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Winner, South Dakota
Week 1

I’M GOING ON AN ADVENTURE! I was not sure what to expect as I left for Winner on Sunday, but as I drove into town, I felt right at home. Everyone in the hospital and clinic was friendly and more than willing to help me find where I needed to go. Monday morning Karey, our preceptor, gave us a tour of the facility. I was impressed by all that this small town critical access hospital has to offer its patients. That afternoon I attended a meeting with one of the pharmacists in which pharmacy, nursing and various business administrators discussed implementing a bar coding system used in giving medications to inpatients as a double check to ensure patients are receiving the correct medications. The hospital pharmacy was quite different from large hospital pharmacy. The workflow was much calmer and everyone, technicians and pharmacists, worked together to get things done.

I spent a day with a cardiologist as he talked with patients about their conditions and medications. While waiting for the doctor to arrive in Winner (they had trouble flying out of Sioux Falls due to fog), I talked with a radiology technician. She spent time showing me various films and explaining what she looks for while performing the tests. It was interesting to watch a stress test being performed. The experience gave me insight to nuclear pharmacy as well.

I also spent a day with one of the doctors as she saw patients in the clinic as well as round with the inpatients. This doctor saw many different patients, ranging from O.B. and pediatrics to geriatric patients with broken bones. It was great to hear what the doctors are thinking as they talk with patients about their conditions as well as the medications available to treat them. We even discussed a patient who overdosed on an over-the-counter medication in hopes that it would help her pass a drug test.

Friday I was in the O.R. watching five different procedures, two wart removals, two esophageal ablations and an orthopedic surgery to fix a fractured ankle. This was the first time I watched any operation outside of veterinary medicine. The nurses were incredible at what they did and were great at keeping the patients calm as they came into the O.R. and as they woke up.

We ventured out on the town Saturday morning, stopping in at various little shops on Main Street. The people are all so friendly and welcoming in Winner. It has been a great week! I am excited to continue with this adventure!

Week 2

What a week in Winner! I can’t believe this experience is already half over! On Monday Deb and I followed patients through an O.B. outpatient clinic. We watched several ultrasounds, one of which show the baby was not moving as much as he should be. The doctor explained that it was not unusual for the baby to be so quiet but he ordered a non-stress test to watch for baby movements. Lucky, after a very short time of being hooked up to the monitors the baby woke up and was moving around, earning him and mom a clean bill of health for this check-up. Throughout the day, the outpatient clinic had two port flushes to perform. We have discussed ports in class, but seeing one for the first time and discussing it with the patient gives a new perspective to their advantages and disadvantages.

Tuesday I talked with an audiologist and watched as he evaluated a new patient. I learned a great deal about audiology, the schooling required before practicing, and about the field itself. For instance, did you know that audiology was once a male dominated profession which is now largely dominated by female practitioners? I also learned a great deal about hearing aids from the hearing instrument specialist. After leaving the audiology clinic, I sat in on a cardiac rehabilitation session. The nurse performing the session explained all the work that goes into setting it up and what she watches for on the monitors as the patient goes through the session. After the session, she counseled the patient on the importance of watching what we eat and avoiding high fat and high salt foods in eating a heart healthy diet. I admire the progress the patient was making after only a month of starting a new heart healthy diet. The second patient was not as compliant and struggled to even remember to take his medications before coming into his session, showing how different patients can be. I also had the opportunity to sit in on a counseling session between a dietitian and patient who was struggling to understand how to count calories on a diabetic diet.

Wednesday I drove out to Gregory, Dallas and Colome with a home health nurse. She saw seven patients total but told me that she will typically see nine or 10 a day. I spent the morning helping her by filling medication reminder boxes for patients, most of which are taking 10 or more medications. I was impressed by the knowledge many of the patients’ caregivers had about these medications and when they needed to be given. I also watched as the nurse cleaned various wounds on patients. One patient had severe stasis ulcers on the leg. Originally the doctors said there was no chance at healing them, but with wound care and proper nutrition the ulcers have shrunken considerably in the past few months. Another patient had deep wounds that require a wound-vac. Another new experience for me.

Thursday was cataract surgery day at the outpatient clinic, a long day for the nurses who were there from 5 A.M. to 7 P.M. prepping and recovering patients before and after the procedure. I followed a patient from check-in, through prep, the surgery, and finally recovery. They start by recording vitals, asking questions, starting an I.V., and giving drops in the eye as prophylactic antibiotics and to dilate the eye. I learned that dark colored eyes typically do not dilate as well as light colored eyes. The patient was sent back to surgery where I was allowed to watch the procedure. It was amazing how the doctor could manipulate the tiny instruments to perform this delicate procedure. After the surgery, the patient was wheeled to the recovery room and given a lunch to eat and discharge instructions before they left the clinic. I counseled a patient on the importance of using eye drops properly. I spent a great deal of time talking with patients while they waited for their turn to head back to surgery. I learned the official difference between ranching and farming, how to treat a calf after it has been bitten by a rattlesnake, the problems with prairie dogs, what trees grow well in South Central South Dakota, and many gardening tips! The people here are incredible and were more than willing to talk with me even when they were nervous about the procedure they were about to go through.

Friday I spent the day at Healthmart, a retail pharmacy in Winner. I helped the technician fill the scripts to get caught up and then spent the rest of the time asking hundreds of questions to the pharmacist. The pharmacist showed me the computer system and let me work through entering a new prescription. I also counseled patients on medications as they came in. Healthmart also does unit dose packaging for various facilities. It was great to see the packaging process and review the laws about unit dose systems outside of the classroom.

What a week it has been! I cannot wait to begin week 3!

Week 3

It’s hard to believe week 3 is over already! On Monday I spent the day with a nurse in the long term care facility. We discussed the various regulations on when she can give various medications to the residents and the various medications that the residents are taking. It was a whirlwind giving all the medications and making sure the residents were happy and comfortable. I enjoyed visiting with them and getting to know them. This was also my first experience with an NG tube.

I spent two days in the hospital pharmacy this week. I talked with the pharmacist about a few specific patients, learning about balancing a warfarin dose and managing a patient with a high INR. We also worked in the IV room, practicing preparing IVs. Later in the week we garbed up and prepared an IV infusion for an outpatient. It is exciting for this small hospital to have a new IV room! They are also working on setting up a new barcode system for medication administration for the nurses. This requires all the medications in the pharmacy to be scanned into the system. So the technician and I spent an afternoon scanning in medications.

Wednesday I was in the operating room observing two procedures. The first one of the morning was a hysterectomy. This was a fairly long, open procedure. The surgeons and the anesthesiologist explained the procedure and what they found throughout. The second procedure was an esophageal ablation. The rest of the day was spent working on gathering and reading through information about our community project.

I spent an afternoon in the outpatient clinic where I conducted a medication reconciliation with a patient coming in for an infusion. We also had a patient walk in for a procedure that was not on the schedule (luckily the outpatient clinic was not busy and we could get her in the room right away). This was the first time I had heard of a colposcopy. I learned about sending biopsies via courier and the process it can be.

The final day of the week I followed a nurse practitioner. We started out rounding in the long term care facility. We then saw a variety of patients, from family planning to urinary tract infections. We also saw a patient struggling with depression that she sent to the hospital for observation. This was my first experience with behavioral health.

This has been such a fast week! It’s hard to believe that this experience is almost over!

Week 4

They say time flies when you are having fun and they are not joking! It’s hard to believe that four weeks could go so quickly! The last weekend in Winner I experienced my first drive in movie and had the greatest popcorn. Tuesday, Deb and I presented DOT updates to trucking agencies in Winner as our community project. The drivers were receptive to our presentation and many, already hearing of the updates to the medical certification process, had questions for us.

I spent a day in the clinic with a nurse practitioner. We saw a baby for a well baby visit, a patient with a fungal infection, and a patient with a parasite. My last day in Winner, I hung out in the lab. I learned about the various machines and tests they run in the lab. I also watched as cultures were plated. It was a great refresher in infectious disease and how microbial susceptibility to various antibiotics is determined.

I could not have been more blessed to have met so many great people and have stayed in such a friendly and welcoming community the last four weeks! I have had a wonderful experience in Winner! What an adventure it has been!