Kerri Larson
Week 1 at Philip

Wow! First week done already! I was welcomed to Philip, SD with open arms. Everyone I’ve met this week has been so wonderful. I arrived to a warm welcome, a tour of the facility, a lunch date, and a town tour. Philip turns out to be much bigger than I thought.

The weather has been quite dubious this first week. I always took Philip to be an arid landscape, but this week it has rained nearly every day and everything is a luscious green.  What are you up to Philip??? Saturday was filled with a constant drone of lawn mowers, much to my surprise.  

We spent Friday rounding with the nurses’ station, which was supremely interesting. I cannot say enough about how incredible nurses are. Their work is so relentless, unforgiving, and complex. Not only do they have to administer meds and treatments, they are first line for patient care. They have to give meds, answer questions about them, and know their side effects, but all of that knowledge takes second to whether or not the patient is comfortable, how much of their meal did they eat, if they need a warm blanket, or help to the restroom. This is a healthcare position I could never master, and I will always be in awe of nurses’ skills. I felt so meager shadowing this brilliant young lady that let three of us follow her around all day.

The weekend has been rather slow while anxiously awaiting an ambulance call to go on, even though the lack of calls is a blessed occurrence.

Week 2
Monday
Whew, what a busy day! Today we were with the radiology department. I had imagined it would be a rather slow day and that there wouldn’t be many patients that needed X-rays at the Philip Clinic. Boy was I wrong! We actually spent most of the day going between the ER, the X-ray room, and the CT scanning room. The ladies of this department are truly wonderful and kind. They allowed us to watch over their shoulders all day, and always entertained our questions. The Philip hospital and clinic send all their scans to be read by radiologists in Rapid City at the Regional Hospital. This process was fascinating to me and I can’t believe how quickly the volume of information goes and comes back. These extremely detailed images of peoples’ insides send as fast as emails!

The first ER patient we saw was an elderly patient who was quite ill. The doctor and the nurses spent the morning trying to improve the patient’s condition, but the patient was unable to recover. This was a very bittersweet thing to experience, but I was glad to know the process of how these things happened. This is a process of life we are all aware of, and to be able to see and understand how and why it happens gives me the knowledge to encourage and support patients and families through these times. 

The second patient was a male with extreme side pain. We spent a good portion of the morning following the doctor as he tried to figure out what was happening. We ran several tests that offered no answer, and finally did an X-ray.  When Kelly and I viewed the X-ray we only noticed a bunch of air pockets. The reading on it came back that this patient had a bowel volvulus (or twisted bowel). Kelly was extremely shocked by this as she just learned this generally happens to elderly females and presents in X-ray to have a coffee bean shape. None of the symptoms were true of this case. This was a really interesting case in that proved to be against the norm and taught us to never rule out the unsuspecting.

We saw several other patients in the clinic that day, two of which needed X-rays, and another ER patient that also needed X-rays. We sure learned a lot about X-rays though!

Tuesday
Whew, again! We started the morning shadowing the orthopedist, looking at patients bones and X-rays (that we now knew so much about!) It was really interesting to look at the X-rays and see the screws/nails and parts in peoples bones. Most of the patients we saw were having post-surgery follow up appointments. However, we did get to see a cortisone injection to the knee.

Around noon, we got a call for the ER. A patient had fallen and hit their head on cement. When the patient arrived we became aware that the patient was on blood thinners, and that changed the game quite a bit. The patient began to have swelling and sizable amounts of bruising around the eye. A CT scan revealed that not only was orbital bone fractured but there was also a developing hemorrhage. The doctor quickly was on the phone with an ornithologist, who recommended a lateral canthotomy be performed so that the pressure of the hemorrhage didn’t injure the optic nerve.

So, Kelly and I have no idea what this means; I Googled images to understand what is going to happen. We start looking at pictorial images similar to those in medical books. Pretty soon Kelly is pulling up video of a procedure. I start to feel my whole body become hot and I can feel my face turning white. I calmly hand over the phone and say I need to sit down for a second. At this moment I know I choose the correct healthcare field of study.

At the end of this day, I was nervous to see what the rest of the week had in-store for us. However, I am extremely thankful that I had this opportunity to see and understand these situations, as I will not have these experiences in the pharmacy.

Wednesday
Wednesday we shadowed the employees of the assisted living center, Silverleaf. It was a much calmer day then the previous! The residents here were kind and happy to have someone new to chat with. We cleaned some rooms, passed some medications, and visited. They offered us a wonderful homemade lunch with three kinds of dessert! Kelly and I are still thinking of going back for another visit to get some more delicious food. It really is a lovely place, with kind hard-working employees.

Thursday
Thursday we spent shadowing a nurse at the nursing home that is connected to the hospital. It was an interesting morning for me, one that I think Kelly preferred more than I. We followed the nurse as she gave nebulizer treatments, tested blood sugars, and gave insulin injections. Then it was time for dressing changes. There were two that were quite severe, and Kelly was excited to get right in there and help. I however felt more at ease on the patient side of the wound. I was able to spend some time chatting with the Med Tech that passes out the medications throughout the day. It was interesting to see what happens with the packages I would deliver.

Friday
This day was really fun for me. I got to be part of the Get Out and Play Day put on by 4H and the Department of Game Fish and Parks. There were four stations; bb guns, archery, fishing, and first-aid, and about ten kids from 8 to 12 years old in each of the four groups. I was the first-aid station where we talked about sunburns, sunscreen, snakes, snakebites, and how to wrap a splint. I definitely was not the most interesting station, but the kids were fun and seemed to enjoy it. Hopefully I was able to leave them with some useful information.

Saturday
Saturday I got an ambulance pager! However, it was another uneventful Saturday of no calls. Thankfully no one needed to use the ambulance service today, and for that I am glad.

It’s hard to believe we are half done already! I am excited to see what next week has in store for us.

Week 3
This week brought many exceptional learning experiences!

Monday
Monday was really interesting! We spent the day in the lab. In the morning we spent most of the time learning and watching.  Man oh man, they fill out a lot of paper work in there. The morning was quite busy with urine samples constantly being brought in, doctors stopping by, going out to get blood samples from patients, and then analyzing those samples. A few patients came in after lunch and let us observe the phlebotomist draw their blood. Then one of the lab technicians saw the size of my veins and thought Kelly and I should draw each other’s blood. Kelly thought this was a great idea, and as for me, well, not such a good idea. We decided that Kelly should draw my blood because when would she have another opportunity. She was a champ! She did perfect for it being her first time. It took me several juice boxes to turn back from white. The lab techs let me off the hook for drawing Kelly’s blood. After this experience I am confident I choose the right career! We looked at my blood in the microscope and ran some tests on it too. Everything looked good except, my eosinophil count was really high, so yes I do have allergies and should keep taking Claritin.  I don’t think many other people in the REHPS program are drawing each other’s blood. Because of all the machines, the lab is kept extremely cool so Kelly and I didn’t mind spending the day there. We were fascinated at the talent of the lab technicians and now understand all the work that goes on behind the scenes of the doctor or the pharmacist requesting a lab be drawn.  

Tuesday & Wednesday
We spent Tuesday and Wednesday in the home health department. The ladies that work there have so much knowledge, kindness, and understanding.  These nurses are key in supporting a patient’s desire to continue to live at home and not have to be in the hospital. These lovely ladies help patients set-up weekly medicine holders, clean house, take baths, change clothes, or whatever else is needed to improve the patient’s quality of life. One of the nurses we shadowed has been working in home health for the 20 years of the program.

One patient we saw had three sets of medication orders from three different doctors, and the home health department was so instrumental in reconciling this patients orders to one clear and concise sheet of how to take what meds, at what time, and for what reason.  Wednesday we spent the day going to various patient homes to check-up on them. At these places Kelly did a physical assessment and documented her findings, while I was able to set up the patients medication bottles.  We had the opportunity to do a home visit to a patient with ALS who had an awesome attitude towards life. It was difficult not to get emotional while chatting with this patient. His attitude was truly inspiring. We also had the chance to work with a patient with an extremely rare blood disease, and this patient’s attitude was absolutely humbling. These patients have forever changed my attitude on complaining!

One of the most important aspects I’ve learned in Philip is that this department is helping patients discharging from the hospital with an understanding of what to do at home. These nurses meet with the patient prior to discharge, at discharge, and to a follow once the patient is home to ensure everything is going well. As a pharmacy technician, I often see patients coming in with so many questions of what they are supposed to be doing when they go home from the hospital. I would like to see more healthcare sites incorporate this type of transition of patient care.

These two days were really special for both Kelly and me.

Thursday
Thursday was a busy day for us! We spent the morning visiting with the community health nurse. While here we learned about WIC, Planned Parenthood, community immunizations, school health, and how new governmental policies are changing these programs. Heidi was so fun and inspirational to talk with. She has a deep affection for the health of the young adults and children in the community. So many people are benefiting from her hard work. Personally it was frustrating for me that the awareness of the positive impact of these programs is so unknown in other communities, especially the ones where I grew up. Heidi goes to give numerous presentations throughout the community to schools and organizations. Heidi even has a teacher that brings her class to her office, where she discusses confidentiality and what to do if you need help or if you know someone that needs help. Heidi was really inspirational to see how you can positively impact your own community.

Next, we interviewed Scothman Industries for our project. The owners were so kind and fun. Much to our surprise we got to tour the facility! Machining is so far beyond our specialties that everything was fascinating! From the tools and parts being made, to the machines making them, to the technology involved, to shipping all the products out, everything was highly interesting. I’m sure we looked out of place with our dress clothes and safety glasses walking around in this metal machining factory.

Shortly after this visit we interviewed the superintendent of schools. We may have got Kelly’s brother a position helping coach the high school football team during this visit! It is always interesting finding out how our communities in South Dakota are connected.

This was a fun day to get out of the hospital and meet some exceptional people of the community.

Friday
Friday we spent the day learning of all the fun things that happened on Thursday while we were out. For lunch we went to the Dakota Country open house downtown. The local pharmacy was having a get together to welcome the new owners and say goodbye to the previous owners. It was welcoming to see a rural retail pharmacy growing, as I hope to someday work in one myself. The hospital was also there to say thank you to the pharmacy for all their hard work helping to support the hospital. The two organizations have such a supportive connected working relationship that really benefits all patients.

Later we returned to the hospital for another round of questions from doctors (I am growing quite fond of all their questions to us in order to help us learn) and Kelly had a second chance to suture in the ER. However, this was her first experience injecting subdermal lidocaine. We are learning so much!

Can’t wait to see what this last (ah! already) week has in store for us!

Week 4
Monday
Today we had the opportunity to shadow at the dentist! It wasn’t as bad as we thought it was going to be! Kelly and I requested to be together on this adventure because teeth make both of us a little queezy. We got to see several cleanings and some cavities get filled. I was unaware of how much of your tooth gets drilled out when your face is all numbed up. The lidocaine injections to numb the roots still freak me out.  It’s a big injection into a small space. But boy am I thankful for this medication and it’s effects! It was rather fascinating watching the technician getting everything ready, assisting the dentist, and cleaning everything up. They complete a large amount of the tasks that need to be done. I guess I never realized how critical their work is to everyday function at the dentist’s office. I am happy to say that this experience has decreased my fear of this profession. However, I’m not going to be switching to this profession anytime soon.

Tuesday
Today we shadowed Black Hills Orthopedics again, but this time Dr. Dushane. We got to see more interesting X-rays of hardware, replacement parts, and incorrect bone structures. I found all of these types of X-rays to be super fascinating. The technology being used in these parts, pieces, and tools is awesome. I’m so thankful for what this technology does for patients, especially the elderly. It’s hard enough getting older, but really hard doing it with poorly functioning body parts. I am thankful this technology is available to provide relief to these patients and increase the quality of their lives (which a lot of the time increases the quality of their retirement!)

This afternoon I had the opportunity to learn CPR one on one. This is a skill we have to learn before school starts in order to be able to give immunizations. Linda was so wonderful to take time out of her day to teach me this. She works at the nurses reception desk, is on the volunteer ambulance crew, and is the CPR trainer/coordinator. She wears so many hats! I learned so much in the CPR course, and am so thankful for this opportunity to take my own personal course instead of having to complete the training online.

Wednesday
Today we got to be on the radio! We are getting so famous here in Philip; in the newspaper twice (once on the front page) and the radio too! We had a great time down at the bank promoting the REHPS program. Look for the broadcast to be on Facebook soon!

We spent the afternoon passing out thank-you cards, chocolates, and saying good-bye to many of our new friends. It’s like we just got here and already have to go.

Thursday
Goodbye dear friends in Philip! What a sad day. Kelly and I are excited to head home and play with our puppies, but we are so sad to leave all our wonderful friends. Today we gave a powerpoint presentation of the pictures of all our experiences to staff and friends. The donuts were delicious! It was fun to end our experience sharing laughs, stories, and pictures over donuts and coffee.

The REHPS program has been a truly awesome experience that will help me in my pharmacy career. It was a great opportunity to see and understand other health care professions, and to understand how important it is to patients that we all work together as a team. I look forward to be able to return to Philip for rotations during school.

Thank you Philip!