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Parkston, South Dakota
Week 1

Tuesday 6/18/2013

Today I was excited about starting our experience in Parkston, SD and curious what the facility would be like.  We met with Rita, the CFO, and sat in on a meeting concerning the go live for electronic order entry.  Julie, Public Relations, gave us a tour of the hospital, clinic, and nursing home.  Throughout the day, we were able to meet people in the different departments.  Of course in a small state like South Dakota, Maria and I both had various connections to the people working at the hospital.  Kassy and Cheri from AHEC took Maria and I to lunch at the Schuver’s Café downtown Parkston which had a great atmosphere and delicious food!  After lunch, Julie took us on a drive around town where we toured the high school and saw most of the businesses around town.  We got set up at the wellness center that is just downstairs from our amazing apartment above the clinic. We of course got ice cream at Boom’s; you just can’t pass that up.  The sweet food service ladies set us up with a great meal and we got settled into our new home for the next month!

Wednesday 6/19/2013

Maria and I began our morning enjoying breakfast down at the kitchen.  The food service ladies have really been spoiling us.  I feel like I am at home.   The lunches and dinners so far have been delicious and we are allowed to raid the fridge for anything we’d like. 

We sat in on the monthly department head meeting this morning.  I liked getting a feel for what each department was working on.  They shared ideas and it seemed to keep everyone working as one big team.  After the meeting, Maria and I split up and I headed off to the hospital to do rounds with Lindsay Weber, CNP and Dr. Honke.  After seeing a few patients, I was able to scrub in to a procedure with Dr. Honke and Dr. Boschee.  They removed a basal cell carcinoma and grafted a skin punch into its place.  After lunch I spent some time in the SIM SD simulation truck.  This truck goes around South Dakota and has very realistic mannequins that help simulate medical scenarios.  Thankfully we were with a great group of nurses that knew their stuff!  After spending more time with Lindsay and a patient, we were off for the day.

Maria and I spent our down time doing an Insanity workout in the Wellness Center, eating another great meal, and headed out to check out the town.  We drove around a little and got the really important information – what time the bakery is open!  We stopped by the grocery store and picked up some snacks to undo our workout.  We went to The Pond, the baseball field that is home to three amateur baseball teams, and watched the Parkston Teeners play.  We settled in with our Oreos and popcorn and are ready for another great day in Parkston!

Thursday 6/20/13

This morning we started out watching a colonoscopy.  It may not be everyone’s choice for entertainment but I thought it was amazing to watch and learn a little more about the scope.  I spent the rest of the morning in the hospital pharmacy with Mallory and Suzanne.  Mallory is the new pharmacist and she is finishing up training.  I helped unpack meds, got a tour of the pharmacy and got to see the chemo room where the chemo nurses mix drugs to administer to cancer patients.  Dr. Trail, a general surgeon from Yankton, let me observe a portacath placement.  After lunch I joined Dr. Honke in the clinic.  Dr. Honke was a great teacher and always had a great story up his sleeve.  I really had a great time in the clinic.  The patients were all interesting people and Dr. Honke spent a lot of time just listening to his patients and hearing how they were doing.   Dr. Wickersham invited me over to see a man in supra ventricular tachycardia.  He had him do a number of maneuvers but his heart didn’t go back into sinus rhythm until he was sent over to the hospital to get an IV placed.  Before they could push medication, he was back to normal.  A fun day and I can’t wait for speech camp tomorrow!

Friday 6/21/13

We started out our morning again with rounds with Lindsey.  One of the best parts of the experience so far has been the continuity.  I get to see the same patients as they progress in their care.  I’m sure I may see that on the clinic side as well since we will be here for three more weeks.  This morning seemed to be full of discussions about nursing home placement.  I am sure it is a hard decision to make and I was grateful to be able to see how the whole staff approaches the patient and helps them with that decision.   Dr. Wickersham guided me through a feeding tube replacement which was a first for me!

The rest of my morning was spent with the Speech/Language Camp that the Speech Therapists are putting on this week and next week.  About twelve kids, ages 3-7, attend for two hours in the morning three days a week.  Today’s theme was sports.  We had fun dancing, singing, playing kickball, and doing some activities with the Physical Therapist.  There were some tears, occasionally, from little ones missing their moms, but all in all I think the kids had a great time.  The speech therapists really make it a good time.

This afternoon Maria and I joined up to hang out with Lindsey again.  We were able to see the TeleHealth system in action while consulting an Infectious Disease doctor in Sioux Falls about an infected port.  We watched a sterile urine sample collection by straight catheter on a pregnant woman. There are always too many new experiences for me to write about!  It has been a great week and I am excited for Monday!  I’ll be back at Speech Camp for a little while and then into the clinic; can’t wait!

Week 2

Monday 6/24/13

I was excited to get back into the hospital this week and we started our day out as we always do, on rounds.  I love the chance to follow up on patients and see their progress.  We watched Dr. Wickersham take out the same infected port that was the subject of the TeleHealth meeting last week.  Dr. W let me do the sub-cuticular suture to close up the incision!  I was slow but I loved it. 

I ran off to Speech Camp again this morning and today’s theme was “What I want to be when I grow up.”  There were rock stars and cowgirls and dancers.  There wasn’t any crying today!  The funniest part of the morning was watching those little kiddos play Red Light/Green Light.  One little guy always cheated and had extra flair when he stopped. 

In the clinic in the afternoon, I hung out with Dr. Boschee.  I was able to help put a cast on a scaphoid fracture patient and see a couple interesting infections that are a little too personal for this blog. ;)   Dr. Boschee sent me in to see a patient before him, which I know isn’t unusual for a med student.  However, I haven’t been put in that situation yet and it was nice to do it in an environment where I was free to make mistakes and learn.  We ended our day in the nursing home visiting a patient. 

Dr. Boschee confirmed some of my thoughts on rural medicine.  I am interested in Family Medicine but would also like to have some time outside the clinic doing procedures.  Here in Parkston, you definitely get a mix of both and the doctors here don’t get stuck doing the same thing day in day out.  The downside is being on call a lot more and maybe overall working more because of the isolation.  However, I think the mix here is great and I could really see myself in a setting like this.  Looking forward to tomorrow!

Tuesday 6/25/13

We started our morning out right, watching a colonoscopy.   After our jump start, we met Dr. Vander Pol.  She had been on vacation last week so this was our first time with her.  After watching another colonoscopy, we hung out in the clinic with Dr. Vander Pol.  Just like all my other days in clinic, there were a variety of complaints.  The morning was interesting with plenty of subjects for discussion and for Dr. V to teach us about. 

We took off in the afternoon to go to clinic in Lake Andes.  It was pretty slow in LA with two no shows but it was good to see the clinic and meet the staff there.  We watched Dr. V place an IUD and check a 39 week OB patient.  We will probably get to see her delivery while we are here, which is pretty neat.

Dr. V invited us out to her acreage this evening.  We helped her load up a cart and one of her horses.  We took them out a little west of Dimock where the Hutchinson County 4-H Club was having a horse judging clinic.  They invited Dr. V out to be an example for the kids to practice judging.  Knowing practically nothing about horses, I learned quite a bit about them (and judging) tonight.  I got to tease a couple of the girls I get to see at Speech Camp and got a ride in the cart.  It has been a fun day but I’m wiped!

Wednesday 6/26/13

Today we joined up with speech camp after morning rounds.  The kids were full of stories as usual.  It is always funny to hear how the kids answer questions.  In the afternoon we went to the clinic where we spent the afternoon with Dr. Vander Pol.  We saw a different mix of patients today.  We saw edema, basal cell carcinoma, and physicals including a new OB. 

One theme of the day for me was how to speak to patients.  I had a lesson in motivational interviewing in school and it was good to see some examples today.  One patient was dealing with a difficult personal life and another was a newly diagnosed diabetic.  Dr. Vander Pol spent time with both patients talking through things and in the end the first patient said she felt better about things and the diabetic had a plan to use diet to control his diabetes. 

This evening I went down to a buyer’s appreciation dinner at Steckley’s in Geddes with my Mom and Dad.  Tomorrow I’m with Physical Therapy. 

Thursday 6/17/13

This morning was interesting.  After morning rounds I jumped into Physical Therapy.  During this past year, a physical therapist talked to my class about lymphedema treatments and today I got to see them in action.  Heather, a PT, worked on a patient with lymphedema in her arm.  Next, I got a call over to the hospital to watch Lindsey and Dr. Trail place a chest tube in a patient with a hemothorax.

This afternoon I got to see more patients and the PTs showed me a lot of the different things they can do.  Heather is trained in treating lymphedema and wound care.  Becca is trained in women’s health and can help women with pelvic floor and incontinence problems.  Denise focuses a lot on orthopedics.  I was impressed by the range of issues that physical therapy can help with.  I loved the PT department!

Friday 6/28/13

After rounds this morning, we put on our swimming suits and jumped into the pool at the Wellness Center with Ember, the Athletic Trainer for an Aquasize class.  Most of the individuals have some sort of pain issue such as arthritis that makes working out difficult to do.  The pool allows them to move with less stress on their joints.  Class was small today but we worked out for about an hour and some of the moves were pretty tough.

Sadly today was the last day of Speech Camp, pool party day.  When Aquasize was over, the stampede of children came into the pool.  It was wild with cannon balls, floaties, and a huge inflatable octopus that we floated around trying to capture kids.  After getting soaked, we had a pizza party and said goodbye to all the kids.  I’m glad we were able to help out with it the last two weeks.

The clinic was pretty slow after lunch because of some cancellations.  It mostly amounted to several minor injuries and one jaundice baby that didn’t require much treatment.   Our one excitement was a kidney stone that Dr. Boschee sent over to the hospital to run pain medication and fluids.  My husband and baby are coming up this weekend so we will check out the pool and I’ll get to see weekend clinic. 

Saturday 6/29/13

Last night I had a little excitement.  An ER patient came in around 8:00 pm and I sutured the leg laceration with guidance from Dr. Wickersham.  This morning I met up with Mary Schaefer, PAC in the Saturday morning urgent care clinic.  There were many injuries so lots of xrays to look at.  I was excited to see my boys after clinic!  I got to take them around town and show them what I have seen.  We ate at Schuver’s Café and played in the park.

Around 6:00 pm the OB patient we checked on Tuesday arrived.  She wasn’t quite in active labor yet so it was time to wait.  Around 11:00 pm she was dilated far enough that Dr. Wickersham could place the intrathecal.  Around 3:00 am, Dr. W let me help guide the baby boy out into the world!  Just before she was ready to push and before I got called in, Wickersham had three new ER patients.  After baby boy was checked over we went over the new patients and then I finally got settled in to bed at 4:00 am.  I learned how tough it is be sharp when you wake up in the middle of the night for something like a birth.  It was an amazing experience and reminded me how awesome it is to see your new baby for the first time!

Sunday 6/30/13

After breakfast this morning I learned another OB patient was in active labor.  She was pretty far along and unfortunately I missed the birth.  Josh, Owen, and I went to mass at Sacred Heart Catholic Church in Parkston and when we returned Wickersham got me up to speed on baby number two.  I rounded on a couple patients with Wickersham, got some questions answered, and then was off for fun the rest of the day. 

My little family headed off to the Parkston baby pool.  Owen loved the pool and we went down the tiny turtle slide about 50 times.  We stayed long enough for me to burn my back then after supper we watched one of the local amateur baseball teams, the Rock Bass, play Mt. Vernon.  It was an exciting weekend to be at the hospital.  Looking forward to the coming week!

Week 3

Monday 7/1/13

After rounds this morning we watched a gastroscopy.  It was a nice change of pace from all the colonoscopies we have been watching lately.  Afterwards, I went over to Radiology to hang out with the Xray crew.  Radiology had a light schedule today.  On Mondays, the MRI truck drives from McKennan in Sioux Falls.  It is amazing that they drive a couple million dollars worth of equipment around South Dakota, every day, to perform MRIs.  I watched a couple patients and looked at a MRI of a spinal tumor. 

Dr. Wickersham let me watch a circumcision and then guided me through the second one.  Lindsay and Dr. Boschee had to place the chest tube back into the same patient from last week.  His lung didn’t re-inflate and he had a hemo-pneumo-thorax.   Dr. Smith, a radiologist from Mitchell, came in the afternoon for a breast biopsy.  Dr. Smith had a new needle biopsy instrument that was pretty neat to see in action.  I watched a mammogram and an xray and that was the day! 

Tuesday 7/2/13

This morning during rounds, Dr. Wickersham guided me through changing a supra-pubic catheter.  After rounds this morning, Maria and I went off to the laboratory.  I worked in the Sanford Hospital Laboratory in Sioux Falls before coming to medical school so it was interesting to see the lab again. Most of the lab is automated and everything is very accurate.  We watched a couple venipunctures and an EKG.  The MLTs showed us each area of the lab, explained how their system worked, and we watched a couple tests.

This afternoon we drove down to Lake Andes and joined Dr. Honke for clinic.  We saw a few OB patients, some pediatric patients and some elderly.  It was a good mix and Dr. Honke always has great information and stories to share with us.

Wednesday 7/3/13
Today was our last day for the week because of the holiday.  We visited with a couple patients in the hospital and then went with Dr. Boschee to Our Home.  Our Home is a treatment facility for adolescents that have gotten into trouble with the law or have some inappropriate behaviors.   Dr. Boschee or one of the other doctors come once a week to be part of treatment planning meetings with each client.  We sat in on about eight planning meetings.  A lot of the patients had difficult home lives and were dealing with a lot of issues. 

This afternoon we had a light schedule so we worked on our project a little bit and then met with Phyllis, the Human Resources representative.  Phyllis told us the history behind the Avera system and the St. Benedict Hospital.  She talked about her role and how new employees get started with her.  Everyone is getting ready for the holiday, so we are off for a long weekend!

Final Blog
Saturday 7/13/13
Today Maria and I slept in and relaxed in the morning.  We stayed up late finishing our project.  My boys came and we went down to the cafeteria to say hi to everyone in the kitchen and eat lunch.  Owen loved walking up and down the hallways. This evening Josh and I went out to eat at Schuver’s with a good friend of ours that lives in Parkston.  I’m becoming a regular at Schuver’s.  I love their “Big Kenny” burger.  It’s amazing! 

Maria and I set up our table at the Donkey Ball game after supper and wow was it hot!  The players on the donkeys must have been roasting in jeans!  I’m not sure if I explained Donkey Ball previously, but it is a fund raiser for Parkston to do some renovations on The Pond baseball field.   In Donkey Ball, all the players have to be leading or riding a donkey during play, except while batting.  It was hilarious to watch the players try to get the donkey’s to go where they wanted them and they were always being bucked off. 

We had a good number of people enter our free drawing for an Avera blanket.  We did quite a few glucose tests and handed out most of our healthy recipes and food guidelines.  It was a fun night!

Sunday 7/14/13
Today we woke up to lots and lots of rain.  It rained all morning.  We had planned to go to the river with Dr. Honke but it wasn’t looking good.  My boys and I went to church in Dimock, just a few miles north of Parkston.  I’m not sure how old the church was but it looked like it was from the late 1800s and was beautiful. 

When we called Dr. Honke, the weather had let up in Pickstown so we took our chances and headed down to visit him and his wife, Anita, at their cabin.  The weather turned out to be perfect!  It wasn’t too hot, but the water felt great.  They were amazing teachers and showed us how to ski.  Maria, Josh, and I all got to ski and we thought we were pretty hot stuff until Dr. Honke showed us his moves.  He slalom skis through a ski course he has set up in a bay near his cabin.  He was incredible!  The boat was traveling at 34 mph and he had to be going faster as he weaved in and out of the course! 

We had such an amazing time at the Honkes’.  They treated us to a delicious summer barbeque supper after skiing and we played with his new puppy, Rusty.  I said good bye to my boys for the last time and Maria and I headed back to Parkston for our last two days.

Monday 7/15/13
This morning we went on rounds and then Carla joined us in Cardiac Rehab in the Wellness Center.  I didn’t know much about cardiac rehab before visiting with the patients and the nurses.  There are three phases to the rehab program and the patients are monitored differently in each one.  How much rehab each patient does depends largely on how many sessions their health insurance will cover. 

One of the nurses in cardiac rehab is also one of the community health nurses.  So, after dinner we saw Deb again as we learned about Community Health and the WIC program.  This was also an area I didn’t know much about.  We sat in on a couple certifications, one for a pregnant mother and one for an infant.  The dietitian that counsels people in these programs stopped by and told us a little about her role as well. 

Between the two departments we visited with today, I gained some background that I think will be beneficial to my patients someday.  I now know what programs are available to help them and what those programs entail.  This evening Rita Blasius invited Carla, Maria, and I over for dinner and socializing.  We had a great time chatting, learning more about Brazil and more about Parkston.  It was so great of Rita to open her home up to us and we had a wonderful evening.

Tuesday  7/16/13

Today was our last day in Parkston.  Everyone always says it, but I can’t believe how fast the time went.  We were always busy and had so many things to see and do that the weeks just flew by.  I’m sure my husband, home with my son by himself for four weeks, thinks otherwise.  We ate our last meal in the dining area and worked on our presentation.  We had planned an amazing presentation, but we made a rookie mistake.  We failed to go down early to the conference room and try it out on the hospital computers.  So when the time came for us to present, it didn’t work.

Maria and I just spoke from the heart and I know we forgot to mention and thank some important people to us during our experience but I think we got our main points across.  I usually don’t like giving presentations much, but looking out at a room full of friendly faces that I got to know over the course of our experience, I felt completely comfortable.  Everyone has been so amazing to us and I will always value the positive experience I’ve had in Parkston.

The experience in Parkston has been a powerful one for me.  I went in trying to decide if I really should pursue a career in family medicine.  After my time in Parkston, I am excited about family medicine in rural South Dakota.  The physicians have a wide range of things they can do in their practice, from procedures to hospital work to the clinic.  I don’t think I would be happy doing purely clinic in a larger setting and I’m so thankful Parkston showed me that. 

Everyone at St. Benedict’s was warm and welcoming.  I felt at home and actually quite spoiled.  Maria and I had a great time together and we became fast friends!  I’m going to miss her and miss everyone at the hospital.  I am so grateful for all the opportunities I was given during this experience.  I will never forget it!