Week 1 Redfield, South Dakota
Wednesday morning started off early for me with a 2 ½ hour drive through thick fog and on unfamiliar roads. I rolled into Redfield about 8:30 am and made my way to the Redfield Community Memorial Hospital. I had driven through Redfield a few times when I was younger but had never stopped. I was pleasantly surprised to find the town was already full of energy as I made my way down its busy streets. Once at the hospital, I moved into my new room for the next few weeks. I was kind of leery at first to stay in the hospital. Fortunately, I was placed in a separate wing of the old assisted living known now as Sunset Court. Although my bed is still a hospital bed, my room is more like a cute little apartment with a big closet. The food I have had so far is also super delicious and kitchen staff is so friendly when we go down and eat!
My day started off quickly with a tour from Brenda, my site coordinator. My partner, Randall, is from Redfield and has been at the hospital and clinic before, so he got to pretend like he had no idea where things were. After winding around a few hallways and going up and down a few stairs, I can honestly say I was confused, lost, and a little overwhelmed. Thank goodness Randall will be around to guide me for a while. I have lots of names and places to start trying to remember. I have also had little hospital or clinical experience, but I am hopeful that I will be able to find my way around and will pick up on things quickly.
After the tour with Brenda, Dr. Owens and I headed to Eastern Star nursing home. I followed him while he did rounds and met a few of the patients. It was such a nice facility and the staff was very friendly while I was there. It was no surprise to me that the wait list for this facility is very long!
Running a little behind, I met up with Cheri and Randall for our orientation and lunch. We went to lunch at Terry’s on Main Street in Redfield. The burger I had was delicious and we had a great time laughing and telling stories.
After lunch, Randall and I went to the clinic to follow Ron Wren, a PA at the facility. I really enjoyed watching Ron interact with his patients. Ron said he is treating neighbors and friends and not just treating patients. I think this speaks profoundly to the culture of a small town and the healthcare facility. Ron definitely likes to give the patients a hard time and they will dish it right back at him.
Thursday and Friday during the morning we followed Ron around the clinic. The hardest thing I have had to do so far was hold a baby while we tried to start an IV due to dehydration. The poor little thing was very sick and mom was in tears as well. While at the clinic, Danene, one of the nurses, let me watch her give allergy shots and explained the different concentrations for the shots. As a pharmacy student, we do not necessarily discuss these shots and it was very interesting to learn. I have also gotten to see more x-rays in a few days than I have in my whole lifetime. We looked at knees, a few chests, and a wrist. Ron also showed a few old MRI images and explained things that they look for in serious infections and other conditions. We also saw multiple patients with the stomach flu, strep, and tick/bug bites. A child also came in with a bee sting near his eye and the little guy could hardly open his eye to see.
During my time here, I have already been able to utilize some of my knowledge from pharmacy school. We adjusted diuretics to help with edema, cautioned about the use of steroids in diabetics, and researched the duration of Plavix. My favorite part was being able to counsel a patient on how to use a steroidal nasal spray. It was nice to share tips and tricks with Ron and Randall, so they can pass on these administration tips when talking to their patients in the future.
My first night in Redfield, I also started helping with the Community Vacation Bible School. I worked with a group of rowdy elementary school students as an assistant crew leader. I have always enjoyed helping with VBS back home. It was exciting to see the kids so excited to be at VBS. I was able to watch their VBS program at the end of this week. The church was packed with noisy kids and lots of families. Sometimes in smaller towns the population is a lot older, but Redfield definitely has lots of young people and is thriving. On Friday afternoon, I had some free time to start exploring the town. I went on Main Street and even stopped at a local coffee shop and store called “Simply Charming.” The place was very cute and I plan on going back sometime in the next few weeks.
The weekend brought a bunch of rain. When the rain finally let up on Saturday, I went for a walk. I was on call for the ER this weekend as well. There was not anything too out of the ordinary, but since I have never been to the ER myself I learned a lot. I was able to participate in a few community activities over the weekend. I went to my first ever Drive-In Movie with Sharon, one of the nurses on call for the weekend. I also went to church and attended the local dance recital. Sharon and I ended the weekend with an hour long walk, Subway sandwiches, and the Bachelorette.
After my first few days, I feel so blessed to have the opportunity to spend 3 weeks in this great community of Redfield. I know from personal experience that communities rely on and trust their healthcare providers to do the best they can to help their neighbors achieve optimal health. I am excited that I will be following and learning from providers that are very passionate about this community. I look forward to seeing what else I learn from this great experience. Thanks Redfield!
Week number 2 in Redfield flew by. This week, Randall and I followed Dr. Owens. We did rounds in the hospital to see inpatients and swing bed patients. We also followed him on his clinic visits. In the clinic, the average age of patients we were seeing was about 70 years old. Most patients had checkups for hypertension, hypercholesterolemia, and diabetes. We had to watch renal and liver function when choosing and adjusting medications for many of the patients. Patients raved about Dr. Owens and the care they receive here.
This week we also had a few new experiences. On Monday, I was able to follow some of the gals in physical therapy for the morning. I watched them go through many different exercise routines with their patients. It was fun to see all the work the patients were putting in to get back to their busy lifestyles. Later in the week, I was also able to go back to physical therapy and see a balance test performed on a patient after a concussion. It was interesting to see how drastic of a change there can be in the balance with a head injury like that. The ladies down in physical therapy were so nice and explained the goals and expectations for their patients.
On Tuesday, Randall and I had our first big experience in the Emergency Room. The doctor used E-medicine to help in the treatment of the patient. E-medicine is a two-way video technology that allows rural physicians to consult other doctors to assist in treating critical situations. The service is around the clock and allows the doctors to have help determining diagnoses and initiating medications in difficult situations. The nurses were also able to be more hands-on, because the E-medicine nurses could fill out the patient’s chart while the rural nurses started IVs and performed other tasks. This is a great way for physicians and nurses in smaller hospitals to focus on their patients during these emergency situations.
On Wednesday, we followed Dr. Owens on rounds in the nursing homes. It is so fascinating to see how the body can age so differently in different people. There is not a lot of data for elderly patients because traditionally people have not lived as long as they are now. As people start living longer, pharmacists and doctors that have knowledge in geriatrics will be in high demand. These small communities will also have a very high ratio of elderly patients that will need lots of care. My partner Randall and I are quickly learning that we will definitely be working together as a team in our future careers as people start living longer and as medication regimens get more complicated.
On Wednesday afternoon, I was able to go visit Randall Pharmacy and spend a few hours with the pharmacists and technicians. I have quite a bit of retail experience, so it was nice to chat with the staff about their pharmacy. They use a pressurized air system as an automated counter for some of their medications. I had never seen this particular machine. It looked like it worked efficiently but it was very loud. While visiting the pharmacy, I also had the pleasure of meeting Everett Randall, the original owner of Randall Pharmacy. I loved hearing about how pharmacy has changed since he started practicing and his vision for pharmacy in the future.
This week we also were able to be a part of discharging a patient from the hospital. It was interesting to watch the progression of this patient from admission to discharge. Medication adherence was unfortunately a big contributor to this hospital admission. Fortunately, the hospital was able to set the patient up with home health to help organize his medications. I am looking forward to spending some time with home health next week.
At the end of the week, Randall and I started our community project. We interviewed community members that have an interest in the health of the community. We asked them questions about active living and healthy eating. It was interesting to hear about the health programs the community of Redfield already has and hear about possible wish list of items they would like to see added. I learned from our interviews that the biggest barriers for improving health in this community were funding problems and people’s beliefs about their own health and assistance programs.
This weekend my boyfriend Aaron came to Redfield to visit me. I was able to show him the town and better explain the things I have been learning here. On Saturday, we went to Aberdeen to see my friend Stacy. We brought her kids to Storybook Land. It was such a fun family place and the kids had a blast. It is hard to believe that I am half way done with my experience here.
This week went by very fast. I was able to follow a few more of the providers at the clinic. On Monday, I followed Heidi during her regular clinic visits. I was able to watch her perform a mole removal in the treatment room. On Tuesday, I followed Lynn while she performed some of her regular checkups and physicals. On Thursday, Randall and I followed Dr. Adams from Aberdeen in the clinic for a few hours as well. It was interesting to see the different approaches that each one of them uses to interview the patient, make a diagnosis, prescribe a treatment, and explain the information to their patients. I think that this variety was very valuable for me, because I was able to see different techniques in professional communication.
On Tuesday morning, Randall and I were able to spend some time in the hospital pharmacy with Cari Mack, RPh. Cari explained the Pyxis machine to us and showed us how the pharmacy stocks the machine, orders, and keeps track of inventory. She also showed us how the nurses pull medications from the machine and the safeguards put in place to make sure they are grabbing the correct medication. I have not yet had experience in a hospital pharmacy. I am interested to compare my experience in this rural setting to my hospital internship at the end of next month.
On Wednesday, Randall and I continued our interviews for our community project. We interviewed the co-directors of the Food Pantry in Redfield and one of the coaches from the high school. We are learning that there are a lot of programs this community has to offer, if community members are willing to embrace them.
On Thursday, Randall and I rode with the home health nurses to their appointments. We loaded up “Big Bertha,” the hospital van, with supplies and drove many miles to some of their locations. We watched them organize medications, collect lab samples, perform foot care, and many other tasks. Courtney and Natalie were so good to their patients and made the experience fun for me.
On Friday, we spent the most of the day at the South Dakota Developmental Center (SDDC). The SDDC is run by the SD Department of Health and is an intermediate residential facility for developmentally disabled individuals. We toured the facilities and saw the Activity Center, Food Services, and residential areas. We also spent the morning in the health care services building. We sat in on some of the patient’s appointments with their care team and the psychologist. I found it very interesting to hear which medication therapies they found the most beneficial in specific patient populations and how they balance drug regimens for these patients. It was also interesting to hear about some of the adverse effects that limit the use of some of the medications. While at SDDC, we toured the pharmacy and met the staff that works there. They fill bubble packs in cycles and divide the patient groups up so they fill a certain number of prescriptions each week. It was very interesting to see how self-sufficient the entire facility is when providing care to its residents.
On Friday night, I participated in the Golf Tournament hosted by the hospital. I had fun learning how to golf with my teammates. We also had a good time driving around on the golf carts and taking pictures. It was a great way to get to know the nurses at the clinic better. I can honestly say I am not a good golfer but I learned a lot about the sport. After the excitement of this weekend, I cannot believe there is only one week left here in Redfield.
Week 4 – Redfield
On Monday of this final week in Redfield, I was able to go with Lynn Munce to the Doland Clinic. The Doland Clinic is an outreach clinic run through Redfield. It is open 2 times a week in the afternoons. While I was there we saw a few patients, gave an immunization, rechecked someone’s blood pressure, and did a house call. It is a rarity that both Clinics still do house calls. The Doland Clinic provides their patients with great access to healthcare and takes very good care of the patients that came to visit.
Monday night this week and during many of the days this week, we were called into the ER. It is amazing the range of patients that come in. Some of them should be seeking care in the clinic instead of the ER, but some are serious emergencies. I have had the opportunity to watch quite a few stitches be put in this week while in the ER. I quickly learned that I do alright as long as the patient is cleaned up and prepped for the stitches. It takes a very steady hand and a lot of patience to suture. This week, we also saw cases that needed to be sent out and one that stayed until passing away. This week I really experienced how fragile life is and how much the providers touch the lives of their patients and vice versa. As a healthcare provider in a small community, it is hard to be the one with bad news or to see a neighbor pass away.
On Tuesday, we followed Dr. Owens in the hospital and clinic. I was able to visit with patients before the doctor came in to do assessments. I like learning about the lives of the community members here and what brought them to Redfield or why they have stayed here all of their lives. Some also had some very colorful medical backgrounds.
On Wednesday, we finalized our project and final presentation. It was fun to look back at the pictures we had taken and the memories that we have made here. We also visited Dr. Perry, a 95 year old retired doctor that served the Redfield area with his wife for many years. Dr. Perry had non-paralytic polio when he was very young that has started to affect his muscles now that he is older. He is most likely one of the few patients still alive with polio. He also showed us his collection of area newspapers from 1905. It was interesting to read the old advertisements for medications, food, and household items. The newspapers were in wonderful condition and told the stories of that time period. Dr. Perry told us about his career and how different medicine was back before vaccinations, antibiotics, and computers. He told us stories about flying his patients in his own plane to Rochester and Sioux Falls. It is amazing the things we can learn from the past and how history has changed the course of medicine. I feel very blessed to have met Dr. Perry and to have read his prized possession.
On Thursday, we spent most of the morning in the ER. Things get a little crazy when multiple patients come in to the ER at the same time. I was impressed to see nurses, assistants, and the technicians assist each other in any way they could to take care of the patients. I also had the opportunity to take my first ambulance ride with one of the patients. I learned a lot about the process of transferring the patient from the hospital, to the ambulance, and eventually to a flight to get them to Sioux Falls or Aberdeen. This is an experience that is rare for pharmacy students and I feel lucky to have the opportunity to go along and ask questions.
I cannot believe my final week here in Redfield is over. It has been a great journey and learning opportunity for me. I want to thank all of the nurses, practioners, pharmacists, and other staff members that worked to make my experience great! I know that a lot of extra time and planning goes into hosting students for an internship like this. I have learned valuable skills for my professions, developed interprofessional relationships and communication, and ultimately became a better student pharmacist. I know that my experiences and lessons I have had here will carry on to my future profession in rural healthcare.