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Parkston, South Dakota
Week 1

Beginning the REHPS program in Parkston, SD had me in knots.  But, as I have stayed here and met many different people and their roles, I have learned that this is not just a medical facility, but also a tight knit family.  I feel so spoiled with the newly remodeled apartment, which is located above the clinic.  Also the fact that we can raid the cafeteria kitchen for food about any time and eat for free, is truly awesome.  I feel so blessed to have been chosen for a position in the REHPS program and to have been placed in such a warm town as Parkston.

Tuesday:  Today was our first day in Parkston, SD at the Avera St. Benedict’s Medical Center.  When we arrived, we met with Rita Blasius, hospital administrator, and she gave us an idea of the activities we would be participating in and what she wanted us to have experienced before the completion of the four weeks. Next, we sat in on a meeting about going live with the new order entry system.  It was interesting to hear each physician voice their concerns and work to come up with resolutions alongside of the head nurses, administrator, and CEO. Upon completion of the meeting, we took part in the Daily Line-Up, which is used as a tool to maintain the cohesiveness of all Avera employees. Julie Semmler followed with a facility tour and helped us sign up for wellness passes and showed us how to sign up for meals. Also, after a delicious lunch with Kassy and Cheri at Schuvers, we were given a town tour by Julie and even went for ice cream at Boom’s to wrap up the day.

Wednesday:  We began the day with a department head meeting and met the head of each department of the Avera St. Benedict’s Medical Center.  I was then directed to the Children’s Speech Camp, which is held three days a week for two weeks for children ages  3-7 years old. The most exciting part of the day was an unexpected visit from the SimSD van!  It was so much fun to participate in an activity with SimMan once again! The case was with a 42 year old male who rolled his vehicle while driving drunk.  It was great to work with the nurses and Martha on the patient as though it were a real life scenario.  We learned how to open a line intraosseously and that it is okay to use that option more frequently.  Also we learned the importance of caring for hypothermia in trauma victims even during the summertime. 

Later, I was able to follow Lindsay Weber, CNP, as she interacted with a lymphoma patient who was experiencing severe pain, had confusion, and was a little goofy.  Medically,  she was at the level where it may have been best to put her into the nursing home because her husband was having trouble taking care of her and dealing with her.  Another interesting encounter was with an ER patient who experienced tingling throughout his entire body while driving home.  It was unfortunate though that we could not find any reason for the issue but it dissipated and he was sent home.

That evening, Martha and I went to the grocery store and then attended a baseball game at the Pond, Parkston baseball field, between Parkston and Plankinton/Mt. Vernon.

Thursday:  Today was the most fun so far!  Martha and I started out by doing rounds with Lindsay Weber, CNP.  Before completing rounds we were invited into a colonoscopy procedure with Dr. Honke.  It was definitely an experience. Dr. Honke was great about explaining things to us as he performed the procedure. Upon completion of the procedure, I drove over to the Medicine Shoppe to spend time with Janelle Varney, the pharmacist and owner.  The girls out there were great!  Janelle taught me so much about owning a pharmacy and also the hardships that come with that responsibility.  She also showed me how she fills for Bormann Manor and Our Home.

Friday:  We started the day by doing rounds with Lindsay Weber, CNP, and Jason Wickersham, MD.  It was great because we gained exposure to all the patients and then were able to come back throughout the day to see their labs and X-rays, diagnoses, and treatments.  As rounds started to wrap up, I joined Suzy Weber, Pharm.D., in the pharmacy along with Mallory Muntefering, newly board-certified Pharm.D.  She explained to me how she has the pharmacy organized and why it is set up the way it is.  Also, she told me about MediTech software and its shortcomings.  I cannot wait to spend some more time in there doing some filling and I guess I will also get to do some inventory.  After lunch, I spent some more time following Lindsay and actually was able to watch a nurse insert a straight catheter into a 33-week pregnant woman to obtain a clean urine sample to send to the lab to determine if she was experiencing Braxton Hicks contractions or a urinary tract infection.  Just when I thought things were dying down, Martha was offered an opportunity from Dr. Wickersham to replace a patient’s feeding tube and she took it! It was so exciting to see her in action and being taught by Dr. Wickersham!  Also, we were able to sit in on a TeleHealth conference between Lindsay and an infectious disease specialist in Sioux Falls for a consultation on whether to take out a patient’s port-a-cath.  It is so cool to see how a small town is able to utilize a big city specialist by a little technology!

This was a great week! I have met so many fun people who have welcomed me and definitely showed me many interesting things that they experience on a more regular basis.  I love being taught and shown new things and that is what they have been very generous about.  I cannot wait to see what next week holds for me.  :D

Week 2
This week was quite the experience! I observed so many cases and procedures that I never imagined ever seeing.

Monday, I did rounds with Dr. Wickersham and Lindsey, CNP. Once rounds were complete, I spent the rest of the day in radiology. The ladies in radiology were so kind to me and showed me what they look for in different X-Rays and how to interpret them. Dr. Wheeler, Avera Queen of Peace radiologist, was doing outreach and took me under her wing for a few different assessments. One was an ultrasound of a 14-week pregnant mother and her baby. Another was a breast mammography. Lastly, I was able to observe Dr. Wheeler as she performed a replacement of jejunum feeding tube. Also, I was able to sit in on an echocardiogram ultrasound.

Tuesday, after following the physicians on rounds I observed a colonoscopy of a woman who had had colon cancer and a colon resection surgery. After that, I met Dr. Antoinette Vander Pol and joined her in the clinic. We saw a patient who was experiencing vertigo and orthostatic hypotension and determined that it may be due to a couple of the many medications she was currently taking. Then, we were lucky enough to see the cutest two-week old baby girl for her check-up and she was doing great with a little bit of breast milk jaundice that a bit of sun would take care of. Also, we sat in on an appointment with a teenage patient with resistant acne and observed as Dr. Vander Pol went through different treatment plans and helped the teen and her mother decide on which plan would be best to try next. Then, Martha and I were lucky enough to get to get to travel to Lake Andes Clinic with Dr. Vander Pol to see some of Dr. Honke’s usual patients, as he is on vacation. In Lake Andes, I watched Dr. Vander Pol carefully insert an intrauterine device, IUD, into a woman. Then observed a check-up on a 39-week pregnant woman and discovered she was three centimeters dilated! She is due July 2nd so hopefully I will be allowed to see her deliver her baby while I am here!  :-) It was so great meeting the women at the Lake Andes Clinic and also Beth Schroeder, CNP. Later, Martha and I went horse cart driving with Dr. Vander Pol and watched her drive as she showed for a 4-H judging clinic not far from Dimock, SD. It was so much fun!!

Wednesday, after rounds with the physicians I was able to join the kids again for speech camp. The theme for the day was Independence Day and we made flags from construction paper and shaving cream and played backyard games with the kids. I even made a really good friend.  :-) I had so much fun! It was exciting to see the progress the kids made since last week too! That afternoon, as I followed Dr. Vander Pol I was able to see an ultrasound of a 16-week pregnant mother’s baby. It was amazing! I could see the baby’s spine, heart, hands, feet, head, arms and all!! The baby was moving so much! What was also interesting about this mother was that she had a desmoid tumor removed and actually was reconstructed with a skin graft!

Thursday, once rounds were complete, I spent time with Suzy Weber, hospital pharmacist. She showed me what she does on a daily basis and how she organizes her pharmacy and why. She did a great job of organizing the  pharmacy…it is one of the most organized hospital pharmacies I have seen thus far. While I was in the pharmacy, Lindsey came and grabbed me because they were going to perform a chest tube placement into a man with a hemopneumothorax, collapsed lung filled with blood. It was so interesting and we were able to watch Dr. Trail and Lindsey put it in. When she got into the part of his chest where the negative pressure was, I could hear a gasp of air release from his chest!! Then, once the tube was placed in his chest blood came rapidly out of his chest and flowed into the equipment that he was hooked up to! It was exciting to see but I couldn’t help but think of the pain that poor man was experiencing.  :-(

Friday, I spent time following the physicians as they did rounds and then was able to participate in an aqua-sizing class, water exercise, that Ember, Wellness Center Coordinator, taught. Afterward, the speech camp kids all came to the pool for a pool party to wrap up their two week camp. It was so fun! Once the kids were all worn out, we dried up and changed our clothes and finished the party with pizza!  :-)   That afternoon, I helped Suzy perform inventory in the pharmacy and then finished the day out following Dr. Christopher Boschee in the clinic. We had a patient come in with kidney stones that were causing him so much pain that he was sick to his stomach, then we saw an eight day old baby with breast milk jaundice that was much better than the last time Dr. Boschee had seen her earlier in the week.

It was such an eventful week full of new experiences!  :-) I bet Parkston will continue to amaze me!

Week 3

Monday – I did rounds with Dr. Wickersham and Lindsey, CNP, then I observed a colonoscopy that Dr. Wickersham performed. After he was finished with that, I spent the rest of the morning in the physical therapy department. I saw the PT girls work with patients who suffered from a torn rotator cuff, neck pain, back pain, brain injury, prolapse, total elbow replacement, a rod and pin ankle, and more. Also, I was able to watch Dr. Smith, Avera Queen of Peace radiologist, perform a breast biopsy on a woman with suspected breast cancer. It was so interesting, yet I felt terrible for the woman going through the experience.

Tuesday – After rounds with Lindsey, Dr. Vander Pol, and Dr. Wickersham, we spent time in the lab. We learned of many different tests that they run, the different types of specimen they use for the tests, and the awesome technology and software they use to improve their efficiency and reduce errors. I also was able to watch one of the lab techs perform an ECG on a patient. It was pretty cool to see what goes on behind the scenes in order for the doctors to choose an appropriate method of treatment.

That afternoon we drove to the Lake Andes Clinic and shadowed Dr. Honke and were able to see a few different patients. We saw a couple of pregnant women, a woman with a one month newborn, a gentleman with bladder problems, a young boy with impetigo, and a gentleman with a spinal infection that put him into a halo while he awaits surgery. Dr. Honke is a great teacher and it is so much fun shadowing him. He has impeccable knowledge and great bedside manners.

Wednesday – After rounds, we went with Dr. Boschee to Our Home. Our Home is a facility for juvenile delinquents and troubled youth. We listened to the treatment plans for each kid which consists of their past, goals, strengths/weaknesses, and medical issues. These kids are so troubled and came from some of the worst homes and circumstances imaginable.

That afternoon, we met with Phyllis from the Human Resources Dept. She spoke with us about the history of the hospital and the rest of the facility. She also explained to us the Avera mission and why it was chosen. I loved the many great facets of the Avera St. Benedict’s facility and I think it would be a great place to work! :-)

This was an awesome week!  :-)   I am so sad we are getting close to completion of the REHPS experience, but I am so glad for what I have been able to experience and I definitely am going to get the most I can out of the time I have left in fun, Parkston, SD.

Week 4

Monday – After completing morning rounds, Martha and I watched Dr. Honke repair a hernia in the OR. It was so interesting to see! It was weird seeing the inside of a living person!

Later, Julie Simmer and Phyllis Ehlers took us to a couple of different Amish colonies near Tripp, SD. One colony makes rugs and candy while the other makes quilts and woodworks.  Both colonies use these products for income. It was neat to see how the Amish don’t use electricity, plumbing, carpeting, or any other luxuries we are accustomed to for living a comfortable life. They make their own clothes and eat mainly what they raise and grow. I can’t imagine going without a shower, air-conditioning or even my straight iron for a long period of time! Crazy!

That afternoon, we met up with Dr. Wickersham and his nurse, Jen, at the Dugout, a lounge in Tripp, SD for dinner. Then, we spent the rest of the day in the Tripp Clinic seeing patients. We observed a hypertensive patient with a questionable mole, another with issues of self-mutilation and sinus problems, and even a patient with a large rash on his back that was causing him a great amount of pain, amongst many other patients.

Tuesday – Today we attended a diabetic group meeting at the clinic. This is where diabetics receive a lesson and tips on their diet and lifestyle, and then they meet with a physician in the clinic for a wellness check-up. This month’s lesson was about carbohydrate choice and carb (gram) equivalency and how to determine that. I thought it was very helpful the way they assessed each group member’s month of diet and exercise.

Wednesday – This morning Dr. Buhler, an Avera Queen of Peace radiologist, was here at the hospital. I watched him perform a swallowing test using X-Ray. After that we watched as he removed nearly 2,000 ml fluid off a patient’s lungs. It was unbelievable!! Later, we met up with Dr. Boschee at Our Home again and observed more kids and their treatment plans. The stories are unimaginable!

This afternoon, we met with Brenda Stoebner who is the Quality and Risk Management Officer at the facility. Then, we met with Health Information and were told many things about dictation-to-text and other situations they are currently dealing with.

There was a baby boy born tonight weighing 8 lb. 9 oz. So cute!

Thursday – Today is Martha’s birthday!! J

We started the morning out with Dr. Wickersham circumcising the baby boy born last night. He was such a trooper! J

I spent time later at a Med Safe Training session that is required for all nurses to attend because they are going live with the bedside bar coding beginning Monday. This new system requires them to scan the patient’s barcode on a bracelet they will wear and then the medication they are trying to give before they are allowed to give it. This is to help prevent many of the med errors, yet it will be more time consuming.

This afternoon, I spent time at Parkston Drug with Rick Boettcher, the Pharmacist, President and Owner. I was able to learn from him and his technicians, Nikki and Laurie. They were so nice! And, I love the software they run off of!!! It is so easy to pick up on and use, and all pharmacies should have this software! I really love their cute store and all the neat items they carry! I will definitely be going back!

Friday – This morning there was a little baby girl born and she is so cute! We were able to perform a well baby exam on her with Lindsay, CNP, after morning rounds. There are so many little things to check on a newborn baby that I didn’t realize.

Today, I watched as Dr. Honke injected cortisone into the ankle of a woman experiencing extreme arthritis pain. It looked painful! Then we saw a little girl who fell off her bike and cut her tongue. Later that afternoon we re-casted a man’s entire leg because his was not quite healed yet and he hurt his ankle earlier while wearing his cast.

Lastly, we observed a man with an abdominal pain we are having trouble diagnosing. We have a few ideas of what it could be but we are unsure of what it exactly is. It is difficult as a healthcare provider to not be able to give someone the answers they want to the questions they have.

Final Blog:
This was the last week of REHPS. I am going to miss all of the kind and generous people here in Parkston, SD. I am so glad to have had this experience. Now that I have shadowed in and learned so much about these types of rural medical facilities, I believe that a small rural location is where I want to be. I have had such a blast hanging out with the doctors and other employees of Avera St. Benedict’s and the other locations I was able to spend time at. Thank you to all of you for welcoming me with open arms and spoiling me rotten with your generosity. Also, I am so glad I met my partner, Martha Holstein, and was able to go through this experience with her. Without a doubt, I will miss all the time I was able to spend with her. She and I are so similar it is outrageous! Thank you, Martha, for being such a great partner – I can’t wait to hear how much smarter you are the next time we meet up! I can’t describe to you how great the REHPS program is and I will recommend it to anyone who is able to apply! Take a leap of faith…you won’t regret it. :D