Kiel Grant
First Week at Custer
My first week in Custer has been nothing short of a whirlwind being both exciting and hectic at the same time. On our first day we were given a tour of the Custer Regional Hospital, a partner facility of Rapid City Regional.  Everyone was so welcoming and excited to show us their part in making the hospital run. We met with Mike, our coordinator, and he showed us plans for the new hospital they are planning on starting construction on this summer. Everyone we have talked to, including patients and community members are excited for the new hospital to be done and recognize that it is going to be a great investment in their community!

Later that week we were able to follow doctors in the walk in clinic and the emergency room as they cover both when they are working. Between seeing patients in the walk in clinic and having people come through the emergency room the doctors don’t have a second of down time! It was fun as a pharmacy student to get to see the clinical side of medicine.  I feel like I have been able to see things that I will never see once I graduate, such as an emergency thoracentesis!  Later that week Mike gave us a lesson on suturing since he used to help in surgery as a surgery technician, he even let us borrow the tools to practice over the weekend. I took full advantage of this since it is not something a pharmacist ever does, but it was interesting to learn all of the different techniques.

Sunday Wade and I hiked up Harney Peak.  It was a difficult climb but it was worth it at the top to have such an amazing view of the Black Hills. I cannot wait for next week to see what is in store at the clinic and to explore more of this amazing community.

Second Week at Custer
My second week in Custer was just as active as the first! On Monday we got to see patients in the walk in clinic and patients in the emergency room. For a town of less than 2,000 who knew we would see so many patients that day! The next day I was able to get more pharmacy experience by following around the consultant pharmacist for the Custer Regional Nursing Home. It was a lot of fun, but I never knew how many more rules a nursing home pharmacist has to follow than a retail pharmacist. Reviewing every patients chart every thirty days is a lot of work! On Wednesday, Wade and I got to go to Hill City and shadow Zach Peterson, the PA, who works in the clinic. It was great to see that Custer and Hill City have a great working relationship since Zach also works at the Custer clinic. On Thursday, I was back in the clinic with Dr. Falkenburg who was seeing her scheduled patients, many of whom she knew on a first name basis. I spent the later part of the day with Jess, the hospital pharmacy technician. She showed me how the hospital stays stocked with medication, along with a ton of other jobs that she does.

To round out the week I had the opportunity to follow the optometrist in town, as he saw patients, giving me an opportunity to learn more about the eye. I was then able to get into a retail pharmacy setting at Carson Drug, the local drug store, and work with Pharmacist John Carson. It was really interesting to see how an independent pharmacy operates versus a large chain store pharmacy. I was surprised Friday night when my wife came for the weekend. Over the weekend we were able to see a lot of the sights in Custer and the surrounding area; including Reptile Gardens and Jewel Cave. Our favorite part was driving through Custer State Park and going through all of the tunnels and seeing the wildlife. I don’t think I have ever seen a buffalo that close up before!

Third Week
This week in Custer started with Memorial Day. Having come out for the weekend, my wife and I spent all day hiking in Custer State Park which ended up being a great day for a hike. The rest of the week was a whirlwind of meeting with medical providers from many different backgrounds. On Monday, I met with Dr. Nathan, a chiropractor, who taught me about spine and hip alignment and how he came to work in Custer. I then moved on to the physical therapy building where I got information on the specialties of physical, occupational, and speech therapy and was able to sit in on a session of physical therapy for a lady who had recently had a knee replacement. The next day I got to meet with radiology and help with an x-ray, a CT scan, and an OB ultrasound, all of which I had never seen before! I then met with the lab and was shown all of the different machines that they run lab results on such as CBC and electrolyte panels. I even got to help make a blood smear to send off to Rapid City to be read. Thursday was a crazy day as we met with someone from Social Services and got to go on house calls with her to see what services they provide. We then went to the clinic to meet with Jessica, the pharmacy technician, who works between Rapid and Custer to see more of how the pharmacy side of things works in a rural area. Finally, we went to the Hot Springs Clinic to tour their new hospital facility. Wade had already done 2 rotations out there so he was able to show me around and introduce me to many of the facility MD’s and the Pharmacist. Friday came around and I was able to meet with someone from the Rapid Regional Hospice House and follow her to house calls to check on patients in their homes. It was a great experience. I can’t wait to see what my last week has in store!

Fourth Week
My final week in Custer was just as exciting and busy as my first! On Monday, I was with the local dentist at Destination Dentistry. I got to see a crown placement and a filling where the crown was made in a machine right in the office, making it a same day appointment. On Tuesday, I took trip to Rapid City where I meet with Kerri, the nursing home consultant pharmacist, and got to see her other job at the long term pharmacy. It was neat to see the differences between a long term care pharmacy versus a nursing home pharmacy. The next day Wade and I went to Hot Springs to meet with Dr. Preuss, who runs the clinic. It was cool to see that there are so many clinics in the area around Custer. While they might have limited resources to operate, they still are able to provide quality health care to people in such rural areas. Near the end of the week Wade and I met to put together our presentation for the site, which we gave on Friday. Our presentation went well and a lot of people that we had met over our few weeks came to hear us speak. I had a good time in Custer and I had a lot of experiences that I probably won’t get have again. I hope these experiences will make me a better pharmacist in the long run.