Francoise’s Blog

Back to Students 2014

Week 1 Webster, South Dakota

My first week in Webster was pretty busy. I met my partner Dawn Holborn for the first time as I entered the clinic, where we were greeted by Evelyn Christensen, the clinic manager.  Evelyn gave us the grand tour of the facility, and introduced us to the staff. We were impressed as to how welcoming all the staff was.  She gave us our four weeks schedule, showed us our rooms, then two gentlemen helped us move our luggage in our rooms.  Upon entering our room, we each discovered a beautiful fruit basket, and a second basket full of Sanford logo items. It was a nice welcoming gesture.  We started the afternoon’s events with a meeting with Cheri Buffington which was followed by attending the Health Webster meeting; where community members from different backgrounds met to discuss the future of their community.   During the meeting, each participant was encouraged to give his/her opinion and/or suggestions on how to develop and help the town grow.

The second day was very eventful. We started the day at 0600 with the cataract-implant surgery. We met a dynamic group of surgeons, CRNAs, and nurses.  We spent our time following patients from the admission, surgery, to recovery/discharge. In the afternoon, we attended the clinic staff meeting. We shadowed Lola, PA for the rest of the day. We had two acute cases: The first one presented with C/O right lower quadrant abdominal pain. X- Ray and Labs were ordered. WBC came back normal, UA and X-R were normal as well. The provider contacted the general surgeon for consultation.  Patient was admitted to the hospital overnight for observation. The second patient, with history of CHF, came to the clinic for 2 weeks follow up after starting on Aldactone. The med combination with other meds caused hyperkalemia, with the potassium level at 7.3. The patient was asymptomatic, and stated that she was doing fine. She was admitted to the hospital for IV fluid and treatment nonetheless. The patient received a dose of Kayaxalate, and Lasix and Lisinopril were discontinued.

The morning of the third day was spent in the LTC. We participated in their morning meeting, and morning devotion with the residents. We spent the rest of the morning shadowing nurses in their daily activities.  We took time in the afternoon to meet some community members to arrange time for the final project interviews.

The fourth day we shadowed the orthopedist and his PA. These two providers visited their patients in Webster from Aberdeen, as part of their community outreach.  In the afternoon, the SIMSD (Simulation in Motion South Dakota) truck came to the facility for the hospital/ ER nurses training form 1300-1500. We spent the rest of the day with Lola, PA at the clinic.

Day five was spent with the outreach dietician, through her consultations.

Overall, we had a good week; the staff is very friendly, they are trying to make our stay easy. On Wednesday we went out with some clinic staff to a restaurant. It was a fun time to get to know each other.

Week 2

Day 1: We had a D-con session training this morning with hospital/ER nurses; it was a video training with a quiz, then we learned how to don the mask and suit during D-conning episode. At noon we went to the Kiwanis club for a presentation. I spent my afternoon at the clinic shadowing Cheryl, PA. It was good taking care of patients.

Day 2: We spent the morning in the OR with Surgeon, Dr. Christensen and his team. They had six patients scheduled for a colonoscopy. It was interesting to view the procedures live, versus photos. A polyp was removed from one of the patients, and a cancerous growth was discovered from another patient. In the afternoon, I shadowed Cheryl, PA at the clinic. It was interesting to see the relationship between a provider and her patients—going beyond patient care. Active listening of patients is as important as direct care.  In the evening, we were invited by Kari, RN and her husband for dinner; then they gave us a tour of the countryside.

Day 3: We shadowed Angie- the pharmacist- this morning and she explained her role working in a rural area. She not only takes care of inpatients, but also outpatients who need different infusion treatments. The hospital pharmacy holds commonly used medications, but in the case that they don’t carry what is needed for a patient, they can order it from the local pharmacy. In the afternoon we shadowed Dr. Amin-the outreach oncologist- with his team. He did not have many patients to see today, but still drove from Watertown to Webster. I took the opportunity to discuss with Dr. Amin regarding my school research project questioning the recommendation of self-Breast examination (SBE) as a mean of early cancer detection. I am in great admiration and respect of these providers who take time to drive for miles to attend to their patients in their own community.

Day 4: Today I shadowed Dr. Mantone, the outreach orthopedist.  He had 16 patients, some scheduled for follow ups, others as new patients with different complaints. The most interesting case was the intra-articular injection of Synvisc-One (hylan G-F20) in the knee. Synvysc-One is an injection used in the case of osteoarthritis knee pain, to supplement knee fluid and help lubricate and cushion the joint; it can be repeated every six months. After lunch, I went back to the orthopedic outreach clinic, and then Dawn and I went to meet with the city mayor for the wellness coalition interview.

Day 5: We spent the morning with Lana, CRT and Mary Jean, CRT at the cardiac Rehab. I went to the clinic in the afternoon, and shadowed Cheryl, PA. I visited with one of her patients on the floor; she had a swollen and erythematous L jaw, and a 103 F temp, caused by a dental abscess. Was started on Amoxicillin 3 days earlier, but it did not help. After dental intervention, she had a drainage tube inserted, was hospitalized, and started on IV Clindamycin 600mg every 6 hrs; she also received analgesics around the clock for pain management. The antibiotic helped to decrease the swelling, than it came back again. She received IV Solumedrol to help with the inflammation, and a CT scan of the head and neck was ordered, the ENT was consulted with the CT scan results; and he advised to continue with antibiotics. Around 1500 we went to the lake to meet with Lola, PA and her key club members.

Week 3
Sunday: Dr. Gravely let me follow her while taking care of one of her patients, who ended up being transferred to Sioux Falls by air.

Monday: We shadowed Dr. Flaherty, the outreach OB/GYN; he only had one patient today, which gave me time to spend at the clinic with Dr. Gravely. We took time in the afternoon to interview some community members for our final paper.

Tuesday: We followed the outreach podiatrist from Watertown this morning; and in the afternoon, we observed Dave and Kyle, physical therapists taking care of their patients.

Wednesday: We were scheduled to shadow Dr. Sharma, the outreach cardiologist, but ended up working on our final paper. In the afternoon we went to the retail pharmacy and stayed there for the rest of the day.

Thursday: We spent our morning in the lab. It was interesting to watch and even run some tests with the guidance of the lab professionals. This lab is well equipped; and can run almost all the tests. We went back to Cornwell pharmacy where we spent the rest of the day before we took off for the holiday.

Week 4
Day 1: I was at Dr. O’Dell’s office, the dentist, this morning, and with his dental hygienist in the afternoon. He had two patients for fillings and one who needed to be fit for a set of dentures, and the last one needed a tooth extraction in preparation for molding, then dentures.

Day 2: We followed Dr. Werth, general surgeon, today; he had seven patients scheduled for a colonoscopy, most of these procedures were diagnostic screening. It was interesting to see, live, what diverticuli looks like. We did not have anything scheduled in the afternoon; we had an interview with the local newspaper “Reporter & Farmer” regarding our experience in the hospital and the community as a whole.

Day 3: We took time to work on our final presentation in the morning and I went to the clinic with Lola, PA-C in the afternoon.

Day 4: We observed the Excell, an athletic skills improvement program, with Kyle, PT, and Randy, OT and were able to assist the middle and high school students participating.

Day 5: Today is our last day of the summer experience; we had a PowerPoint presentation regarding our experiences in Webster.