Emily Young
First Week at Chamberlain
On Monday I arrived at the hospital at 10:30 AM. Laura and I met with Dotty Hieb and Jess Neilan. Jess took us on a tour of the facility and then on a tour of Chamberlain and Oacoma. As we came down the hill towards town from the hospital, I was overcome by the view. The people of Chamberlain are very fortunate to be surrounded by rolling hills and a beautiful river. After our tour, Laura and I met with Cheri and Corryn for lunch at Cedar Shore. After that, we had the rest of the day to get settled into the house and to get acclimated with the town. The house we are staying in is graciously provided by St. Joseph’s Indian School. It’s great to live in town and be so close to Main Street!

On Tuesday, I started the day off with the nurse’s huddle at 9am. From there I spent time with Jennalee, a nurse who works in cardiac rehab. She explained to me all the testing they do there as we awaited Dr. Stys’s arrival from Sioux Falls. They perform stress testing, which allows the physician to see how the heart is doing physically and an echo test, which allows the physician to see how much blood is being pumped by the heart; the echo test is used to see if the heart is working efficiently. Once Dr. Stys arrived, everything was very fast paced. He likes to keep everyone moving so patients don’t have to wait around. Dr. Stys was very good at explaining what was going on and why. With almost every patient, he talked about cholesterol levels. This was cool to me because in my program, we learned a lot about HDL versus LDL and what factors predispose someone to heart disease. Overall, I greatly enjoyed observing him! After Dr. Stys clinic, Laura and I observed a few members of the nursing team practice putting on PPE (Personal Protective Equipment) in case Ebola ever came to South Dakota. The order in which one puts on and takes off PPE in situations like this is very important so that other members in the facility do not get contaminated. It’s nice to know that smaller facilities like Chamberlain are preparing for every situation, even if the situation is unlikely. To end our day, we observed Jennalee download and look over the information from a heart monitor. This particular monitor was a 48 hour monitor. With the monitor, the patient keeps a log of any strenuous activity they did during the day so that the doctor can correlate that with the patients EKG. Overall, it was a very informative and interesting day!

Wednesday started off with Dr. Santos and his vascular clinic. He was mostly doing follow up visits with his patients. One patient, however, was getting a catheter removed from their upper thigh. I think it is so great that specialty doctors fly in from Sioux Falls so that patients do not have to travel all that way. Although Sanford in Chamberlain is not equipped to deal with some procedures these doctors perform, it is nice that the doctors will travel for follow-up visits and simpler procedures. That afternoon, Laura and I spent time with Christy Graves in the Quality Department. When looking at different areas of the hospital, I think the Quality Department is one that often gets overlooked. The Quality Department mostly deals with patient ratings of the facility and specific providers. Christy is actually an RN, which I feel would come in very handy. Being an RN, she understands what the providers and what the patients are going through. Her background as an RN puts her in a great position to make sure that everyone is satisfied with the care that is being provided. We ended the day with the Department Managers meeting. This really allowed us to see the communication that happens between the different departments in the hospital. Each department let the others know what was happening in their department; So far, I’ve been really impressed by the communication that goes on in the facility.
Wednesday evening Laura and I went kayaking down the river. It was very refreshing and a ton of fun!

I started Thursday at the lab while Laura went off to the clinic. I was particularly excited to see their lab and to learn how they do things. While there, I got to freshen up on my phlebotomy skills. Scott, the lab manager, let me draw blood from his hand using a butterfly needle and one of the other techs let me draw blood from her arm. I also observed how they do microbiology and learned a little bit about how they do blood banking. I was surprised to hear that they do not do antibody identification at their lab; they send any patient specimen that has an antibody to Sioux Falls. After my time in the lab, I went over to the Care Center for their Care Conference. The meeting was comprised of the social worker, dietitian, head cook, and head nurses. In this meeting, each member talked about their “piece of the puzzle” when it came to each patient. This allowed each of them to fully understand what is happening with each patient that was discussed. After that, Laura and I attended a State Trauma meeting. During the meeting, Doctors from the region in South Dakota discussed how certain trauma cases were handled and what should be changed, if anything. The main thing they discussed was deciding as soon as possible if a patient needs to be transferred to a larger facility. What really impressed me about this was the team work that was happening across the state. Not only was this teamwork amazing, but it was even more amazing because these doctors were from all different facilities; from Sanford, to Avera, to independent hospitals across the region. It did not matter who they were associated with these doctors had the patient’s best interest in mind. The last thing Laura and I did at the hospital was spend some time shadowing Jen, the social worker. To end the day, we had dinner at the Busted Nut with some employees from the hospital and then Laura and I went to DQ for some ice cream. It was a great way to end the day!

Friday I spent the day at Lewis. I had no idea what all happened at a pharmacy and what employees roles were before that day. While there, I learned the general lay out of what they do on a day to day basis and what other services they provide like counseling and vaccinations. Mostly I shadowed two of the pharmacists or filled medication cards for the nursing home. One thing that really stood out to me was that every time someone came into the pharmacy, every employee could greet them by name and ask them questions about specific events happening in their lives. Coming from a larger town, this was a new experience for me; I thought it was very nice. Laura and I ended the evening by attending a fundraiser meal at Zion Lutheran Church with Cynthia, the pharmacist, and her husband. Their youth group was hosting a meal to raise money for them to attend a youth rally in New Orleans. They served jambalaya, fried walleye, and banana foster. All of the food was delicious!!

Laura and I woke up bright and early Saturday morning to help Ron Lamie with the 5K/10K Race on the River. We filled cups with water for the runners at water stations. I spent the rest of the weekend with one of my good friends at her farm in Kimball.

Week Two
This week started with me in the lab all day. The day included almost all aspects of the lab including chemistry, microbiology, urinalysis, phlebotomy, and blood banking. Quite a few urines came into the lab today, which Tahnee, the MLT I was with, let me do. I was really happy to see that the lab here has an automatic dipstick reader, since that is one of my least favorite parts of urinalysis. I also ran QC on 10 organisms in microbiology, which is something I had never done before. Phlebotomy was a very active part of the day. I witnessed draws on two babies and a draw for blood cultures. Both of these situations are special because they are not like most blood draws. Babies are usually drawn from their heel and before blood cultures are drawn, a patients arm has to be scrubbed down with a special antiseptic in a certain way. I freshened up on my phlebotomy skills by practicing on Meghan, one of the MLT’s. She then had me run a blood type on her so that I could practice blood banking. Overall, I had a great time. We were running around the lab the whole time and everyone there was great to work with.

Tuesday morning, Laura and I shadowed Dr. Reynen’s while he did his clinic. As a part of his clinic, he performed a knee scope. So far, this was one of my favorite things to observe! In this particular patient, one of the meniscus’ in his knee was cracked, so bone was rubbing on bone; this caused inflammation. Since the inflammation was longer term, this “sea-weed looking” stuff had formed, causing the patient discomfort. The procedure involved chopping up the “sea-weed looking” stuff so that the patient would be more comfortable for the next few years. I was told that this patient is a candidate for a total knee replacement. After the surgery, Laura and I did follow-up visits with Dr. Reynen. That afternoon, after a short meeting, I headed to my next stop: The Emergency Department. While we were in the meeting, a child came into the ER who was having an appendicitis. I was able to observe Dr. Tucker perform an appendectomy on the patient, which was very eye opening. The OR was very busy that day! From the short amount of time I spent in the OR, I have to commend the nurses and technicians who aid doctors in the OR. Each doctor likes the room set up in a certain way and likes to use certain equipment that others do not. These nurses and technicians have a lot to remember in a high stress situation and I greatly applaud them for that. After the surgery, I ended the day with Eric (an ED nurse) learning the ropes of the emergency department.

I started of Wednesday early in the Coumadin clinic with Lauren. Before this, I was not really sure what we’d be doing. Basically, we took protime levels on patients who take blood thinners (Coumadin) long term. The point was to make sure that these patients are taking the right amount so that their blood is not too thick or too thin. I liked this because in the lab, we can and will run pT levels for patients on our chemistry analyzer. After finishing at the clinic I headed down to Radiology to spend some time there. A radiologist comes from Sioux Falls about every two weeks, so they try to perform a lot of testing on that day. The radiologist was there today so there was a lot going on. I spent most of my time with Haley, one of the technicians. I observed a chest X-ray and a mammogram. There were a lot of mammograms scheduled for today; unfortunately, but understandably, most patients do not want a student to observe their mammogram. I learned a lot from Haley about different procedures and testing they do in Radiology. It was a fun department to be in and I greatly enjoyed the time I spent there! I ended the day at the hospital pharmacy with Jerri Ann. We went over everything she does and one thing that stood out to me was that pharmacists make IV fluid. I had no idea! I thought all IV fluid came pre-prepared from the manufacturer; this is not the case. Normal saline or glucose comes in the bags they receive, but the pharmacist adds the actual drugs whether it be antibiotics or other additives. The reason for this is because once the drug is added, the shelf life of an IV fluid decreases to about one week depending on the drug. Overall, the day was very informative.

Thursday we went to the Fort Thompson Health Fair with Leslie and Sarah. This experience was eye opening to me in more ways than one. Before this, I had never been anywhere near a reservation. It was hard for me to believe the amount of poverty that surrounded me; it made me very sad. At the health fair, we handed out information about proper use of the emergency room and gave people different resources they could use if they have questions about their child’s symptoms. There were a ton of booths there including a giant inflatable colon! It was a beautiful day for the health fair and it was interesting to see all the health care resources available in this area.

On Friday, I went with Dr. Jones to the clinic in Kimball. I observed him as he did basic clinic visits with his patients. I also got a tour of the clinic, which I enjoyed. That clinic not only houses the doctor’s office, but also a dentist’s office and a chiropractic office. I think it is cool that these health professionals come together to offer their services to the community. That afternoon, I went with Dr. Jones to a meeting where past trauma cases were being reviewed. The major concern and point of the meeting was to see if proper procedure was followed and if the decision to transfer a patient was made in a timely fashion. After that, I finished my day in the lab with Meghan. One thing that was particularly interesting to me that happened was that a patient came in for therapeutic phlebotomy. Therapeutic phlebotomy is used to keep a patients hematocrit level around a certain value. Almost a pint of blood is taken from the patient.

Over the weekend, I went out to the flea market in Oacoma and I walked around town visiting all the shops on Main Street. I also went exploring for beaches along the river. It was a good weekend to just relax and hang out.

Week Three
Monday started with Laura and I observing a hernia repair. It amazes me what doctors can do with a little amount of space.Throughout most of the procedures I have observed, only small incisions are made.Throughout these meetings, we covered topics such as Advance Care planning, Measurement and Satisfaction, and Long Term Care. I had never really thought about advance care planning before.Even at my age, it is a good idea to have an advanced care plan just in case anything happens. We also went and toured the South Dakota Hall of Fame. It was cool to see what famous people were from South Dakota. That evening, Laura and I started to prepare for our presentation.

Tuesday we started the day by getting a tour of St. Joseph’s Indian School. We not only went through the museum, but the campus as well. It was fascinating to hear the history of the school. Unfortunately, the chapel was under construction so we could not go inside, but I hear that it is beautiful. After that, we headed to the hospital where I was to be in the lab the rest of the day. Every day in the lab is very different here. One of the exciting things that happened was that Paul, the Director of Operations, let me draw blood from his artery; I had never done an arterial stick before. It was also nice to see Alyssa, a recent graduate from SDSU’s MLS program. This was her first week starting her new job at the lab in Chamberlain. It was nice to catch up with her.

Wednesday I returned to the lab to spend my last full day with them.It was so good to get to know all of the lab techs in Chamberlain. I enjoyed learning from each and every one of them. It was nice to learn from people who have been in the field for a while and know the tricks of the trade.Throughout my time here, I have enjoyed working with real specimens for real patients. It has also been great getting to work with actual analyzers and other lab equipment. Overall, I have greatly enjoyed the time I have spent in this lab.
We observed a hysterectomy with Dr. Craig in the morning and then gave our final presentation that afternoon.The hysterectomy was probably one of the coolest and most complicated procedures I have ever seen performed.I cannot begin to describe what was happening in that operating room. I would like to take the time to thank everyone for the wonderful hospitality shown to us.  Both of us are extremely grateful to everyone who made this possible.  This experience has impacted me in a positive way and has contributed greatly to my education as young health professional.  Thank you REHPS Program and thank you Sanford-Chamberlain for hosting us!