Ashley B’s Blog   Back to 2013 Students

Sisseton, South Dakota
Week 1

My first week in Sisseton is done already, and it was nothing short of amazing!   After weeks of Facebook messaging and getting to meet each other briefly during the REHPS orientation, I was finally able to get to know Lizz (the medical student I’ve been paired with for the month).  We both arrived Sunday night to unpack and move in.  We were placed in the upper floor of a rental house owned by Dr. Staub from the hospital, and we were happy to have such a nice place to stay for the month.  We didn’t know what the next day would bring, but we were very excited to start our internship with Coteau des Prairies Hospital and get to know the community of Sisseton.

Monday: Our first day was full of new faces and exciting things.  Lizz and I met with the hospital CEO and HR Director to go over our schedules and all the things we’d be doing during our time in Sisseton.  It was great to see that each day involved something different – part of the REHPS program is getting to see how the hospital functions as a whole.  Not only do I get to spend lots of time shadowing the hospital pharmacist, but I also spend time in other areas getting to know what the nurses, doctors, lab and radiology technicians, and physical therapists do.  I can’t wait to see all of the different experiences this internship will bring!

Later that morning, the nurses taught Lizz and I how to scrub in so we’d be able to observe surgeries during our experience.  I was really excited about the possibility of scrubbing in on any surgeries, because I’m a huge Grey’s Anatomy fan and would love to get to see some of those things in real life!  I also spent some time in the pharmacy getting to see how a small hospital pharmacy functions with one pharmacist and almost no technicians.  I also spent time in the clinic with Lizz and one of the doctors.  Later that night, Lizz and I worked out at the hospital’s fitness center.  It’s amazing to be in a place that has the hospital, clinic, physical therapy, dental office, and fitness center all under one roof.  We also attended a Diabetes Seminar put on by the hospital’s dietician and a nurse to educate patients on how to better manage their condition.  This was a great first day, and I can’t wait to see what tomorrow will bring!

Tuesday:  This morning, the hospital held a Meet and Greet so the hospital staff could get to know us.  Kassy, the REHPS Program Director, gave an overview of the program.  Afterwards, we introduced ourselves to many of the hospital employees that we hadn’t had the chance to meet yet.  I was very grateful with how friendly everyone was- one of the perks of being in a small community!

I spent most of today with the hospital pharmacist, Michaela. Having only worked in retail pharmacies, I’m pretty unfamiliar with the drugs used in hospitals other than what I’ve learned in school so it was great getting to see some of the IV medications and how they are used.  Michaela showed me everything she does on a daily basis to dispense medications for the hospital inpatients.  She has only been at the hospital for two years, and before her the pharmacist was only there two days per week.  It was fun learning about all of the changes she’s made and the impact she’s had as the first full-time pharmacist at the hospital.  Lizz and I had supper and worked out again that night, and once again got back to our house exhausted.  We’re planning on seeing some of the sights around Sisseton later this week or next week- with many state parks and lakes in the area, we know there will be plenty to do if we ever have any down-time here!

Wednesday:  Today was really fun!  I spent the morning making IV medications with Michaela, and then got to see a little bit of an endoscopy performed by one of the outreach doctors from Watertown.  Then Lizz and I went to a Roberts County ALIIVE meeting with one of the nurses who participates in the group.  The organization does many events for the community to help make a positive impact on youth and families.  It was inspiring to see different people from the community coming together to work towards a common goal.  Two of the main problems they focus on are underage drinking and suicide prevention.  They also developed a Teen Court program in the county where kids who have pled guilty in court are later sentenced by their peers.  They’ve had a lot of success with the kids who have gone through court, completed their community service, and then later served on the jury.  I had never heard of Teen Court before, but it sounds like a great program that could really benefit a lot of communities!

Later that day, Michaela took me to a baby shower in the hospital’s cafeteria.  It’s very special that the hospital holds a baby shower for any of their employees’ first baby, I can’t imagine any larger hospitals taking the time to do this for their staff.  That night, Lizz and I attended a drug rep’s presentation about a new diabetes medication.  It was really interesting to hear about this new drug because one of my professors had briefly mentioned it in Therapeutics when we went over Type II Diabetes, so I had a good background about the drug before hearing the drug rep’s presentation trying to convince the doctors that it was the new miracle drug in diabetes treatment.  Lizz and I spent the rest of the night watching Grey’s Anatomy, and realized how thankful we were to have such a nice learning environment with doctors and hospital staff who truly want to teach us everything they can.

Thursday:  I had the opportunity to shadow in Physical Therapy today.  One of the interesting cases was a 6-month-old born with torticollis, where one of the muscles in the neck was weak so his head always turned to one side and actually ended up rotating his entire body and causing scoliosis in his spine.  The PT did a lot of stretching and exercises with him to encourage him to turn his head the other way and align his spine.  It was great getting to see the important role physical therapists play in a patient’s rehabilitation after an injury or surgery.  After that, I spent time with the Home Health nurses going over the charts of the patients I would see with them tomorrow.  I’m really excited to get to see what Home Health does because it’s an area that has always interested me.  I was very surprised to learn that Dr. Gallagher, Lizz’s preceptor, does house calls many times per week.  I honestly didn’t think any doctors did that anymore, and it’s amazing that this community has such a dedicated provider willing to visit patients at home.

Friday:  I woke up this morning and found out that Lizz had helped deliver a baby a few hours ago!  I’m so happy for her, and I know she’s going to be an amazing OB/GYN someday!  She has more energy than anyone I know – I would have so much trouble getting up in the middle of the night like that, and then still going to the hospital in the morning.  The interprofessional experience is the best part of the REHPS program because it has helped reinforce my confidence in deciding to become a pharmacist.  Before going to pharmacy school, I had always debated between medicine and pharmacy.  Seeing how tough med school is and learning about all of the things Lizz has gone through has made a huge impact on me – I know I chose the right profession and that I’ll greatly enjoy my career in pharmacy.  Sometimes you have to take the time to understand what others do before realizing where you fit into everything, and I’m so grateful that I have the opportunity to complete this experience so closely with a student from another profession.

I spent the morning going to patients’ homes with the Home Health nurses.  This was one of the most rewarding experiences I’ve had so far in Sisseton.  The patients we visited have major difficulties in getting out of their homes, but their families take care of them so they don’t have to live in a nursing home.  The nurses visit the patients a few times per week to take vital signs, take blood or urine samples for labs if needed, and talk about any concerns or questions the patient may have.  A home health aide also visits multiple times per week to help the patient organize their medication boxes, give baths, and take care of other needs.  One of the ladies we saw was on multiple medications and was experiencing some undesirable symptoms.  I looked through her chart and was able to catch the combination of drugs that was causing her problem, so we talked to the provider about adjusting the meds.  Just one simple catch can have a positive impact on a patient’s health, and I’m really glad I was able take part in this.  Later, Lizz and I also met with the ambulance crew because we’d be riding along on any 911 calls they took.  Tonight was my first night “on-call” with them, so I waited around with Dr. Gallagher for ER patients.  The ambulance wasn’t called out at all, but I got to see some interesting cases in the ER.

Weekend:  I woke up Saturday morning with a missed call from Dr. Gallagher and found out I had missed an emergency Cesarean section at 3 AM!  It’s a good thing most pharmacists never have to be on call, I’m not sure I’ll ever be able to wake up to my phone in the middle of the night.  I was disappointed knowing that I missed the most exciting surgery all week, but I knew there would be plenty of other opportunities to see babies born here.  This hospital delivers as many as 15 babies a week sometimes, so I know I’ll get to see one soon.  I was on-call with the ambulance again, but spent the entire time seeing patients in the ER since the ambulance didn’t get any calls.  There were a lot more ER cases tonight, ranging from a very severe case of scabies to a 7-year-old who needed stitches.  On Sunday, I finally got to ride in the ambulance to pick up a patient.  It was really exciting seeing how the EMTs work even though it wasn’t a true emergency.  We also saw multiple patients in the ER including a dislocated shoulder and a baby with bronchiolitis.  This first week has been amazing, and I can’t wait to see what the rest of my REHPS experience in Sisseton will bring

Week 2

Monday:  Our new roommate Nichelle arrived last night.  She is an engineering student who also goes to SDSU, and she will be doing an internship with IHS all summer.  It’s nice to have a student from a completely non-medical field to help keep us well-rounded, although she already said she would love to watch Grey’s Anatomy with us at night!  I spent today with radiology.  One of the exciting things I saw was an EEG, which was used to measure an elderly woman’s brain patterns after she suffered from amnesia a few months ago.  The equipment allowed the radiologist to transmit the EEG live to a specialist based in Fargo, and she could adjust the patient and EEG leads according to his instruction.  This kind of technology seems very important to a rural area because it allows the patient to stay close to home rather than having to travel to larger cities for these procedures.  Another fun case I observed was an echocardiogram performed on a 12-year-old who had a heart murmur.  It really made me want to brush up on my anatomy – identifying structures through an ultrasound is much more difficult than seeing them in textbooks or on models.  Working with radiology definitely gave me a great appreciation for anyone who can look at those images and make a diagnosis based off of them.  It was great to finally work with Sheila, the head of the radiology department.  She was one of the first people to introduce herself to us when Lizz and I first arrived at the hospital, and she invited us to her ranch so we could get to know her family.  I’m super excited to get to see her ranch this Friday!  After the day was over, Lizz and I worked out at the fitness center with her new kettle bells.   I’m hoping she can whip me into shape so I’m ready for my wedding in August!

Tuesday:  This morning I spent time in the hospital pharmacy with Michaela.  We went over some of the new things that will be going on in the pharmacy once hospital construction gets finished.  As I forgot to mention during last week’s blogs with all of the other exciting things going on, the Coteau des Prairies Hospital is undergoing some major construction to almost double the size of the hospital/clinic.  Each department will be receiving a much larger space and updated equipment.  The pharmacy will be expanding into an area about twice the size of its normal location, and it will be getting a Pyxis system.  All of these changes should be completed later this year, so unfortunately I won’t be able to see them during my four weeks with the REHPS Program.  However, with how beautiful it is around Sisseton, I plan on coming here later this summer or early fall and can hopefully see the completed hospital then.  It’s amazing that all of this will be taking place here – the community of Sisseton and all of the smaller surrounding communities will benefit so much from this increased availability of quality health care.

Although a lot of this expansion was entirely up to the hospital, Michaela actually played a part in some of the changes happening to the pharmacy by applying for grants to help fund the Pyxis system.  It’s great to have a preceptor so devoted to the profession and loyal to her hospital and patients – Michaela doesn’t only do what’s expected of her as the only hospital pharmacist, but she always goes above and beyond to do whatever she can.  The more I’ve worked here, the more rules and policies I’ve noticed that have been put in place by her to help reduce medication errors and make things easier for all of the staff.  It’s great to have so many wonderful people to look up to during this experience, and I hope to develop the same leadership and management skills myself as I work towards becoming a pharmacist.

Wednesday:  Today was one of my favorite days so far in Sisseton.  Lizz and I toured the IHS Woodrow Wilson Keeble Memorial Health Care Center this morning.  A public health officer who works in the pharmacy took the time to show us the pharmacy, clinic, lab, and other areas of the health care center.  It was really interesting to see how this federally-funded facility operates compared to CDP Hospital and Clinic.  I’ve always had an interest in working for IHS or VA facilities, so I was very grateful to have the opportunity to tour Sisseton’s IHS.  Afterwards, Lizz and I drove out to Agency Village, which is a tribal reservation south of Sisseton.  We went to the Sisseton Wahpeton College to visit a craft show.  There were beautiful handmade items including woven rugs, Native American Star quilts, and drums made from animal skins.  The craft show was just starting so there weren’t many vendors there yet, but it was fun to see some of the traditional Native American crafts from the Sisseton Wahpeton Oyate Tribe.

Once we got to the hospital, I spent the day with Dr. Gallagher.  I had already enjoyed lots of time with Dr. Gallagher last weekend seeing ER and hospital patients, so it was great to finally spend some time with him in the clinic.  We saw many sick children and adults with pain after surgery; we also did some wound debridement and skin lesion removal.  Dr. Gallagher was also on-call for the ER today, which was very busy!  One interesting case was an 86-year-old woman who came into the clinic to have her blood pressure checked because she was feeling a little dizzy.  The nurse noticed a heart rate in excess of 180 beats per minute, so the patient was immediately admitted and taken care of by Dr. Gallagher.  It was interesting to finally see my first major arrhythmia – supraventricular tachycardia.  The nurse administered adenosine, and surprisingly the patient’s HR dropped to 80 bpm after the first dose!  What’s even more amazing is that this patient cooked lunch and was doing her normal daily activities prior to coming into the clinic, and only noticed a little dizziness when her heart rate was sky high!  While many elderly patients may pass out with this type of arrhythmia, it hardly even affected her.

I really enjoy shadowing Dr. Gallagher.  Everyone that knows him says that he is “one busy guy,” referring to his love of patients and the time he puts in to always take care of them.  He is one of the few, main full-time providers at CDP Hospital and Clinic, but he also sees patients in Browns Valley, MN.  Not only is he a Doctor of Osteopathic Medicine, but before going to med school he actually attended pharmacy school!  He runs a pharmacy at the clinic in Browns Valley in addition to all of the patients he sees at the facility, and I look forward to seeing his pharmacy in Browns Valley next week.  As I already mentioned previously, he also does house calls multiple times per week.  How he manages all of these patients and a pharmacy then still has the energy to be on-call for ER and hospital multiple days in a row, I have no idea!  But he is yet another great role-model I have at CDP Hospital, and I’m very grateful for the opportunity to learn from him.

Thursday:  Today I went in very early to see Dr. Gallagher perform a colonoscopy.  I found out that I had just missed a natural birth, but was excited to see that two inductions and a C-section were scheduled for the week so hopefully I can see a baby born soon!  After the colonoscopy, I helped Michaela fill medication bins for the inpatients before we went to the med staff meeting.  The CEO, all physicians, and representatives from each hospital department were present at the meeting.  It was fun to hear everyone’s perspectives about what was going on at the hospital, and to see what issues each department had.  There was discussion from each department about what they would be doing temporarily to function when construction began in their area, and also about some of the new changes that will happen once construction is complete.  Radiology will be converting to digital imaging, lab will be getting some new analytical equipment, and many other exciting things will be happening here soon.  I also presented some information about reconstitution and administration of a common injection because of questions that arose about it last weekend when I was working.  It was a little scary presenting information to all of the physicians and other staff, but it was great to have the chance to research and share information about a relevant issue.  P4 rotations provide many opportunities for more formal presentations to healthcare staff, so I was grateful to have the chance to present during an informal meeting.

Friday:  Today started off with two baby deliveries – Lizz helped with the natural birth, and we both observed the C-section.  I had never seen any surgery or baby delivery (other than on Grey’s Anatomy!) so I wasn’t sure what to expect.  I was surprised with the complexity of the C-section.  As with any other surgery, there are multiple layers to go through before exposing the target organ.  The doctors had to go through skin, adipose, fascia, muscle, and finally the uterus to remove the baby; and each layer had to be stitched up to close.  It was great to see a delivery where the mother was completely relaxed and calm; I was glad to observe one of these before seeing a natural birth just to know that the process isn’t too much for me to handle.  I’m glad CDP Hospital delivers so many babies and I hope I’m able to observe more of the deliveries; it’s wonderful welcoming new babies into the world!

After work, Lizz and I were finally able to go to Sheila’s ranch after looking forward to it all week.  Although I grew up in town, many of my friends grew up in the country and one of them was quite the cowgirl.  She had a horse and competed in rodeo, and I always wished I would’ve had horses and other animals while growing up.  We followed Sheila out to her place – we turned into the driveway of Prins Ranch and drove by miles of pastures with cattle.  Then the driveway continued on through a lake area and the secluded island where the ranch is located.  I couldn’t believe how beautiful this was, I had never seen anything so unique!  We met Sheila’s daughter, Natalie, who is a high school junior.  We also met Sheila’s husband, Bryan, and their younger son.  Natalie helped us get a few of the family’s horses ready so we could go for a ride.  I have never really gone horseback riding (other than sitting on a horse while it walked around in a corral for a friend’s birthday party) so I was pretty much a complete beginner.  Natalie was an excellent teacher, and all of the horses were so well-behaved that even a completely inexperienced rider could feel safe!  Although a little scared at first, I soon became used to my mare, Ginger.  Natalie, Lizz, and I rode around the lakefront area and through many pastures; it was so relaxing and definitely the best way to end the week!

After we got back from the ride, we toured a little more of Prins Ranch.  We bottle-fed one of the calves and met many of the other outside animals.  Natalie also showed us some of the prizes and things she’s won from being active in rodeo and being the 4-H Rodeo Ambassador – what an amazingly talented young girl!  She’s going to be right behind Lizz and I in the field of healthcare, hoping to attend medical school and become a dermatologist someday.  The family took us out for a delicious supper at Clausen’s, a small restaurant in the middle of the country.  Later, we went to the Pickerel Lake Lodge for a few games of pool.   What a great night, it was wonderful of Sheila and her family to show us such a good time!  Tonight was the most exciting night we’ve had in Sisseton so far, and we’re looking forward to going to the Ranch again next week so Natalie’s brother can take us fishing.  Only families in a small, rural town would take the time to welcome strangers and make us feel like a part of the community, and Lizz and I are so grateful that the Prins family was so welcoming to us.

Weekend:  My fiancé, Dustin, arrived Saturday.  We spent the afternoon sightseeing in the surrounding area; our favorite places were Pickerel Lake and the Waubay National Wildlife Refuge.  Saturday night, we enjoyed some of the entertainment in Sisseton – TG Sheppard with a local band, Just Between Friends, as the opening act.  It’s amazing that a small community is able to get such a popular country singer to come here, and Sisseton has at least one big event like this every month.  The local band was fun to listen to, and we really enjoyed TG Sheppard’s show.  On Sunday, Dustin and I went to the Nicolette Tower, where you can see all three states (SD, ND, and MN) when you climb to the top.  We also went to Sica Hollow State Park near Sisseton, which was extremely beautiful.  I’m so impressed with all of nature’s scenery in this area – it truly is one of the most beautiful places in South Dakota!  It’s hard to believe my REHPS experience is already half over, but I’m grateful for all of the wonderful opportunities I’ve already had and I look forward to what the rest of this internship will bring!

Week 3

Monday:  Today was full of interesting new things as I shadowed Dr. Gallagher at some of the CDP-affiliated clinics he practices at outside of Sisseton.  Dr. Gallagher spent some time in Wheaton doing colonoscopies in the morning, and then I met up with him in Browns Valley to see some patients.  The Browns Valley Clinic is small with only two patient exam rooms, but three of the providers including Dr. Gallagher come from Sisseton to see patients at the clinic.  Although the clinic has no laboratory capabilities, specimens such as blood or urine samples may be taken at the clinic and analyzed by the lab at CDP in Sisseton.  Many of the patients we visited with needed medication refills and blood work done, so Dr. Gallagher took blood samples and wrote them new prescriptions.  Some of the patients get medications from his pharmacy, so he just made himself a list of ones to renew and fill at his pharmacy later that day.  I mistakenly thought his pharmacy was located in the Browns Valley Clinic (too many small towns around here to keep track of!), but then found out the pharmacy is actually in Herman so we went there after lunch. 

When we got to Herman, there were already many patients waiting to be seen.  One of the interesting cases was an elderly woman with polycythemia who has blood taken out on a regular basis.  It was fun to get to see both sides of the spectrum – patients that come to the hospital with such low hemoglobin levels that they need Aranesp or a blood transfusion, and now someone with such a high red blood cell count that we actually have to remove some of her blood!  I spent the rest of the day in Dr. Gallagher’s pharmacy, which is located in what used to be a patient room of the Herman Clinic.  It really put things into perspective for me – I’m used to working at a busy Sioux Falls pharmacy that fills 400-500 prescriptions daily, and this pharmacy fills up to 100 prescriptions a week and is only open on Monday afternoons!  I enjoyed my time in the different clinics today because it really helped me appreciate Dr. Gallagher’s willingness to travel and serve patients in all of these small towns.  Many of these patients are unable to travel up to an hour to get to a larger facility such as CDP, so he really makes an impact on their lives by offering them access to healthcare. 

After an exciting day, Lizz and I were really looking forward to going with Josie (one of the nurses) to a place for dinner.  She made reservations at The Birdfeeder in Twin Brooks, which is a small restaurant in the country.  It turned out to be one of the most unique places I’ve ever been too – there are only 2 or 3 tables in the entire place, which made for a very quiet and peaceful meal.  The walls were covered with cute little knick-knacks and trinkets that were all for sale, so it was fun to look around as we waited for each part of our 4-course meal.  The food was amazing, and we’re very grateful to Dr. Beumer for sending money along with Josie to cover our meals.

Tuesday:  I spent today in the pharmacy with Michaela.  I’m starting to get used to all of the different things required to manage and operate a small hospital pharmacy, and I’m finally able to picture myself in hospital pharmacy as a future career.  I was somewhat hesitant about hospital pharmacy at first because of all of the unfamiliar IV medications and the riskier nature of the work compared to working in retail pharmacy, but all of the challenges seem like opportunities now after spending so much time with Michaela.  After work, Josie invited us to her house for a spaghetti supper so we could meet her family.  It was fun spending time with her husband, dog, and 6-month-old son.  I’m really surprised that that my REHPS experience is already half over – it’s sad that I’ll be leaving Sisseton next week already after getting to know so many of the great people here!    

Wednesday:  This morning I spent time with one of the floor nurses to see how she hooked up IV’s to patients and administered medications.  I also started a new project Michaela wanted me to work on – organizing all of the medications in the crash cart.  She’s already done a lot of work to get each medication tray uniform and organized with all of the necessary medications, but the physicians requested a new medication be added so it was a good time to redo all of the trays.  My plan involved printing labels attached to Velcro so they can easily be changed around if the medications change again in the future, and also making some of the look-alike/sound-alike medications distinctly separate so the wrong medication isn’t used in an emergency.  I will also be putting all of the supplies needed to prepare and administer the medication in with each drug so that all of the things can be quickly grabbed in an emergency.  This project will keep me busy for the next few days because there are many trays that need to be redone. 

After a busy morning, Michaela took Lizz and me out for lunch.  We went to The Cottage, one of the local restaurants in Sisseton.  The food was amazing and we had lots of good leftovers to bring home.  Then Lizz and I met with the hospital director and other people who were helping with the Car Seat Roundup.  This is the event we’ll be helping with as our community project – the hospital identified car seat safety as a major issue in the community through a survey done recently.  Many of the locals drive around with babies and children on their laps rather than in child safety seats, so this is definitely an issue that needs to be addressed.  During the event, certified car seat specialists will inspect people’s car sets for correct installation and usage, educate them on safety, and provide them with a car seat if their child needs one.  Lizz and I have already helped advertise for the event; we’ll also be making signs to direct people where to go and playing games with the children at the event.  We’re excited to help with a project that’s so important for the Sisseton community, and hope that a lot of people will show up for the event. 

Thursday:  I spent the morning with lab and got to see many of the tests they do.  Although some tests are sent out, many different ones can be performed by CDP’s lab.  It was very useful to see how these tests are used to help make a diagnosis or rule out a suspected condition.  Microbiology has always interested me, so culturing and looking at slide smears under a microscope were probably my favorite activities done in lab this morning.  I spent more time this afternoon working on the crash cart medication trays, and then Lizz and I worked on our presentation that we’ll be giving next week.

Friday:  I spent the morning with Cardiac Rehab, where a nurse helps rehabilitate patients after a major cardiac event such as an MI, stroke, or cardiac surgery.  It was interesting to learn about each patient’s story – what led to them having an event, what happened, and how they’re recovering.  The patients are evaluated by the nurse, and then spend the majority of the time exercising with a goal of 40 minutes of physical activity per session; all while wearing a cardiac monitor and having the nurse check vitals throughout the session.  It was great to see the help and support available to these patients while on the challenging road to recovery after a cardiac event, and it really makes me want to spend more time educating my patients on the importance of heart health and regular physical activity to avoid heart problems.  I spent the rest of the day working on the crash cart project and helped make signs for next week’s Car Seat Roundup.  

My third week in Sisseton is over, and I can’t believe that Lizz and I will be done next week already!  We’re both sad that we’ll be leaving so soon – it feels like we’re finally getting used to everything.  I am hoping that there will be an opportunity for other practice experiences with CDP Hospital such as P4 rotations – it will be fun to come back and work in the pharmacy once all of the hospital construction is done and the pharmacy changes are complete. 

Week 4

It’s hard to believe my last week in Sisseton is already here!  Over the weekend, Dustin and I checked out some of the different shops and restaurants in Sisseton.  We found an old-fashioned independent pharmacy with a huge variety of gift items and knick knacks; it was great to see there are independent pharmacies still in business after all – many of these cherished small-town businesses that I know of have struggled to keep up with all of the chain pharmacies.  We also drove up to Fargo for a day, because I wasn’t sure if I’d be this far north again!  It was interesting to recall from Pharmacy Law class that North Dakota is unique because any new pharmacy in the state must be majority-owned by a licensed pharmacist.  This makes it difficult for chain pharmacies to dominate the market in North Dakota, so independent pharmacies can continue to provide excellent care because they have fewer chain pharmacies to compete with.  Lizz and I had Monday off for Memorial Day, which will make the week go by very quickly.        

Tuesday:  Today I was able to follow one of the physicians who I haven’t spent much time with – Dr. Staub.  We saw many patients in both the clinic and ER.  Doctors really practice on all ends of the spectrum, and it was interesting to see how his approach to medicine differed from the other practitioners I’ve shadowed.  One of the interesting cases we saw was a young adult who presented with lower abdominal pain, and was later transferred once diagnosed with appendicitis.  Another case was a child who had been seen 5 days prior for an upper respiratory tract infection and was started on antibiotic therapy.  The child came back today with an extremely high temperature and severe cough, suggesting the antibiotics hadn’t taken care of the infection and that something new should be tried.   The interesting finding was that the child’s LFTs were significantly high, which would suggest some type of liver damage.  I did some research and found that acetaminophen overdose and viral hepatitis were some of the most common things that resulted in elevated LFTs.  Since none of these things really fit with the patient, I consulted a laboratory reference and found that LFTs can also be elevated from certain antibiotics and IM injections, both of which the child had received.  Dr. Staub ordered more tests to rule out liver damage, and ended up prescribing a stronger antibiotic to help fight the lower respiratory tract infection that was found on the chest X-ray.  It was great using my skills as a student to do some research and determine what was going on with this patient; it was also a good lesson that although laboratory tests are very helpful in diagnosing a patient’s condition, they can sometimes be misleading and distract you from the main problem that needs to be treated. 

Later that day, Lizz and I helped at the Car Seat Roundup for our community project.  One child’s car seat wasn’t in the proper position so it was adjusted for increased safety; one car seat was outdated so we replaced it with a new one; and one child was too tall for car seats so we referred her parents to IHS to receive a free booster seat.  We didn’t have many people show up, but the low turnout was probably due to the project being so new; hopefully once it gets going more people will benefit from the event next year.  It was still a lot of fun learning about all of the requirements and safety rules that go along with car seats, and we had a blast coloring with the children! 

Wednesday:  Today started out pretty normal with me in the pharmacy, and then turned out to be one of the most exciting days at the hospital.  One of the nurses, Tanya, helped me go through the entire crash cart to inventory what else was in there besides the medication trays we had already redone.  We wanted to get an idea of all of the important things that should be in there for emergencies just to be sure the ER and ICU carts were both adequately stocked.  After lunch, we were headed back to continue working on the carts when a “Code Blue” was called.  We both followed everyone to the ICU, where a patient who had come in by ER was crashing.  Lizz and I were both in on the code, and it was the first one I’d ever seen so it was scary at first.  However, I became more comfortable the longer I was in there.  Every time the doctor would order a new med or the nurses needed something, I knew where it was in the crash cart.  I was able to quickly locate multiple items for them, and it felt great to contribute when there were at least 8 other people in there who were skilled nurses, physicians, or EMTs.  The patient was stabilized and safely transferred to another facility, so everything turned out ok.  I’ve always been interested in emergency medicine, and this experience definitely confirmed that interest.  I look forward to  taking the critical care elective next spring, and hopefully spending more time in this area of practice someday. 

After all of the excitement, I spent the rest of the day shadowing a physician’s assistant and Dr. Gallagher.  The nurses were going to take us out to a locally-famous place for wings tonight, but the severe thunderstorm warnings and potential for tornado weather spooked us into staying in town.  We ordered pizza and spent the evening at Josie’s instead, and got to spend time with her cute baby boy.  Later, we worked on our presentation that we would be giving to the hospital staff and Board of Directors tomorrow.

Thursday:  Our last day is here, I can’t believe it!  I spent the morning in the pharmacy with Michaela, and then went to get Subway with Lizz and Leslie for our REHPS Celebration.  Our lunch in the board room had a great turnout including Kassy and her mother, many department heads and hospital staff, many members of the Board of Directors, and even Lizz’s parents.  Dan and Kassy both spoke about the REHPS Program and our time at the hospital, and then Lizz and I presented a slideshow.  Our presentation included a blurb about our community project, as well as some myths about rural healthcare and how our experiences really shed light on those myths and opened our eyes to the realities of rural healthcare.

I am so thankful that I had the opportunity to take part in the REHPS Program at Coteau des Prairies Hospital and Clinic.  So many people here had a tremendous impact on me, and I’m very grateful for all of their time and encouragement.  I feel blessed for getting to know the community of Sisseton and for discovering all of the great things practicing healthcare and living in a rural community has to offer.  I’ve learned so many things that will stick with me throughout my career as a pharmacist – thank you CDP staff and everyone else who made this experience possible!!!