Week 1 Bowdle, South Dakota
Day 1: Monday, July 7th
I began my travels to Bowdle on Sunday afternoon because the drive is five and a half hours from my home. I spent the night in Aberdeen and woke up this morning to start the hour drive to Bowdle. I ended up arriving a little late because of some road construction near Ipswich, but when I arrived, I was greeted by Mary Turner, the clinic manager, Mindy, who had arrived a few minutes before, and the front desk girls, one of which happens to be Mary’s daughter. We were shown our home for the next few weeks, a very cute set of rooms, mainly used for providers to stay. After we got settled in, Mary and the girls took us out to eat at a local café. The food was really good and it was so fun getting to know a little bit about each other. After lunch, Mindy and I got the tour of the clinic, hospital, and nursing home, all together called Bowdle Health Care Center. All are connected, so this makes it very convenient. Bowdle is home to a 12 bed hospital, which we found out quickly is not short on equipment or kind hearts. Remodeling phases are taking place and recently a new emergency room was added, which has room for two beds and much more equipment than the previous, cramped, one bed room. In addition, a MRI machine was recently purchased, which has been a tremendous convenience for locals, as they now do not have to go all the way to Aberdeen to have an MRI done when a suspected stroke or other trauma injury has occurred.
After our tour, we were able to be introduced to Doug Turner, Mary’s husband and town pharmacist, at Turner Drug downtown. This pharmacy is very quaint and on a busy day fills around 200 prescriptions for Bowdle, a town of a little over 500 people, and the surrounding communities. Mindy and I were able to jump right in with entering orders, counting prescriptions, putting away medications, and working the cash register. We were also able to observe Doug as he checked prescriptions and counseled patients.
This evening we had our first meal at the hospital. The break room is right across from the emergency room and as we were eating, a woman was brought in by ambulance. After the PA evaluated the patient, he came to us across the hall to tell us about the case. The patient had come in with anaphylaxis from peanuts and the PA quizzed us about which medications he should use and then informed us of which medications he would be sending her home on and why. I was so impressed to see how willing everyone is to help students learn and how they realize the value we get out of experiences such as these. After we fulfilled our duties for the day, Mindy and I spent the evening relaxing in our rooms. I went for about a half hour walk around town, checking out the community and enjoying the gorgeous evening. Today was a wonderful day – we have seen warm, welcoming people, great experiences, and learning opportunities already. I cannot wait to see what is in store next!
Day 2: Tuesday, July 8th
Today we got up for breakfast and started the day by meeting with Doug at the hospital pharmacy. We learned about the process of putting the order away and verifying medications that the nurses used during the night. In addition, we prepared a couple of medication cards for patients in the hospital.
After the morning duties at the hospital, I was able to follow Wayne Washenberger, PA-C in the clinic all day. He saw a variety of patients including a young man getting a physical before a knee scope, a mother and child diagnosed with a sinus infection and strep throat, a new diabetic patient, a DOT physical examination, an assessment of a patient with complaints of knee pain, a patient with complaints of swollen ankles, which was determined to be a medication side effect, and a patient with complaints of anxiety. In addition, I was able to observe Wayne while he dictated his patient notes and wrote prescriptions for patients. Wayne is a very caring provider who takes the time to listen to each of his patients. He works well with patients of all ages, as I observed him with both the young and old, and is an excellent teacher. He made sure I understood everything he was doing and his rationale behind it all, and made sure to discuss the pharmacy side of things with me. I was humbled to see how much patience and interest he has in both his patients and students.
Over lunch, Mindy and I met with Cheri at another local restaurant. We discussed our schedules and wellness coalition projects, and had fun catching up with one another. Once again, the food was great and the company was even better. This evening the weather was beautiful again, so another walk was in order. Every person I passed as I was out was very friendly and made an effort to wave or say hi. This made me feel right at home.
Day 3: Wednesday, July 9th
After breakfast, we joined Doug in the hospital pharmacy again to verify prescriptions that had been used in the emergency department the previous evening as well as to replace some expired medications in crash carts. Then I spent the rest of the day with Doug in the retail pharmacy. I was able to answer the phone, fill and verify prescriptions, and fill nursing home Opus cassettes. I was also very excited to be able to compound a cream for a patient with psoriasis. Some of the patients that I saw yesterday while at the clinic picked up their prescriptions from the pharmacy today, so it was fun to see them again and be involved further in their health care.
After a full day at the pharmacy, we went to Roscoe, a neighboring town, to eat at Three Paws Baking Company, a local restaurant and bakery with a great atmosphere. Doug, Mary, and their daughter treated Mindy and me to a delicious meal from a menu which included homemade noodles and sauce. I enjoyed the time spent getting to know one another better in a relaxed way, outside of the business scene. Roscoe is a town with a little over 300 people and they are very lucky to have such a great place to eat!
During the day, the hospital had received two new admits, so after supper Mindy and I joined Doug in the hospital pharmacy to verify the prescriptions for these patients and make sure everything is ready for their stay through the night. Doug is involved at the hospital in the morning and evening, has a very close relationship with the nursing home as he does consulting for them, and runs the retail pharmacy downtown. In just a short time I have recognized that his knowledge about his patients is almost unmatched and he is a great asset to the community and is well respected as a result.
Day 4: Thursday, July 10th
The morning duties in the hospital pharmacy today included returning medications to the pharmacy stock after a patient was discharged, verifying new patient orders, and supplying medications for these orders. After we finished these tasks, I packed my bags and headed to Watertown for a wedding rehearsal.
Day 5: Friday, July 11th
Today Amanda Nelson, a classmate and fellow REHPS student, married Casey Janisch. I was honored to be a bridesmaid for their big day!
Day 8: Monday, July 14
After breakfast, Mindy and I split up the day between the clinic and retail drug store. Both were extremely busy as it is Monday. In the clinic, I was able to observe a skin spot being frozen, assessments before cataract and hip surgeries, and a young person with an inflamed eyelid.
At the retail pharmacy, the day was spent counting prescriptions and conducting final verifications before the prescriptions were sent out. I was excited to be able to practice my skills in final verification, as I do not have much hands-on experience in this area.
Day 9: Tuesday, July 15
We woke up early to watch the medication pass at the nursing home this morning. During this experience, we were able to watch a nurse give residents their medications as we noted any interactions or problems with the administration. Such problems include: crushing medications that should not be, giving medications with food when they should not be, drug-drug interactions, or food-drug interactions.
Afterwards, we spent our time in both the clinic and retail store. The days were similar to most others, but not a busy as Monday. At the store, it was time to fill the weekly Opus nursing home cassettes, so that kept us busy for much of the afternoon.
Day 10: Wednesday, July 16
Mindy and I had the opportunity to meet up with the public health nurse, Mel, in Hoven were we spent the day meeting with WIC families. We were able to observe while Mel gave immunizations, recertified patients, and updated patients’ food packages, making sure they were receiving what they would use and need. One of the most important parts of this program is to ensure that infants and children are receiving the nutrition that they need and that their immunizations are given. Infants and children are assessed for height and weight as well as hemoglobin levels. These assessments are used to determine how well they are growing in comparison to other children and infants their age. For many low income families, this program is essential to their children’s health and outcomes.
The Turners had us over to their beautiful home for a very delicious supper this evening. They are such a kind, generous family and it was so nice to have great company for a home cooked meal.
Day 11: Thursday, July 17
We spent another day with Mel, the public health nurse, today. We were up and at it early as the day started with Take Heart in Selby. This program is a cardiovascular screening event, partnered with one local employer, which is available to those employees as well as community members. Patients came to get their weight, family history, and blood pressures taken. A lab technician also took blood for analysis and at the end of the work day, we went back over to Selby to give the participants their results. Many of these people have been involved in this program for several months to years, so they were interested in evaluating how they have been doing over time.
After a few hours conducting this program, we headed back to Bowdle to start on home visits for a few patients. It was a busy day as we were not only in Bowdle but two other neighboring towns as well. While on a home visit, Mel would set up the medications for a patient for the next week or two, depending on how frequent she stops there, assess the patient’s weight, blood pressure, heart and lung sounds, and address any concerns or other healthcare problems they may have concerns with. All patients really respected Mel and were very appreciative of the work she does to help them stay in their homes and healthy. For many patients, the visit was the highlight of their day as they do not get out much and they really enjoyed talking to Mel and catching up for the week.
This evening, we were able to meet the Turners uptown for supper at The Shotgun, a local restaurant.
Day 12: Friday, July 18
Mindy and I spent time with the CEO and CFO of the hospital today. After discussions with each of these individuals, we also met with the human resources coordinator. Later in the morning, Mindy and I helped conduct the annual hospital pharmacy inventory. I was happy to help with this very important job.
Day 13: Saturday, July 19
I spent the day relaxing after another busy week. This evening I checked out the “Cathedral of the Prairie” in Hoven. It was an absolutely gorgeous church both inside and out! The architecture was an added bonus to a great mass.
Day 14: Sunday, July 20
The Turners took us out fishing with Peter, a fishing guide, on the Missouri River. It was a beautiful day on the lake, with the water as smooth as glass and not a cloud in the sky. Peter knew just where to take us so that we could get the best fishing experience. On top of an excellent grilled brat lunch (right on the boat!) we were also able to end the day with our limit of walleye. This evening we were invited over to the Turners house to enjoy our fresh fish meal! I could not have asked for a better day!
Day 15: Monday, July 21
After breakfast, I spent the morning at the store helping with final verifications and counseling of patients. Then after lunch, Mindy and I were able to get all of our interviews done for our wellness coalition project. This evening Doug took us over to the nursing home to help him start the monthly drug regimen reviews. This was an interesting process that I have never seen before. Doug was really good about explaining to us what needed to be done and why.
Day 16: Tuesday, July 22
Mindy and I were able to observe during 7 different endoscopy examinations this morning, both gastrointestinal and colonoscopies. These proved to be very interesting. We saw everything from polyps to ulcers to hemorrhoids and even what appeared to be severe pancolonic ulcerative colitis. Dr. Larson, the scope doctor, and the nurses all joked that Mindy and I must have been bad luck because only one person examined was able to say that they had no new diagnoses or treatments. I guess this just goes to show how very important it really is to get checked regularly to catch problems early, if they were to occur.
In addition to this full morning, a patient arrived at the emergency room who had a dislocated scapula, where the scapula was pushed upwards and the inferior angle was stuck between two ribs. Apparently this gentleman was shot in the shoulder while serving in the Army and this situation happens often, as he knew just the process in order to put it back into place. Neither the PA nor the nurses had ever seen anything like this, so everyone was pretty intrigued to see what the patient looked like and the process of fixing the situation.
After this pretty eventful day, we were invited over to the Beadle’s, the owners of the local car dealership, home for supper. They provided us with delicious grilled steaks and great company. We spent the entire evening there getting to know each other and discussing life in general.
Day 17: Wednesday, July 23
Today Mindy and I headed over to Aberdeen to visit State Street Pharmacy. The pharmacist we were in contact with, Kendall, showed us the ropes of the compounding side of pharmacy. This pharmacy prepares many different products for many different applications. Kendall let us jump in by helping him prepare some capsules for patients and fill syringes with single applications of topical creams. It was very interesting to see this side of pharmacy and Kendall was very knowledgeable about what he does and made sure we clearly understood what was being done and why. In addition to creams and capsules, State Street Pharmacy also compounds medicated lollipops, freeze pops, orally dissolving troches, custom made ointments and liquids, and a “magic” concoction as a medication vehicle that “no cat can resist,” just to name a few. They provide these specialty products to humans and animals alike.
We were also able to observe while Kendall visited with a new patient who was advised by her doctor to consult about a topical application to help with skin lesions she is experiencing. This was a very unique case where the patient had been diagnosed with breast cancer and it was now metastasized to her skin. These lesions started as a rash, developed into a large raised bump and then eventually would break open and profusely bleed. Kendall had some really innovative ideas to help this patient with pain as well as stopping the bleeding all while providing an application that was convenient for the patient and stayed where applied. This is an advantage of being able to custom compound products; a product can be made uniquely for each individual patient’s situation, no matter how complex. Overall, this was a very educational day that gave new insight to using my pharmacy knowledge.
Day 18: Thursday, July 24
We had a busy day today! The morning started off seeing a patient with Wayne in the emergency room who came in complaining of dizziness and fainting episodes, for which he had been seen in the emergency room before. After this case, and a decision to admit him into the hospital for observation, we saw a few patients in the clinic. By mid-morning, we were in the nursing home doing checks on residents and observing while Wayne completed chart orders and responded to the drug regimen review reports we helped generate just a few nights ago. It was really interesting to be able to see the full circle of why the pharmacist would write up a specific report and the reasoning behind whether or not the physician would approve of the suggestion.
After lunch, I followed Wayne in the clinic the rest of the afternoon. All day long Wayne was very quick to quiz Mindy and me about many different topics relating to patients’ medications. Some answers we knew for sure, but others required referencing our resources to answer. I think of all of the days so far, I learned the most today through this. Being able to look up answers I don’t know really allows me to learn the best, so there was no doubt I was learning all day.
This evening, Mindy and I went back to the hospital pharmacy to help Doug verify orders, check out medications, and prepare cassettes for patients who had been admitted during the day. Doug was happy to have help, as this process was a lot faster with three people completing the work.
Day 19: Friday, July 25
After the morning duties in the hospital pharmacy, Mindy and I were able to finish our paper for the wellness coalition interviews we conducted earlier this week. Then, I drove to Bismarck, ND to attend my cousin’s wedding. I was excited to be able to attend, because if I wasn’t in Bowdle the drive would have been about 7 hours from my home, which would have been a little too far and I would have missed a great wedding and reception, complete with lots of dancing.
Day 20: Saturday, July 26
After driving back from Bismarck this afternoon, I was able to attend the Bowdle Healthcare Foundation steak fry. This steak fry was in conjunction with their 2nd annual golf tournament, where all of the funds raised go to support the Bowdle Healthcare Center. Later, I was able to spend some time at the Turners’ home taking a dip in their hot tub and enjoying a bonfire under the stars on a calm, beautiful evening.
Day 21: Sunday, July 27
I checked out the St. Augustine church in Bowdle this morning. They also have a really beautiful church! The Turners invited me over to have brunch and then we headed over to Mina Lake to do some kayaking. I had never been in a kayak, so it was fun to try it out. I think I was able to get the hang of it after a little while and I am looking forward to finding a place where I can do more kayaking in the future!
Day 22: Monday, July 28
Today we had the opportunity to spend some time with Clint Perman, PA-C at the Avera Medical Group Clinic in Selby. He was also very knowledgeable and gracious enough to allow us to observe him all day. It was interesting to see how a clinic is managed in a town where there is not a pharmacy. Clint has a “pharmacy cupboard” with a few different courses of antibiotics and starter packages of other medications from the two nearest pharmacies. This allows him to prescribe medications for patients and he can also be assured that they have these medications to be started, even if the patients can’t drive to get the medications or the pharmacy is closed. At the clinic, we were able to see a few patients that we saw in the hospital in Bowdle or during the Take Heart event in Selby a few weeks ago. It was interesting to see how these cases were able to come more full circle.
Mindy and I enjoyed lunch at Mr. Bob’s Drive Inn, a cute outdoor restaurant with only a walk-up window. The food was delicious and we were able to soak up some sun at the same time.
Day 23: Tuesday, July 29
This day was spent between the clinic and retail store. After the morning duties at the pharmacy, which included checking for the monthly outdates in the crash carts around the hospital, I spent the rest of the morning in the clinic with Wayne. Now that we have been here a few weeks, some of the patients we saw today were seen previously, so it was fun to connect with those patients again.
This afternoon, I spent time at Turner Drug. The day got somewhat busy for a Tuesday afternoon, so that kept us on our toes. I also had the opportunity to compound some bowel preparations that are used at the hospital for patients prior to scopes. This was a very easy and cheap compound, which makes me wonder why providers around home have not caught on to this trend yet!
The Turners had us over one last time to help finish off the fish that we caught a couple of weekends ago. As always, the food was great!
Day 24: Wednesday, July 30
Mindy and I had the day off today after we put the hospital pharmacy order away. We worked on our final presentation and wrote our thank you cards. It seems so crazy that 3 ½ weeks are almost over!! This evening, the Turners took us out in their convertible to go over to Roscoe one more time to enjoy the delicious homemade food!
Day 25: Thursday, July 31
After our last breakfast at the hospital, we packed up our things and got our projector set up for this afternoon’s presentation. The whole hospital crew was treated for lunch at The Shotgun by the Turners in celebration for the last days of one of the clinic receptionists and Mindy and me. It seems just like yesterday we met all of these great people and now we are saying goodbye. Later in the afternoon, Cheri met us and brought some delicious desserts to share while we gave our brief presentation about the highlights of our experience in Bowdle.
Looking back on these past 25 days, I cannot believe how incredibly fast they went. I was somewhat unsure of how the experience would turn out at first, especially because I only would know one other person when I got to Bowdle and she wouldn’t know anyone other than me either. But, I learned very quickly how kind, generous, and welcoming the people in Bowdle are and I felt right at home. I actually drove away today misty eyed as I thought about this fact. I feel so blessed that I was placed in such a great community and had the opportunity to meet such wonderful people, all while expanding and using my knowledge I’ve learned in the classroom. I know for a fact that this experience has forever changed my life and has had a positive impact on my education and future.
Thank you to all of those people, who are too many to name, that had any part in our time in Bowdle, even if it was as simple as a kind wave while I walked by one evening, it was truly appreciated. A big, special thanks goes to Doug and Mary Turner who showed us such great hospitality throughout our stay and made sure we had the best experience possible. I look forward to coming back to visit this fine town in the future!