Week 1 Miller, South Dakota
Monday, July 7th
I arrived in Miller around 10:30 am. After being introduced to Teresa, the site coordinator, I was taken to my home for the next couple weeks, a small house owned by the hospital. There I met Kim again, my partner in Miller and a nurse practitioner student from SDSU. We unpacked our cars, and then met with Cheri to go over some last minute things before we started the experience. The hospital had prepared a lunch for us with all the managers of the various departments, so it was nice to meet them before we showed up in their various departments. After that, Teresa gave us a tour of the hospital and the community, then we were left on our own until supper. Kim and I spent some time unpacking and getting to know each other, then decided to take a tour of the downtown a little further in hopes of seeing advertisements for community events. We also went to take a picture with the Miller sign, and probably made a man’s day, asking him to take a picture of us with it. He seemed a little confused, but it’s probably not every day random girls show up at the airport and want you to take their picture!
Tuesday, July 8th
I spent Tuesday with Karen Runge, CNP. She had a fairly quiet day, so a lot of it was spent just visiting with her and learning about her experiences and her children, but we did see some patients as well. I watched her remove stitches on one patient, and I saw numerous physicals. A baby got his first shots, and a woman had her thyroid checked. During the afternoon, a patient came into the ER, so I took a break and went over to see that process. After that was under control, I finished the day with Karen, observing her see a boy with urinary retention. Though I got to see a variety of things I had never seen before, as I (luckily) have not spent much time in the doctor’s office, I was a little disappointed because as a pharmacy student, I was looking forward to seeing how providers determine which medications they prescribe. With so many physicals and rechecks, as well as babies, Karen did not write a single prescription that day, so it is good that I have lots more time here to see that! I did enjoy seeing her consult with both the town dentist as well as the pharmacy when she was making recommendations to patients.
Wednesday, July 9th
I spent the morning in Physical Therapy. I watched one patient have an exercise plan determined, and another get UVB radiation for dermatitis. I never had realized that you could use ultraviolet light for therapy! I then went with Amber, a physical therapist, to the school to work with a little boy from the Hutterite colony located south of Miller. This was very interesting to me, as I was able to watch her help with therapy, as well as learning a lot about their culture from his grandmother at the same time. I hope to go down to the colony at some point during my time in Miller to learn more. Amber and I then went back to the clinic where she helped a woman with therapy after a knee replacement. I had seen a total knee replacement done in another experience, so it was very interesting to see what happens after the surgery. She also used ultrasound therapy, which I learned can do more than just imaging! The next patient came in because of cervical pain, and after giving her some basic exercises, she used heat and electrode therapy on her.
In the afternoon, I visited respiratory therapy. The first patient came in for a sleep study followup, which was done via webcam with the doctor. The patient ended up with a CPAP machine, which I had only briefly learned about, so it was fascinating to see it in person and listen to the therapist’s explanation of all the parts. I then went with her to Highmore, a small town about 20 miles away for home health visits. We brought various supplies to patients over there and changed a ventilator. In a small town, many of the healthcare workers wear various hats, and this was a good example of that. That evening, I went downtown to a free-will spaghetti feed that was supporting those affected by the tornado in Wessington Springs a few weeks ago. I know some people in the area, so I thought I would attend. I spoke with one of the restaurant employees, and she told me that the owners had some friends in the area, and wanted to help out. She said that she and other employees thought it was a great idea, and she hoped that if something like that ever happened in Miller, she hoped other towns would help them out as well. This mindset is what I love about small-town America.
Wednesday morning, the head of maintenance informed me that my car had a flat tire. He gave me the number of a place to call, and they were able to take care of it that morning. They even came to pick up my car and brought it back when they were finished. I was able to stop back later that night to pay for it, and was reminded how nice it was to be in a small town, where people will be right there to help each other.
Thursday, July 10th
I visited the lab on Thursday morning. They service both the hospital and the clinic, so it was interesting to see that interaction. They gave me a tour of all the machines and tests that they can do. I don’t know how they ever keep track of it all, much less get all the maintenance done in between tests! I watched the technicians draw blood from patients, and they even drew some from each other to show me a blood typing reaction! I also was able to see a urine analysis done, and I saw both blood and urine under the microscope. The technician made a growth plate of the urine to send to Sioux Falls, and I was able to come back Friday morning to see the growth. I also saw the process of a drug test, which was interesting as I have had to complete drug tests for work before.
I went downtown Thursday afternoon to spend time with Travis at the pharmacy. He showed me around, and told me all that he does above and beyond for patients. He showed me his medication synchronization program, which I was very interested in, as I studied that for an Honors project the past couple of years, so I really enjoyed seeing it in action. I went back to the hospital with him as he is the one that oversees their med room, and double checks the nurses work on the Pyxis machine. He also had me help him check the nursing home cassettes. As the only pharmacy in at least a 40 mile radius, he has a fairly large patient base, and takes care of most of the nursing homes and assisted living facilities in the area. He had a man coming in for a medication reconciliation session, so I visited with the man first about all his medications, and then Travis checked it over. He goes out of his way a lot for patients to improve their care and quality of life, and it is obvious how much they trust him. He gave me a lot of ideas of how I can incorporate ideas like that into my future practice, and I am excited to spend more time with him.
They also had a community blood drive, so I signed up to give blood Thursday evening. Kim came along to take pictures. I have given blood before but never with this company, so it took a little bit to get all the information in their system. This is the company that the Miller hospital gets their blood from, so it was nice to think that my blood could be helping someone that I might run across during my time here. After I was done, I went to the refreshment area. I had heard that the coordinator makes the best homemade donuts around, and I was not disappointed. She told me the story of them, and even wrote out the recipe for me! We had a lovely conversation with the volunteers there and heard all about the success of the donuts.
Friday, July 11th
I spent Friday in radiology. An orthopedic doctor came from Pierre to see patients that morning, so it was a very busy place! After doing an abdomen x-ray on an ER patient, they jumped right into his patients. I was able to observe x-rays on hips, a forearm, several knees, a pelvis, a chest, and more on the abdomen. A technician was there from Aberdeen to do ultrasounds Friday morning. With all of that, they didn’t have much time to explain much to me, so I went back Friday afternoon to view some of the x-rays they had taken that morning, as well as some interesting cases they had archived. They are in the process of getting a new CT machine right now, but the technologist showed me some results from those as well.
Kim and I had heard that one of the main things to do in town was go to the drive-in movie theater, so Friday evening, we did exactly that! The drive-in had food as well, so we went early to eat supper there, then hung out for a while before getting popcorn for the movie. The Fault in our Stars was the movie playing this weekend, and as that movie revolves around cancer, it fit right into our week of a variety of healthcare.
I was able to see many things this week, that I have not gotten to see through school and other opportunities, and all of it was very interesting. Everyone has been very kind and welcoming, and I look forward to what I am able to see and do in the upcoming weeks. This first week has only strengthened my desire to live and work in a rural community, and I know that what I learn here will continue to stay with me and help in the future. I look forward to the next thing Miller has to offer!
After a relaxing weekend spent experiencing more of what Miller has to offer (city park, Hi-Lite restaurant, church services, and Outlaw baseball), I was back and ready for more action Monday morning. I spent the day with the hospital nursing staff, and learned a lot about how they interact with and care for patients on the floor. It was a quiet day, but I still was able to observe them checking vitals and distributing medications and meals throughout the day. I was also able to consult with Dr. Turner about a patient she was rounding on. As this was not a clear-cut diagnosis, it was very interesting for me to see how she tried different lab tests and medications until she found something that worked. I was able to observe outpatient infusions as well.
After I had observed nursing for most of the day, Kim and I went over to Community Health to see what they offer to the community as well as starting on our Wellness Coalition project. We spoke with the receptionist and she informed us of the various services they offer and answered our questions about the status of active living and healthy eating here in Miller. That night, we came back to the hospital to observe the set-up and beginnings of two sleep studies. A technician comes from Moorhead, MN about once a month or so, so it was nice to see that during our time here. I had not realized how prevalent sleep disorders were, so it was very interesting to see how the actual study takes place, especially because they took place in the rooms we would have stayed in if the house hadn’t opened up!
Tuesday, July 15th
On Tuesday, we didn’t have anything planned at the hospital, so we spent the day in other parts of Miller and working more on our wellness project. We drove out to the Hutterite colony, and had a lovely visit with one of the ladies there. She showed us how they operate their promotional design business, and showed us their gardens, kitchen, and a home as well. She was very interested in our internship, and was very willing to answer our questions about their lifestyle as well. After that, we stopped at a pizza place downtown for lunch, and then went to Helping Hands, a thrift store/food pantry located in Miller. We learned a lot about the population that they serve, and later stopped in the drugstore for ice cream at their old-fashioned soda fountain.
We met with the mayor as well to find out what the community leader knew about wellness in Miller. We had some time before another scheduled interview, so we stopped at the Friendship Center, the local senior center, to see what was going on there. After answering our interview questions, the ladies invited us to play cards with them for a while, and wouldn’t let us leave without some of their rhubarb crisp. We then had an interview with a high school student on a health advisory board in town, and learned a lot about that from her. Once we got back to the hospital, a patient came into the ER with a dislocated shoulder from a farming accident, so it was interesting to see them do what they could for him.
Wednesday, July 16th
Wednesday was kind of a crazy day full of running from one thing to the next. Right away in the morning Dr. Werth, a gastroenterologist from Aberdeen, came to do colonoscopies, so we were able to observe. He explained to us what he was finding as he went, and we were able to watch him remove a polyp from one patient. I then went over to the clinic, and first observed the ear, nose, and throat specialist consult with one patient’s mother about a tonsil-and-adenoidectomy. I then watched Cassie Gutzmer, a nurse practitioner do a school physical, and see a patient that came in with a cold. I really enjoyed this because she explained to me the rational for which medications she was choosing for the patient.
In the afternoon, I spent more time downtown at the pharmacy with Travis. He showed me more about the medication synchronization program he has recently started, and a patient brought her meds in to be synchronized, so it was cool to see it in practice. I was able to counsel on a few new prescriptions and helped some patients out in the OTC aisle as well. I also helped him work through some MTM cases, and came up with a project to do in the hospital pharmacy as well.
Thursday, July 17th
Thursday morning began bright and early with cataract surgeries. Dr. Bormes, an ophthalmologist, comes from Aberdeen once a month to do them and other minor eye surgeries. After dressing in surgical garb, we were ready to watch. He did the first surgery with us observing off to the side, but then attached a second microscope so we could see what he saw. I watched the second surgery through the microscope right next to him, and he explained what he was doing the entire time. I never would have thought of it as “removing the chocolate from the center of the M&M and giving the candy coating a new chocolate center”, but I will never forget it now! After doing all the left eyes, he switched the room around and did the right eye surgeries. The nurses were very good at explaining all the medications that were used to me as well. On my IPPE, I prepared all the medications for the cataract surgeries there, so it was very interesting to see the medications being used!
In the afternoon, I followed Diane, the occupational therapist. She is not actually employed by the hospital, but rather has a private practice and contracts out to the hospital, nursing homes, and schools. I watched her work with the first patient on regaining strength and dexterity after a head injury, and then we went over to the hospital. She took me to the first patient’s room so the lady was able to show off for me how much she is now able to do on her own with the help of various assistive devices. Diane explained to me that occupational often uses such devices to return people to their level of ability before the hospital stay, surgery, accident, etc. Lastly she evaluated another inpatient to see if occupational surgery was right for her. Then Kim and I did an interview for the Miller newspaper!
Monday, July 21st
I spent Monday morning with Tim in physical therapy. He worked on an outpatient recovering from a knee injury, and I learned how therapy can work for more than just surgery rehab. I then went with him as he did an initial evaluation on an inpatient, then we went to the nursing home. He explained to me how therapy is billed at the nursing home depending on if the patient was in the hospital when it was ordered or not. After working with a patient there, he came back and worked with a patient that has suffered for months, but nothing he has tried seems to work. He told me afterwards that sometimes the problem is more in the brain than in the joint itself, and there is only so much he can do with physical therapy if the patient is scared of the exercises he wants them to try. I spent Monday afternoon unloading medications from the Pyxis machine, and cleaning out the refill list, as many things that come up are not in the hospital’s inventory and no patients are on them anymore.
Tuesday, July 22nd
Tuesday morning started bright and early with the Medical Staff meeting. It was nice to be a part of the leadership at the hospital, and it is rare to see all the providers and administration come together like that. After a brief introduction and breakfast, they talked about the new renovations at the hospital and the plan to introduce medical bags to help patients keep track of all their medications. A lawyer from Huron then spoke about the plans to coordinate with the county to transport mental health patients when they need inpatient treatment in Sioux Falls or Yankton. They touched on nursing home protocols at the end of the meeting as well.
After that, I went with Dr. Schroeder to do nursing home rounds in Highmore. He knew some of my professors, as well as my dad and some of his partners in Estherville, so we had a nice chat during the 20 minute drive. Once we were there, he did his rounds, and he had me look over the medication lists for the patients he was seeing to double check that everything was appropriate. After he finished with that, we attended the Quality Control meeting they hold with the medical director quarterly. In the afternoon, I stated going through all the medications in the med room and double checking the expiration dates. Everyone was grateful for the time I spent going through everything. In the evening, Kim and I attended the famous “Chick Flick” night and treated ourselves to fruit pizza while watching The Other Woman.
Wednesday, July 23rd
When we got to the hospital Wednesday morning for breakfast, they were preparing to send a STEMI patient to the Heart Hospital in Sioux Falls, so we were able to observe what they do for flight transfers. It was a busy day in the ER, as 4 patients ended up being flown or driven to other facilities. I followed Dr. Turner in the morning as she did rounds and then saw patients in the clinic. One of the hospital inpatients was being discharged, and the other transferred to another facility for a CT scan, so it was interesting to see the process and paperwork for that as well. When she saw the patients in the clinic, she went over their medication lists with me, so it was interesting to see how all of that fit together, and then her rationale for modifying drug therapy. We saw patients for a variety of disease states also: COPD, hypertension, pain, and cholesterol, so everyone was a little different. In the afternoon, I finished my expiration date project in the med room, but while I was in there, I missed two more patients coming into the ER!
Thursday, July 24th
We did not have anything scheduled on Thursday, so we spent the morning working on our presentation and paper. This involved talking to a variety of community members, and taking pictures all over town. In the afternoon we went to the assisted living center to play bingo with the residents, and I ended up winning twice, earning me a total of 50 cents! Kim has family who live nearby in the town of Faulkton, so we drove up there Thursday evening to see them and visit their hospital, one of the few in the area that has managed to remain independent.
Friday, July 25th
On Friday, I spent the morning observing cardiac rehab. This was something that I did not know much about beforehand, so it was interesting to see how the exercises, tests, medications, and diet all went together. One patient was brand new, so I was able to see how they get them started, as well as how it progresses as patients continue their sessions. The last patient watched a video about heart healthy eating, so we had a good discussion with him about that as well. I had never realized how much salt was in ketchup! I helped the nurse go through their medications as well.
In the afternoon, I went back to the pharmacy. Travis had me counsel the patients on any new medications, and I was able to observe his interactions with them as well. He then showed me what he does for nursing home consultations, so I helped him go through that as well. One of the faxes in the stack was a response to a message he had sent to a doctor last week when I was there about adding an ACE inhibitor for a diabetic patient, so it was nice for me to see the follow-through on that. I enjoyed talking with the staff and learning more about how independent pharmacies keep their patients’ business, despite competition from mail order and big chain stores. My time in Miller is winding down, but there are some exciting things planned for next week yet!