Kelly McKnight
Week 1 at Philip

I had a short week this past week and really only worked Thursday and Friday! During the first half of the week, I was at the Mayo Clinic in Rochester, MN, to get a second opinion on my treatment for my thyroid cancer! I was very worried about missing my first day in Philip but I am so lucky that all of Philip (as well as Cheri!) is super supportive. I arrived in Philip Thursday evening after attending some training Thursday morning in Sioux Falls. Our first shift in Philip was a 6am-2pm shift following the nurses at the nursing station. We started off the morning passing medications to the patients in the hospital. Philip has an 18 bed hospital and about 15 of the beds were full! While we were busy doing assessments on patients, Terry, the PA, came and grabbed Kerri and I, as well as two nursing students who were following in the morning, to see a patient who had metal in his eye. We removed the tiny fleck of metal and then had to decide what type of eye drops to prescribe. I have had some pharmacology during my first year of medical school but we had not covered any eye drops! I was put on the spot to decide what to prescribe and why we would prescribe A over B and I failed, miserably! I learned that steroid eye drops have to be VERY carefully prescribed because it can cause immunosuppression and allow latent viruses (herpes, varicella) to reactivate and that can wreak a lot of havoc on the eye. So, before prescribing those types of medications, patients should be tested to see if there’s latent herpes or varicella waiting around.

 For lunch we had a pizza party with everyone from the hospital invited! It was fun to meet so many new people- I hope that I will have names figured out soon! After lunch it was pretty slow. We had one patient come into the ER after slicing off the tip of his finger! I know how to suture but have not gotten to practice on a human. Terry has a “see one, do one, teach one” policy, so after the nice refresher this afternoon on how to suture, I am looking forward to getting my chance sometime next week! I got quizzed again (and struggled to an answer) about using lidocaine with or without epinephrine. Epinephrine will cause the blood vessels to constrict, which decreases blood flow to areas of the body. This can cause tissue death if prolonged or if it’s to an area that needs to be well-perfused! After I got out of clinic, I received news that my 4 year-old dog, Bailee, had passed away suddenly. This was extremely heartbreaking and instead of spending the weekend in Philip, I headed to Rapid City to have a good cry and try to recharge before the next week. I’m looking forward to next week and the weeks to come! My main goal for while I’m out in Philip is to learn as much as I possibly can and practice my clinical skills – I think that I am well on my way towards that goal!

Week 2
Remember last week when I said I was excited to get my opportunity to suture? Well, I got my chance within the first five minutes of being at the clinic on Monday! A patient came in with a laceration on their arm and it was my time to shine! We had been taught how to suture way back in January and didn’t get a chance to practice on an actual human, so I was a little nervous for my first time. However, our patient was EXTREMELY kind and patient, so I felt comfortable and was able to gain more confidence as I went! It was an easy, couple-of-sutures kind of injury so that also helped. My partner, Kerri, got some great pictures of me in action and of the sutures, which I have been proudly showing to my family and friends (of course, no patient info was shared but a close-up of the arm sure has been)! I feel so accomplished and maybe like I DO know what’s going on J

Monday was an extremely busy day out in Philip. Aside from the laceration and the full clinic, we also had a full ER for most of the day. We had a patient come in with diabetic ketoacidosis (DKA) and pulmonary edema, two things that I have yet to really learn about in school. It was extremely interesting and a complicated case that kept us busy throughout the morning. We also had a patient come in with a volvulus, which is when the intestines twist around one another. It can cause blood flow to be cut-off to the intestines and is EXTREMELY painful I’ve been told. This was a really interesting case because I just finished my GI unit in school! The patient didn’t fit the typical volvulus clinical vignette and the radiograph didn’t show the classic “coffee bean sign”, but it was very interesting to see something I learned in the classroom show up in the clinic. I learned that if you are going to request a CT with contrast that you need to make sure the kidneys are functioning well. If the kidneys aren’t working right, it is hard to breakdown the CT contrast and this can cause more problems. We also had a patient come in after crashing his motorcycle. He had a broken clavicle (collarbone) and some bad road rash. Luckily he was wearing his helmet and riding gear so his body was pretty well-protected.

The majority of our day was spent in the ER and with radiology, which was really neat to see. There was a lot of teamwork and good communication and I really enjoyed it. It was a stressful and busy day!

Every other Tuesday an optometrist and an orthopedic surgeon travel from Rapid City to Philip to meet with patients at the Philip clinic. Kerri and I had the opportunity to follow over on the orthopedic side following Dr. Duchenne’s PA- Nick Tolsma. We saw a plethora of patients in the morning – most of them being post-operative patients after a joint replacement surgery. It was good practice looking at X-Rays since we had to double check placement and how things were looking. It was a great refresher after the full day in radiology. Over lunch, Terry gave Kerri and me a clinical case of a patient that he was doing a work-up on. The patient had hypothyroidism, as well as tachycardia. Hyperthyroidism is when the thyroid gland (a butterfly-shaped gland, found right at the base of the neck) is overactive and hypothyroidism is when the thyroid gland is underactive. I have had my fair share with thyroid troubles and even had mine removed, so I am very interested in learning about it! The thyroid controls a LOT of things in the body- including metabolism and temperature regulation. This patient had tachycardia (a fast heart rate) while also having hypothyroidism. This is something that can happen but seems like it would be pretty rare, since usually hypothyroidism slows everything down in the body. It was a neat case to read on and it was interesting to ponder treatment options.

We had a patient come into the ER after falling and hitting their head. Terry had Kerri and I go in and do an initial work-up and decide our plan of action. We decided to do a head CT, as well as a full-spine CT without contrast. Contrast would light up the blood vessels well but any blood outside of the blood vessels appears white too, so it would be hard to differentiate between what is contrast in blood vessels and what is free blood. After taking any radiograph (X-ray or CT), the radiologist in Rapid City reads all of the scans and then sends back his report to Philip. We learned that this patient had fractured the base of the orbit of the eye! There was a hematoma (blood collection) behind the eye that was building and putting pressure on the eyeball. If we didn’t do something to remove the pressure, it might cause the optic nerve to die off, which would cause blindness in the eye. Terry called in assistance from Dr. Holman and Dr. Klopper, as well as the optometrist who happened to be there that day (thankfully), and they performed a lateral canthotomy. It was a very neat procedure but one I will let you all look up so this blog post doesn’t get too long J

After our day in-clinic, Terry and Jennifer (our program coordinator) invited us over to their house for halibut, pork loin, veggies, and dessert. It was really fun to meet their family (they have two young little boys and two very fun dogs) and to get to know them better outside of the hospital. Kerri and I shared our favorite experiences and our not-so favorite ones. It was nice to visit and I am so thankful for how kind they have been to us. They have welcomed us to Philip with open arms and have gone above and beyond to make sure that we are comfortable, having fun, and learning.

Today was a relaxed day! We were at the assisted living center in town and had a blast meeting the residents and staff. We started off the morning cleaning the “pods”- a grouping of four rooms in each corner of the building. We got to visit with the residents and help clean up their rooms. Each resident gets their choice of furniture and how they want the room set-up, which was neat because everyone had something a little different. We then passed medications and chatted with the residents. Soon it was lunchtime and we helped serve lunch, as well as just visited. I took a social dance class last year at SDSU where I learned how to foxtrot and waltz, which really surprised some residents that I knew how to do that! The food over at the assisted living center was phenomenal (really though, I haven’t had a bad meal here yet…) and after passing some early afternoon medications, Kerri and I were off for the day!

While we are out in Philip, we are working on a community assessment for the South Dakota Good and Healthy Campaign, so after we left the assisted living center, we went and worked on our project. We have a ways to go but thankfully we have some time still to work on it! We went and explored the town of Philip a little and set up our window air conditioning unit! We wish we would have figured out how to set that up earlier this week. I went for a run this evening and the weather was beautiful (SO MANY BUGS THOUGH). Jennifer was kind enough to send me a variety of running routes and I have been exploring. There is a LOT of open space, something I’m not used to living in Sioux Falls/Vermillion! I heard a bunch of turkeys gobbling, as well as a few helmeted guineafowl. I’m having fun exploring and it was nice to have a quieter day to regroup and breathe a little!

Today was a fast day- I was only in the nursing home for the morning! We watched medication passes and then we went to watch wound care. It was really interesting to look at the different types and kinds of pressure ulcers but also very sad. I would imagine that they are painful! This morning also brought me back to my CNA days doing medication passes, getting people ready for the morning, and then assisting in eating. It was really refreshing to see the positivity of the nursing staff and CNAs and it was great to see the good care the residents received. After a morning in the nursing home, I am headed to Rapid City to fly out to Boston for a conference on how to break bad news to patients!

Week 3
Today we spent the morning in the lab at the hospital! They have three medical lab techs there and they were very busy completing lab requests from the Monday morning rush! Kerri and I kept ourselves busy looking at blood smears under a microscope and taking pictures for the Philip paper! Kerri also let me practice drawing blood from her! IT WAS AWESOME. She has great veins so that made it a little easier for me. Under the medical lab techs instruction, I drew a small vial of blood and we ran a blood work-up on her. Kerri had said to me earlier in the morning that her allergies were bad and her blood certainly showed that! She had a LOT of eosinophils, a white blood cell that contributes to an allergic response. Later in the afternoon we saw a patient who had a “boxers fracture”, or a fracture of the 5th metacarpal bone. To take care of this, we put on a gutter cast- we wrapped the hand in gauze, then got some plaster of Paris wet, and molded it to form a U-shape. We took this U shape and put it on the side of the patients arm on the pinky side. We then took the 4th and 5th fingers and bent them so the palm of the hand and the two fingers made an “L” shape. We then molded the cast around that, so the fingers would stay bent and the bone would stay in place. After wrapping in an ace bandage, the patient was ready to go! It was very interesting to see as I have learned about a boxers fracture but I have never learned about what to DO with it!

Today we followed Dr. Holman over in the clinic for one case and then joined home health for the rest of the day. Dr. Holman’s case over in the clinic was a 24-week pregnant lady in for her check-up. This past semester at school I was in the “Care of the Mother and Child” clinical track, so I got lots of practice at the Sanford OB clinic measuring fundal heights and finding fetal heart tones. I was SO excited to get to do some of that out here in Philip! It was a fast and easy check-up but it reminded me that I need to look at my “what to do at what pregnancy visit” sheet!

For the rest of the day we learned how home health works and Kerri got the opportunity to set up two medicine planners for the patients we were seeing that day. It is hard to keep track of your pills when you are taking at least 5 different kinds of pills at varying amounts and varying times throughout the day. So home health helps set up the medicine planners and writes out instructions and a guide as to what pill is where and what it does. It was cool to see Kerri in her element! We had two patients stop in to visit and do a short “home health” visit. I was lucky enough to see a VERY rare medical condition that I probably won’t ever see again. I am going to do more research on it before I post about it though J

We started off the morning doing actual home visits with home health. I did a head-to-toe assessment on the patient, while Kerri set up their medicine planners at home. We were very lucky to visit with some neat people and it was a really good reminder to not complain. Life could be a lot worse and there are a lot of people dealing with things harder than I am. I am going to try to remember that when school gets rough this next year. We did 3 home visits and saw a wide range of what home health does. I was very impressed!

Philip gets a lot of physicians and physician assistants that travel into the clinic to help out. One PA is Janelle Gerberding and we got to spend some time with her this afternoon! We learned about a patient who had smashed their face after falling from a ladder (ouch!) that was transferred to Sioux Falls via a fixed-wing plane! It was a very interesting clinical case with very cool CT pictures. We also had a busy ER (probably because the students were there as Kerri and I joke) this afternoon that kept us going. I was able to do more stitches – yahoo! This time it was a head laceration which was a little more challenging than sewing up an arm like last time!

Today was a fast day! We hung out in community health for the morning. The community health nurse is also the school nurse, as well as the person in-charge of WIC, Family planning, and other health programs. We had a great time visiting and seeing a little of what she does! After visiting in community health, Kerri and I went to eat at the steakhouse in town before meeting with community members for our REHPS project. We went out to Scotchman industries and to the school to do our interviews! After doing our interviews, we went home to enter our data into our spreadsheets!

This morning we went to the hospital to hang out for a little bit before attending the pharmacy open house. It was a busy day on Thursday in Philip and there was a major motor vehicle crash that came in. Kerri and I looked at the X-Rays and tried to piece the story together. They ended up life-flighting a couple of the patients out because they were so severe. I wish that I could have seen the trauma come in but I am hearing that it was for the best that they were life-flighted out so fast. I have been hoping they are healing well.

After our morning at the hospital, we went down to the pharmacy open house. There is one pharmacy in town, Dakota Country, and they were celebrating being open for one year! The owner of the pharmacy is going to be related to me in a few months (my brother is marrying her sister) and her entire family was there so I got to meet everyone! They had a great turnout and gave out some super fun prizes. I didn’t win any but Kerri won a bag of treats! It was really cool to see the community support their pharmacy and I was impressed that everyone was on a first-name basis with their pharmacist. After the open house we went back to the hospital for a bit and then we went to relax at home. We went and ate at the 73 Saloon- a place in town that does a “make your own steak” night! We split a steak and got unlimited potato wedges and breadsticks. It was AWESOME!

Week 4
We started off the morning with Dr. Mann at the dentist! Woof. I am very happy I didn’t try to pursue dentistry- I don’t think it would be for me! Dr. Mann has one assistant but he does all of the teeth cleaning, which was cool! All of my teeth cleanings have been done by a dental hygienist and then the dentist comes in to check my bite and that’s usually it. It was cool to see him actually working on patients and getting to do a lot of procedures. We filled a few cavities and did a bunch of cleanings. It is a lot more fun to be at the dentist when you aren’t the one in the chair!

After the dentist we went to the hospital to get some lunch and then we worked on our project! Our final presentation is on Thursday and we have a lot of loose ends to tie up before we leave Philip!

This morning Kerri had an appointment with a chiropractor! I have never been to a chiropractor before but I have a lot of friends who are going to school to be a chiropractor and a lot of friends who swear by them! I joined Kerri for her appointment and watched her get her back aligned- it must have felt so nice based on all of the adjusting I could here! After her appointment we went over to the clinic to join Dr. Duchene from Black Hills Orthopedics! We saw a variety of patients, most of them post-op or pre-op. I really liked how Dr. Duchene stayed neutral in his conversations with patients. He didn’t try to sway them towards surgery – he listened and just provided feedback and input when it was needed. I also got the chance to help cast a patient’s leg! They had a tibia fracture that wasn’t healing quite right so I got to go in and cast! Dr. Duchene’s assistant did most of the work but I held the leg and learned. It was really interesting and I am hoping to get a chance to cast something in one of my future clinical rotations.

After our day in clinic Kerri and I went home to work on our project some more and tie up more loose ends. Cheri came to eat with us at the Steakhouse- it was so good!!

Tomorrow is our last day in Philip and we are doing our final presentation at 9AM! Kerri and I already finished our PowerPoint so today we are just finishing up other things we have to do. We were on the radio this morning with Hometown Tour – it was a short five-minute segment but it was still kind of nerve wracking. I think we did well- we are getting this press thing down! J After our interview we went to get breakfast at the sale barn – there’s a cool café inside. We worked on thank-you notes for all of our people out here in Philip and are going to do some thank-yous for the CNAs since it is national CNA week! We also have to do some cleaning and packing before we head out tomorrow. I am running a marathon this weekend in Duluth, MN, so I am trying to get all of my running gear washed and decided on for race day! I cannot believe how fast our time out here has gone.

Our last day in Philip has come! I am pretty sad to be leaving such a welcoming place. I have learned so much in my time here and I am so thankful for the opportunity to see and do and learn so many awesome things! Philip has been so fun and I am kind of bummed to head back to school again so soon- the summers just aren’t long enough! We did our final presentation this morning- complete with Wall Doughnuts (YUM) and then we ate lunch with Jennifer. She has been instrumental in making our time so wonderful and it was great to have a few last laughs with her! Kerri and I then parted ways and I headed back to Sioux Falls to get ready to run my marathon. I am so thankful for the opportunities Philip gave me and I can’t wait to share my knowledge.