Nicholas Purcell
Week 1 and 2 at Parkston

The first week was obviously full of orientation and meeting all of the people in the system, but it was surprisingly easy to get my bearings in their system. The people were very helpful and friendly for my introduction week into REHPS, and they made it smooth for me to get used to the system. The entire campus impressed me from the start because it was easy to find my way around, and they had so many amenities for a rural system. From the technology of their campus, to the care for the Hutterite and Amish colonies, they really encompass so many aspects of a great healthcare system. On top of this, it was easy to recognize that the people they hire are sincere and caring individuals. Each of the physicians, CNP’s and PA’s are all great people to follow when I am around them, and they are capable of teaching with their own methods. I didn’t mention nurses because I didn’t directly follow them, but I was impressed with their work each and every day. They are great at handling the work that people throw at them, and they are smooth with the use of the EMR. The nurses, in general, are essential to a great healthcare team, and the ones at Avera St Benedict are talented in their own right. Getting to know all of these people has been a pleasure.

During the first two weeks I have seen many “firsts” for my clinical experiences. I did my first suture on human skin, which was honestly a struggle until Dr. Wickersham showed me along, but I was able to wrap it up much better than the start. I did my first injection with corticosteroids, which was in the knee, and that went quite smooth and easy. I saw my first baby delivered during that first week and it was incredible! Seeing that first-hand is a truly awesome experience, especially in a clinic that doesn’t do a ton throughout the year – they treat each case with compassion and care. I visited a Hutterite colony for the first time, and that was interesting to see up close and personal. We got a tour of the colony, so I was able to see how they live each day, while also caring for a few of the residents there. I drove the camera on my first colonoscopy, which was actually a fun thing to do since I know the anatomy and the implications of what we can find during the procedure. It doesn’t sound like much, but I also was shown around in a pharmacy for the first time, which was cool for me, but also daunting – I was technically supposed to know when and how to use a majority of the drugs within that place. Even mentioning all of these firsts, there were so many more in the clinic setting that I won’t be able to mention them here. Needless to say, I have had an incredible experience thus far, and I can’t wait to continue my time here in Parkston.

Week 3
Another great week in Parkston, and yet another one full of “firsts”! I was surprised, yet again, with how well each of the physicians was able to teach me the clinical relevance of my knowledge. The transition from didactic knowledge to the clinical setting can be a tough one, but these docs know how to explain it, which is very helpful. There has also been a family medical resident in Parkston lately, which has been nice to pick their brain for how “new” medicine is being practiced compared to what we have been learning. All of these people involved in my learning experience have been great, and I can’t wait to see what this last week has in store for me.

I also saw a few surgeries that were new to me! I saw a few carpal tunnel and trigger finger surgeries and was quizzed along the way, which was a great way to remember the anatomy of the hand. On one of the days we had a radiologist join the hospital, who also did interventional procedures, which was great to shadow in because I could see how important even one day with a radiologist can be in the rural setting. There were various specialty doctors that came to the clinic, and do so each week. I was able to follow with the Cardiologist on one of the days, and he showed me how to detect murmurs on patients! These are tough to pick up, especially when hearing them for the first time, but he walked me through them, and it was great to hear them in real patients that had physical symptoms. This really helps the material stick so much better when we can correlate with the lecture knowledge. I was even able to listen to a diastolic murmur, which is much less frequent than a systolic murmur. We also spent an evening with the Diabetes support group, which was good to see how they interact and how they support each other while they deal with their diagnosis. This helped them to rely on each other since each of them have similar problems, but they also learned as a group because the nutritionist was able to help them through the questions they had.

I have had a lot of interest in neurology since I have taken the block in medical school (and even before that), so when I was told I was going to perform my first mini mental status exam, I was excited! This isn’t honestly a big deal in the overall picture of a physician’s duties, but it was cool to perform to see how the patient did with their memory and reasoning. I was to perform the test on a patient to get a baseline score for them, and evaluate how well they reason, remember and perform logical actions based on how the brain should progress in thought. Like I said, for the experienced physician this isn’t much of a feat, but it was fun to perform since I am so interested in neurology.

Finally, we also took a trip to some Amish properties just south of Parkston, and then we went to the Avera clinic of Tripp. The Amish communities are somewhat similar to the Hutterites, but also have some differences. First, the Amish and Hutterites are similar in that they specialize in certain products that they make and sell to the general population. Second, they are different in that the Amish don’t necessarily form colonies (at least in SD) like the Hutterites do. They definitely help each other, but they just don’t live in such close proximity to other families like the Hutterites. Third, both of these communities have a strong German background, and almost exclusively grow up with German as their primary language, and English as their second.

Tripp, is a small community that acts as a smaller, but more local hub for people south of Parkston. This helps the people that don’t have the means to travel to Parkston and allows them to get great care with the same physicians they would see if they did travel.

Another great week in Parkston and I must say, I feel quite privileged to be so involved in all of the activities throughout the clinic and hospital. They treat me so well and involve me whenever they have the chance, while also teaching me along the way. All of the physicians have been where I am, so they know how valuable these early years can be. They truly have a special facility with special people!

Week 4
This week seemed like it went by so fast, mostly because I was seeing so many different things. I spent a lot of the week seeing the ins and outs of the “front line”, which is the Family Medicine Clinic, with Dr. Honke. He is incredibly knowledgeable and wise about things that happen in the clinic and the hospital aspect of the rural community. Following him was a privilege and I valued the time I had shadowing him. Spencer and I also went with him to the facility in Armour, which has been newly renovated and upgraded for the people near that community. Dr. Honke routinely goes there and to Lake Andes, which is where we went after our time in Armour. Lake Andes is a little different since they are located on a Native American reservation, which gives them a diverse patient population. This clinic was good to see as Dr. Honke is the only physician that makes it down there anymore, which makes him almost a celebrity.

Also this week, I was able to shadow yet another specialty clinic physician. This one was Dr. McHale, who is an Oncologist. I was able to see how a few patients throughout the area decide what to do with their cancer diagnoses. This process was mostly after they had realized their diagnosis, and Dr. McHale decides how they can approach treatment. Some of the treatment can happen within the Parkston facility, such as chemotherapy and some of the surgeries, while radiation and major surgeries either go to Mitchell, Yankton or Sioux Falls. It’s nice for them to have some options so close to home, while the next options are also not too far away. Almost every one of the cancer diagnosed patients near Parkston will eventually see Dr. McHale there. He comes each week and goes through around 30 patients, which is truly impressive.

During my last week I also helped with a deep lateral leg laceration. It wasn’t the longest cut I have seen, but definitely the deepest for a person not under anesthesia. The laceration went all the way into the muscle at a certain point, which made it interesting to stitch up. I mostly helped and cleaned while the resident stitched it up and gave me pointers the whole way. During my time with the resident I learned many important things, especially about how medicine is being taught for them now. It’s incredibly valuable to hear her side of things because my experience will be most like hers when I start to go through residency myself. Her advice to me during my time there was just another great thing about being in Parkston, as they have a resident on duty about 80% of the time, albeit in segments of time. This is great for any students there (which there are many) so they can pick the brain of a soon-to-be M.D. about how they progressed within school.

To top off this incredible month, we were lucky enough to have Dr. Honke take us to his cabin right near the Missouri River! He has an incredible location for his getaway house, and it has plenty of “toys” for him to take out, of which he showed us a few. First though, he put us to work helping put in the water ski course, which barely seemed like work because the day was so nice out. He then let us get on his nice boat and attempt to water ski. I want to emphasize that we merely attempted, and it wasn’t very pretty. We each got up just at the beginning, multiple times, but then fell shortly after that. He had a lot of patience and let us try a few times, but ultimately it was just great to get out there and do something outside with each other. It was a great ending to a wonderful month in Parkston and the rural experience that it brings. I couldn’t have asked for a better time or a better facility.