Erin’s Blog Back to Students 2013
Platte, South Dakota
From the moment I arrived in Platte, I have felt completely welcomed. Everyone has been so friendly and helpful. Not only have I felt welcomed by the staff at the Platte Health Center, the community of Platte has also made me feel like I am a part of the community. For example, when we have gone on walks, almost every person that drove by us has waved at us. Shelby, my pharmacy partner, and I have discussions several times everyday about how Platte has some of the nicest people we will ever met. I am looking forward to meeting more people within the community in the upcoming weeks.
I spent quite a bit of time this first week with the physical therapy department. To be honest, I really had never spent any time with physical therapists. Mark, Matt, and Jen were all very knowledgeable, and seemed to enjoy their jobs. Many of the patients I saw with them were improving in their health and quality of life because of these therapies, showing just how important physical therapy is and how successful it can be. Having been able to see the success of physical therapy, I have a greater appreciation for what physical therapy is and what it can do. One patient that I found particularly interesting was a young girl from a nearby Hutterite colony receiving physical therapy treatment for spinal muscular atrophy (SMA). SMA is an inherited disease that causes muscle weakness and wasting. For her treatment, she got out of her chair and walked with a walker down a long hallway in the facility. She almost walked the entire way back! I was told that that was the most she had ever walked with her walker. She then did some other muscle strengthening exercises. Although the prognosis for SMA is poor, with many of those diagnosed not even making it past infancy and others living only into their twenties, the girl had a smile on her face and an optimistic look in her eye for the entire appointment.
I also spent time in the laboratory. Erica, Cathy, and Angie showed me around the lab, and explained the different machines and what tests they could run. The lab was open and well organized. Their lab is able to do many tests, which I think may be a surprise to some because of what they may assume is available in rural health facilities. In the lab, a 8-9 day old newborn came in to get her blood drawn. For babies, blood is drawn from the heel. It is a significantly slower process to get blood from a newborn; the process is literally drip-by-drip. As each drop was collected, the medical technologist soaked the blood up on a Guthrie card, which is used for newborn screening tests.
Shelby and I went downtown on Saturday morning to look at the stores. We did not get a chance to go to them all, but plan on getting to them at some point. At every store that we did go to, I found many things I wanted to buy, such as candles, scarves, and quote plaques. I know I will be visiting these stores again before I leave Platte because I will have to bring something home to my family. On a personal note, on Saturday night, my sister texted me a picture of her hand with a ring on it. Her boyfriend had just proposed to her! I immediately started tearing up because I am beyond happy for them. Later that night, my sister and I were able to talk via FaceTime, so it was kind of like me being there with her. I am very thankful for the technologies of FaceTime and Skype because I am still able to directly talk to my family and friends while I am here. This (Sunday) morning, I attended a church service at Trinity Lutheran Church. As I assumed I would be, I was welcomed by several people including the pastor. The service was very similar to the church services of my home church in Vermillion. It was an extra special service because it was Mother’s Day and the graduating seniors received their senior quilts from the church. I plan on attending that church for the remainder of the weeks of this summer internship and then also plan on becoming an even more active member when I return to Platte next year through the FARM program. On my walk home from church, I called my mom to wish her a “Happy Mother’s Day.” Although I miss my family, I cannot wait to continue on with the REHPS internship. I am already learning so much about medicine, other healthcare professions, and rural healthcare, as well as life in rural communities. And I know I will only continue to learn more!
Shelby and I started this week by attending a telehealth appointment, through Avera eConsult. The Avera eConsult is just one of the several “e” services that the Platte Health Center has. These services connect Platte with physicians and other healthcare professionals and resources in Sioux Falls, showing how technology is allowing rural areas to enhance their care and services with additional and expanded help. It is quite an advanced technology that gives another set of eyes and other brains to the health issues that come into the facility. It also allows patients to avoid having to travel to Sioux Falls for some of their appointments. The appointment was with an older woman with multiple myeloma and her oncologist. The patient had received a stem cell transplant months ago, and was continuing to receive her chemotherapy treatment here in Platte. Before her appointment, we talked briefly about how she had been diagnosed with multiple myeloma. She had said that she had first noticed her back hurting, but just had attributed it to aging and just pain from her daily life. After about 5 months, she finally went in and had it checked out. Combined with other common symptoms of the disease, she was diagnosed with multiple myeloma. Even before the eConsult appointment started or the patient had continued to talk about her symptoms, I recalled my Biochemistry class (Yes…I used what I learned in Biochemistry!), where we were taught a way to remember the symptoms of multiple myeloma. It is with the acronym CRAB: C-high calcium; R-renal failure (high serum creatinine levels, Bence Jones proteins in the urine); A-anemia (low hemoglobin); and B-bone lesions. During the eConsult, she talked with her physician about how she was feeling much better since then. The oncologist said that her blood tests had all came back improved, and that he would like the patient to continue her chemotherapy treatment.
We then spent time in Cardiac Rehab with Nancy, the main cardiac nurse, as she worked with a man who had had an myocardial infarction earlier this spring. The patient had noticed his chest feeling tight and came into the hospital soon after. He had otherwise been in good shape. He also had not had any family history of heart problems. His job was quite physically demanding and stressing, which may have been a factor in his MI. Now, this patient was coming in a couple times a week for these tests. Nancy said that it is important that people find healthy outlets for stress because stress can greatly affect one’s health, especially their heart health. The stress test was quite a workout. The patient had to walk on a treadmill, do arm resistance exercises, and exercise on this bike-like machine. Throughout the test, the patient’s heart rate, EKG, and blood pressure were monitored.
The radiology department was very interesting to be with. Lelsey and Emily showed us around the department and explained what they were able to do in Platte, which is quite a lot. Once the scans are taken, they are uploaded into a database connected with other health institutes to be read by radiologists most often in Mitchell or Sioux Falls. We were able to watch an ultrasound of a woman who was 20 weeks pregnant. That was the first ultrasound I had ever seen. Lesley showed the patient and us the limbs, the spine, the face, brain, the organs, and some of the other features of the fetus. At that point, the patient did not want to know if she was having a girl or a boy, so Lesley had to keep it to herself. Emily did a CT scan on a nursing home patient who had been having seizure-like symptoms and a X-ray scan on a patient with neck and upper back pain. Having just finished neuroscience, I was able to identify structures and features on the CT scan. Fortunately, it did not seem to show any severe signs of damage. On the X-ray scan, I was able to see wires physicians had used to reattach the sternum together after having to break it for heart surgery.
Some of this week was spent preparing for our community project. In this area, they have a high occurrence of cardiovascular disease in men. So, Shelby and I have been tasked with creating a project that is directed towards men, providing them with information about cardiovascular disease. I researched quite a bit on this and found some easy-to-understand and detailed pictures that we will use. As of now, we are going to go to a local business whose employees are mostly males and set up a station where they can get their blood pressure checked. We are going to make a poster that will have information about cardiovascular disease on it. The hope is that we can educate some of men in the community about their health, and have them become more aware of their cardiovascular health and consider going into the clinic for a more comprehensive health assessment.
We attended a diabetic educational counseling session and then consultation with a dietician. Diabetes can be quite confusing, so it is good that educational counseling and consultation with a dietician is available.
I spent an afternoon at Hoffman Drug. Hoffman Drug is the local drug store in downtown Platte, that also sells housing decorations and small gifts. It is really the only pharmacy in Platte. I absolutely loved this experience. Mary, one of the pharmacists there, was so nice and helpful. Mary showed me how to look up and figure dosages, count pills, and fill orders. I do not know a lot about drugs, as pharmacology is a part of our second year curriculum. Mary did “test” me on some physiology that is helpful in knowing why medications were prescribed. I am happy to say that I was to know the answers!
I spent time shadowing Dr. Hagge in the hospital and clinic. From the moment I met Dr. Hagge, I could tell that he was a great physician who truly cared about his patients. He seemed very dedicated to the profession and seemed to take joy in meeting and working with his patients and the other healthcare professionals. He was very genuine in approach, and had very good manners. I also want to note that Dr. Hagge has one of my favorite doctor’s offices I have ever been in. The walls in his office are painted in Husker red and he has Husker memorabilia all over his office. We discussed and found a connection in our love of Husker football and respect for Tom Osborne. Go Big Red! He also has pictures of his beautiful and happy family all over his office. During that day, we saw many patients, ranging in age from a newborn baby to a nursing home patient and all of those in between. One of the patients I saw with Dr. Hagge was an older man, who was having a pre-op stress test. The patient was supposed to be having surgery to remove various areas on his face and neck in which there is skin cancer. However, during the stress test, the EKG revealed some concerns for Dr. Hagge, so he was unsure if he would allow the patient to go through with the surgery. The newborn that I had seen having her heel poked when I was in the laboratory for concerns of hyperbilirubinemia came in for a checkup, and her color was much improved even in just a week, and her levels were in the normal range. She had also gained weight, as she was eating better and her stools had changed to a more normal color and consistency. Another patient that I found interesting was an older diabetic patient who had had his fifth toe amputated. The surgery looked like it had been done well and the area was healing well. The patient had corns and large patches of dry skin elsewhere on his feet, reminding me that foot care can be an indicator in one’s health, especially in diabetic patients. After the day, Dr. Hagge copied some materials for me and asked me to look over some things over the weekend. I already have so much respect for Dr. Hagge. I truly look forward to being with him in the upcoming weeks and being with him during the FARM program. I know that Dr. Hagge is going to push me to be a better medical student, which will only help me to become a better physician.
I really enjoyed this week because I was able to spend most of the week with the physicians and the physician assistant. When I was with Dr. Bentz, we started the day by rounding at the hospital. After that, we went to the nursing home to visit a few patients. Nursing home patients have to be seen by a physician every 60 days, which allows their health, and treatment plans, to be reviewed by a physician. Most of the patients in the nursing home we saw had varying forms, and in various stages, of dementia. In the clinic, almost all of Dr. Bentz’s patients were in the older population. Dr. Bentz has been a physician in Platte for many years, so many of these patients have had time since he started here. Hypertension and diabetes were health issues of almost every patient we saw. Before going into each appointment, Dr. Bentz would review each patient’s chart, via EMR, and even make a list of health concerns, possible tests, and questions he wanted to discuss with that patient. Then, during the appointment, Dr. Bentz took his time with each patient. He listened to them, never rushing in the examination or hurrying to leave. I noticed that Dr. Bentz made it a point to “touch” each of his patients when he entered as well as when he left. This “touch” was in the form of a hand shake or a gentle pat on the back. I had learned in my Introduction to Clinical Medicine class last fall how important touch is in establishing and maintaining relationships, as supported by numerous studies. A touch can convey compassion, concern, and interest; it conveys a connection. I also noticed that many of the patients we saw were interested in improving their health so that they could continue to spend time with their families, specifically with their grandchildren. As several patients indicated, having children and grandchildren gave them new perspectives on life.
I spent time with Pam, a physician assistant, in the clinic. With Pam, I saw a variety of health issues in a diverse population of patients. I really enjoyed seeing and learning about women’s health issues, which is a significant part of Pam’s practice. I think it is very important that patients feel comfortable with their health care providers, and I definitely could tell that patients were comfortable with Pam. I could see the genuine care she had for her patients. With Pam, I also was able to see some children’s appointments. I realized during these appointments that I had enjoyed being around kids, as I have worked with kids as a lifeguard, swimming lessons instructor, Sunday School teacher, and volunteer in local elementary schools. I realized that I had missed being around kids. Maybe realizing this is helping me to narrow down what area of medicine I might be interested in going into (but I still do not have a definite idea…everything is so interesting in its own way).
While with Pam, Shelby came and got me because there had been an accident at the local meat locker. A cow had kicked a gate, that then swung and cut a worker’s head open. The cut was from the top of the worker’s forehead all the way to his eye brow. And it was deep. It was so deep that we were able to see his skull! Dr. Bentz put nine stitches in the man’s head, and then wrote a prescription for the man to have the rest of the day off from work to go fishing.
I was with Dr. Hagge for a few days, and again he tested me. I am appreciative of this because these “tests” challenge me to apply what I have been learning. I was with Dr. Hagge in the hospital and the clinic. We went back and forth between the two several times each day. Dr. Hagge seems to be the main OB physician in Platte, so we saw several patients in for OB appointments. On the first OB appointment I was with him for, Dr. Hagge explained what he was doing as he went through the appointment. Then, for the next OB appointments in his schedule, he said “You can do it.” I am going to assume I had a deer-in-the-headlights look, and said that I didn’t know if I was ready for that. But, Dr. Hagge reassured me that I could and said that the only way to learn is to try. So, with a deep breath, I went into the exam room. I measured the pregnant patient and then used the ultrasound to listen for and measure the heart rate. And I did it! I did that for the rest of the OB appointments that day as well. Although taking such measurements may not be much, I was proud of myself; having the confidence in my knowledge and skills is a step in the right direction towards becoming a physician.
I spent time this week again in the clinic with Dr. Bentz. One of the most memorable patients from my time with Dr. Bentz this week was a follow-up appointment to go over the results of the imaging tests of an older man who had come in the week before for weakness in his legs. Before going into the appointment, Dr. Bentz handed me the report from the radiologist who had read the images. My eyes went directly to two words: BONE METASTASES. We went into the room, and Dr. Bentz simply and gently explained that the man’s prostate cancer, which he had had for many years and which had been treated with radiation, had most likely spread to the bones in his back and that this was what was causing him to feel weak in the legs. I felt the man’s heart sink as I saw him sink back into his chair across the room. My heart sank too. Dr. Bentz then shared how this man had also had lung cancer in the 1970s, which had resulted in doctors removing one of his lungs. He had also been put in the nursing home several years ago, and by his own sheer determination, he got healthy enough to leave the nursing home. Dr. Bentz said he was a fighter and that he never wanted to give up, and the man agreed with a small smile. Dr. Bentz asked several times during the appointment what the man was feeling, what was going through the man’s mind, and what questions he had. The man really didn’t say too much, so Dr. Bentz shared what he was feeling, what was going through his mind, and what questions he himself had. Doing this, I feel, showed the compassion Dr. Bentz had for the man and that Dr. Bentz wanted to have an open and trusting relationship with this man as he would continue to need care. The man and Dr. Bentz discussed options for treating, never curing, the man’s cancer and/or his other symptoms. In the end, they decided that the man would go to Sioux Falls to meet with a highly respected, kind, and “good” oncologist. Although the man was hesitant about having to go to Sioux Falls, as he thought it would be a regular drive he would soon have to be making, Dr. Bentz explained eConsult and reassured the man that such appointments could be right in Platte and treatments could possibly be done in nearby Mitchell. Dr. Bentz told the man that they would arrange everything so that almost all, if not all, of the tests and everything could be done in just one trip to Sioux Falls. The man felt better about going to seeing the oncologist after learning about this. And just as the man had came into the exam, as a fighter and a small smile, he left the exam room, continuing to fight with a hopeful smile.
Shelby and I worked on our project by making a handout on blood pressure. Then, we set up our project at the local drug store, Hoffman Drug, in downtown Platte. We did blood pressure and blood sugar checks there. Having been told that cardiovascular diseases and diabetes were problems in the community, it was a pleasant surprise that most of the people we checked had healthy blood pressures and blood sugars.
Looking back on my time in Platte, I immediately think about all of the welcoming and helpful people that I was able to meet. Everyone that I was able to be with in the hospital taught me not only about their profession, but about themselves and their life in Platte. They had strong work ethics, a genuine compassion for others, and a passion for their professions. I have an even greater appreciation for every healthcare profession, as I was truly able to see the importance of working together as a healthcare team for the betterment of patient care. And the welcoming people I met extends beyond those in the hospital. From the ladies enjoying the cool, sunny mornings sitting outside that said good morning to me as I walked past them to enter the hospital, to the teenaged boys that carried my groceries to my car, to the ladies who own the cute clothing stores downtown, and to the little kids that played on the school’s playground as I walked around the track, I always received genuinely, welcoming smiles and conversations. I have enjoyed my time in Platte, and I cannot wait to get to be a part of the community even more when I come back next year with the FARM program; I know I will be greeted with just as many smiles and will be able to have even more learning experiences.