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Week 1 Parkston, South Dakota

I arrived to Parkston early Monday morning and pulled into the Avera St. Benedict parking lot at the exact same time as my partner Cody Maxwell.  Cody is a pharmacy student from Council Bluffs, Iowa, so we were both unsure of what to expect as we entered the clinic doors.  It wasn’t long before a smiling Julie Semmler greeted us.  Julie is the director of public relations for the hospital and plans a lot of the community events.  She toured us throughout the halls of the hospital and introduced us to numerous people.  We couldn’t believe all the amenities and capabilities for a facility in a community of approximately 1,500.  My excitement was mounting, and I could hardly wait to get some new experiences after a year of straight bookwork.  After our tour, we had lunch at a diner downtown called Schuver’s.  The food was fantastic, and I am sure we will be making return trips throughout our stay.  After lunch, we were able to get a little hands-on time in the hospital.  Before the afternoon was over, I was seeing patients and helping staple up a scalp laceration.  I couldn’t have asked for a better start to the experience nor imagined I would be gaining such valuable skills on my very first day.

Tuesday began early as we met Lindsey Weber, CNP at 7 a.m. for morning rounds.  We were able to listen in on the nursing report and accompanied Lindsey as she examined each of the hospital patients.  The physicians arrived around 8 a.m. and we were there as Lindsey briefed them on patient updates and admits.  Once rounds were over, we learned that a patient was going to be transferred to Avera McKennan by the local EMT crew.  We were invited to tag along with the crew and jumped at the opportunity.  It was a very unique experience riding in the ambulance to Sioux Falls and back.  The EMT crew was a lot of fun to work with and taught us some of the basics of emergency medicine.  We returned to Parkston shortly after lunch, and I finished off the afternoon by following Dr. Boschee in the clinic.

My Wednesday was a unique experience as I spent the entire day with the physical therapists of the hospital.  The ladies were a joy to work with, and I was introduced to an entirely new aspect of medicine.  I was first given a tour of the department and the myriad of tools utilized by physical therapists on a daily basis.  During a break in the patients, I was introduced to Electrical Muscle Stimulation, where electrodes are hooked up to an individual to help relieve inflammation or strengthen muscle.  To demonstrate its capabilities, I was hooked up and placed under a setting called “Russian” which is utilized to strengthen muscle.  The electrodes were placed on my bicep and soon the machine was flexing my arm for me…  It was definitely one of the weirder feelings I have ever experienced!  The afternoon was interesting because the department was learning to create orthotic molds, and I became the mock patient for the PT’s to learn on.  The physical therapists spent time casting feet to make foot molds that can be sent off to create custom orthotics.  Later on, I got my butt kicked by a local athlete in ACL rehabilitation exercises.  We went through some of her rehab workouts together, and needless to say, my two healthy ACLs were no match for her!

Thursday was another early morning following Lindsey through morning rounds.  Rounds were followed by an upper gastrointestinal endoscopy and colonoscopy that I was fortunate sit in on.  Dr. Wickersham even allowed me to assist with the scope maneuvering which was incredible to experience for the first time.  Once the procedures were over, I strolled down to the clinic and followed a few patient visits until the emergency room got extremely busy.  A patient came in with signs of heart attack, so I was able to witness the acute and emergent steps necessary for myocardial infarction.  As soon as the helicopter arrived to take that patient to Sioux Falls, another patient with a stroke arrived to the ER.  I never would have imagined that a small community such as Parkston would have so much critical medicine in such a short time period but it really showed the proficiency and knowledge of the providers here.  The afternoon was a valuable experience with some less medicinal, but equally important, aspects of medicine.  We first met Melissa Gale, the behavior health specialist for Avera St. Benedict.  She talked to us about the many hats that a behavioral therapist wears in a small community and the role she plays with psychological disorders, substance abuse cases, domestic disputes, etc…  She also is an important member of a very successful diabetes group within the hospital.  We finished the day in the health information department, learning the intricacies of HIPAA and billing.  Once I was done at 4:00 p.m. I quickly packed up and got on the road towards Platte, where I met my father-in-law for an evening of fishing on the river.  The weather was gorgeous and the fish cooperated, so it was a great night out with family and the natural beauty this region has to offer.

As Friday came around, I couldn’t believe how fast the week had gone!  I spent the entire day in the clinic with Dr. Wickersham and Dr. Boschee.  My medicinal knowledge has greatly improved as I have talked through a multitude of cases and been given some helpful insight by two great physicians.  I was able to give my first steroid injection, which seems very minor but was exciting nonetheless.  Friday night, Cody and I headed to the grocery store in town and picked up pork chops and potatoes.  We are by no means professional chefs, but we had a lot of fun grilling out and reminiscing about the past week.

The weekend was nearly as eventful as the previous week.  Saturday was another gorgeous day, so I spent it with family in Mitchell and fishing for walleyes near Platte.  Sunday ended the week with church and the Parkston Kickball Tournament.  Cody and I were recruited to play for one of the hospital kickball teams, so we did our best to not disappoint.  Our team didn’t win the championship, but we surely had a lot of fun in the process.  What a great end to an awesome week!

Week 2 Parkston, South Dakota

Sitting over coffee and breakfast at 7:00 a.m., I was feeling pretty excited for the week ahead.  My schedule showed a variety of new experiences, and I could hardly wait to get started.  I headed downstairs to the floor and joined up with Dr. Honke but never would have imagined how many things he could teach me in one day…  We started with a colonoscopy and endoscopy case, which I had seen before but still learned some valuable tidbits about.  After the scope session, Dr. Honke took me down to the emergency room and supervised as I replaced my first G-tube.  We then scurried off to perform a stress test on a patient and then moved on to another patient to drain a large abscess.  He finished by showing me the basic procedure of a thoracentesis, where fluid is drained from the lung cavity in patients with a pleural effusion.  One thing I truly appreciate about Dr. Honke is his approach to medicine.  He is one of the most even-keeled individuals I have ever met, and nothing ever gets him frazzled.  He is extremely knowledgeable about many aspects of medicine and is always willing  to spare a little time and patience to explain the cases to me.  Lunch was educational with representatives from Humalog demonstrating their Humalog KwikPen.  Besides some good information about diabetes management, the Godfather’s Pizza was excellent!

Tuesday was a new experience for me as I traveled with Dr. Honke to Lake Andes, SD.  Lake Andes is about 50 minutes from Parkston and boasts a population of 828 people.  Avera St. Benedict has a clinic in Lake Andes and Dr. Honke travels there frequently to staff the clinic and nursing home.  After an afternoon seeing patients, we drove out to the Honke’s family cabin in Pickstown.  Dr. Honke is an incredible slalom skier, and he was kind enough to share his love of watersports with us.  Cody was able to get up on the wakeboard without any trouble and circled the bay a few times before it was my turn.  I have never been one for water sports myself, so this was an entirely new experience for me…  After some coaching from Dr. Honke and his wife, I was able to get up on my first attempt and looped through the bay before eventually losing my balance and face planting into the chilly waters.  We finished the night at Pickstown’s local diner for some chicken fried steak.  It was a beautiful evening to be on the water and we are so grateful to the Honke’s for a wonderful evening.

Wednesday morning had been circled and starred on my schedule for quite some time, and I was extremely excited as we hopped into a vehicle with Mary and Kerri that morning.  Kerri is a nurse and also the primary coordinator of a mobile clinic that circulates the local Hutterite colonies and has been in that position for four years.  Mary is a physician’s assistant that helps Kerri see patients in the colonies.  We had been invited to tag along for a morning of cultural insight, a tour of the colony, and some mobile medicine!  The entire car ride to Oak Lane colony near Alexandria, SD was filled with discussion about the Hutterite culture.  As we walked through the colony with our bags and totes of medical supplies, we were also given a tour of the dining, laundry, school, and church facilities.  Besides seeing the facilities and way of life, we were able to spend some time with a family.  We had good discussion and were given some homemade root beer to sample!  We finished up in Oak Lane and headed to New Elm Spring, another colony near Ethan, SD.  There we met with another patient and were given another quick tour.  It was an eye-opening experience to see the differences in culture, but the Hutterites were an extremely welcoming and friendly community.  We greatly appreciated their hospitality and had an all-around good time!

Cody and I started off Thursday morning by accompanying Dr. Wickersham on another colonoscopy case.  I again got a little training with the controls, and although better, still have a long ways to go!  Cody thinks I needed to play more video games growing up… J After that, I met with the radiology department for a little time with Planet Heart.  Planet Heart is a screening program that allows patients to evaluate their cardiovascular status.  It is totally optional for patients to enroll in, but is a very effective cardiac screening and has the potential to save a lot of lives.  After lunch, Dr. Wickersham and I headed to Corsica for an afternoon in the clinic and nursing home. The nursing home had a ton of great people, and I met three residents over 100 years old…  There must be something in that Corsica water!!  The nursing home staff was a lot of fun and even provided us with a little ice cream treat that was the perfect afternoon snack.  It was a really good afternoon with Dr. Wickersham seeing patients and “talking shop.”  I have learned that Dr. Wickersham is a pretty big fisherman, so instead of talking strictly medicine, we had a good time swapping big-fish tales.

Friday was the day for minor procedures.  The morning began in clinic with Dr. Farchmin, a Sioux Falls resident, showing me how to drain a couple different types of boils.  Then I headed down to the operating room and was able to watch Dr. Honke suture in a skin graft.  After the procedure, Dr. Honke talked us through the basics of skin grafting and taught me a lot about the process.  He even taught us how one can utilize a single blade razor for harvesting skin grafts.  It was a very interesting and informative discussion to say the least!!  I followed Dr. Honke on rounds then spent the rest of the afternoon in the clinic.  Bouncing between the doctors in the clinic, I was able to see quite a few more patients and even froze a few skin lesions.  Once 4:30 arrived, Cody and I quickly changed and headed over to the school.  RASDAK (Ride Across South Dakota) was stopping in Parkston this evening, so we helped the Commercial Club serve pork loin sandwiches to the racers.  They have 80 more miles tomorrow to reach Sioux Falls and complete their journey.  Definitely a feat to be proud of, and it was fun to hear the stories from the bikers we talked to.  A good end to the week…

Week 3 Parkston, SD
We started week three by revisiting Oak Lane Hutterite Colony bright and early with Kerri, the mobile clinic nurse that deals with all of the local colonies.  After hopping into the vehicle and driving towards Ethan, we arrived to the familiar colony we had been to last week.  Kerri parked the vehicle and we grabbed her medical supplies bag.  Amidst the blustery South Dakota winds, we went from house to house and saw a few patients that Kerri had appointments with.  Then we met with an incredible woman named Judith that showed us around the colony.  She gave us an even more detailed tour of the colony than we had received last week, including the turkey barns, greenhouse, and machinery sheds.  She had so many stories to tell and was extremely welcoming.  We are very grateful for the time she took out of her busy day to give us the in-depth tour and history of a Hutterite colony.  When we returned to Avera St. Benedict, Cody and I sat in on the hospital board meeting.  We were even able to share a little about ourselves and the REHPS program, which was fun.  I snuck out of the board meeting a little early to scrub in for a C-section that was performed by Dr. Honke, Dr. Boschee, and Dr. Farchmin.  This was my first time being in on a C-section, and it was incredible witnessing the birth of a little child.  I learned a lot about suturing technique and operation room etiquette from the physicians that will help me immensely as I progress into clinical rotations.  As interesting as the experience was, the operating room was extremely warm, and I was happy to lose the layers of gowns and cool down afterwards.  I finished my day following Dr. VanderPol in the Memory Clinic.  The Memory Clinic is an operation run predominantly by Dr. VanderPol for patients with dementia.  She does periodic testing of mental status to track disease progression and offers advice and coping mechanisms for the patients and their families.  Dr. VanderPol was absolutely remarkable with the patients and their families!!  She is so compassionate and offered comfort to everyone involved while providing insightful tips and tricks that make daily living easier.  I learned a lot from Dr. VanderPol’s demeanor this afternoon that will hopefully help me better relate to patients dealing with difficult diseases one day.

Avera St. Benedict was a buzzing place on Tuesday morning!  Cody and I began early, meeting Kerri and Melissa Gale at 6:30 a.m. in the clinic.  We hopped in a vehicle and headed to a local manufacturing business in the area.  Kerri and Melissa had lined up a health screening for the business employees, who were checked for heights, weights, blood pressures, and blood panels.  Cody and I were in charge of taking all the manual blood pressures, so we were nearly pros by the end of the morning.  We arrived back in time to catch a subarachnoid bleed that had arrived at the ER and was flown to Sioux Falls.  The radiology ladies were very nice and spent a little extra time with us going through the CT scans of the patient and showing us the different structures.  We then stood in on a natural birth performed by Dr. Wickersham and Dr. Farchmin.  It was really neat to see and compare the natural birth with the C-section I had witnessed Monday, so I got a double dose of OB this week.  With such a hectic morning, Cody and I ended up having lunch pretty late and finished the afternoon with some time in clinic.

Wednesday morning consisted of accompanying Dr. VanderPol and Dr. Farchmin to Our Home.  Our Home is a program that looks at holistically treating troubled youth.  The youth will occasionally have conferences with their treatment staff and that was the reason for our visiting today.  It was awesome to see how great of an impact the Our Home program was having on the lives of some of those individuals!  We got back to Avera St. Benedict, and I went on a mission with Julie Semmler, the public relations director, for some suture practicing materials.  We ended up with a manikin arm and a bunch of practice materials.  Dr. Honke found out about our search and took a half hour of his lunchtime to talk me through various suturing techniques and tips.  It was a great educational opportunity for myself, and I am so thankful of Dr. Honke for taking his free time to help me learn.  With suturing techniques fresh in my mind, I took the manikin arm to our apartment and sewed up a few lacerations over a quick lunch.  After lunch, we attended the SIM truck that was in town for the day.  We had signed up to visit the SIM truck thinking we would be learning how to use the LUCAS device, which mechanically provides compressions for someone needing CPR.  Little did we know, the SIM lab consisted of not only an educational introduction to the equipment but also a mock scenario.  Before we knew it, Cody and I were thrust into a mock cardiac patient with two nurses, Carol and Diane.  Our “patient” survived until the “helicopter arrived,” so we felt pretty accomplished in our mock scenario.  It was an awesome learning experience and fun collaborative effort that further affirmed the interdisciplinary collaboration that this program strives for.  Another great day in Parkston!!

Thursday morning was the typical rounds followed by a meeting with Brenda Stoebner of quality management.  She shared with us a lot of behind the scenes accreditation and quality tracking that must be conducted at a hospital.  It was a very informative session, and I definitely have a newfound appreciation for all that the quality management departments do.  I went straight from my meeting with Brenda to sit in on the Bormann Care Team meeting.  The Bormann Care Team deals with the nursing home and assisted living facility that is adjoined with the hospital, and they meet periodically with residents and their families to discuss the current care plan and changes that should be made.  It was interesting sitting in on the conferences and hearing both the family and staff sides of different challenges.  Both parties worked very well together and were always striving for the end goal of optimal living conditions for the resident.  Later in the day we met with Melissa Gale, the behavioral health specialist (but really she does a little bit of everything :-) ) and sat in on a teleconference with a psychiatrist in Sioux Falls.  It was neat to see her and the physician discuss patient medications and cases, but I think Cody got a little more out of it since most of the meds were over my head :-)  We ended the day in the hospital following Lindsey Weber, CNP in her treatment of an OB patient that was experiencing complications and eventually was flown to Sioux Falls.

Friday through Sunday consisted of packing my bags and driving to Eden Prairie, MN for a college buddy’s wedding.  Being surrounded by all this interesting and exciting medicine, I had neglected writing my best man speech until the last minute.  Fortunately it all turned out well…  It was an awesome weekend spent with some of my best friends!

Week 4
June 23 – June 24: Week four was a quick week for Cody and I, but we had a few more unique experiences to finish out our time in Parkston.  Monday morning we started in radiology with the radiologist that was doing outreach that day.  As 9:00 came around, we met with Kerri and Mary to visit Clearfield Hutterite Colony near Delmont, SD.  This was the third different colony we were able to tour and see patients at.  Each colony had its unique characteristics, and it was a lot of fun to see how they were so alike yet so different.  After finishing up at the colony, we met with Julie Semmler in Tripp and went rug shopping at a local Amish family’s shop.  The Amish are incredibly skilled in making rugs and we got to see the loom that had been used for many, many, years.  We stopped by another family that specializes in furniture and got to see their immaculate woodworking skills as well.  We then headed back to town and spent the afternoon touring downtown Parkston.  Cody showed me a couple of the local pharmacies that he had served time in throughout our stay, and it was a nice final afternoon in downtown Parkston.

Tuesday was the very last day of our program and surely a bittersweet day.  It was an absolutely incredible experience, and we were both disappointed to see it ending so quickly.  Cody and I rounded with Lindsey Weber and the physicians in the morning then broke off to get things organized for our end-of-the-program presentation.  At 11:30, Cheri Buffington arrived with lunch for the guests, and by 11:45 the conference was full of friendly faces.  It was a lot of fun to reminisce about our experience with all the people that made it so special!  All in all, I could not have asked for a more amazing experience and am so thankful to the REHPS program, Avera St. Benedict, and all the people that helped make my summer great!