Week 1 Winner, South Dakota
Today I started my journey as I traveled west from Sioux Falls toward the town of Winner, SD. I can honestly say I have never driven this far west all by myself so I considered it an adventure into the unknown. To make things a little more interesting, I also decided to “man-up” and make the trip without the assistance of any GPS device. However, I will admit, I did have to use my smartphone once as I entered Winner to see exactly where the Winner Regional Healthcare Center was located. I was so close to achieving total self-reliance. Ugh… but oh well. It was actually a very scenic ride as I went from different areas of farmland through Parker, Parkston, and Platte. Then I experienced some hills right as I was crossing the Missouri River towards Winner.
Chance and I arrived at about the same time and met Cheri and Rose who was staying in the nearby town of Platte. We discussed the REHPS program and then went to a local restaurant called Joie’s for lunch. After this Cheri and Rose went back to Platte while Chance and I were given a town tour by one of the hospital coordinators named Lynnelle. After seeing the sites of Winner and learning some history about the town we were brought to our apartment residence for the next few weeks. We all went inside and Lanelle decided it was not ready for us yet because some previous tenants still had belongings there so Chance and I ended up staying in the Holiday Inn Express located on the edge of town. We did not mind because there was pool access and free breakfast. Later that night we went to another local restaurant called the Holiday House for dinner and went to a local ice cream joint called Frosty Boy for dessert. It was a really good time but Chance and I both agreed that we would not be walking that distance from the hotel again because of the swarms of mosquitoes that attacked us along the way.
Today was my first day in the pharmacy where I met the two pharmacists, Marla and Liza, along with the one technician Kristy. There were around 10-20 patients that needed attending to and only a handful of IV medications needed to be prepared. I went on a few medication reconciliations and toured the microbiology lab. To my surprise this lab actually had quite a bit of advanced technical equipment. Patty the lab coordinator showed me all of the standard lab procedures as well as the old and new technology used on a regular basis. Later, Chance and I saw more of the hospital and then left to go lift weights at the armory gym weight room. There we met Harvey who was the past high school principal/athletic director and John who is a current math teacher and baseball coach within the school system. They were both very friendly and willing to inform us on the gym information and access times.
Today I followed Dr. Tarek Mahrous within the cardiology clinic. Throughout the day we helped patients diagnose their heart problems and get them on the right track toward good quality of life. We reviewed charts, spoke with various patients, ran regular and chemical stress tests, ordered echocardiograms, and had some fun around the office. I learned a lot about interpreting doctors’ notes and about how certain tests were conducted. It was interesting to see the patient-doctor relationship within this rural setting. There seemed to be a closer family centered sort of care compared to what I am use to seeing in a bigger city. After work Chance and I were able to move into the cleaned apartment known as “The Loft.”
Today I was mainly in the pharmacy where I did many standard intern duties such as preparing the daily medication cart, compounding medications, and reviewing orders. I was also allowed to attend an EMR meeting where many of the hospital employees gathered and talked out issues that could help make the hospital more safe, efficient, and productive. Throughout the meeting it was interesting to see the give and take of information presented at this forum. Many issues were brought up and some seemed to get resolved. After work today I ran into Rose as she was traveling through to Rapid City from Platte because she had finished her four weeks REHPS program. We explored the town, went to Frosty Boy, and then went our separate ways. I decided to run the track for a few laps and then Chance and I went to Leahy Bowl to watch a few baseball games against Colome. It was a fun experience to see such good teams playing in a very nice stadium that one would not expect to see in a smaller town. You never know what you will find in the middle of South Dakota.
Today was my first day visiting the clinic that is connected to the hospital and nursing home facility. I started the day off by talking with a drug representative about Linzess and Fetzima. It was nice because I learned all about these products as I enjoyed some Panera Bread that the drug rep. supplied in return for my attendance. Next I shadowed a CNP by the name of Rebecca Olson. As we made our way through the clinic and made our rounds through the long-term care facility I was quickly put to work. Throughout the day I was able to participate in a number of activities that were very unique and interesting to me. I was able to help remove a few stitches, look at collected specimens under the microscope, help with diagnosis, run a few strep tests, and I was able to see how this side of healthcare correlated with the pharmacy. When I wasn’t with Rebecca Olson I was with another CNP named Erin Tobin. It was interesting to see their prescription preferences and I liked being able to ask them why they chose certain selections of medications and what medications they seemed to have the most luck with. After work, I decided to run a few miles on the track while getting a little sun. Later Chance and I decided to checkout a local restaurant called Sargent’s Café where we were both pleasantly surprised at how delicious the food was. After dinner we decided to stay out and witness a little of the nightlife around Winner. It turns out that our apartment is conveniently located within walking distance of the three bars located with the town. The folks were nice, the drinks were cold, and the pool tables were open. It was a fun night had by all.
On Saturday Chance and I ended up participating in the Winner Country Club golf tournament. We just had to show up and the nice people there quickly found us both a set of clubs to use and a golf kart. I have never played so much golf in my life or had that much fun while playing. Thankfully we were playing “best ball” because I will admit I am sometimes just lucky to hit the ball on my first swing. However, 18 holes and a little sunburn later, our group ended up winning within our division of the tournament. I was able to meet some new people, work on my golf game, and walk away with a prize bag.
On Sunday Chance and I went to the Immaculate Conception Catholic Parish in Winner. It was nice to see a full attendance in a small town church and the priest was very friendly. Also late Sunday night we were joined by Chris Wong who is a medical student doing one of his last rotations here in Winner. He is now staying in “The Loft” as well and working at the hospital.
Monday: Today I was in the main pharmacy again filling medication carts and helping with compounding. I was able to find time to work on my REHPS projects and I witnessed a fire drill within the hospital. I was also able to see how an IV room hood was fixed. Apparently the chemotherapy drug hood had too much negative pressure causing things to get blown around in the hood as medications were being compounded. A few guys were able to fix the problem by adjusting the motor to the ventilation system and correctly adjusting the negative pressure.
Later, Chance and I discovered that our new med student roommate is actually the next “Turtle Man.” We noticed that he had a few aquariums in his room and Chris gladly showed us his Bearded Dragon lizard (that is 11 inches long) and 7 of his albino turtles. We now claim to have our very own mini reptile gardens in Winner, SD.
Tuesday: Today was my first day outside of the hospital setting. I actually worked at the Healthmart retail pharmacy in town with pharmacists Jack Burns and Kara Zeigler. This small stand-alone pharmacy was a little different from my larger Sioux Falls Hy-Vee pharmacy that I was used to. The staff knew every person that walked through the door and customers rarely had to wait longer than a few minutes for their medication because of the pharmacy’s efficiency and typical but steady workflow. This pharmacy is actually responsible for all of the long-term care patients’ medications. These medications are supplied on a monthly basis in the form of bubblepaks that the pharmacy generates and delivers. The Healthmart Pharmacy also delivers and supplies a number of medications to some assisted living homes and special-needs clients. While working there I became familiar with their system and was able to fill orders, counsel patients, and take orders over the phone. I would have to say I was most excited to actually have to use a mortar and pestle to ground up some medication tablets into a fine powder so that it could be mixed into a suspension for nasogastric application. I can now check that off my bucket list.
Wednesday: Today I mainly shadowed Dr. Berg who is a family medicine doctor within the Winner healthcare system. This day was full of activity right off the bat. I arrived in the morning and actually got to see my first natural birth. After that Dr. Berg and I raced to the Mission clinic near the Rosebud Native American Reservation to take care of patients there. Dr. Berg is the pain specialist in the area so most of his clients had pain issues and were seeking treatment. The Mission clinic is also unique because it contains a telepharmacy within the clinic itself. The main pharmacy it connects with is in the town of Burke, SD. I was able to see how the system worked and talk with the pharmacists on the other line. Throughout the day I was able to learn a lot about the Native American culture and about the challenges of dealing with patient therapy. After leaving the Mission clinic, Dr. Berg and I responded to a house call for a patient. We arrived at the patients home, assessed her needs, and then modified her drug regimen. All in all it was an eventful day.
Thursday: Today I was stationed at the Shopko pharmacy in Winner. Nelle Schloemer is the PIC and I spent most of my time with her as we discussed the business side of pharmacy relating to costs and insurance dealings. We went over all of the different forms and individual aspects of a pharmacy business from the AWP to the MAC. I learned a lot about the differences between my hometown Hy-Vee pharmacy compared with this small town Shopko pharmacy. While at Shopko, it was fun to see some of the patients from Wednesday when I was with Dr. Berg come in to get their prescribed medicine. I got to see the whole healthcare process full circle. After today’s work I was allowed to go home for the 4th of July weekend. So I packed up my bags and drove back to Sioux Falls. However, I did happen to stop at Boom’s Ice Cream store in Platte along the way for an excellent root beer float.
Friday/Saturday/Sunday: This weekend was full of fun and family. I’m glad I was able to go back home to celebrate.
Monday: Today Chance and I both went to the Winner jail here in town. We were able to enter the building once we passed inspection and then Karen showed us how she went about delivering the daily medications to the inmates. The 96 inmates at this facility were pretty much grouped into 6 different large holding rooms. The women were separate from the men and the men were separated based on behavior towards others, age, and whether or not they were on the work release program. The medications were organized on a regular med cart with the bubble packs of medications sorted by inmate. Once all of the medications were given to an inmate the inmate then had to swallow all the meds and show the jailer all around his or her mouth to prove that they were not trying to save their meds for other activities. They also had to show their hands as to prevent the inmates from hiding the pills in-between their fingers for later use. I had never been in a jail before so this was quite the experience for me. Some inmates seemed nicer than others at times just by the way they carried themselves. Some would refuse their medications and others would want extra meds like cough drops and Tylenol. Apparently cough drops are used like candy if they are not limited.
Later on that day Chance and I were with Dr. Berg when he came to the jail to treat some of the inmates who were requesting medication. It appeared to me that this could be a difficult task when some inmates had no medication compliance in the past or medication history.
After our time at the jail we decided to go to the gym. Chance and I played Racquetball for a while at one of the gyms and then we went to the drive-in movie theater and saw “How to Train your Dragon 2.” We met the owner of the theater and got to watch the movie from the car. It was the perfect clear night to do so.
Tuesday: Today I was scheduled with the OR/anesthesia group. As soon as I arrived in the morning I was able to see a c-section. The procedure went very smoothly and the baby was healthy. There were no complications and the staff seemed to work well with each other. Later on I was able to witness an endoscopy ablation. This patient was one of the most calm people I have ever seen when it was time for the hose insertion. There was no reflex or moving from the patient therefore the doctor was able to get in and out with efficiency.
After work it was pretty nice outside so I decided to go for a walk and explore. I saw quite a bit of the town but I guess I must have looked suspicious because a cop car seemed to follow me for a good portion of the walk.
Wednesday: Today I was with the home health nurses. We travelled to a few towns including Mission, Colome, Gregory, Witten, Carter, and Ideal. During a visit we would find the patient at their home, see how they were doing, and check their vitals. Sometimes I was required to help fill their pillboxes. Other times I helped with medication reconciliation because sometimes IHS would change a patient’s therapy without properly educating the patient or without informing the patient’s regular doctor and pharmacy. The Winner Regional Healthcare center is actually the only home health outfit within a 60-100 mile radius so it keeps busy with patients from the neighboring towns. At almost every house that we went to I was asked if I played basketball. Ha! It may have been because of the fact that I was quite a bit taller than the nurse I was with for the day.
After work Chance and I decided to walk to the only “non-drive-in” movie theater in Winner. It just so happens that it is located a block a way from our “Loft.” It only has one screen that shows only one movie for a week at a time. They have one show time a day every day except for Fridays and Saturdays when they have two show times.
Thursday: Today I was back at the Healthmart pharmacy with Kara Zeigler. This time around I was much more familiar with how things were operated within the pharmacy so I was able to help out a lot more. I was taking phone calls, counseling patients, filling prescriptions off the queues, and I was able to compound again.
After working at Healthmart, Chance and I were able to get CPR certified because Sharon had to do a session at the hospital anyway. I’m now hoping that session counts for this next year’s CPR requirements for the next school year.
After getting trained, Chance and I played racquetball for so long that I actually got blisters on my fingers from the racquet. You know you play too much once you start getting blisters!
Friday: Today I was in the Long-Term Care building connected to the hospital. This area was basically the nursing home section where patients were admitted if they needed to recover from a disease state or surgery but they still needed to be monitored closely. But this area mainly housed elderly people who could no longer take care of themselves. I was with nurse Betsy most of the time as we delivered the morning and afternoon meds. Some patients seemed more compliant than others and some required pudding or applesauce with their pills. This population is just full of stories and I bet I could spend the rest of my life with all of them and still not get to hear all of the stories they have to tell. It was interesting hearing the history behind their lives, what they used to do, how they got to where they are, and getting to know each personality.
Also today, for some odd reason, the Aflac Nascar was in the hospital parking lot and the hospital staff had a free big hot dog cookout for the noon hour. You could get lunch, check out the car, and hear how loud it gets when you rev the car engine. I had to plug my ears for fear of losing my hearing.
After work Chance, Chris, and myself decided to walk to Frosty Boy because Chris had not been there yet. I got a brownie sundae while Chris enjoyed a turtle sundae. Chance had a coupon for a free cone so he got a vanilla cone with cherry hard shell and sprinkles.
We were walking home when we decided to go to the latest movie at the theater. So we walked straight to the theater and made it just in time for the movie to start. It was all perfectly unplanned.
Saturday/Sunday: This weekend was pretty chill. Not a whole lot happened and Chance and I mainly stayed around town working out and working on our REHPS project. On Sunday I watched the World Cup as Germany defeated Argentina for a sweet victory. I myself am German so I felt that I should probably root for them. Chance and I also walked to Subway for dinner later on that night.
Monday: Today Chance and I were both with Dr. McNamara, a maternal-fetal medicine doctor, and we were also with Dr. Stamato who is a pediatrics specialist in cardiology. These doctors only come to the Winner clinic a couple of times a month to see patients otherwise they are located at Sanford in Sioux Falls. While with Dr. McNamara I was able to see a few ultrasounds of developing babies ranging from 20 to 33 weeks of age. We were looking for proper growth development and addressing any abnormalities that possibly came up. It was very interesting to see the different babies’ toes and faces through the advanced ultrasound technology. It was also pretty neat to see how the nurses could calculate how old the baby was and how much it currently weighed based on measurements from the ultrasound. Some patients had normal pregnancies while others were close to premature labor. Some future mothers were in good health while others were developing gestational diabetes.
While with Dr. Stamato I was able to view how she analyzed the children who had possible heart abnormalities. Sometimes there would be an issue that runs in the family related to heart disease and other times there would just be an abnormal heart lab value that just couldn’t be explained.
Two FARM students, David Kapperman and Heather Walker, also joined Chance and I today as we shadowed the physicians. It was fun talking with them and seeing where they were in the education process.
Tuesday: Before work today Chris and I decided to walk next door to the bakery and have some fresh donuts for breakfast. We talked with the owner for a while and got a picture with him for our REHPS slideshow. At work I decided to go into the clinic with Dr. Wong. (AKA, Turtle Man Chris, my other roommate.) We had a variety of cases today ranging from parents demanding antibiotics for their viral children, to a case with a kid having eczema behind his ears. We were able to look at x-rays of a fractured wrist, some sore feet, and we prescribed some medication for nerve related pain. I was basically Chris’s consult and one of the patients even called Chris and I the “Dynamic Duo.” It was really fun working with Chris and I did enjoy recommending medications and researching medications for certain disease states. Later on I helped select a Zosyn dosing schedule for a vaginal tear that had come up. At the end of the day I was joined by Chance and we watched Dr. Wong perform a circumcision on a newborn baby. We were both feeling for the little guy but he ended up being a real champ throughout the painful looking procedure.
Wednesday: Today I was back in the hospital pharmacy with Marla, Liza, and Kristi. We began the day as usual by filling our inpatient med cart and then I spent a good amount of time going over all the medications included in the different “kits” that the pharmacy was responsible for making. It was interesting learning about why each kit had certain medications based upon preference and therapeutic use. I was also able to go with Marla to discharge counsel a patient who had a few different directions on his medication vials compared to what his charts said. That could have been a problem but the guy was a good historian and he new how his doctor had most recently told him to take the medication. After this, I spent a while in the IV room with Kristi preparing antibiotics that I had recommended the day before when I was with Dr. Wong. Then I also assisted in compounding a variety of medications for the thirteen cataract surgeries that are scheduled for tomorrow.
It is hard to believe that this is my last night in Winner. Chance and I made the most of it by going to the gym one last time to play some basketball and racquetball. It was actually one of the best times at the gym. We were playing a little one on one and had a great time. We then walked home and realized we were both going to miss this place.
Thursday: Today was my last day in Winner. I find it hard to believe that my time here is over and I am so glad I was able to go through all of the experiences. In the morning Chance and I were able to help Dr. Hafner with four cataract surgeries. We only had time for four but Dr. Hafner actually had thirteen procedures scheduled for today. This was a very interesting procedure and there were actually three scope-optics available to view the procedure: one for Dr. Hafner, one for his nurse, and one for Chance and I to alternate using. I watched as he would pierce the eye, scrape up the entire cataract, suck it out with a special vacuum, and then implant a new lens. This was all done while listening to “80s Rock Hair Nation” Sirius radio. At times I felt like a rock star in that procedure room.
After a few surgeries Chance and I gave our little slide show presentation of our experiences and then headed our separate ways home. I will have to admit that Winner, SD will always have a special place in my heart from now on and I will remember my great time and experiences here forever.