Week 1 at Platte
Sunday, May 31st
Today I packed up my suitcase and headed for Platte, SD. Being from Sioux Falls, I have never lived in a small town before, but I am excited to see what this experience will have in store for me. Turning off the interstate, my first impression was seeing about 5 deer cross the road, farm equipment and open field- you sure don’t get that in Sioux Falls! The Biehl family is who we are staying with while here in Platte, and they are awesome! Immediately, I was struck by their warm welcome and serving nature. They cooked a great spaghetti dinner for us and filled us in on what we could expect during our stay in Platte. I can tell already that this will be a great experience and can’t wait to start tomorrow!

Day 1: Monday, June 1st
This morning with met with Tera (program coordinator) and she gave us a tour of Platte. We also drove the 14 miles to the Missouri River- a local favorite for camping, swimming and other activities on the weekends. Tera was extremely helpful as she introduced us to the majority of people that work at the hospital. In Platte, the hospital is connected with the clinic, dentist and nursing home which I thought was interesting. This connectedness allows for a more integrated healthcare experience that I have not seen before. After our tour we ate lunch at the Pizza Ranch here in town. Afterward, I went to shadow the nurses in the hospital. It was a relatively slow day as there were not many patients and no Emergency Room calls, but that allowed for me to get to know the nurses. I heard stories of previous ER visits that were interesting to the nurses and began to learn the ins and outs of the hospital in Platte. Overall, it was a great first day!

Day 2: Tuesday, June 2nd
Today I was with Pam Veurink, one of the Physician Assistants here in Platte. Pam was great to follow, and we saw many different patients throughout the day. Some of these included: children’s physicals, a man with a foreign object in his eye, and wound care. Over lunch, there was a child who came into the ER with a fishhook lodged in his hand- what an experience that was to witness! I was told before coming here that I would probably see quite a few fishhook removals, but I didn’t expect it to start on my second day! Today I also met Brooke, a FARM student that attends the Sanford School of Medicine. It was great to talk with her as I will begin school there next month. Pam is retiring this week, and many of the patients expressed their thanks for her service. Pam’s willingness and ability to form relationships with her patients was a testament to how much they trusted her. I hope to someday have the same type of practice, and being with Pam strengthened that desire. I am extremely grateful that I had the opportunity to shadow her on one of her last days.

Day 3: Wednesday, June 3rd
What a day! On Monday, the nurses told me that the hospital is not typically that quiet. Today, I understood what they meant by that. We had 4 ER calls come in while I was with them today- it felt like we did not have time to sit down. My day started off with Brooke and upon arriving, she told me that an ER call was coming in. After talking to the patient (who came in with severe abdominal pain) and doing a brief examination, Brooke demonstrated how to perform a newborn exam on a baby born earlier this week. This was a great experience as she allowed me to perform parts of the exam after she showed me how to do it. We then filled Dr. Bentz in on the patient in the ER, and I continued my morning with him. While with Dr. Bentz, I sat in on a conversation with a family that involved deciding how to move forward in treating a chronically ill, elderly patient in the hospital. Witnessing how he interacted with the family and empathized with them allowed me to observe the balance between physician and friend. These types of conversations are tough, but he handled it with great respect and care, which I know the family appreciated. Something else that I noticed about Dr. Bentz was the way he juggled his patients in the clinic and running the ER today. It was a stressful day, but he controlled each situation with poise. (My day continued as we had another ER patient called in that was unresponsive. The atmosphere instantly became tense as the staff prepared the room. I was able to see the different equipment used in a situation like this such as LUCAS (a machine that will do compressions on a patient so the team can focus more on the patient), defibrillator and other various medications. Unfortunately, the patient passed away. Therefore, the patient was not brought into the ER. Platte, being a small community, is a place where everyone knows everyone. Naturally, the staff knew the patient that had passed and I could feel the atmosphere change when they heard the news.) Another ER patient came in soon after with a severely dislocated and broken elbow. This patient had to be transferred to Mitchell to have a pin surgically inserted into the elbow. During this time, I followed the first patient that came into the ER along the journey to discover what was causing the abdominal pain. After a CT scan and ultrasounds, it was ruled an ovarian cyst that had ruptured. I was also able to sit in on an ECHO of a patient’s heart, which was fascinating to see. This was a hectic day, but I learned a lot about healthcare in a rural community.

Day 4: Thursday, June 4th
I was re-certified in CPR today. As part of the REHPS program, we will be completing a service project that included interviewing community members here in Platte. Today, we put together a list of people that we will be reaching out to over the next couple of weeks.

Day 5: Friday, June 5th
I shadowed Dr. Callie Houdeshell, a chiropractor in Platte. Having only been to one chiropractor before, I initially had some hesitations about shadowing her. However, my hesitation was quickly alleviated as I experienced what Dr. Callie does. She treated migraines, various shoulder and back issues (common here with the amount of farmers in the area), and many children. I was shocked to hear how she also treats ear infections and other common ailments that I was unaware could be treated by a chiropractor. Her adorable 9-week old daughter spent the day with us, adding to the family atmosphere that was obvious to me the second I walked in. Dr. Callie, like so many other people I have met, forms great relationships with her patients and completely changed my perspective on chiropractors. She also gave me advice about working in a professional setting, and I am extremely grateful for the opportunity to be with her today! I also had my first encounter with a couple members from one of the three Hutterite colonies around Platte. Interacting with them today made me excited to visit a colony, which we get to do next week.

Overall:
This has been a great experience so far! I am continuously struck by the friendliness of every person I meet. Here, people wave as they drive by whether they know you or not. People in Platte take the time to enjoy family, something I have seen with the Biehl family every day. We have been invited to lunch, a softball game and multiple bike rides around town. Everyone is family here and works together to take care of each other, with an emphasis on building and fostering relationships with neighbors. I grow to appreciate Platte and all this rural community has to offer more each day I am here. If this first week is any indication, the next three weeks will be full of great learning experiences and surely go by faster than I would like them to!

Week 2
Day 6: Monday, June 8th
Today was another great day! This morning I was back with the nurses in the hospital. The first thing I did was observe Dr. Bentz and Rick, the hospitalist in Platte, on their morning rounds of the hospital patients. The theme with each patient was the ethical background of their treatment. Unfortunately, in today’s medical world there are limitations due to insurance. Often, doctors have to delay treating a patient until they know if insurance will cover it. For the elderly population, this becomes a problem when the recommended treatment is going to nursing home but insurance won’t cover it. This aspect of the medical field was interesting to experience as these ethical concerns will only become more prevalent. Seeing these conversations happen today was a great example of an issue that I will deal with as a physician. After going on the rounds, an ER patient came in with severe and sharp pain in the back that radiated down the arm. We learned that the patient was diagnosed with stage 3 lung cancer last year and had surgery in an attempt to remove it. The patient had shooting pain off and on after the surgery, but today it did not subside. Ultimately, after a series of tests, it was determined that the patient would be sent home with some medication to help the pain. However, the patient ended up coming back to the ER later that afternoon with the same problem. In the afternoon, I shadowed Dr. Hagge, who mainly sees OB patients and children. I was able to follow Brooke as she would perform routine OB checks on expectant mothers, and she allowed me to find the heartbeat of the babies. Dr. Hagge is leaving Platte at the end of the month, but he will remain busy as there are 3 babies due by the time he leaves. I was grateful to shadow Dr. Hagge as he was a great example of how to interact with children and expectant mothers as a doctor. I also appreciated his willingness to allow me to participate in the examinations of the mothers and children that came in.

Day 7: Tuesday, June 9th

This morning I was in the laboratory, which was very interesting to me. I have not spent much time in a lab before and it was great to see that aspect of the medical field. While at first I was overwhelmed by all the machines and equipment, Cathy and Angie were patient as they explained all aspects of the lab and what they do. What I particularly enjoyed was learning what happens when tests are ordered. Following Cathy and watching her draw the blood of a patient with tough veins made me appreciate what she and all other lab people do. This afternoon, I shadowed the Physical Therapists at the hospital, Matt and Mark. I was mainly with Mark and he worked on a frozen shoulder, a bum knee, neck pain and a weak hip. Having never experienced physical therapy before, it was intriguing to watch as he used the stretch and strengthen approach to treating each patient. He would start off by stretching the area of concern and then proceed to strengthen the area with various exercises. I think there are many benefits to this type of therapy for treating injuries and other ailments. Tonight we went to the Missouri river where the Biehl family was camping for a couple days. We went to the river with the kids and I learned how to skip rocks! It was a lot of fun and we ended the night by making s’mores around a campfire.

Day 8: Wednesday, June 10th

Today I worked on the community project and called around to various community members within Platte. I am excited to visit the Hutterite Colony tomorrow!

Day 9: Thursday, June 11th

A passion of mine has always been learning about other cultures, and I cultivate that passion by experiencing them as much as I can. Today I had the opportunity to tour one of the three Hutterite Colonies near Platte. I had heard a little about the culture within this type of colony, but honestly I held the stereotypes that are pictured on “reality” shows- the hierarchical society in which rules are strictly enforced. I was pleasantly surprised when I saw that while there is some truth to the stereotypes, there is much more to these colonies than meets the eye.

We were welcomed by the Minister of the colony, and he proceeded to show us around. We saw the laundry area, kitchen, church, workshops, and inside the Minister’s house. I was amazed at the self-sufficient nature and incredible work ethic that those in the colony had. While the men work all day in the shops and fields, the women tend the houses and garden. They grow their own food and can the extra for the winter months. The simplicity of the people and society as a whole was rather refreshing. Not having many of the things that those outside of the colony- phones, computers, games, even personal cars- deem important are absent for the most part. In a way, it reminded me of being in India when I worked with people that did not have those same material things. While I was a bit shocked in India by the lack of modern technology at first, I grew to understand how it may not be such a bad thing. Therefore, when I noticed this in the colony, I better understood why they elected to live without the temptation of technology.

Another thing that we witnessed was the meal time. Men go through the line first and sit on one side of the room. Women follow afterward and sit on the other side. Everyone then waits for the Minister to open the meal with prayer and proceeds to eat in a span of approximately 5 minutes with no talking. The meal ends with another short prayer by the Minister, and then the men go back to work while the women go to the houses. A different experience was being served by the women in charge of running the kitchen (they alternate weeks of kitchen duty) and then not cleaning up our own plates because they were responsible for them. Throughout our time there, I couldn’t help but try and picture myself living in the colony. While there are many benefits that I can see, I also appreciate where I am now. It was fascinating to see how their culture works right in the middle of my own. They may live in South Dakota, but it is like they live in another country. The biggest benefit from visiting them today was to get to know the culture and meet the people. I know for a fact that understanding their culture better will help me in my future practice, and I am extremely grateful to the Minister for allowing us to have this opportunity!

Day 10: Friday, June 12

Today I was with Tia, one of the Physician Assistants. I enjoyed getting to know her and shadow her. It was also great to have a fellow USD Coyote as there are many SDSU people that I have met here. I also know Tia’s sister from school- what a small world it is! It just goes to show that these types of small connections can go a long way to forming a relationship with others, something crucial to a practice I think. With Tia, there were many pediatric patients with issues ranging from a fungal infection on the head to ear infections. She was great with the kids- always smiling and interacting with them. In the afternoon, I shadowed Stephanie, a Nurse Practitioner. While with her, there were a couple patients that were from the Hutterite colony I had visited yesterday! This was a cool experience because they remembered me and instantly felt comfortable around me. I knew that the tour of the colony would benefit me in the future, but I did not think it would be so quickly! It felt almost like I had a bond with these patients already- one that I know they appreciate in their healthcare providers.

Second Week Overall:

It is hard to believe that two weeks have gone by already! Even harder to believe that there are only two left. The time here in Platte is going by extremely fast as each day I meet new people and experience a little bit more of this small town. From the people to the random-but-hidden-gem thrift stores, there is more to Platte than I ever thought. The more I am here, the more comfortable I become and familiar the town is. I am grateful for all of the opportunities from this week and can’t wait to see what the last two weeks here have in store!

Week 3

Day 11: Monday, June 15

This morning I was back with Mark in Physical Therapy because Stephanie did not have any patients scheduled until the afternoon. I was then with Stephanie for her afternoon appointments. With Mark, it was great to see how individualized each session is- he may see 5 patients with knee problems and treat each one differently. I like this approach because often in healthcare, there may not be a standardized treatment. During one of the appointments, I met the wife of one of the patients. We had a valuable conversation about a medical career as her grandson wants to become a doctor. It was a chance for me to further reflect on how my years in undergraduate school have helped shape who I am. Looking back, the most beneficial part of my college career was growing into who I am today. Who I was as a freshman compared to who I am now are two very different people. If someone had told me my freshman year that I would have experienced things such as going to India, I would have laughed. The same goes for being in Platte- I never would have thought I would end up here for a month after graduation! Being here has made me realize that everything I have done has led me to where and who I am today. I know that I am more prepared to enter medical school but understand that I have a lot more to learn. One of the best parts of this journey to becoming a doctor is being humbled by the fact that I do not and will not know everything. Being in the medical field is a lot of trial and error, but the reward of serving patients is so much greater than the hardships and stress. In the end, I know that the hard times of the years ahead will be worth it as they will help me learn more about myself. They will also make me a better doctor but, more importantly, a better human being.

Day 12: Tuesday, June 16

Today was another day of firsts for me! I was with a Dietician this morning. Every so often (twice a year so far), the clinic offers a free diabetic clinic where patients with diabetes can come in for a free check-up and consultation/education. I stayed with the Dietician during the clinic and learned a lot about how patients can help their diabetic treatment with what they eat. A common misconception is that many people think they will have to give up their favorite foods. However, diabetes is best controlled though smaller portions of what people are already eating and learning to count carbohydrates. I took a Biochemistry course this last semester, and the knowledge I learned from that class came into play during these meetings. Watching her explain the complex system of how metabolism works and why we should only eat certain amounts of food each day made me realize how important it will be to communicate this with the patients. One thing I have heard multiple times is how difficult it can be for healthcare professionals to explain what is going on to a patient in terms he or she will understand. Not many patients will comprehend what big, scientific terms mean and will simply nod or agree with whatever the doctor is saying because they are afraid to admit they do not understand. This is important to keep in mind for the future. I also had really good conversations with the dietician about topics such as diabetes, mission trips and other social issues impacting the local and world-wide community.

This afternoon I shadowed Mary, the pharmacist at Hoffman Drug. I have never been in a pharmacy before or talked to a pharmacist. The providers in Platte have a successful relationship with the pharmacists, and I did not realize how important that was until today. I also realized that the pharmacists are an invaluable resource that I will need to use once I am a doctor. Mary was extremely knowledgeable about the various medications and drugs that the providers were prescribing. She also gave me advice about having a legible signature, making sure I remember what medications need a paper prescription and using the pharmacists as a resource. I also met Shelby, an SDSU student who will be starting the pharmacy program at SDSU this coming fall. They showed me how prescriptions are filled and what they have in stock for medications. It was interesting to see this side of medicine and how much Mary interacts with the patients. I wish I had more time to spend at Hoffman Drug with Mary, but I was appreciative of the opportunity to be with her today.

Day 13: Wednesday, June 17

I was with Dr. Griese, one of the dentists here, today. I have luckily not had much dental work done in the past so it was interesting to see the procedures that were done. The first patient I saw was getting a root canal done. We proceeded to see patients that needed dentures readjusted, cavities filled and broken teeth. There was a wide variety of cases that I saw, which was great to witness. Dr. Griese was rather busy as Dr. Hoffman was not in the office today. We were going non-stop from the time I arrived until the time I had to leave. I was grateful to Dr. Griese for explaining what he was doing with each procedure or patient. I also enjoyed spending time with the staff that work at the dental clinic as they showed me some of the more extreme x-rays from patients in the past. What struck me about today was the importance of having good relationships with your co-workers and those that work for you. Fostering a positive work environment can make a huge difference for them and the patients.

Day 14: Thursday, June 18

What a day! I was with Stephanie as the hospital started out slow today. There was a man from one of the Hutterite colonies that had diverticulitis and needed to be admitted to the hospital for IV fluids and antibiotics. When I was with the hospital nurses in the afternoon, I was able to check in on him which he appreciated. Brooke and I also ran into Alvin, the minister of the Hutterite colony we visited last week. He remembered us and asked how we were doing. It was great to think that we had developed a relationship with him after one short day visiting- this reiterated the hospitality of the Hutterite people.

Perhaps the most intriguing experience I have had since arriving happened this afternoon. When I got back to the hospital after lunch, the ER was crowded with policemen, EMTs and nurses. I was quite confused until Brooke approached me and told me that there was a patient who they were trying to bring into the ER. They knew the patient would need behavioral health assistance but first would need to be medically cleared.   

I had the opportunity to get to know the police staff here in Platte. Interacting with policemen in Platte at the hospital was not something I was expecting, but it was interesting to see how everyone worked together to try and help this patient. Eventually, the patient was transferred to Sioux Falls for further testing.

Day 15: Friday, June 19

We worked on our community project today and then were able to explore Platte a little bit more.

Third Week Overall:
Jaysea, the younger daughter of the Biehl family, said it feels just like yesterday that we arrived in Platte. I could not agree more. The time here seems to be on fast forward. Alissa and I have met so many great people here and experienced so much. We worked at the movie on Monday night. We sold candy and popcorn beforehand and vacuumed up after the movie. However, we did get a free ticket to see Tomorrowland and free popcorn, so it was definitely worth it. The Biehl family wanted to go camping over the weekend, but all of the spots were taken. Instead we “camped” in their backyard. We had a bonfire and played a movie outside on their garage. While it may not have been the real thing, it was still a great night. It worked out better perhaps as a storm came through that night so we were able to stay dry. Saturday was Jaysea’s birthday, and she wanted to go to the river. We started the morning with a big breakfast/brunch with pancakes, eggs, bacon and fresh fruit. I was on a boat for the first time, went tubing for the first time, and went kayaking for the first time. It was quite a day! I now understand why people love going to the river on the weekends. The weather was beautiful, and it was a great day to celebrate Jaysea’s birthday! Tomorrow begins our last week in Platte, and I have no doubt that it will be a good way to end our time here.

Week 4

Day 16: Monday, June 22
Today we worked on our community project. We interviewed Joel Bailey, Superintendent of the Platte-Geddes school. In addition, we talked with Ross, manager of the Platte Health Center.

Day 17: Tuesday, June 23
What a fitting last day! This morning I was able to remove staples from a patient in the hospital who had hip surgery after he fell and broke it. Linda, a hospital nurse and someone who was always so willing to teach me, showed me how to remove them and allowed me to follow. It was a really great learning experience for me and I realized how much I enjoy the procedural aspect of medicine. She made a comment after I was done that I didn’t even act scared while I was removing them. I was able to revisit this patient later on in the day, and that interaction reiterated why I want to go into medicine. The foundation for my desire to be a doctor lies within the call to serve those around me. I can think of no greater gift that I can give than to live out this calling.

In the afternoon, we received a truly integrated experience. I was with Dr. Bentz for the day, but a patient came in to see Stephanie complaining of shortness of breath. After ordering a multitude of tests and X-Rays, Stephanie came to ask for Dr. Bentz’s opinion. We took a look at her X-Ray and immediately they sent the patient to the ER. The patient’s lungs had hardly any air left in them and the heart was enlarged. They came to the conclusion that the patient had a heart attack the previous week and was experiencing heart failure. With a sinking feeling, the staff knew that they needed to transfer the patient to Sioux Falls. Transferring the patient to the ER meant that the hospital nurses were now involved. They used the E-ER system to facilitate the transfer and its preparation. There were some moments of chaos as the spouse was trying to contact their kids, the E-ER staff was attempting to tell the staff what they should do, and the E-ER doctors were calling Stephanie. Fortunately, the tense atmosphere was relieved when plans were set in motion and the flight team was on their way. I never thought that I would see an air transfer, and while it was unfortunate that I had to see one, it was a great learning experience. Something about rural medicine that I never thought about was the transfer aspect. Being a doctor or provider in a rural community means that you have to understand that you cannot take care of everyone. I can imagine that it would not be easy to have to send a patient on, and added onto that is the fact that you know the patient personally. However, it would be comforting to know that you are doing what you need to in order to provide the best care for your patient. Our last day ended with watching the helicopter take off for Sioux Falls. This experience today brought everything full circle as most of the people I interacted with during the month were involved in this one patient’s care.

Day 18: Wednesday, June 24
Today we finished up our community project.

Day 19: Thursday, June 25
W
e worked on our presentation for tomorrow. We went to the river tonight with the Biehl family and hung out with two other families. This was the perfect last night as we had a campfire complete with s’mores and other treats.

Day 20: Friday, June 26
Well, today was our last day in Platte. It was weird having to pack up our things because it feels like we just got here yesterday. We were so busy here in Platte that the 4 weeks went by in a blur. We gave our presentation to a full room that included: the Biehl family, a newspaper representative, Mark the director of the hospital, Brooke, the next FARM student and his family, and various members of the hospital board and people we worked with. I was so grateful that they were all there to support us. It was great to be able to share our experience and what we learned while in Platte with them. I can’t believe that our time in Platte is over!

Week 4 (and whole experience) overall:
An integrated experience- that is what I was told to expect from the REHPS program. However, I did not understand what that meant. I have experienced urban healthcare in cities from my hometown of Sioux Falls to India, where I went on a mission trip. When I was assigned to Platte, I was apprehensive yet excited to see what was in store for me. Platte exceeded my expectations. While my time shadowing the healthcare providers and staff within Platte was eye-opening and taught me many lessons, I realized that the town greatly enhanced the experience. Platte possesses a unique charm that I have rarely seen in all my travels. A huge part of that charm is contributed to the charismatic people. The Biehl family welcomed me with open arms and adopted Alissa and I into the family for the month. Each person waved to me when they drove by, and everyone would stop and welcome me if they saw me around town. The willingness to help, positive atmosphere, or simply just the friendly smile and wave made me feel that Platte was a home away from home. A major theme of what I learned from Platte is that the people are integrated, which makes everything else the same way. Each person is taken care of because everyone in Platte is family. I witnessed this in my time with the healthcare staff while they interacted with patients as well as with each person I met within the town. In such a short time, I feel as though I became a part of that family- something I am truly grateful for. I may not have understood what an integrated experience meant at the beginning, but once I became part of the community, I was integrated into a family that will do whatever they can to provide for me.