Austin Huber
Week 1 at Custer

This was my first week here in Custer. I got moved in to the Wedgwood assisted living on Monday evening and got settled in for a big week. Josh Ohrtman, my partner in crime, and I started out with a bang on Tuesday meeting the clinical director of the Custer hospital and clinic (Mike Delano). He gave us an all-inclusive tour of their facilities including the hospital and clinic which shared the same building, their rehab facility, ambulance shed and also the nursing home. After he finished with the tour and introductions he sent us on our way to the Crazy Horse Memorial where we got a bus ride to the base of the mountain.

On Wednesday we spent the majority of the day in the nurses’ station of the ED/hospital. It was a fairly slow day, but we were able to get to know the friendly staff up there well. Dr. Waddell, the physician on duty kept us on our toes with medical/pharmacological questions whenever he was around. Things did pick up in the afternoon and we got exposed to a particularly unique case in the emergency department. Later on in the day we headed to the Chamber of Commerce to meet with Fred. Fred gave us a quick rundown of all the many things to experience here in Custer. He was one of the most colorful and energetic people I had ever met and clearly is great at what he does, which is bragging up Custer. I left excited to go out and try all of the activities he introduced us to. One fun fact he brought to my attention is that Custer County, way back when, was considered as a location for the United Nations home base. Who knew?!?!

On Thursday we were in Rapid City for our training for the city project we will be working on over the next couple weeks. When we got back to Custer I went and shadowed with Dr. Lisa Brown. She was in charge of the walk-in clinic and emergency department that day and had a busy afternoon of seeing a plethora of cases in the urgent care setting that they have available in the hospital.

On Friday, I spent the day following Dr. Waddell around as he saw scheduled patients. We saw cases ranging from sports physicals to Nexplanon insertions and removals to the management of chronic diseases like CHF and diabetes. He allowed me to get my hands dirty a few times with some more basic things like removing stitches and assisting in the Nexplanon removal. I really appreciated his willingness to take the time to go over some things with me when the day slowed down a little bit including chest X-rays, the pharmacological management of diabetes and some basic good advice on bedside manner.

This weekend I was able to get out and do some hiking in the hills as well as further get to know some of the residents and faculty at the assisted living I’m at. The residents have been a lot of fun. I have played a few games of ‘King’s Corner’ almost every night with a group of them and learning a little bit about their history has been humbling and interesting. They still work me at that game, though, so I’m fairly convinced it is rigged :) .

I can tell already that this is a worthwhile experience. The wide range of practice that the docs and other faculty here in Custer provide is rare, but from my angle they do a great job with their patients. The docs all bring a different personality to the table, but they are all great at providing a solid quality of care.

Week 2
The second week of my experience here in Custer was as interesting as the first. 

Monday was with Dr. Graber as he managed the walk-in clinic and the emergency department. Of the many physicians I have followed throughout the past couple years, he had the craziest day of any of them. I didn’t get an exact count on the number of patients that he saw in the walk-in clinic but my guess is around 30. On top of that he had 2 fairly involved emergency department cases to deal with during the day that took up at least an hour. As if that wasn’t enough he was on call that night. I stayed on call with him until around 8:30 and during that time there was a rush of 3 more emergency department visits. Luckily none of them were serious.  That kind of patient load in one day boggled my mind and really gave me an eye-opener as to the influx of people that Custer’s clinic/hospital brings in, especially during peak tourism seasons. I was most impressed with Dr. Graber’s ability to keep cool throughout all the craziness. He didn’t let the fact that he had a whole host of patients waiting for him in the waiting room stop him from giving great individualized care to everyone that came in, even if it was in a shortened setting. At the end of the day he spent a little bit of time explaining some of the things that I witnessed throughout, as there was not an opportunity to do so during the time. The fact that he was able to field questions and have a conversation with me at all after the craziness was a testament to his love of medicine and drive to help others. 

Tuesday was with Dr. Falkenburg. She has a special way of practicing care. Her rapport with her patients was extremely open (she hugged most of them) and she took the time to explain things at their level often. She got a little bit behind on her schedule with this method, but her patients didn’t seem to mind as they knew that this is how she operates. I especially appreciated her willingness to take the time to explain things to me. She was even alright with me going in and grabbing as much information from the patients as possible before she came in (great history taking practice) and allowed me to get in on the action in the two procedures she did at the end of the day.

Wednesday we were all over. We started in the assisted-living and had a conversation with Katie Weiderholt, the manager. It was great to get a first-hand explanation of some of the aspects of the care they provide here and the challenges that come with, especially on the financial side of things. During the afternoon we got a tour of the nursing home and got to discuss it’s facility and functions with Rhonda VanWinkle. While there I even got the privilege of calling a few games of Bingo for the residents. If medical school doesn’t work out, Bingo caller may be a good plan B as I think I enjoyed that more than I should have.

Thursday morning I was at Carson Drug with John Carson. I was able to witness how things get done behind the counter at a pharmacy which was a great eye opener to the organization and procedures for checks of the meds. They had an efficient set up and ran through a lot of prescriptions in an impressive time. In the afternoon I hopped in with Dr. Waddell as he saw scheduled patients.

Friday morning Josh and I had the privilege of following Tony Lammers as he saw patients at his chiropractic clinic in Custer. I had never been to a chiropractor and had no idea of what to expect going in. Dr. Lammers allowed us to sit in on all of his morning patients as he gave adjustments. He took a lot of time to explain a lot of what he does with us and really opened my eyes to the benefit of chiropractic care. I was impressed with the way in which he, the physical therapists, and physicians here in Custer worked with one another. He said that they often refer patients to one another when they know what they do isn’t necessarily the right fit for the patient’s needs. It was nice to see competition put aside for the benefit of the patients. We got Friday afternoon off, and I used it to get a head start on my trip back to Sioux Falls for the weekend.

All in all, this was a great (and very, very busy) week. I look forward to the second half of this experience.

Week 3
Monday started with a meeting with the principal of the high school to get some information on the city and school district for our project. Principal Barrios was extremely informative and gave us a good glimpse into lots of the health issues that he faces in the school. Included in that list is the amount of tobacco and drug use among the teens in the area. For the rest of the day, Josh and I switched off in the radiology and lab departments of the hospital. It was an uncharacteristically slow day in both departments, but both departments did give me a rundown of the equipment that is available here and ran me through a few of the tests they ran as some came in. Another activity on Monday was a scheduled lunch with the Rotary club at the Senior Center. The members there caught Josh and I up on what they do and we were able to witness some of their inner workings and fundraising efforts. It is really good to know these sorts of groups exist in today’s world to find needs in the community and do what they can to get them taken care of with their volunteer work.

Tuesday was another day of shadowing physicians here. This time, however, was unique in that it was house visits with Dr. Heather Preuss at the Pine Hills Assisted Living in Hot Springs. I had never witnessed house visits before so this was a new experience for me.  I noticed that the patients seemed to be more comfortable in their home setting than they would have been in the clinic. Also, for many of the residents in the assisted living, leaving is a physical struggle so this was a major convenience for them. Dr. Preuss had great rapport with her patients. She did mention to me that she was limited in what she could for them outside of the clinic without labs, imaging, etc. but said that if it was a more serious thing that it would normally be scheduled in the clinic anyways. Her job during these visits was more focused on check-ups and medication management. Tuesday afternoon I spent with Dr. Brown as she saw scheduled patients at the Custer Regional Clinic. Again, as has been the norm here in Custer, I am in awe of the wide array of patient conditions that come in for care here.

Wednesday was another full day of shadowing. In the morning I shadowed with Dr. Preuss again as she had walk-in clinic and the emergency department. During the summer months here they are absolutely swamped throughout the day with these as tourists and locals alike come in with ailments ranging from acid reflux to broken arms. In the afternoon I went up to Hill City and shadowed Zac Petersen, a physician assistant that spends the majority of his time there and a few days down in Custer. He saw a slew of patients that day too. Something that really stuck out about Zac was his knowledge of diabetes management. Two of his patients were in to check in on their management. It was clear they weren’t doing a great job with compliance so he was willing to change things around to make it easier for them with some new treatment regimens he had recently studied. His ambition to go out and learn these things to the level he did was impressive and his patients were grateful. That night I stayed on-call at the hospital with Dr. Preuss. She was willing (in all the times I’ve shadowed her) to teach and let me get my hands dirty doing some basic things. Among the things that came in that night were a toddler with nursemaid’s elbow and a teenage camper with a knee injury (most likely a partial tear of the patellar ligament). Around 1:30 AM another teenage camper came in, this time it was with severe abdominal cramping. We were even able to have an honest chat about the pros and cons to rural medicine. She gave great pointers about things to consider when choosing a specialty and area to practice.

Thursday Josh and I had the privilege of getting to shadow some physical therapists affiliated with Custer Regional Hospital. I was paired up with Danielle Dykstra. She ran me through just about everything they do at their facility and even hooked me up to the electrodes they use for neural recruitment in muscles so I could experience it first hand. This was a priceless experience as far as seeing what they can do. One of the many things I learned was that there are PTs specializing in incontinence (a very common problem) and pelvic muscular strengthening. What a great resource to refer to in my future as a physician.

On Friday, along with working on our presentation and project, I shadowed a hospice nurse in Rapid City. She didn’t have a very full schedule so I was only able to tag along with her for one family with a pancreatic cancer patient. This was still an eye-opening experience to an extremely helpful resource for terminal patients and I have the utmost respect for these nurses and what they do on a daily basis.

Week 4

My last week in Custer had a huge variety. Monday I was with pharmacists at Rapid City Regional. I was with the outpatient hospital pharmacists in the morning, and got a really good feel for what they do. Something neat about their niche of pharmacy was that they got to go and do discharge med consults face to face with the patients. I got to witness a couple of the OB discharges as they went up and had a brief conversation with the patient getting ready to leave. During the afternoon I spent some time with one of the inpatient pharmacists. He was extremely knowledgeable and I learned a lot of new information about some of the more common drug issues in the hospital setting.

Tuesday was a day set aside for our REHPS presentation. I was surprised at the number of people that decided to show up. It was humbling to get their support.

Wednesday was probably the most diverse day of this experience yet. I started the day with Premier Eye Care and the optometrist Dr. Nathan Wiederholt. It was interesting to see the pathology of the eye from a specialist’s point of view and to see some of the high tech instrument’s he used for tracking things like astigmatisms, glaucoma, and macular degeneration. Later on in the morning I hopped over to Destination Dentistry. I was amazed with the amount of high tech material that they used for their small town clinic. The dentists there seemed very determined to make sure that their patients had the top of the line equipment to make their procedures as effective, safe, and pleasant as possible. That afternoon I hopped in with Dr. Brown at the clinic as she saw scheduled patients.

Thursday was also quite diverse. Josh and I both went on a couple house visits with a social service worker based out of Custer, Laurie Morgan. We were able to see her interaction with a couple disabled individuals as she determined their needs were being met. She was the right woman for her job and I was continually impressed with her compassion and understanding for the individual’s freedom in decision making. Later that morning we met with Bill Chamberlain of McColley’s Funeral Home. He talked with us about some of the challenges he faces as a small town mortician (always on call, know many of the people he has to prepare, etc.). He also gave us a tour of the building that he uses as a chapel and mortuary for the families. It was interesting for him to talk about the unique business of what he does. During the afternoon we headed over to the ambulance shed to spend some time with the fun ladies over there. There wasn’t a whole lot happening, but it was still good to have a conversation with them about some of the things that they see as challenges and rewards to what they do. We did get to ride along as a patient was transferred from Custer to Rapid City. Luckily it was a pleasant patient and all went well, but it was still good to get back into the ambulance and see how much I remembered (I used to have my B-EMT license).

Friday was the toughest day of the experience. Saying goodbye to everyone that we had grown close with and passing out thank yous and hugs. All of the people at the assisted living I stayed at had gained a special part in my heart and it was difficult to say goodbye to them. Also, it was hard to part with Josh, my partner in crime in this whole endeavor. We truly had meshed like brothers throughout the experience and I’m sure we will stay close beyond this month throughout the years ahead. All I can say to the REHPS Program is thank you for a great and eye opening glimpse into what rural healthcare is all about. I will never forget this experience as long as I live.