Week 1 Wagner, South Dakota
The last week and a half of participating in REHPS in Wagner, SD has been a blast! I have had a wonderful time getting to know the community members and hospital staff including Lindsey Barthel, the CNP in the clinic, nurse Connie, Dr. Qazi, Dr. Szilagy and the many other physicians, nurses, kitchen staff and house keepers who have made my stay enjoyable. A lot has happened in the last 12 days, but I’ll try to bring you up to speed!
Wednesday, May 28th – My first day of the program was a relaxing one! I moved into my double hospital room that I share with my fellow REHPS student, Kelsey. I was able to meet both Dr. Qazi, a physician in the clinic and E.R., and Lindsey Barthel, a CNP in the clinic who is leading my experience in Wagner. Lindsey showed me the ropes in the hospital and provided a community tour. I did not expect Wagner to have so much! To top off the first day, lunch with the local Rotary Club was a must!
Thursday, May 29th – The great thing about the REPHS program is the chance to experience a variety of health fields. I spent the morning with Joe, a physical therapist, and Rhonda, a physical therapy assistant. It was interesting to see how the number of rotator cuff injuries increases with the number of farmers/ranchers in the community, and the numbers in Wagner are definitely high! I was also able to see a patient with plantar fasciitis and see the administration of iontophoresis. A lot of time was spent with community members during both lunch at a local establishment, Boom’s, which may have the best patty melt and fries I’ve ever had, and dinner, learning about the recently introduced Dakota Rising program, which cultivates local entrepreneurs and helps to build their businesses. The night was spent on call in the E.R. where Dr. Pinter, a wonderfully intelligent “cowboy doctor,” walked me through a head laceration (with the promise of suturing in the future), seizures induced by Tramadol overdose, and a case of Shigella! It was great to be able to see such a variety of cases!
Friday, May 30th – The morning was spent with occupational therapy. I worked with a patient recovering from a recent back surgery who was learning how to shower and get into bed with her new restrictions on movement. In the clinic we saw a patient recovering from a stroke that greatly diminished movement on her left side. In the beginning she was unable to complete most exercises and I had the pleasure of watching her complete a very difficult exercise with minimal fatigue!
Monday, June 2nd – I met my fellow Wagner REHPS student Kelsey! She is a pharmacy student at SDSU and has already taught me so much. We spent the morning in the clinic where Connie taught us how to flush ears. Later, a learning experience in the E.R., we observed an emergency chest tube insertion. The patient had been stabbed in the chest and was developing a pneumothorax. This also provided a unique experience of rural medicine; e-Emergency. Through video chat, a physician at Avera in Sioux Falls provided instruction on how to perform the insertion. The technology and the resources that are provided for rural facilities are just amazing.
Tuesday, June 3rd – I spent the morning in lab with Leslie learning about the different machines used to check lab values. I was also able to see first hand a blood typing test using gel that checked for compatibility of bloody type and antibodies. The afternoon was spent in various radiology departments where I was able to observe a carotid Doppler, an MRI performed on a knee and an MRI performed on the brain!
Wednesday, June 4th – The day was spent in the clinic with Dr. Oazi and Lindsey. We had a very interesting case of a 15-year-old patient who had yet to show any signs of the beginning stages of puberty including the growth spurt (he had yet to reach 5 feet)! I was able to assist in the differential diagnosis and selection of lab tests and radiologic imaging for the patient. Dr. Qazi really enjoys discussing aspects of medicine with students in the clinic. I had the pleasure of discussing a variety of topics such as Tanner Stages, 10,000 Step Program, and Streptococcal Pharyngitis.
Thursday, June 6th – The morning was spent with Dr. Brent Adams, an orthopedic surgeon doing outreach work from Yankton. While no surgeries were scheduled, we were able to squeeze in 19 patients. The scope of ailments seen throughout the morning had me tripping over my feet but Dr. Adams was able to bounce between the varieties of cases easily. The cases included hip and rotator cuff surgery recoveries, ulnar nerve transposition recovery as well as multiple depo-medrol injections at the shoulder joint, thumb joint, the 4th MCP joint for trigger finger. Kelsey and I traveled to James Drug, the local pharmacy, and learned about the happenings of a rural pharmacy and assisted by counting out pills. They organize their drugs based on brand name so that was a difficult adventure as I learn by generic names. One of the pharmacists also owns the Wagner Theatre and I was invited to enjoy a private screening of Godzilla. So here’s a plug, check out that theatre! It is beautiful and they have done an amazing job with it! Thursday evening I was able to observe another unique aspect of medicine when working with Dr. Nathalie Slizagy in the Wagner E.R.. Dr. Slizagy is a “Coast to Coast” doctor and fills in at hospitals in need of ER physicians to cover time periods anywhere from one day to over a month. That night we were visited by an elderly women with a scary low blood pressure of 65/30 due to sepsis. The sepsis stemmed from a urinary tract infection that led to pyelonephritis. Once stabilized, the patient was sent out by helicopter.
Friday, June 6th – In clinic Friday morning, I learned how to correctly administer allergy shots. Bouncing between the clinic and the ER allowed me to meet a patient with hepatic encephalopathy, something I had recently learned about. Having Hepatitis C since 1991 from sharing needles and not seeking treatment until recent months as well as continuing illegal drug use until a year ago worked to exacerbate her condition until full on liver failure was reached. The evening was spent at a fundraiser for the community nursing home and participating in a “resident walk” by assisting a lovely man named Ernie! I remained on call for the ER that evening and was able to see a few patients including a male with LLQ abdominal pain stemming from a UTI and a young male assault victim with a broken nose and cheekbone.
This last week in Wagner was filled with more adventures and more hands on experience than last week. I got to know the Wagner community and surrounding areas a little better as well as practicing some of my clinical skills. Here it is in a nutshell (sort of).
Monday, June 9th – I had the pleasure of visiting the Good Samaritan Wagner nursing home on Monday. I spent the morning meeting with Michelle Juffer to learn about the history of Good Samaritan Society and Wagner’s home and with Lynne Doom to discuss quality assurance policies at Good Sam and to receive a tour. The facility had so much more to offer than I expected! After a wonderful lunch made by Dr. Qazi and Lindsey, I was back at the nursing home to do rounds, check blood sugars and give insulin shots, and learn from the nurses on staff. The residents were amazing and so much fun. Monday night Kelsey and I explored the area and we stumbled upon an awesome find, the Lake Andes Wildlife Refuge! We got some cool pictures, saw a few herons (who knew they were in this area!), and got to relax a little bit. It was a good day.
Tuesday, June 10th – I was back in the clinic again on Tuesday to see a variety of cases. Patients with COPD, inflamed ears, and recent stroke victims traveled in to see us. The patient with the inflamed ear had tried too many cures for a pimple just inside the ear canal resulting in such inflammation you could barely located the tympanic membrane! After clinic, Kelsey and I journeyed north to Platte to visit fellow REHPS student, Rose. She took us out for a night on the town and followed it up with some fun at a local park. Another great thing that happened, Kelsey conquered her fear of slides!
Wednesday, June 11th – Wednesday was a really fun day in the clinic. During the morning session, we saw a hypertension patient and another stroke recovery. Afternoon came with a possible ACL and meniscal tear where I was able to use my knowledge of Anterior Drawer Tests and McMurray’s Sign and later a newborn with an umbilical hernia. After learning about both cases in school and seeing pictures, it was really awesome to see them both first hand. To top off the day, Lindsey coached me through my very first punch biopsy! Even though it was really little, it was a great experience and one I’ll remember for a long time.
Thursday, June 12th – Talk about a busy day! I started at 7:30 a.m. and didn’t hit the hay until just before 6 a.m. the next morning. The day started in the clinic as I gave the first allergy shot of the morning before running down to the hospital to do rounds with the on-call doctor, Dr. Pinter. I bounced back over to the clinic to see a few patients before lunch. The afternoon was action packed as well with performing my first throat swab and a staple removal from a nasty gash in a 3 year olds head. That night the E.R. was BUSY and I got to jump in on it. Two of the really interesting cases included an elderly woman with new onset atrial fibrillation was our first patient and I got to read up on everything associated with that and a 15 month old boy with a history of hydrocephalus presented with a possibly infected gastrostomy tube which later fell out resulting in a second E.R. visit. Even though the day was long, I am grateful for the opportunities given to me! J
Friday, June 13th – I was able to enjoy a little bit more sleep and relaxation on Friday due to the late nature of Thursday. When I finally got up and moving I worked in the E.R. with another Coast to Coast doctor, Dr. Bushell. With him I met a young girl with pneumonia and subsequently learned about fluid bolus and maintenance dosing in pediatrics as well as a hypotensive elderly woman where I learned how to diagnose an orthostatic hypotension.
Saturday, June 14th – Saturday morning Kelsey and I volunteered with our nurse Connie at the Wagner Area Health and Wellness Consortium’s “The Best Dam 5K Run/Walk at Fort Randall.” As Connie in a member of the consortium, she was able to hook us up with really good positions; road guards. Decked out in fancy vests, we directed runners and walkers when confusing turns came about. Once the last walker came across the line, both Kelsey and I headed out of town to celebrate Father’s Day.
My last week in Wagner for the REHPS program was both enjoyable and fast! The days flew by with interesting cases and continued hands on work until Kelsey and I were giving our end-of-experience presentation. I was able to perform a couple of allergy shots, give a chicken pox injection, do a strep throat swab, and perform a mini-mental assessment on elderly man. The mini-mental assessment tests different memory and functioning skills to assess decline in dementia patients. The highlight of the week was inserting a catheter in the emergency room on Tuesday night. I was terrified! One of the nurses walked me through the procedure and everything went great. Kelsey and I ended our experience with a presentation about what we learned in the clinic, in the community, and during our own explorations to Bryan Slaba (hospital CEO), Lindsey Barthel (Site Director), Christina (Pharmacist), and Cheri (REHPS Coordinator)! All in all, the experience in Wagner was great and I really enjoyed my time. I am sad to say goodbye to my hospital room, partner, hospital staff, and community members that I was able to meet and get to know the last three weeks but I am excited to get a week of relaxation before school starts. Thanks REHPS!