Emma Bye
Week 1 in Parkston

May 20, 2015
Today was our first day in Parkston.  We arrived around 10:00 am and had a tour of the hospital and were introduced to many new faces throughout the Parkston facility.  Everyone was very welcoming and excited to have us in Parkston for the next few weeks.  I was very impressed with the facility and there were many recent updates and additions such as the nursing home and recent Physical Therapy areas.   We were invited to a coaches meeting over the lunch hour where topics such as good nutrition, the risks/expense of supplements, and overview of services were discussed with coaches of various high school athletics from around the area.  In the afternoon I went with Becky Moke, a Nurse Practitioner to the Tripp outreach clinic.  In Tripp we did nursing home rounds and assessing residents for any recent major changes and re-certification.  We also had patients in clinic at Tripp that afternoon as well.  I really enjoyed seeing the outreach process and how healthcare is really dispersed to the areas of need surrounding Parkston so that patients do not have to travel as far for care. 

May 21, 2015
I started my day with hospital rounds with Dr. VanderPol and Becky Moke , CNP.  It was nice to be involved in rounding and visit with the patients and providers about the plan of care.  There seems to be really great chemistry and teamwork between the care providers at Parkston.  After rounds I went to the clinic and worked with Dr. VanderPol and Dr. Boschee until lunch.  After lunch Dr. VanderPol and I went to another outreach clinic in Corsica.  Dr. VanderPol is from the Corsica area and really did an awesome job showing me around the community and giving me a little background.  We did nursing home rounds and assessments of several residents.  Dr. VanderPol walked me through a joint injection process.  We also had an obstetrics appointment scheduled at the clinic in Corsica and I was able to do fetal heart tones with the Doppler, Leopold maneuvers, and measure fundal height. This was a unique clinic that is in a very rural setting.  Typically there is only one Nurse Practitioner and a Lab Technician, but they do everything.  Their jobs are very diversified and definitely do not meet the typical job description you would expect for their positions, which they noted is never boring. They were very welcoming, knowledgeable and did a very nice job.  My favorite part of today was seeing the continuity in care that Dr. VanderPol has with her patients.  Many of these individuals have been under her care for years and she really has built wonderful rapport with all of them.

May 22, 2015
The day started again in the hospital, rounding with Dr. VanderPol and Becky Moke, CNP.  This morning Lisa and I rounded together which was really nice.  She has a fresh look at this whole hospital process and really looked and thought of things in a new way, which was great.  After rounds we observed a skin treatment for venous stasis disease.  After being in the hospital I went and shadowed in the clinic.  Dr. VanderPol had a variety of patient appointments ranging from an obstetrics appointment to counseling, to a hospital admission.  It was a nice day in the clinic; there were not a lot of procedures going on that day, as it was the Friday before a holiday weekend.  Overall, I feel really good going into our second week and am getting more comfortable each day with the facility and providers.  There is a lot to learn and I am looking forward to the next three weeks!

Week 2
May 26, 2015
Today I started my day early with surgery at 7:30.  The morning was spent with Dr. Likness in surgery for 3 hours observing tonsillectomies, adenoidectomies, and a septoplasty surgery to correct a deviated septum.  These were all new procedures that I have not previously scrubbed in for.  It was really nice to walk through the procedure with Dr. Likness and talk through the various instruments that were used during each surgical procedure.  I really enjoyed the morning and feel that I have a much better understanding of the procedures as well as the risk factors.  Later in the morning and throughout the afternoon I shadowed Dr. Likness in clinic.  Many of the patients that we were meeting with in the clinic needed surgical intervention, most of which were the procedures that I had finished observing so it was great to see both aspects and fully understand what was being described to the patients.  Dr. Likness did a great job with communicating with patients and carefully outlining the risk factors and potential benefits with each patient.  Also one aspect of the clinic visit that I really liked was going through the CT scans and having Dr. Likness show me the areas in the sinuses that were chronically inflamed and likely going to need surgical correction.  We have not had much education on reading CT scans so it was nice to get a better idea of what was actually being observed.  At each patient visit Dr. Likness brought the patient back to look and talk about their individual CT scan so that they could see the evidence of why they were having sinus and breathing problems, showing the need for intervention.  This was a full day that really showcased available outreach opportunities and surgical procedures in a small town.

May 27, 2015
Today was an exciting day as we had a delivery here in Parkston!  I got a call during the night letting us know that there was a patient that came in to deliver.  Meredith, the FARM student, and I met the patient and her husband and talked with Dr. Wickersham.  We did cervical checks and talked through reading fetal heart tones and measuring contractions.  I also observed administering an intrathecal for pain relief throughout labor. We went home and were called back in the morning.  It was a really awesome experience to be a part of the labor and delivery.  Lisa and I were both present for the birth and I really loved talking about Lisa’s thoughts and her perspective about the whole experience.  She had really great insight on patient communication between the patient and physician that I had not previously considered.  Her fresh perspective of being a clinical psychologist with a focus on patient well being during a life changing experience was really valuable and something I will reflect on.  In the afternoon we helped with a babysitters clinic that was held for 10-12 year olds teaching first aid, childcare skills, and CPR skills.  I helped teach CPR in the afternoon, which I really enjoyed.  I think this was a really great program that Parkston provides and the fact that they are introducing CPR skills to 10-12 year olds is great, even if it educates them to stay calm and call 911 it could make all the difference.

May 28, 2015
Today we spent the day in Mitchell learning about our community project within the REHPS program.  We are going to be collecting data in the Parkston community for the South Dakota Good and Healthy Project.  During this project we will work on collecting data for the worksite, school, and community sectors in Parkston.  Overall Parkston does a nice job with a community Wellness Center and fitness opportunities at the high school gym. It will be interesting to see what the assessment data for the project will show.  We had lunch and toured downtown Mitchell for a while after our training session. Lisa had never been to the Mitchell Corn Palace so we stopped by for a tour and a few pictures!

May 29, 2015
Friday was a busy day! I was able to be in on a couple of colonoscopies and Dr. Honke let me run the scope for a while! I really liked it and after observing it was nice to actually feel what it is like to run the scope. It is not as easy as it looks. It was pretty clear I need a lot more practice!  There was also a scheduled endoscopy and it was a nice refresher on many of the concepts and pathology covered in our GI block.  I shadowed Dr. Honke throughout the remainder of the day and we had a variety of patient visits throughout the afternoon.  I was able to do a mole punch biopsy and Dr. Honke walked me through suturing.  This week really flew by and I am looking forward to next week in Parkston.

Week 3
Monday June 1, 2015
I drove back to Parkston early Monday morning and was able to sit in on a medical staff meeting at 7:30.  They typically have this meeting once a month and it includes all the providers, director of nursing for both the hospital and nursing home, and all administration members.  It covered a range of topics and they had 2 presentations during the meeting as well.  The dynamic and being able to sit in on this meeting was great. Lisa and I watched a barium swallow study with speech therapy that was really eye opening.  It was great to see what a swallow study actually entails and visualizing the aspiration into the trachea.  It vividly demonstrated why aspiration is dangerous and the speech therapists explained how different diet orders, such as honey-thickened liquids, are determined.  In the afternoon I shadowed with Dr. Honke and worked with Meredith on doing patient assessments.

Tuesday June 2, 2015
Today we hit the floor running with a scheduled C-section. Everything went really well and a healthy baby girl was delivered. There was a lot of action in the OR with many people assisting.  It is always fun to be involved in a delivery.  Later in the morning I sat in on a counseling session with Parkston’s Mental Health Professional.  I am really impressed by the mental health care that is provided here in Parkston. I feel this is an area that has not been well addressed in medical school and I am sure we will have more training in the future but it is nice to have more current exposure. 

In the afternoon I went with Dr. Honke to Lake Andes clinic where we saw clinic patients as well as did a few assessments in the nursing home.  The Lake Andes clinic is located on the reservation and the 50-mile distance provided a new scope of health, social justice, and cultural challenges.  I really liked this outreach and feel that the clinic does a really nice job providing local care.   That evening Lisa and I were able to sit in on a diabetic support group, which was a lot of fun.  This particular group has been together for about 3 years and they have a great dynamic together that was really fun to sit in on.  They are all doing much better managing their diabetes and they all have significantly lowered their hemoglobin A1C showing efficacy of the support group intervention.  I finished the day with my husband and date night at Schuver’s….best milkshakes!!!

Wednesday June 3, 2015
We started our day with Dr. Honke at Our Home, a residential treatment facility for teens ages 12-17 who have had previous legal, family, or social problems.  We were able to sit in on the treatment plan meetings of 8 different residents at Our Home with their individual group leader, their nurse, the clinical psychologist and Dr. Honke as the attending physician.  It was interesting to see their treatment plans and discuss whether they had met their goals over the past month in an interdisciplinary setting.  We learned a lot about the program and Dr. Honke gave us a tour of the facility.

In the afternoon Lisa and I went and met with the local superintendent Mr. McIntosh about our community project and data collection for the Good and Healthy South Dakota initiative.  After the meeting I shadowed Dr. Wickersham in the clinic for the last visits of the day.  

Thursday June 4, 2015
Today we headed out with Kerri she is a Registered Nurse who takes care of all the Hutterite colonies in the surrounding area.  Avera St. Benedict takes care of 5 colonies in total and we visited four of the colonies today.  Kerri has been working really hard to get the children ages 0-18 up to date on their vaccinations.  When she started her position the vaccination rate was only 10%, now vaccination rates in these colonies have reached 9/10 kids on each of these colonies all being up to date for ages 0-18.  This was a huge accomplishment for the colonies and to celebrate we brought root beer floats out for the kids of the colonies.  It was a really fun morning! Kerri also did some injections and lab draws while we were there.  Their overall health maintenance has been positively affected by the impact and care that Kerri provides through St. Benedicts. 

I really enjoyed getting to know the communities a little better and Hutterite history from the area.  They are all very welcoming and happy to have the services that are provided. They were so welcoming we even got lunch! We ate lunch at the Lakeview Colony it was so awesome!! They served us dumpling soup and fresh from the garden spinach salad!   It was evident that there is a great relationship between Kerri and all of the colonies and that has been built over several years. It was a really fascinating day and I feel like I understand a little more about their culture and way of life after visiting these colonies.  I know this experience will help me build rapport with Hutterite patients in the future.

Friday June 5, 2015
I started my Friday morning with a colonoscopy with Dr. Wickersham.  He let me take over the controls for the scope, and again…. I’m going to need a lot more practice but still awesome to assist!  After that Lisa and I loaded up with Kerri and headed out to the Tschetter colony, this time for chronic disease support group.  This was a lot of fun!  I did blood pressures and heart rates on the women in the group and Lisa recorded their weights.  Melissa Gale led us in exercises using resistance bands teaching the women from the colony how to utilize stretching and resistance bands for daily exercises to improve their strength.  Lisa and I determined these exercises were harder than they looked! After the session we headed back to Parkston and drove past a few Amish horse and buggies on our way.  They were headed into town to sell their goods, as it was the citywide rummage sales in Parkston.  After lunch I shadowed in the clinic with Dr. Wickersham.  It has been really nice to spend time with all the physicians as they all practice a little differently and it is great to see variety and the different patient physician relationships.

Saturday & Sunday
This weekend was a busy weekend in Parkston.  There was a Relay for Life cancer 5K walk/run on Saturday morning.  They had a really great turnout with around 150-200 people participating.  They did a really nice job organizing the event.  On Sunday they held the annual Kick Depression Kickball Tournament.  They had 8 teams and I was really surprised by the turnout and amount of competition within the teams of the community.  Everyone was really excited for the event and many teams had made team t-shirts, participating annually.  It was really fun to watch and be a part of the event.  Lisa and I ran the concession stand for the tournament.   I knew it was serious when they started telling us about the “official rules” and traveling trophy.  Awesome event to support mental health awareness and I think something that is often considered “taboo” or not discussed openly especially in smaller communities.  There was great participation and all the proceeds from the event stay local in Parkston to help support depression awareness and mental health services.  There were also citywide rummages all weekend.  Overall, this was a very active weekend for the Parkston community.  This is a progressive and involved community it was fun to take part in the excitement.

Week 4
June 8, 2015
We started our morning out with some water aerobics!! It was a great time, the ladies were excited to have us and were really welcoming! The exercises used water weights and the resistance of the water for the exercises.  I can see the huge benefit for individuals who have arthritis, trouble walking, balance problems, and back pain, as the water is very therapeutic and easier to exercise in.  Then we went to Physical Therapy for a while and watched a fitting for orthotics where they actually make a mold of the patient’s feet.  This particular patient has significant foot pain with walking and is really looking forward to getting the orthotics. 

After lunch we went to the lab and went through the chemistry, hematology, and microbiology testing.  I really enjoyed this part of the day. I really struggle to study microbiology but seeing the concepts in person being used on a daily basis will hopefully motivate me to study this area a little more! It was nice to see what the other end of ordered lab tests really entails and the lab techs really had a great scope of knowledge behind all the tests. I finished my day sitting in on a therapy session with Melissa Gale.  I feel that mental health is not a focus throughout our curriculum but it is an area that we will likely see in many of our patients so I am grateful to get as much exposure as possible.  We finished our day with dinner at Rita’s house.  It was really nice to have a chance to relax and visit about our experience while getting to know everyone a little better.  Big thank you to Rita!

June 9, 2015
We started our day bright and EARLY! We were at the hospital at 5:30 am to head out to Parkston Grain & Feed to do health screenings.  The screenings involved height, weight, blood pressure, and lab work including a lipid panel, basic chemistry, hemoglobin A1C.  I did blood pressures throughout the morning.  When we finished at Parkston Grain & Feed we went to Noteboom Implement in town to continue our screenings. It was fun to meet members of the community and visit with them about their jobs as well as stress levels and demands on the job.  We were even able to interview the manager for Noteboom for our community project.  In the afternoon I shadowed Dr. VanderPol in the clinic.  I removed some sutures and she taught me about communication with individuals with a hearing deficit.  It was eye opening to consider the challenges facing individuals with a hearing impairment throughout the pregnancy, delivery, and modifications to assist with parenting an infant.  This was a tiring day and as we approach our last day in Parkston we have been working hard on our final presentation, community project wrap up, and our paper summary of Parkston. 

June 10, 2015
Our schedule was pretty free on Wednesday so I took the opportunity to attend hospital rounds and shadow some procedures.  Dr. Kampmann was there for outreach services and did a carpal tunnel release.  It was a nice review over the anatomy of the hand and an interesting procedure to watch.  He did a great job teaching throughout the entire procedure.  Dr. Honke also did a basal cell carcinoma removal on the back.  It was nice to see the technique used and the margins that you have to take to ensure that you got all of the area as well as so that it heals easier with less of a scar.  Dr. Honke did a nice job walking Meredith through each step of the procedure while she performed it.

In the afternoon we went out to some of the Amish acreages in the area.  The Amish do not believe in running water, electricity, indoor plumbing, or motor vehicles it is a part of their religious beliefs and integrated into their way of life.  I really enjoyed seeing this and meeting these individuals.  Everyone was super friendly and we quickly discovered they are very talented craftsmen.  I bought a rug that they had made on a loom, they had many to choose from and all were very beautiful.  They showed us some beautiful quilts that they had hand stitched as well as some of the furniture they had made.  It is a different way of life and I am really glad I had the opportunity to visit them and hopefully able to better understand to care for them in the future.  We also drove through Delmont, where exactly one month earlier a tornado ripped through the town causing horrific destruction.  The town has come a long way and it is easy to see the power of community during a challenging time.

June 11, 2015
Today was mostly a day we used to wrap up all of our paper work for the REHPS program and our community project.  We also attended the Parkston Commercial Club, which I had never heard of but realize now that it is very similar to a Chamber of Commerce in bigger communities.  This organization does a great job organizing community events and have several planned for the remainder of the summer.  In the afternoon I shadowed Dr. Witt, a family medicine resident, who is currently in Parkston for a rural rotation.  It was great to learn from her as she is a little younger and vividly remembers being a medical student and what to teach me throughout the day.  There was also a motor vehicle accident that required a counseling consult that came to the Emergency Room.  It was nice to see the behavioral health component and how both the providers and Melissa Gale used interprofessional teamwork to better care for this particular patient.  We wrapped up our presentation and paper that evening. 

June 12, 2015
Hard to believe that today is our last day in Parkston! This has been an amazing experience and I have learned so much about the Parkston area and the services available through Avera St. Benedicts.  They have a wide reaching footprint extending more than 50 miles.  This is a wonderful facility that does a great job for the community.  The physicians have been so patient with me throughout this experience; I have learned so much from each of them.  Their scope of practice and the procedures they perform is unmatched; I quickly realized just how much more I have to learn.  It has been a rejuvenating 3.5 weeks, a vivid reminder of exactly why I want to be a physician.  I have a long road ahead but the REHPS program has helped to motivate me to continue my journey in medicine and shown me all that rural family practice has to offer.