and along with seeing patients, he educated me on the rising rate of controlled substance abuse by women.  He and Dr. Lim said they are seeing a rise in the number of patients abusing their pain medications.  While Dr. Dean did some computer training in the afternoon, I spent the rest of the day assisting (to my best ability) in the pharmacy. 

On Tuesday, I was with Dr. Lim in the clinic all day.  We saw various patients for follow-ups on blood pressures, acute sinusitis, abdominal pain, and athletic physicals, to name a few.  We ended up referring one person to gastroenterology in Sioux Falls due to persistent nausea and vomiting without a known or obvious cause.

On Wednesday, I was with the PA, Terri Groves, in the morning, which was nice because she has a similar scope of practice that I will have as a nurse practitioner.  I felt she was easy to follow and learn from as she explained each patient and her reasoning behind choosing particular medications and diagnostics.  In the afternoon I was with Dr. Orstad.  In the evening, Dr. Lim was on call and we watched him put some staples in a scalp laceration. 

Thursday was a busy day for Emily and me.  In the morning I followed Dr. Dean in the clinic where we saw a couple of nursing home residents and he talked to me about bundled payments.  He explained how these would affect the amount of testing providers ordered and change their ways of practicing in the future.  Emily and I went to the nursing home in the afternoon to hang out with the residents, and 4-H kids brought in various animals for them.  We participated in a women’s water aerobics class that evening and taught the class about women’s health topics afterwards.  Topics included breast cancer screening, cervical cancer screening, colorectal cancer screening, and bone density screening.  We enjoyed the class and might have to participate again!  We also attended the supper and music at Shakespeare Gardens as we had the previous week.  

On Friday, I was in the clinic all day with Dr. Lim.  Dr. Lim diagnosed a patient with Bell’s Palsy, as she had facial drooping on the right side from an unknown cause.  Most often a virus causes this condition, so we started her on Prednisone.  Emily and I went to Sweet Grass for lunch, which is a local coffee shop that also serves breakfast and lunch.  I have a feeling we will become frequents at this place.

Week 4
On Monday, I was with both Dr. Orstad and Dr. Howe throughout the morning.  Dr. Howe is the surgeon that comes to Springs usually once a month and does primarily endoscopy procedures.  I sat in on some of his consultations.  On Tuesday, I was with Dr. Dean most of the day in the clinic. 

On Wednesday, Emily and I were with both Dr. Orstad and Dr. Christopherson throughout the morning.  Dr. Christopherson is the psychiatrist that comes to Springs every two weeks and sees several patients by teleconference.  He taught me about the different medications used for treating mood disorders, anxiety, and depression.  Over our lunch break, a patient came into the ER after experiencing a couple episodes of fainting.  His heart rate would jump up to 200 and drop back down to the 70’s.  They didn’t give him any Adenosine, but he was admitted to observation and eventually sent home on a low dose of Metoprolol per Cardiology’s recommendations.  In the afternoon, I went with the physician’s assistant who was filling in.  He was showing me how to calculate medication dosages and the symptoms specific to various upper respiratory infections.  He was also showing me how to fill out prescriptions and how to interpret different laboratory values based on the patient’s symptoms.  That night, Emily and I went to Dr. Orstad’s house for supper, and we were so grateful for the home cooked meal. 

On Thursday, I was with Dr. Dean in the clinic for the morning and got the opportunity to follow Linda in the lab that afternoon.  Linda was a great teacher, and I actually learned a great deal about how to run different labs and found the susceptibility testing to be especially interesting.  She also showed me the different augers used for cultures. 

On Friday, I was with Dr. Dean all day.  We saw a patient who thought he had a piece of metal in his eye, but we were unable to see anything.  He was sent home on an ophthalmic antibiotic.  I also got to see Dr. Dean remove the outer edges of an ingrown toenail.  He showed me how to perform a nerve block and how to remove the matrix on each side to keep the nail from growing back.  Dr Dean and I had a good discussion on prostate-specific antigen (PSA) testing for screening and the recommendations regarding this.   

Saturday morning Kristi took pictures of Emily and I at all of the “hot spots” in Wessington Springs for our upcoming presentation.  Later in the afternoon we walked for Relay for Life in Woonsocket.