Kimberly’s Blog

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Week 1 Miller, South Dakota

Day Minus One- Sunday, July 6th
I’m starting my blog today, day minus one, because it is packing day. I’m getting ready to head to Miller, and I have no idea what to pack! How do you pack to be gone for a month? Well, I started throwing all my dress clothes in one large bag and some casual clothes (jeans and such) in a smaller bag. My boyfriend looks at me and asks, “You’re not packing 30 outfits are you?” Well, no, but close! Maybe 15. That should be good. I can wash clothes there, so I brought a laundry basket. That will carry some random things for me in my packing spree anyway. I, of course, packed an entire separate bag of toiletries. My boyfriend looked at me funny for that, too. But surely travel size anything isn’t going to last me a month. He didn’t see me pack 4 pairs of dress shoes, tennis shoes, and sandals. I even brought a lawn chair. I am determined to be prepared! I am really excited to start this adventure. I can’t wait to meet new people and see new things. Miller, here I come!

Day 1- Monday, July 7th
I arrived in town mid-morning and found Teresa, our site coordinator, in the hospital. She directed me to the “yellow house” behind the hospital. Prior to this we weren’t really sure where we would be housed. So this was great! It’s just a cute little two bedroom house with a few amenities. Tom and Bryan helped move things in and asked several times throughout the day if there was anything else we would need. I think we got it all! But we knew who we could call if we needed anything. Catherine arrived a little while after me; then we met up with Cheri for a little REHPS orientation and paperwork. Catherine, Cheri, and I met several of the managers for lunch. We had taco bar and it was great. Everyone was friendly and welcoming. Next, we went on a tour of the hospital, clinic, and the community with Teresa. Teresa pointed out some “hot spots” in town that we should hit up while we’re here. After that, Catherine and I went back to our little yellow house and got settled in a bit. We also had a chance to just sit down and talk to each other for a while. We had only met each other briefly a few months earlier in orientation, so it was great to get to know Catherine. Curiosity got the best of us, so we drove around town together and stopped at the coffee shop. What a cute little place! I’ll have to remember this place if I need my latte fix while I’m here. We then decided that was enough for one day. We had our meal from the hospital and vegged on the couch for the evening, something neither of us had done much lately.

Day 2- Tuesday, July 8th
After breakfast, I met up with Noelle in physical therapy. I had a lot of fun with her running around seeing patients. She saw a couple in the clinic, one in the nursing home, and one young man at the skill builders. This little boy was so cute! What a charmer. He had great parents as well. We were going to teach him how to use his new canes, but ran into technical difficulties. Noelle had to go back and talk to the gals with DME to see if smaller canes could be ordered. I had to leave to my next stop, but it was great to see how the different departments worked together. I’m sure I’ll see this often in this tight knit community. Next stop was with Cassie, the nurse practitioner. It was kind of a hit and miss afternoon, but it was nice to get to know Cassie for a short bit. After dinner Catherine and I watched some chic flicks on the TV. I also checked out the wellness center at the hospital that they so kindly granted us access to. It’s a nice little place to get a sweat on! I cooled down by taking a long walk around a few blocks. Miller is turning out to be a comfortable little town!

Day 3- Wednesday, July 9th
Off to the clinic I went to spend the day with Shelly, NP. She had a busy day of patients scheduled. I had to keep up with her! In between patients we got to know each other a little bit. Being a student can be tricky, asking questions but not bogging down the provider. Shelly was incredibly kind and patient with me. Mid-morning I got a surprise that my grandma and great aunt had come to Miller for an eye doctor appointment. In a way this was icing on the cake. I knew I would enjoy the rural experience because it would feel like home, and indeed it sure felt like home being able to see family. As the day was winding down we had a bit of an interesting patient. A conundrum. Shelly had expected it to be a straight forward visit but we were thrown a curve ball. I love using my brain and being challenged, and this patient was a challenge! Shelly did a great job. I hope I can follow up with this patient. For the evening I went out to supper at one of the local restaurants and it was pretty good. Mostly it was just another relaxing evening in Miller!

Day 4- Thursday, July 10th
My morning was spent in radiology. I happened to come on a slow day, so I got some good lessons in on some of the different procedures. I went through a huge stack of old x-rays. It sure would be fun to know some of the stories behind these! My afternoon was spent with the nursing staff in the hospital. They were a bit busy, but I did get to chat with them a little and get to know them. All the hospital staff I have met have been great. We get to chat with them a little while Catherine and I are there for meals. We kind of invade their space, but hopefully they don’t mind and we can just get to know them better. They were doing training on the Lucas2 device, which is a device that performs compressions in a code. Technology is kind of fascinating! I’m all for technology that leads to better patient outcomes. In the evening Catherine, the brave one, donated blood. We met the donut maker, JoDean. She is famous for the glazed donuts at the blood drives. She even got a sticker that said “I donated for the donuts!” I was the photographer and the moral support, so I still got a couple donuts. They were, indeed, something to write home about!

Day 5- Friday, July 11th
Bacteria growth, blood cross matching and viruses. That’s how Friday morning started off. I got to experience the inner workings of the lab and, ironically, it wasn’t a human virus as one might suspect. It was a computer virus. The “big house” IT gurus down in Sioux Falls had been tracking some odd activity within the network and it was pinpointed to Miller. Computers are not my forte’ but it is pretty interesting how they can track and monitor so many different sites. All the machines within the lab were intricate as well. I’ve been on the collection side of specimens for many years, but not the analyzing side. Now I know! After lunch, I was off to Rexall drug downtown to spend the afternoon with Travis and the pharmacy techs. Again, I’ve been on the flip side of prescribing and administering medications, but not on the back side where everything is prepared. My main take-away points from Travis- make friends with a pharmacist and don’t be afraid to ask questions! I knew this, but it was good to hear. For our evening entertainment we took off to the Midway drive in movie theater. It was a beautiful night! Miller is pretty lucky to have the drive in. It’s a unique experience that not everyone can have. I can’t wait to go back for chic flick night! Week one done and I’m still having fun!

Week 2
Day 8- Monday, July 14th
Getting moving on a Monday morning! It was back to physical therapy for me after a relaxing weekend, this time to follow Tim. We saw a few inpatients and a few outpatients. As always, it is fun to get to know the patients and their stories. I also enjoyed talking to Tim about the role of PT in the town and some tips and tricks to learn from when I am on my own as an NP. Unfortunately, PT has as many hoops to jump through regarding insurances; so I guess I’ll stick with my profession.  ;-) I had nothing scheduled for the afternoon so I took this opportunity to make some phone calls. Catherine and I need to interview 6 community members about active living and healthy eating in Miller, and I actually convinced a couple people to talk to us! Just kidding. People were very willing to talk to us, and for that I am thankful!

Day 9- Tuesday, July 15th
How is it that days that initially have very little going on turn into some of the busiest days?! Catherine and I were busy from sun up to sun down. After breakfast we took off to the Hutterite colony south of town, Millerdale. Rebecca, our “tour guide,” started us off in the store where they embroider, screen print, and engrave products. We happen to get there at 9am which she told us was coffee break time so it was kinda quiet at first. By the time we took off it was hustling and bustling with machines. We then saw their very large garden full of yummy fruits and veggies! What a lot of work, but oh the bounty! Naturally our next stop was the dining hall. There were two distinct smells immediately. Pickle canning in the basement and bread pudding in the oven. Both were great, individually! We also toured a family home and were able to talk to Rebecca about their traditions. She was very nice and we enjoyed our time with her.

Once back in town we had lunch at Don’s pizza. Good pizza and good prices, especially for us college kids! Across the street is Helping Hands, which is a store, per se, for people in need to pick up clothes and food, similar to a food pantry. The lovely ladies there told us all about what they had to offer. What a great resource for Miller! Next stop was ice cream at Rexall. We both got mudballs for $1, which is a scoop of ice cream covered in chocolate and rice crispies. A perfect refreshing treat! With our day only half done, we went to meet Ron, the mayor of Miller. He was one of our interviews for our project. He was great! I thoroughly enjoyed talking to him. Across the street from city hall is the senior center, so we bopped over there to meet some more folks. My favorite part of the day was learning how to play Shanghai rummy. Before supper we also met with a high school student to talk about our project from her perspective. To top our day off we also saw an ER patient with an injury from a farm accident. Darn cows! The patient was well enough to be discharged home, so I’d call that a good ending to the day.

Day 10- Wednesday, July 16th
Screening for diseases, including cancers, is an important role of the nurse practitioner. Not everyone is so excited about some of the screenings we do, namely colonoscopies. Well, kudos to those who make the choice to have colonoscopies. We watched a couple this morning, and, thankfully, they were pretty benign. I’m not saying colonoscopies are glamorous, but I am saying they’re really not that big of a deal and they are important. Generally, the procedure takes less than 10 minutes. Thanks to Dr. Werth for allowing us to observe. I also tagged along with a couple of the nurse practitioners in the clinic throughout the day. It was a pretty average clinic day, including well child checkups with immunizations, well women’s checkups, DOT visits, strep throat, rash, and a UTI. Average, yet unique because each person had their own story and individual needs. Sounds like my kind of job!

Day 11- Thursday, July 17th
Today was another procedure day at the hospital, this time with Dr. Bormes and cataracts. The doctor brought along an extra pair of microscopes so Catherine and I could watch the surgery up close. There’s really not a whole lot to see without these. Dr. Bormes did a great job explaining how (and why) the procedure is done, including a funny little analogy of chopping up and sucking out one dirty M&M and replacing it with a clean new one. And window washing. It really does make sense when he explains it and you watch it! Every day has been variety so far and today was no different. I spent the afternoon bopping around the hospital finding things to see, which included mammograms (go cancer screening!), x-rays, dexa scans, and clinic patients. Catherine and I had an interview with the newspaper to talk about the REHPS program. I’ll need to remember to grab some copies next week! Today was also the day to get my latte fix at the coffee shop downtown. And a hazelnut truffle. Because everyone needs a little treat sometimes!

Day 12- Friday, July 18th
It kind of felt like a Friday around the hospital and clinic today. Lots of people talking about plans for the weekend. For the morning I followed Kim and Marissa in respiratory therapy. Well, they’re a bit of a catch-all department, so I saw a few new things. We had a telemedicine appointment for a patient. I think this is a great option for patients in rural communities to be able to see specialists. Certainly there are times when a doctor needs to see a patient in person, but this is a great option for quick follow up appointments, in lieu of driving 3 hours to the nearest specialist. That’s a lot of time and money saved! I also saw the home medical equipment side of the department and we talked about some of the patients they serve. They dispense the cpaps that are prescribed if the doctor orders one after the sleep studies, so this tied in well to sleep studies we saw. We talked about pulmonary rehab that the department is in charge of. As Marissa said, this would be a fun part of the job to be able to watch patient’s improve and their hard work pay off. I chose not to watch a nebulizer treatment as I’ve seen a few hundred of those in my eleven years of nursing.  Marissa and Kim cover a lot of territory with all the tasks they have. I think the variety would be a lot of fun! They both enjoy what they do and I enjoyed spending time with them. After lunch I stopped in the pharmacy downtown again. They were busy bees as usual. Travis and I talked about more medications (obviously) and prescribing practices. I find it very helpful to learn tips and tricks from other specialties that I can use in practice. I topped the end of my day off with a strawberry malt from the soda fountain. Sounded like a great way to end the week to me, and perfect for a warm summer day, too!

Week 3
Day 15- Monday, July 21st
It was a busy Monday, yet I’m not sure what to say about it. It must have been such a busy day I didn’t have much time to process. I followed Shelly, NP, in the clinic and we didn’t have a whole lot of time to breathe between patients. But it was fun, and educational. Likely this will be a common day for me when I am done with school. I have very much enjoyed watching the interactions with patients.

Day 16- Tuesday, July 22nd
There’s nothing like an early morning meeting to start off the day! We attended the med staff meeting. I met the regional administrator, who is also the father of one of my son’s classmates. It surely is a small world. As he said, “funny we have to come to Miller to meet!” Formally, anyway. I had seen him at basketball games and such. I spent the rest of the day jumping in with the nurse practitioners and Dr. Turner. It is interesting and helpful to see the different styles. I have also enjoyed interacting with the clinic staff. They have been very helpful and inviting. Tuesday night is chic flick night at the drive in! It’s been the talk since we got here, so of course we had to check it out! This time we decided to sit outside for the movie. The bugs weren’t bad at all, but it got chilly. Would be a great night for a blanket and sit outside to munch on my popcorn and fruit pizza. The movie was funny. Everyone needs laughs!

Day 17- Wednesday, July 23
Human emotion. As nurse practitioners (and other healthcare professionals of course) we see the gamut of emotions in our patients and families. We also personally deal with these emotions as well. I thought a lot about this today as we started off the day seeing a husband and wife both holding back tears of concern and worry. There have been several deaths since we arrived as well. I saw a patient who was embarrassed to talk about her emotional struggles and depression. I’ve seen gratitude, stress, anxiety, happiness and many other emotions as well. All these emotions of others just kind of tugged at me today. In a way we are counselors and support for these patients and families, just as much as we are here to diagnose and treat medical problems. I hope I never lose sight of the importance of helping patients and families deal with emotions. Treating the whole patient is so very important.

This afternoon I followed Dr. Turner. This was the only scheduled time I had with a physician. She’s a great teacher and it was great to spend time with her. It was a very busy day at the hospital with admissions, ER patients, and transports to other facilities. One of the nurses didn’t get lunch until 5 p.m. Bless their hearts for their hard work and endurance!

Day 18- Thursday, July 24th
With nothing scheduled today we took the opportunity to work on miscellaneous paperwork and our ending PowerPoint presentation. It was fun to look at our pictures and think about all the people we have met thus far. It brought a lot of smiles thinking about this. I really have enjoyed this time in Miller and all the friendly, helpful people at the hospital and clinic, as well as within the community. For fun, Catherine and I went to the assisted living center and played bingo! It’s kind of a big deal there. I didn’t win anything. So close though! But I did get to visit with some residents and have a piece of cake. Win! I also had supper with my grandma, aunt, and uncle. What a great day!

Day 20- Friday, July 25th
Sore throats and abdominal pain were the specials in the clinic today. I followed both Shelly and Karen throughout the day and even though the chief complaints seemed to be similar, no two stories were the same. Never a dull moment. I really like family practice and seeing all ages. I currently work with all adults and I really miss working with kids. They are so fabulous! I also like to see the variety of problems that are seen in family practice. It’s a lot to know and learn, but I am excited for my career as an NP and to become more knowledgeable. I hope I have great team members like they have in Miller, too!

Week 4
What a better way to start off a Monday morning than with a good cup of coffee! While out running a couple errands I hit up Heartstrings again for an iced mocha. Yum! The gal who made my coffee recognized me, which was really neat to know that people are already recognizing my face in town. Then, Catherine and I headed to Carr Chiropractic Clinic. We had heard they have been very involved in health and wellness and are an important part of the community, so we went to interview them. We specifically talked to Chris, who is their wellness coordinator. Dr. John also spoke with us briefly about the clinic. They obviously have a passion for healthy living and the community of Miller! It was so nice that they took time to talk to us.

After lunch, I headed back to the clinic and followed Karen. Just like Friday, there seemed to be a theme of the day. Today was vague complaints, which is kind of like finding a needle in the haystack. So it was a bit of a challenging day deciphering what the symptoms were from, what tests to run, and how to make the patients feel better. Karen did a great job, and it was beneficial for me to see these types of patients because not everything is cut and dry.

Tonight was officially the most exciting day of my time here so far, as far as clinical experience goes. The flight team came to transport a patient and they allowed me to help in the procedures. We also got to use the E-emergency to teleconference with the ER doctor in Sioux Falls. Not that we would ever wish for anyone to be sick enough to use it, but we were hoping to see how it works in action as this is important technology for rural hospitals. I even got to ride to the airport in the ambulance!

Tuesday, July 29th
North Central Heart came to Miller today to do a clinic, which included the cardiologist, nurse, two cardiac techs/ultrasound techs, and a nuclear medicine tech. Marissa and Kim from respiratory therapy help orchestrate this (see, I told you they’re a catch-all department!). It was a very busy day on our feet, watching echocardiograms and nuclear medicine stress tests, as well as following the doctor around. And it was a great team to follow as they were helpful in explaining what they were doing and what they saw. I’m sure I’ve said it before, but how beneficial to have these specialties do outreach to these towns! My guess is some of these patients would not make the trip to Sioux Falls or another bigger city to see the specialists.

Wednesday, July 30th
Today I followed Dr. Schroeder all day. Not only did I get more experience with patients, I also got to experience some of Dr. Schroeder’s points of view on healthcare, insurance, and the EMR. If anyone knows him, you know what I’m talking about! It was great. I really enjoyed the day. I got to see a post-MI patient that I saw fly out last week, and he was doing really well. I’m really glad for the few patients that I have been able to follow up on. It is very rewarding to see positive outcomes. Some other patients we saw were a female physical, workman’s comp, fatigue, a couple new patients, and medication rechecks.

Thursday, July 31
Well, today concludes our time in Miller, and what an experience it has been! Last, but not least, we did a presentation for the hospital and clinic staff for lunch. There was a sandwich bar to treat everyone and to say Thank You. Catherine and I made a PowerPoint, to talk about the many experiences we had, and the many places in Miller we visited. We made it a little interactive, asking the audience to identify pictures and locations around town with candy as a reward. Hopefully people enjoyed the presentation and know that we are very thankful for our time here. I’ve seen pretty much every department, and met many patients and community members. By far the best part was the people. I love the Midwest and the values of the people. I love how friendly and helpful people are. I love making a difference in people’s lives. I feel very lucky to have spent this time in Miller getting to know the people and the healthcare here. Miller has some very good things going for them for healthcare, for the community, and for wellness. If anyone I have met in Miller is reading this, Thank you! Thank you very much for making me feel welcomed and at home. Thank you for allowing us to get to know you and your community.