Bryant Wieking
Week 1 at Hot Springs

It was a week of getting my feet wet, introductions to new colleagues, and a new community. One saying that continued to come up over and over as we were introduced to the staff was, “I’m kind of a jack-of-all-trades.” For example, one of the nurses that was introducing herself began saying that she was an RN, but more than that she was a wound care nurse, ER nurse, pulmonary nurse, and a long list of other subspecialties that she needed to familiar with in order to take care of the patient population. Being a jack-of-all-trades was not just specific to the nursing staff, that phrase could be applied to everyone working at the Fall River hospital in Hot Springs, SD. Coming from Sioux Falls and having a background in large health organizations I don’t think I really understood the challenges facing rural hospitals, with respect to areas like nursing, laboratory, imaging, and dietary. As a PA student I understood the impact that rural medicine had on providers, but during orientation it opened my eyes to the impact of being in a rural facility had on others in the health care team. It certainly is a challenge; however, the staff at Fall River did not let their rural status impact the quality of care given to patients. Everyone truly cared about the patient and was interested in their care. The CEO of the hospital even participates in morning rounds. I was taken aback by the fact that everyone, even the “head honcho” who had numerous other issues on her plate, took time to make sure that the best care was being given to patients.

Week 2

Fall River Hospital is considered a rural critical access hospital, and this past week I was able to witness firsthand how important our access to the community was. I was able to spend some time in the ER with Dr. Avery Sides, MD. We started our shift at 7 am and at the end of the day we had seen well over a dozen patients (this is busy for an ER with just one RN and provider), with everything ranging from kids swallowing foreign objects to older patients with stroke like symptoms. Throughout my day I saw how important access to care was in a rural setting, especially during an emergency.

Week 3
A hard day…
Medicine can be a difficult thing to practice because of its complexity, but there are certainly emotions when treating people that come into play. This past week I was able to do some training in the ER. Sure, we had our chest pains, broken bones, and lacerations come through the door, but the events that happened towards the end of our shift I have never experienced. The ambulance roared up to the ER door and they quickly wheeled a person into the trauma room. Dr. Side’s, a nurse, EMTs, and myself rushed into assess the situation. The patient was in tough shape and was lying there lifeless on the table. We started running the code, and did everything we could, but this was the day I would lose my first patient. I have had the joy of helping bring life into the world on many occasions, but never have I seen life taken away. After all the dust settled, I laid my stethoscope on the patient’s motionless chest hoping for a heartbeat, but there was nothing. We talked with the family in the waiting room. The emotion I felt was palpable. I walked back into the ER only to see that while we were treating our patient three more patients had arrived and needed attention. I choked back a tear knowing that those people in the next room had potentially lost a spouse, a parent, a sibling, or a grandparent. I needed to press on. Grabbing the next chart I focused on the current patient and headed into the next room. I will never forget the first time I helped bring life into this world and the joy that filled the room, and I will certainly never forget the day that I tried to prevent death, and lost.

Week 4
I came into Hot Springs and knew no one, but I can say with full confidence that when I leave, I will leave with new friends. I have been able to experience things here that I didn’t even know existed. For example, when someone says we are going to a “branding” most people would have no idea what that means. A branding is much more than roping caves, wrestling them to the ground, branding them, and repeating that process over and over again, all while not getting kicked or injured. A branding is a community coming together, lending a helping hand, and getting the job done, with no question about pay, how hard the work is, or how long it will take to get the job done. There are many more stories like this that reflect on the strength of the Hot Springs community. I have learned much more than medicine during my experience. I have seen the sacrifices and difficulties that small rural hospitals contend with on a daily basis. Every day brings a new challenge and if the hospital were weak or inefficient it may not make it. However, Fall River Health Services identifies their challenges and tackles them head on. It takes a coordinated effort from everyone. Everyone knows the goal and works towards success. I could not be more impressed with a small town hospital. For example, this week my teammate Alex and I were invited to give a talk to the cardiac rehab patients in the community. I expected there to be three or four people there. I was wrong, the nursing staff had advertised to the public, made food to get people in the door, and even brought in a pianist to entertain. We had 15 people show up, and by the end of the talk we had a great conversation on the importance of cardiac rehab, and why their medications were important. Living and working in a rural community has opened my eyes to an entire new area of medicine that I had never experienced, but this experience has been much more than learning medicine. It has been about getting to know people with different skill sets than I, and seeing what they can contribute to patient care. It is about learning a new culture, community, and discovering a new circle of friends that I will never forget.