Cody’s Blog

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Week 1 Parkston, South Dakota

Today, Monday June 2nd, I arrived in Parkston. Prior to today, I had never been here so I wasn’t sure what to expect. Upon arrival we met with Julie, the Director of Marketing in Public Relations. She gave us multiple “5 cent tours” today, both of the hospital and of the town. Parkston wasn’t as small as I was expecting, and the hospital was so modern that it took me completely by surprise.

We met with Cheri, the REHPS project manager, at 11 for on-site orientation and afterwards went to get a burger at Schuvers downtown (it was very good!) Afterward we went to the ER to observe and help with some cases the staff was working on with Lindsay Webber, CNP.

The facility is very nice, the staff welcoming, and the patients friendly. Overall, we had a very good and positive first day in Parkston.

6-3-14- Second Day in Parkston
Today we began our day by doing rounds with the CNP Becky Moke and were later joined by Dr. VanderPol. After rounds we went to Physical Therapy to watch a diagnosis/treatment for vertigo for a patient. We then rode in the ambulance with the EMT’s to transfer a patient from Parkston to Sioux Falls. Upon return I met with Melanie, a newly graduated pharmacist from SDSU. She showed me around the pharmacy and I then helped fill some medications for patients with her. Melanie then showed me the chemotherapy hood/room.

After that, the Omnicelle machine was stuck and the nurses couldn’t remove any medications from that drawer so we had to take it apart and clear the jam (it turned out it was a PEG packet.)

6-4-14
Today we again did rounds, but this time with Lindsay Webber. At 8:00 I met with Dr. Jason Wickersham and we went to Our Home, a facility for youth that need extra attention, and discussed each child’s treatment plan with the rest of their team. At lunch time Paul and I grabbed our meals from the cafeteria and relaxed a little bit. After lunch I headed to the clinic with Dr. Wickersham and met with many patients, and met most of the clinic staff for the first time.

6-5-14
We began our morning with the usual routine of rounding with the nurses first and then the physicians. At 8:00 Paul and I attended an upper GI endoscopy and colonoscopy. That was fun to watch and see what it is that they are looking for. Paul took over the controls on the colonoscopy at one point (he needs to play more video games :) ) Afterwards I attended a BSL for Healthcare Providers certification course where I learned CPR and choking protocols. I then joined resident Dr. Kurt Farchmin in the clinic for an hour and a half. We thought at one point a patient may have had a heart attack so that was interesting to see the flurry of labs and activities that were ordered. After lunch, Paul and I headed to see Melissa in Behavioral Health for an hour and a half to discuss what she does in the facility and all of the hats she wears. We then spent an hour with the Health Information Management Team to discuss their HIPAA and compliance policies, how costs and reimbursement at the hospital work, how transcribing providers dictations take place, and all of the various diagnosis and level coding required to do billing. It was a long day, but it went by quickly.

6-6-14
I spent today with physical therapy after rounding this morning. I enjoyed being with PT a lot, all of the ladies were welcoming, friendly, and very understanding of having a student shadowing. I was able to shadow all patients that came in while I was free, and each therapist was very good at explaining everything they were doing, down to the exact ligaments and bones and such (I was like… I’ve heard of that!” One noteworthy case I was able to attend was a stroke patient that is hemiparalyzed and observe what was being done to try to help him recover from a recent stroke. I always learned about the medications used during and after a stroke, but it was interesting to see the actual damage a stroke can cause and what steps need to be taken to try and recover as much function as possible.

Besides helping with patients, the PT ladies used me as a guinea pig to show me other various exercises. They used Sound Assisted Soft Tissue Mobilization ( SASTM) on my back to show me a technique to work out kinks in muscles and they also hooked me up and ran some electric current through my arm to show me how they help muscles contract or to relieve pain. Overall, I had a very enjoyable day.

6-7-14
Today marks the beginning of our first weekend in Parkston. Paul and I were going to run in the Relay for Life but the weather wasn’t agreeing with us so we decided not to run. We just spent the rest of the day relaxing.

6-8-14
On Sunday we participated in the Kickin Depression Kickball Tournament that the whole town is invited to play in. Each team had 10 players and there around 12 teams, so we had a good turnout. Paul and I played on the Purple Avera St. Benedicts team.  We lost our first game, won our second, lost our third, and as a result, we were done for the day.  We spent the rest of the day relaxing and visiting a few stores in town.

Week 2
6-9-14 through 6-15-14 in Parkston
Monday:
First thing this morning Paul and I observed another colonoscopy and after that I participated in a wound care telemedicine conference call for a foot wound that wasn’t healing. After the conference call I made my way to the clinic and saw multiple patients with Dr. Honke and Paul. One interesting case was what we thought was a spider bite. Dr. Honke drained the fluid accumulation, so that was interesting to see. At lunch time we sat in on a lunch and learn for a medication called Tradjenta for diabetes.

After lunch I did some research into a patient case that was at a dead end because I wanted to make sure there was nothing else we could do. I ended up finding a few suggestions to try before we throw in the towel. After some book work I headed to the clinic to finish up my afternoon.

Tuesday:
Today I started out in the hospital rounding with Dr. Wickersham and Lindsay. I then headed to the clinic for a few hours. We had a patient drive himself to the hospital complaining of dizziness that needed to be kept for observation but didn’t want to leave his vehicle at the hospital so I drove him home and tracked down his wife so we could get him back to the hospital. Upon return I followed up on his case a little bit and then spent some time talking with Julie about the next few weeks and a little bit of time in the pharmacy immediately before lunch.

After lunch I was with Planet Heart all afternoon.  I was able to see an ultrasound of a patient’s heart, measurement of the pressure in the carotids, and a CT scan of the heart that looks for calcium deposits in the arteries of the heart. All of this is more of a screening measure and not a diagnostic test. Based on the severity of calcium buildup in your heart, you get an overall score. The higher the score the worse the deposits and your risk of heart attack are. The results are then forwarded to your physician for further testing.

Wednesday:
Paul and I began our day by traveling to one of the Hutterite colonies with RN Carrie and PAC Mary. We saw patients in their own homes for various things like blood pressure, weight, and oxygen checks. We did see a few patients for more specific problems such as numbness of the hand or a bruise that the patient was concerned about.

Carrie visits a colony almost every day so she is extremely knowledgeable about just about every aspect to the Hutterite culture and way of life. They eat meals in a lunchroom type area, women on one side, men on the other. Children have a separate dining area if they are the appropriate age(5-15). Children younger than 5 will eat at home prior to the adults eating. Everything is communal there except for housing. They go to their own homes but eat all of their meals and all work together throughout the day. They don’t earn a salary because everything is provided by the colony as a group. They have gardens, turkeys, cattle, and quite a bit of farm land. They even had heavy machinery for moving dirt, building houses, paving roads… I was shocked. It was a tiny little city.

After visiting the Hutterites I shadowed in a Speech Therapy session with a young boy. He was working on the usage of words such as in, out, on, and off. I then spent some time talking to the Speech Therapy staff. They were both very friendly and welcoming and filled me in a little bit more on some things I didn’t know about the area. To finish up my day I talked with a patient that I helped with their admission yesterday and spent some time in the pharmacy.

Thursday:
Today we started our day off with a few inpatient visits, a colonoscopy, and then I headed to the nursing home attached to the hospital called Bormann Manor for a treatment plan meeting for residents. After the meeting I headed over to one of the two local pharmacies called the Medicine Shoppe. I spent about an hour and a half there talking to Janelle Valry, the owner and only pharmacist. At noon I headed over to the Ponycreek Steakhouse for the Commercial Club meeting that mainly involved the bike tour that would be starting in Parkston on Friday.

After lunch and the Commercial Club meeting I headed back to the Medicine Shoppe where I finished out my day. I spent a lot of time talking to Janelle about the differences between a rural pharmacy and a corporate pharmacy and how those differences affected patient care (all positively.) We also discussed how the healthcare professionals here work more as a team and community rather than separate entities.

Friday:
I started my morning in the clinic and spent about an hour there with Dr. Farchmin. He drained an arm boil which he thought might be infected with MRSA. I then  headed over to Bormann Manor to watch Mallory, the pharmacist, perform her monthly review of all the nursing home patients charts. After spending some time in the nursing home I went over to the wellness center for cardiac rehab that was taking place on the exercise equipment. I spent some time taking patient’s blood pressures and chatting with the two RN’s that run the activity. At noon I went and met with Paul for lunch.

After lunch I spent the remainder of the afternoon in the clinic with Dr. Honke and Dr. Wickersham. Paul and I sat in on a comprehensive physical for a patient applying for disability and I was with Dr. Wickersham for a follow up for a chemotherapy patient. It was humbling to see the pain they were in and how much of a struggle their cancer battle has been. Dr. Wickersham is extremely good with patients and made sure to tell them how tough they were and to keep fighting.

I ended the day with a patient that had a heart attack last week that was following up after a cardiac catheter procedure. Dr. Wickersham and I made sure to educate him on all of the medications that he was started on and just made sure things were going the right way following the MI.

Friday evening Paul and I volunteered some time for the RASDAK bike tour across South Dakota. We helped feed the cyclists, played with some kids downtown, and help set up everything that would be needed. At the end we got to eat some very good smoked pork sandwiches.

Saturday:
I spent the day relaxing today besides going for a run and visiting the grocery store.

Sunday:
Paul and I went to lunch today and got a golfing session in (I haven’t golfed since Junior High), so that was interesting!

Week 3

6-16-14 to 6-22-14
Monday: Today Paul and I headed out to the Oak Lane Hutterite Colony first thing with Kerri, the colony RN. Last time we mostly just dealt with patients but this time we were taken on a tour of the entire complex. It was just as interesting as last time and we both had a lot of questions for Kerri (she knows just about everything concerning the Hutterites.)  At 9 am they all stop working and come home for coffee so that’s the most convenient time for us to meet with them. We see patients either on a scheduled basis or randomly while we’re there.

At noon we met with the Board of Directors for lunch and sat in on their monthly meeting. It was interesting to see all of the administrative things that happen and all of the numbers that have to be crunched to keep an institution open. After the board meeting I spent the remainder of the day with Dr. Honke seeing multiple patients and even observing him drawing blood from a newborn. I can’t remember the last time I have seen a baby so small. The appointments today ranged from a disability preliminary appointment, a checkup for an elderly couple, and a follow-up on a baby on a heart monitor.

Tuesday: Today we got up earlier than normal to help Melissa and Kerri with the MDS wellness screening for their employees. The screening included height and weight checks, blood pressure, and taking some blood from 27 people. The lab will analyze the blood for cholesterol levels and hemoglobin A1C  levels to give some more precise screening  estimates. These weren’t meant to be diagnostic. Our goal was to provide some information for the employees to follow up with their physician if needed.

We interviewed Ember, the Wellness Coordinator, the first thing when we got back. After that we headed to the clinic for a while. Paul went with Dr. Wickersham and I went with resident Dr. Farchmin. Not long after we started in the clinic we were notified of a subarachnoid hematoma that had to be taken via helicopter to Sioux Falls. Paul and I joined the small collection of team members looking at the head CT we were performing in order to figure out where to send the patient. We went straight from that patient to a mother that was in labor and witnessed Dr. Farchmin deliver the baby. We finished up our day in the clinic and spending a little bit of time in radiology.

Wednesday: I began my morning at the department head board meeting. It was similar to the board meeting that we attended but had a more diverse group of people presenting different things. After the board meeting I headed to the clinic to meet up with Paul and Dr. Farchmin whom had just returned from Our Home, the troubled youth organization. We visited with a young girl in the ER who was having some major asthma issues. It was hard to get two words out of her so Paul and I stepped out to give her more space. After that we went to the clinic briefly and took lunch break. I forgot I had the SIM truck LUCAS machine training so I had about 5 minutes to eat and get my break in.

After lunch we headed outside to the SIM truck to learn how to use the Lucas Chest Compression System. This basically is a small machine you place on a patient’s chest to do CPR for you. It just latches onto a backboard on both sides and rests on the patient’s chest as a hand would during normal CPR. After learning to use the machine we did a simulation in which a patient was experiencing a STEMI. The dummy complained of shortness of breath and chest pain. His blood pressure was dropping so we did 1mg of epinephrine to try and stabilize that.

Shortly afterwards he went into ventricular fibrillation so we started chest compressions while others got the LUCAS machine out of its package and set up. We then shocked the patient and used a bolus of 300mg amiodarone. We had to shock him a few times before he became responsive again but was still having an arrhythmia. We did 150mg bolus of amiodarone again and at that point he was stabilizing. It was interesting for not only Paul and I, but the two RN’s in the truck with us. None of us had used a LUCAS before. I have experienced a few of these type of situations in school so that helped prepare me for this. I’m glad we were able to save the patient.

Thursday: Today we began rounding with Dr. Wickersham and Lindsay, CNP, and then we interviewed Brenda Stoebner, the Quality Improvement Director. We discussed all of the roles that she has to fill in that position such as making sure each physician is certified and has no lawsuits filed against them every 2 years, setting up disaster drills and preparedness, accumulating data for everything you can imagine, comparing that data, and distributing new policies/procedures or suggestions to the department heads. She was a floor nurse for many years and misses the patient interactions, but she enjoys her desk job as well. We talked about all of the changes occurring in healthcare and even some of the potential changes Paul and I may see while practicing.

After Brenda’s interview I headed over to Parkston Drug, owned and run by Rick Boettcher. He uses the same computer software and vendor that Hy-Vee uses, so I felt at home even though his system was a little more simplified. We talked about where the profession of pharmacy is currently located and where it may be headed. We also discussed the challenges and rewards of owning and running an independent pharmacy in a small town. I enjoyed spending time with Rick, he was able to offer a perspective that was that of a relatively young pharmacist as opposed to one nearing retirement. It was interesting to discuss pharmacy from a strictly owner perspective as opposed to a staff pharmacist you’d talk to at a local chain pharmacy.

After lunch I headed back to the hospital and shortly after getting back we were notified that there was an OB patient that was jaundiced. We stopped what we were doing and headed down to the ER to meet with the rest of the team. The decision was eventually made to transport her to Sioux Falls due to the potential complications that could have occurred. We then interviewed Mr. Walker, President and CEO of Avera St. Benedict regarding healthy living and eating in the community.

Friday: Paul is gone today and this weekend so I’m flying solo. This morning I went to the lab in the hospital and spent a few hours with them. Becky Long has been there for over 30 years and was extremely helpful, friendly, and knowledgeable in explaining everything that they do in the laboratory. I then interviewed Mary Schaefer, PA-C in the clinic for our Wellness Coalition probing. She let me spend the rest of the morning and afternoon with her discussing and visiting patients. Visits ranged from a few physicals, a young girl with shoulder/back pain, and an older woman with a sty on her eyelid that was causing quite a bit of pain. With our time winding down, I’m enjoying my few days left here even more.

Week 4
Monday: This is our last week in Parkston, and I’m starting to wish we had another week or so here. We started our day in radiology and spent an hour and a half or so there checking out some x-rays and talking with the radiologist. We then met with Kerri and Mary to visit a Hutterite colony that we hadn’t been to yet.

After meeting with Julie Semmler, Paul and I went and visited with a few Amish families around Parkston and browsed some of the things that they make, ranging from candy to furniture, all of which are amazing. It was interesting to see even more differences from the Amish perspective vs. the Hutterites and how each of those are again different than we are used to. We spent the rest of our afternoon in downtown Parkston. I introduced Paul to the staff of both pharmacies that I spent time in while in Parkston.

Tuesday: Tuesday is our last day in Parkston. We got up bright and early for rounds as usual, and Paul picked up some cinnamon rolls that were made by a local gas station for the hospital and clinic staff.  We met with Lindsey and a few of the physicians, snapped a few pictures, and began to prepare for our presentation. The final presentation was to show the hospital staff how much we were actually able to experience while in Parkston, and to thank them for all of their time and hard work in helping train us and get us more experience. Overall, I cannot say enough about the REHPS program and what it has done to continue my education to one day be a pharmacist. Thank you to everyone who made this possible.