Lizz’s Blog    Back to Students 2013

Sisseton, South Dakota
Week 1

Monday – Ashley and I started out our morning by meeting both the CEO and the HR Director of Coteau Des Prairies Clinic & Hospital. We were given a brief overview of the facility and the caregivers. We also got our schedules and were informed about various activities that we could do while we were in Sisseton. After a tour of the hospital, the adventure started. I spent my day with a family practice physician, Dr. Beumer. I saw a few hospital patients with her, but spent the majority of the day at the clinic. It was very educational to be able to put to use the knowledge that I learned throughout my first year of medical school. For example, recognizing drugs and remembering how they work, utilizing the EKG skills I learned during the cardio unit, and attempting to dig back up my anatomy knowledge when looking at various X-Rays and CT scans. Before lunch, Ashley and I learned proper scrub technique so that we would know how to scrub in when we got to watch surgery. During the lunch break, Ashley and I attended a Kiwanis meeting and met the Mayor of Sisseton and a few other really neat men from town! Our day ended by working out at the hospital fitness center and then attending a Diabetes Seminar.

Tuesday – The REHPS Program Director came to visit Sisseton Tuesday morning. She introduced us to the staff and gave an overview of the program. She also answered any questions that the hospital and clinic staff had. It was nice to see her and talk to her! She has been a very useful person throughout this internship. The rest of the morning I shadowed the main physician that I will be with during my time in Sisseton, Dr. Gallagher. He is an amazing teacher. It is so nice to be able to learn in a non-intimidating environment. Dr. Gallagher taught me a LOT about various drugs throughout the day! I also spent the afternoon with him. I have decided that by the time I get to Pharmacology next year, I will have a lot of drugs memorized already! He also taught me how to obtain a detailed history and physical and refreshed my memory on how to complete a physical exam.

Wednesday – In the morning I was able to watch Dr. Carter perform scopes on a few patients. Dr. Carter is general surgeon that does outreach from Watertown. At 11 AM, Ashley and I were able to go to a Roberts County ALIVE Meeting. Check out: www.aliive.org for more information. The organization is fantastic – very proactive within the community and does a lot of activities with the youth in the area. They make a positive impact in various areas and have members who truly care about accomplishing their mission. In the afternoon, I was with Dr. Gallagher. He was doing both clinic and ER and sometimes it got a little busy going back and forth. At the end of the day we had dinner with a drug representative who taught us about a new Diabetes medication that is the first FDA approved drug of its kind. It was very educational to be able to learn about a brand new medication,

Thursday – Thursday morning I started out in Lab. The unique part of this program is that I do not just follow around a physician for 4 straight weeks. I also spend time in other departments and learn about how all of the various areas of a rural healthcare system work together. It was interesting to see all of the lab’s equipment and learn about the various tests that they run.

I took a bit of a break in the afternoon because I decided to come back later for Dr. Staub’s ER shift. With a few ER patients I utilized a lot of my Neuroscience material. I also spent a few hours that evening with Dr. Peterson, the Ob/Gyn. I gave the nurses my phone number and Dr. Peterson and I decided that throughout the four weeks she would phone me in for after-hours deliveries. 

Friday – The morning started out very, very early with a delivery at 2 AM. I took a nap from about 4-7 AM and then went back into the hospital at 8. I got to scrub into a surgery with Dr. Peterson and was even able to assist her throughout the procedure. After the surgery there was another baby delivery! After a quick lunch, Ashley and I met with the ambulance crew across the street to discuss what hours we would be on-call when it was our weekend to be with them. We were also given an overview of how things worked and where different things were in the ambulance. Next weekend I will be on-call with them, and I am very excited. It will allow me to gain some insight into what happens when the ambulance arrives to a 911 call. I followed a family practice physician in the afternoon and was able to see a few patients all by myself! The doctor always went in after me, but it was very useful for me to learn the process of gaining a descriptive History and Physical in order to determine the differential diagnosis and what tests to run in order to give the patient the best course of treatment for their chief complaint. I also had an assignment from another physician to look at an X-Ray and check on a patient in the hospital. After fulfilling that task, I was done with week one! All in all: REHPS is a fantastic program, and I had a stellar first week at Sisseton.

Week 2

Monday – Monday was another educational day with Dr. Beumer (one of the family practice physicians). I got to see a few baby checkups with her, which was great. I learned that babies should double their birth weight by 6 months! I also got to see a 35-week OB patient and felt a Braxton Hicks contraction. In addition, I learned how to do a simple Hemoglobin blood test with a finger poke and a little machine. I watched Dr. Beumer remove a sebaceous cyst, also known as wen, on a forehead. After clinic, Ashley and I ate dinner at the hospital and then did a Kettle Bell workout. After the workout we watched an episode of Grey’s Anatomy and off to bed we went!

Tuesday – I spent the morning with Dr. Gallagher in the clinic today. Once again, he taught me a lot about various drugs and treatments for certain conditions. I was able to see a few little kids, and I even snagged a baby to hold while Dr. Gallagher was talking to the Mom. :) There were a few lesion removals and also a few X-Rays to look at. In the afternoon I was in the OR/CSR with Cameo and Claudette. I watched Dr. Vanadurongvan (Van) place a gastrostomy tube (G-tube). Dr. Van is a general surgeon that does outreach from Milbank. I cannot fail to mention that the Nurse Anesthetist that is there during all of the surgeries, Chuck, is pretty awesome. After watching the surgery, I spent a few more hours with Dr. Gallagher in the clinic. When I left for home, I told Dr. Staub (who was on call) to call me if the ER filled up. I ended up going back from about 7-9 because there were a few patients in the ER. I was able to see a case of appendicitis as well as a baby with pneumonia. In addition, when waiting for some lab results to come back I learned how to count white blood cells on a blood smear. Dr. Staub often does this instead of utilizing the machine to count the WBCs because he likes its accuracy. It was nice to be able to refresh the material that I had just learned in Histology this past semester!

Wednesday – Today was a very eventful day! In the morning, Ashley and I toured the Woodrow Wilson Keeble Memorial Health Care Center, which is a division of Indian Health Services. We saw the pharmacy, the clinic, the laboratory, and also took a quick peek at the X-Ray area. It was a very, very nice facility and the gentlemen who gave us our tour was great! Then, we made a quick stop at a Native American Craft Fair, which was at the Sisseton Wahpeton College. We got there a little early and there were only a few booths set up, but we still got to see some handmade blankets, rugs, and drums. We arrived back at the hospital at about 9:30, and I spent the morning with Home Health. I went on two house calls with Jessi. I loved my time with her! I really enjoyed talking to the elderly patients. In addition, it was awesome to see the impact that Jessi has on their health and happiness. Before lunch, I got to see an interesting ER case. I then spent the afternoon with the Physical Therapy (PT) department. I went with a PT on a home visit and also saw two visits at the PT room, which is conveniently located in the hospital. Physical therapists make a very positive impact on the quality of life and the movement capabilities of a lot of patients, and I enjoyed my time with them! After a little break to workout and eat supper, I went back to the hospital to spend the evening with Dr. Gallagher in the ER. I was able to see quite a few ER patients and stayed so busy that I was at the ER from about 7-11:30! I was even able to practice my suturing on two different occasions, and Dr. Gallagher was a very patient teacher. He graded my sutures at all A’s (well, one was an A- but hey, that’s still an A!)

Thursday – Week two is nearing its end! I cannot believe how fast the time has gone… Hard to believe that this experience is almost half over! The day started with a staff meeting at 8 AM, and I spent the rest of the morning with Dr. Staub. He let me see some patients on my own and taught me about administering cortisone injections into the knee. Lunch was extra special today in celebration of ‘Hospital Week” -we had steaks and potatoes, and they were delicious! In the afternoon, I spent some time with the X-Ray department. I watched two OB ultrasounds. Technology is fascinating and it was really neat to see those little tiny hands and feet. I took a break at the end of the day, and Ashley and I watched two episodes of Grey’s Anatomy. I then went back to the hospital and spent a few hours with Dr. Staub in the ER. There were a few patients and the evening was just as busy as the morning in the clinic.

Friday – Today is what I would label as a phenomenal day. I spent a majority of my day with Dr. Peterson, the Ob/Gyn. The morning started out early, with a 6 AM wakeup call and a natural delivery followed by a C-Section. I was able to scrub into the C-Section and assist Dr. Peterson and Dr. Gallagher. I love being able to scrub in and help with surgeries – it allows me to gain so much more knowledge than just watching from the back of the OR.

Then, I watched an amniocentesis that was done to test a baby’s lecithin–sphingomyelin ratio (L/S ratio). This is done to check the baby’s lung maturity and see if the baby is ready to be delivered. Following that, I watched the NICU team come and get a baby that had transient tachypnea of the newborn, or simply TTN. This is when a baby’s breathing is more rapid and they have to work harder to breathe than they should. With a week or two of monitoring and treatment the baby should be just fine!! Following a busy day, Ashley and I spent a little bit of time hanging up posters around town for our community project, which is a car seat roundup in order to increase car seat awareness and make sure everybody around town has the right size of car seat for their child.

Then came even more fun: horseback riding and a night out with the Prins family. Sheila is the director of the radiology department at the hospital and she invited Ashley and I to spend the night at their ranch. We were able to go horseback riding for a few hours with Natalie, their beautiful and extremely talented daughter. We also got to help their son bottle feed a little calf. He even let me name the calf! Then, Sheila and her husband, Bryan, took us out to eat with their family. We had a delicious meal at Clausen’s Steak House and then stopped by a bar at Pickerel Lake for a round of pool! It was honestly a fantastic night and spending an evening with this family is more reason than any why rural South Dakota is such a beautiful place. Families like the Prins do not come around very often, but most of the time when they do they are from places like Sisseton, SD: a rural area with strong families made up of great people. 

Saturday – I decided to spend a few hours at the hospital today with Dr. Staub. It is a different environment on the weekends, and it was good experience to see what it is like for the doctors on call weekends. I saw quite a few patients in the ER with Dr. Staub. In addition, I was able to ride with the ambulance crew on a call! It was awesome to see the hard work that the crew does and watch how fast they are able to assess the patient and get them back to the hospital. With two weeks down, I cannot wait to see what the next two weeks bring! Sisseton has been great!

Week 3

Monday – It is so hard to believe that it is the third week already! This experience has flown by so fast! Today I was with Dr. Beumer in the clinic. I enjoy shadowing her because she lets me do simple procedures and be more active throughout the exam process. Not only that, but she also explains everything so thoroughly. The simplest procedure for her probably isn’t all that exciting, but whenever she lets me do anything I am always thrilled! Also, her nurses are great and always so nice to be around. One interesting thing that I was able to see with Dr. Beumer was an expressive aphasia. This is basically when a patient is unable to say whatever it is that he or she wants to say. I just learned about this in neuroscience, and it was heartbreaking to see how challenging it is for a patient to experience. Dr. Beumer was gone for a few hours in the morning, and I spent some time with Brad, a Physician’s Assistant. He let me see patients on my own before he went in to talk to them, and he was really good at explaining things.

The evening was tremendous! One of the nurses, Josie, took Ashley and I to a fantastic restaurant, The Bird Feeder, in Twin Brooks, SD. It was the cutest little restaurant and the four-course meal was delicious. The Ghirardelli chocolate brownie for dessert was out of this world, and it was fun to hang out with Josie outside of the clinic!

Tuesday – This morning was extra special because the outreach ENT physician, Dr. Weekly, came to do some surgeries. I have shadowed Dr. Weekly before in Aberdeen, and it was nice to shadow him again. After the surgeries with Dr. Weekly, I spent the rest of the day with Dr. Staub. I learned a lot about inflammatory processes and some various tests to run to check for certain inflammatory diseases, i.e. testing uric acid levels for gout. It was another educational day in Sisseton! At the end of the day, Josie invited us over to her house for spaghetti and to play with her baby, Hunter! I had a blast with her and her husband. She is such a nice person, and I felt so at home with Sisseton when I was relaxing at her house.

Wednesday – This morning I was with Home Health. I went on one home visit with Carol and was able to see how big of a role that Home Health plays in some people’s care. Home health provides care to some patients who would have difficulty coming to the doctor’s office. This ensures that their health needs are being addressed on a regular basis. After the home visit, I went with Carol to a foot clinic. The Home Health nurses do a foot clinic once a month. Anyone can come and get their feet soaked and their toenails trimmed. In addition, Carol checks everyone’s feet to make sure there are no problems. With patients that have neuropathies or other feet issues, this is a good way to keep foot problems in check! After that, Michaela (the Pharmacist) took Ashley and I out to eat. We went to a cute little restaurant in town called, The Cottage. It was so nice of her to take us to eat! We had a quick meeting after that to address any final preparations for the Car Seat roundup. I am mainly in charge of the kids during the process. I am going to color Car Seat Safety pictures with them! Rough job, I know! :) I spent the afternoon with Dr. Gallagher. He was in the clinic and ER and once again, it was very busy. I really like shadowing him, mainly because I am full of energy and he is always very, very busy! I was able to see a patient with sudden onset vertigo – we just learned all about this and the patient presented with textbook symptoms. It is nice to be putting textbook material into a clinical setting.

Thursday – I went to Rosholt and spent the whole day there in the clinic with Dr. Gallagher. I had a blast, which is typical whenever I am with him. Dr. Gallagher also taught me how to draw blood. It is relatively simple, but still something that was great to learn how to do. I was able to go to the nursing home with him to see a few patients too! Over lunch hour Dr. Gallagher took the nurses and me out to eat at a cute little place for lunch. After another afternoon in the clinic I headed back to Sisseton. I decided to stop at the hospital in Sisseton when I got back, and boy am I glad I did! I got there just in time to see another baby delivery. I also spent some time holding the baby in the nursery and it was the perfect end to my day. :)

Friday – This morning I was able to spend an hour with Cardiac Rehab. To be honest, I never even knew Cardiac Rehab existed until today! As stated on the hospital’s (CDP’s) website, “Cardiac Rehabilitation is a medically supervised outpatient program designed to help patients that have experienced a cardiac event, to recover and improve their overall physical and mental functioning.” The nurse in charge supervises patients while they exercise in addition to educating patients on how they can maintain a healthy lifestyle and reduce the risk of another cardiac event happening. The nurse was extremely informative, and it was nice to learn about another area of healthcare. I spent the rest of my day with Dr. Gallagher. I was able to see more patients, and quite a few kids today! I love holding the babies and also enjoy handing out stickers to the little ones. It was nice to see so many pediatric patients. The final week is approaching fast, and I am definitely going to miss the great people that I have met while I have been here!

Week 4

Monday – Today we had the day off for Memorial Day. Thank you to all of the men and women who have passed away while serving our country. Without you, following my dream of becoming a physician would not be a reality. I cannot thank those men and women enough; words cannot express my gratitude.

Tuesday – This morning I shadowed Dr. Beumer. She gave me a really helpful “History and Physical  (H&P) Exam” outline. She also came into a patient room with me and observed while I obtained the H&P from the patient. That helped me immensely! I felt like I really improved my H&P note taking skills! I was sad that it was my last morning with Dr. Beumer. I learned a lot from her not only about medicine, but also about truly caring for patients. She took the time the talk to her patients not just about their chief complaint, but she asked them about how their life was outside of their medical problems. I also really loved all of the patient’s stories! :) After lunch I helped Tanya finalize everything for the Car Seat Roundup. We had the event at the City Hall. We had activities and snacks prepared for the kids and a lot of car seats to give away. Although the turnout was not quite as many as we expected, we still had a few and helping some is always better than helping none!

Wednesday – What a BUSY day around the hospital! I went to the hospital a little early this morning to watch a surgery with Dr. Peterson. She let me first assist again, and it was so awesome to sit beside her and help the whole time. After my time with Dr. Peterson, I hung out at the nurses’ station for a while until clinic started at 9 AM. At 9 AM, my day started with Dr. Gallagher. He was between the clinic and the ER so I was able to see quite a few patients in both places. We had time to grab a quick lunch and then it was back to the clinic. After lunch we had an interesting ER case that had to be transferred to Fargo. I was able to go with on the transfer with the ambulance crew! It was awesome to go on a transfer with them! When I got back, Dr. Gallagher was done with clinic for the day so my day was finished. I am really going to miss spending time with Dr. Gallagher. He was such a fun preceptor – always so willing to teach me about medicine. He is a great physician who values quality patient care, and I learned so much from him throughout my four weeks!

Thursday – Today is our last day! I cannot believe it… I went in this morning to watch my final surgery with Dr. Peterson. I am going to miss her! She was a phenomenal teacher and always so willing to show me things. I appreciated her upbeat attitude and her love for medicine! I was able to spend a short time with Michaela in the pharmacy after surgery and got an overview of what she does every day. She is very, very organized and has a good system in place. I then shadowed the nurses for a while. They do so much around the hospital and clinic!! Over lunch hour, Ashley and I gave a presentation on our experience while at Sisseton. Some of the members of the Board of Directors were there as well as various hospital staff. My parents even came, which made it extra special!

It was hard for me to say goodbye to the staff after our presentation. There were so many people that made such a positive impact on me during my time in Sisseton. The staff at Sisseton’s hospital really made sure to always make us feel welcome. In addition, the care providers were always eager to teach us about their field. Having preceptors who were excited about what they do made us want to learn. I cannot thank the hospital and staff enough for a wonderful four weeks! You will all be missed!